Examining the Relationship Between Stress, Barriers to Healthcare, and Alcohol Use in the US Agricultural Community.

OBJECTIVE: Farming is a high-risk, physically challenging occupation. Considering farmers report high stress and barriers to seeking healthcare, it is important to understand factors influencing alcohol use to tailor interventions and healthcare resources for alcohol use in rural areas. METHODS: An online survey was distributed to the agricultural community in the United States (n = 1045). Data was collected through QualtricsXM, and SPSS 28.0 was used for data analysis. RESULTS: Both formal healthcare challenges (ß = 0.112, p = .004) and stigma (ß = 0.328, p < .001) were identified as predictors of increased perceived stress, while resilience (ß = -0.137, p < .001) was identified as a protective factor against perceived stress. Higher perceived stress was identified as a predictor of binge drinking behavior (ß = 0.151, p < .001), and formal healthcare challenges were associated with higher drinking volume (ß = 0.174, p < .001), and engaging in more frequent alcohol consumption (ß = 0.123, p = .004) over the last three months. Resilience was identified as a protective factor against increased alcohol consumption (ß = -0.084, p = .032). Stigmatization of help-seeking for mental health challenges was associated with fewer instances of alcohol consumption over the last three months (ß = -0.169, p < .001). CONCLUSION: Interventions to address stress and alcohol consumption should focus on promoting resilience, reducing stigma, and encouraging peer support to address cultural norms around mental health and alcohol use. Rural practitioners should develop cultural competence to better serve agricultural communities to prevent alcohol use disorders. To discuss ways to reduce stigma and encourage peer support to address alcohol and mental health disorders in rural farming populations.

The Intersection of Gender and Occupational Roles in Agriculture: Stress, Resilience, and Alcohol Behaviors of US Farmers.

OBJECTIVES: The purposes of this study were to explore behavioral and mental health outcomes among a sample of farmers living in the United States and to compare differences between male and female farmers. METHODS: An online cross-sectional survey was distributed within the farming community by researchers, farming consultants, and community partners. χ 2 and analysis or variance analyses were used to explore relationships between variables of interest. RESULTS: Female survey respondents reported significantly higher perceived stress and significantly lower resilience than their male counterparts. A significant interaction effect was observed between gender and farm roles on alcohol consumption patterns, with female farm owners and managers reporting binge drinking behavior most frequently. CONCLUSIONS: This study identified distinct differences between respondents in terms of stress, resilience, and alcohol consumption patterns, based on both gender and occupational roles.

Stressors and Coping Strategies in Rural Farmers: A Qualitative Study.

OBJECTIVE: Farmers in rural areas face unique lifestyle stressors which may cause physical and behavioral health issues. Because of external stressors, and often an internal drive to succeed, farmers in rural areas have high rates of prescription drug use, excessive alcohol use, depression, and suicide. These methods of coping may increase prevalence of distress and mental illness in farmers leading to poor health outcomes. Social norms within rural farming populations are influenced by culture, family, friends, and community beliefs which make it difficult to conduct research about substance use and mental health. The purpose of this study is to identify stressors in rural farmers and positive and negative coping strategies for stress in the farming population. METHODS: In-depth interviews (35 minutes-1 hour) were conducted with full-time rural farmers (n = 15) in ten counties throughout Georgia. Using qualitative analysis, inductive coding was used to identify themes and patterns among transcribed interview recordings. RESULTS: Stressors reported by farmers included: financial, work-life balance, physical health and disconnect from non-farming populations. Farmers described feeling misperceived by those outside of their community and feeling a distinct lack of control due to external factors. All the farmers identified alcohol use as a primary coping strategy to deal with stressors. CONCLUSIONS: This study identifies distinct stressors associated with a farming lifestyle and socio-cultural factors that are barriers to care for mental health and substance use in rural farmers. This study can provide information to health practitioners that may lead to a better understanding of the factors influencing farmer's health outcomes.

Comparison of Urticaria Activity Score Over 7 Days (UAS7) Values Obtained from Once-Daily and Twice-Daily Versions: Results from the ASSURE-CSU Study.

