Predictors of Adolescents' Transition Through the Stages of Change for Quitting E-Cigarettes: Findings From the Population Assessment of Tobacco and Health Study.

PURPOSE: To identify predictive factors associated with US adolescents' transition through the stages of change for potentially quitting e-cigarettes using the Trans-theoretical model of behavior change. DESIGN: Prospective cohort study. SETTING: United States. SUBJECTS: We utilized data from adolescents (12-17 years) in Wave 3 of the Population Assessment of Tobacco and Health study who used e-cigarettes exclusively over the past 30 days (n = 177) and were followed up with in Wave 4. MEASURES: Outcome variables were 3 transition categories: those who remained stagnant, those who progressed, and those who regressed in their stage of quitting e-cigarettes. Predictor variables were socio-demographics, e-cigarette harm perception, e-cigarette use at home or by important people, social norms, e-cigarette and anti-tobacco advertisements, and e-cigarette health warnings. ANALYSIS: Weighted-adjusted multinomial regression analysis was performed to determine the association between predictor and outcome variables. RESULTS: From Wave 3 to Wave 4, 19% of adolescents remained stagnant; 73.3% progressed; and 7.7% regressed. Adolescents were less likely to progress in their stage of change if they perceived nicotine in e-cigarettes to be "not at all/slightly harmful" (AOR = .26 [95% CI: .25, .27], P < .001); reported important people's use of e-cigarettes (AOR = .18 [95% CI: .05, .65, P = .009); and "rarely" noticed e-cigarette health warnings (AOR = .28 [95% CI: .08, .98, P = .054). CONCLUSION: Intervention efforts must target specific predictive factors that may help adolescents quit e-cigarettes.

Disparities in E-Cigarette Harm and Addiction Perceptions Among Adolescents in the United States: a Systematic Review of the Literature.

BACKGROUND: Health disparities associated with e-cigarette use are increasingly apparent among US adolescents. Perceptions of e-cigarette harm and addiction play an important role in understanding adolescents' e-cigarette use behavior. The objective of this systematic review is to examine racial/ethnic and socio-economic disparities in e-cigarette harm and addiction perceptions among US adolescents. METHODS: We searched five databases to identify cross-sectional or longitudinal studies that focused on adolescents (≤ 18 years of age) who were ever, current, or never e-cigarettes users; we then examined how race/ethnicity and/or socio-economic status (SES) impacted e-cigarette harm and/or addiction perceptions. Two co-authors independently identified relevant studies, extracted data, and assessed the risk of bias. RESULTS: Adhering to PRISMA guidelines, eight of 226 identified studies met the inclusion criteria. These eight studies examined either perceptions regarding absolute e-cigarette harm and/or addiction (i.e., assessing perception of only e-cigarette) or relative e-cigarette harm and/or addiction (i.e., comparative perceptions to traditional cigarettes) by race and ethnicity. Two of the eight studies assessed absolute harm and/or addiction perceptions of e-cigarettes by SES. Our results indicate that, compared to all other racial/ethnic groups, relative e-cigarette harm and addiction perceptions were lower among Non-Hispanic White adolescents; however, absolute e-cigarette harm perception was higher among these groups. No clear patterns of racial/ethnic differences in absolute e-cigarette addiction perceptions and SES differences in absolute e-cigarette harm perceptions were reported. CONCLUSION: More research is needed to explicitly assess perceptions of e-cigarette harm and addiction among US adolescents by race/ethnicity and SES to develop subgroup appropriate public health messaging.

Substance use treatment in Appalachian Tennessee amid COVID-19: Challenges and preparing for the future.