BACKGROUND: The Urticaria Activity Score summed over 7 days (UAS7) assesses the itch severity and hive count in chronic spontaneous urticaria (CSU) using once- or twice-daily diary-based documentation. OBJECTIVE: The aim of this study was to evaluate the comparability of twice-daily versus once-daily versions of the UAS and the resulting UAS7 values. METHODS: Data came from the ASSURE-CSU study. The twice-daily and once-daily UAS7 was calculated from morning and evening ratings, as well as from exact 24-h evening ratings of hive count and itch severity, respectively. Three UAS7 scores were computed: UAS7 twice daily (UAS7TD), UAS7 once daily for maximum itch (UAS7OD1MAX), and UAS7 once daily for average itch (UAS7OD2AVG). UAS7 values were assigned to five score bands (0, 1-6, 7-15, 16-27, 28-42), reflecting urticaria-free to severe disease activity. The score values and score band ratios of the UAS7TD and UAS7OD versions were compared and assessed for correlation by weighted Cohen's kappa statistics. RESULTS: Data from 614 patients were analyzed. All three versions of the UAS7 yielded very similar results, with a mean (standard deviation) UAS7TD, UAS7OD1MAX, and UAS7OD2AVG of 17.3 (10.49), 17.7 (8.90), and 16.2 (8.68), respectively. Correlation coefficients between UAS7TD and UAS7OD1MAX, UAS7TD and UAS7OD2AVG, and UAS7OD1MAX and UAS7OD2AVG were 0.94, 0.95, and 0.99, respectively, showing very high positive pairwise correlation. The weighted kappa coefficient, κ (95% confidence interval) was 0.78 (0.75-0.82) for UAS7TD versus UAS7OD1MAX, and 0.82 (0.78-0.85) for UAS7TD versus UAS7OD2AVG, demonstrating substantial agreement. CONCLUSIONS: The once- and twice-daily UAS7 scores were highly consistent, supporting the use of either version when evaluating CSU activity.

Utilization and safety of onabotulinumtoxinA for the prophylactic treatment of chronic migraine from an observational study in Europe.

Objective To examine treatment utilization patterns and safety of onabotulinumtoxinA for the prophylactic treatment of chronic migraine in routine clinical practice. Background Clinical trials support onabotulinumtoxinA for the prophylaxis of headache in patients with chronic migraine, but real-world data are limited. Design/methods A prospective, observational, post-authorization study in adult patients with chronic migraine treated with onabotulinumtoxinA. Data were collected at the first study injection and approximately every three months for ≤52 weeks for utilization and ≤64 weeks for safety data, and summarized using descriptive statistics. Results Eighty-five physicians (81% neurologists) at 58 practices in the United Kingdom, Germany, Spain, and Sweden participated and recruited 1160 patients (84.2% female, median age 46.6 years). At baseline, 85.8% of patients had physician diagnoses of chronic migraine/transformed migraine and reported an average of 11.3 (SD = 6.9) severe headache days per 28 days; 50.6% had previously used onabotulinumtoxinA for chronic migraine. A total of 4017 study treatments were observed. The median number of injection sites (n = 31) and total dose (155 U) were consistent across all treatment sessions, with a median 13.7 weeks observed between sessions. At least one treatment-related adverse event was reported by 291 patients (25.1%); the most frequently reported treatment-related adverse event was neck pain (4.4%). Most patients (74.4%) were satisfied/extremely satisfied with onabotulinumtoxinA treatment. Conclusions Patient demographics/characteristics are consistent with published data on the chronic migraine population. Utilization of onabotulinumtoxinA treatment for chronic migraine appears to be consistent with the Summary of Product Characteristics and published PREEMPT injection paradigm. No new safety signals were identified.

Investigating race, gender, and access to cigarettes in an adolescent population.

OBJECTIVE: To examine race and gender as potential predictors for access to cigarettes and purchasing behaviors among an adolescent population. METHODS: Data were collected from a survey administered to 4336 high school students. The significance was examined using the chi-square test, with a P-value ≤.05. RESULTS: Noncommercial outlets were the primary source of cigarette acquisition for white students; African American students were more likely than white students to use commercial sources to acquire cigarettes; females were more likely to report not being asked to show proof of age. CONCLUSIONS: Interventions designed to reduce youth access to tobacco must address racial and gender differences.

Risk factors associated with patient assaults of home healthcare workers.

This study used surveys from 677 home healthcare aides and nurses to explore factors associated with assaults by patients. Among respondents, 4.6% reported one or more patient assaults (being hit, kicked, pinched, shoved, or bitten) during the past year. Logistic regression analysis examined associations between several potential risk factors and assaults. Three factors were significant, including having one or more patients with dementia (OR = 4.31, 95% CI 1.47-12.67), routinely handling patients (OR = 8.48, 95% CI 1.89-37.94), and perceiving threats of violence by others in and around patients' homes (OR = 4.45, 95% CI 1.75-11.32). Assaults were not significantly associated with worker age, gender, race, job title, hours of work, or use of needles during patient care. Assaulted workers and workers who perceived threats of violence by others were significantly more likely to have shortened home care visits. More detailed research is needed to confirm these results and evaluate methods to reduce assault risk.