The COVID-19 pandemic created a number of rapidly emerging and unprecedented challenges for those engaged in substance use disorder (SUD) treatment, forcing service providers to improvise their treatment strategies as the crisis deepened. Drawing from five ongoing federally funded SUD projects in Appalachian Tennessee and hundreds of hours of meetings and interviews, this article explores the pandemic's impact on an already structurally disadvantaged region, its recovery community, and those who serve it. More specifically, we note detrimental effects of increased isolation since the implementation of COVID-19 safety measures, including stakeholders' reports of higher incidences of relapse, overdose, and deaths in the SUD population. Treatment providers have responded with telehealth services, but faced barriers in technology access and computer literacy among clients. Providers have also had to restrict new clients to accommodate social distancing, faced delays in health screening those they can accept, and denied family visitations, which has affected retention. In light of these challenges, several promising lessons for the future emerged--such as preparing for an influx of new and returning clients in need of SUD treatment; making arrangements for long-term housing and facility modification; developing a hybrid care delivery model, taking advantage of new regulations enabling telemedicine; budgeting for and storing personal protective equipment (PPE) and related supplies; and developing disaster protocols to withstand threats to intake, retention, and financial solvency.

Toward Eliminating Hospice Enrollment Disparities among African Americans: A Qualitative Study.

Over the past decade, scholars and practitioners have called for efforts to reduce disparities in the cost and quality of end-of-life care; a key contributor to these disparities is the underuse of hospice care by African American patients. While previous studies have often relied on interviewing minority individuals who may or may not have been terminally ill, among them only few who were using hospice care services, this essay reports the findings of a grounded theory analysis of interviews with 26 African American hospice patients (n = 10) and lay caregivers (n = 16). Participants identified several barriers to hospice enrollment and reported how they were able to overcome these barriers by reframing/prioritizing cultural values and practices, creating alternative goals for hospice care, and relying on information obtained outside the formal health system. Finally, participants offered suggestions for eliminating barriers and providing salient information about hospice care to other African Americans.

African Americans and Hospice Care: A Culture-Centered Exploration of Enrollment Disparities.

Over the past decade, scholars and practitioners have called for efforts to reduce disparities in the cost and quality of end-of-life care; a key contributor to these disparities is the underuse of hospice care by African American patients. While previous studies have often relied on interviewing minority individuals who may or may not have been terminally ill and of whom few were using hospice care services, this essay draws upon the culture-centered approach to report the findings of a grounded theory analysis of 39 interviews with 26 African American hospice patients (n = 10) and lay caregivers (n = 16). Participants identified several barriers to hospice enrollment and reported how they were able to overcome these barriers by reframing/prioritizing cultural values and practices, creating alternative goals for hospice care, and relying on information obtained outside the formal health system. These findings have implications for understanding hospice experiences, promoting hospice access, and improving end-of-life care.

African Americans and Hospice Care: A Narrative Analysis.

Recent studies suggest that terminally ill African Americans' care is generally more expensive and of lower quality than that of comparable non-Hispanic white patients. Scholars argue that increasing hospice enrollment among African Americans will help improve end-of-life care for this population, yet few studies have examined the experiences of African American patients and their loved ones after accessing hospice care. In this article, we explore how African American patients and lay caregivers evaluated their hospice experiences. Drawing from 39 in-depth interviews with 26 participants, we use a modified version of Bute and Jensen's (2011) narrative typology to organize patients' and caregivers' stories into three general categories: narratives of satisfaction, narratives of regret, and narratives of ambivalence. Building from these categories, we discuss the implications of this research for understanding hospice experiences, promoting hospice access, and improving end-of-life care for marginalized populations.

HIV/AIDS and minority men who have sex with men: a meta-ethnographic synthesis of qualitative research.

The World Health Organization (2009) estimates that there are as many as 33 million people currently living with HIV/AIDS throughout the world. Studies also reveal that racial disparities significantly influence HIV/AIDS diagnoses within the U.S. men who have sex with men population (MSM). In recent years, the burden of HIV/AIDS has shifted from White MSM to younger men of color, particularly African Americans and Latinos. The disproportionate effect of the HIV/AIDS epidemic in African American and Latino MSM populations requires that scholars and practitioners work diligently to address cultural and structural factors that uniquely influence such populations. The goal of this article is to synthesize qualitative findings that address cultural and structural factors that influence HIV/AIDS risk in African American and Latino MSM populations using a qualitative meta-synthesis procedure. Ultimately, our analysis suggests that "structure-centered" approaches (Dutta & Basu, 2011) are needed to address this health disparity in meaningful ways.