Financial Insecurity and Food Insecurity among U.S. Children with Secondhand and Thirdhand Smoke Exposure.

Objectives: Smokers with financial and food insecurity may find it difficult to quit smoking and reduce their children's tobacco smoke exposure (TSE). The objective was to examine the associations between child TSE and financial and food insecurity among U.S. school-aged children. Methods: We examined the 2018−2019 National Survey of Children's Health data on 17,484 children 6−11 years old. Children were categorized into TSE groups: (1) No TSE: did not live with a smoker; (2) thirdhand smoke (THS) exposure alone: lived with a smoker who did not smoke inside the home; or (3) secondhand smoke (SHS) and THS exposure: lived with a smoker who smoked inside the home. We conducted weighted logistic, ordinal, and linear regression analyses to assess the relationships between child TSE status and financial and food insecurity, adjusting for covariates. Results: Overall, 13.1% and 1.8% of children had THS exposure alone and SHS and THS exposure, respectively. Compared to children with no TSE, children with THS exposure alone were at 2.17 increased odds (95% CI = 1.83, 2.58, p < 0.001) and children with SHS and THS exposure were at 2.24 increased odds (95% CI = 1.57, 3.19, p < 0.001) of having financial insecurity. Children with THS exposure alone were at 1.92 increased odds (95% CI = 1.58, 2.33, p < 0.001) and children with SHS and THS exposure were at 2.14 increased odds (95% CI = 1.45, 3.16, p < 0.001) of having food insecurity. Conclusions: Children with TSE are at increased risk of experiencing financial and food insecurity. When developing tobacco interventions, a holistic approach to tobacco control that addresses ways to decrease financial and food hardships may improve outcomes.

Disparities in Neighborhood Characteristics among U.S. Children with Secondhand and Thirdhand Tobacco Smoke Exposure.

(1) Background: Home tobacco smoke exposure (TSE) and negative neighborhood characteristics adversely affect children's overall health. The objective was to examine the associations of child TSE status and neighborhood characteristics among U.S. school-aged children. (2) Methods: We conducted a secondary analysis of the 2018-2019 National Survey of Children's Health (NSCH) data including 17,300 U.S. children ages 6-11 years old. We categorized children's home TSE status into: (a) no TSE: child did not live with a smoker; (b) thirdhand smoke (THS) exposure alone: child lived with a smoker who did not smoke inside the home; and (c) secondhand smoke (SHS) and THS exposure: child lived with a smoker who smoked inside the home. We conducted a series of weighted linear and logistic regression analyses to assess the associations between child TSE status and neighborhood characteristics, adjusting for covariates. (3) Results: Overall, 13.2% and 1.7% of children were exposed to home THS alone and home SHS and THS, respectively. Compared to children with no TSE, children with home THS exposure alone and children with home SHS and THS exposure had a significantly lower total number of neighborhood amenities and children with SHS and THS exposure had a significantly higher total number of detracting neighborhood elements. (4) Conclusions: Children with TSE demonstrate disparities in the characteristics of the neighborhood in which they live compared to children with no TSE. TSE reduction interventions targeted to children with TSE who live in these neighborhoods are warranted.

Home Tobacco Smoke Exposure and Neighborhood Support and Safety among U.S. School-aged Children.

Children who are socioeconomically disadvantaged face a myriad of environmental hardships in the neighborhoods in which they live. This study examined the associations between home tobacco smoke exposure (TSE) and neighborhood support, neighborhood safety, and school safety among U.S. school-aged children. Children ages 6-11 years were included in this secondary analysis of 2018-2019 National Survey of Children's Health data (N = 17,300). Children's home TSE status was categorized into three levels: (1) no TSE: Child did not live with a smoker; (2) Outside TSE only: Child lived with a smoker who did not smoke inside the home; and (3) Inside TSE: Child lived with a smoker who smoked inside the home. Parent-reported measures of perceived neighborhood support, and neighborhood and school safety were examined; covariates included the child's age, sex, and race/ethnicity; the parent's education; the family's household structure, and federal poverty level. Weighted logistic and ordinal regression models were built adjusting for the covariates. In total, 13.2% of children had outside TSE and 1.7% of children had inside TSE. Multivariable logistic regression model results indicated that children with outside TSE were at decreased odds (AOR = 0.79, 95%CI = 0.65-0.96) of living in a supportive neighborhood compared to children with no TSE. Ordinal regression model results indicated that children with outside TSE (AOR = 0.77, 95%CI = 0.61-0.97) and children with inside TSE were at decreased odds (AOR = 0.62, 95%CI = 0.39-0.99) of going to a school that was perceived as safe. Community-level programs, policies, and funding are needed to improve neighborhood characteristics among children with TSE to improve their future health outcomes.

Assessment and management of gastroesophageal reflux disease following bariatric surgery.

Gastroesophageal reflux disease (GERD) is a common disease in patients with obesity. The incidence of de novo GERD and the effect of bariatric surgery on patients with pre-existing GERD remain controversial. Management of GERD following bariatric surgery is complicated and can range from medical therapy to non-invasive endoscopic options to invasive surgical options. To address these issues, we performed a systematic review of the literature on the incidence of GERD and the various modalities of managing GERD in patients following bariatric surgery. Given the increased number of laparoscopic sleeve gastrectomy (LSG) procedures being performed and the high incidence of GERD following LSG, bariatric surgeons should be familiar with the options available to manage GERD following LSG as well as other bariatric procedures.

The Epidemiology of Recent Alcohol Use Among a National Sample of Middle Eastern College Students.

Alcohol use among college students is a national health concern. The epidemiology of alcohol use among Middle Eastern college students remains to be investigated. This study sought to understand the epidemiology of recent alcohol use among Middle Eastern college students. We use data from the 2017 to 2018 Healthy Minds Study to identify predictors of recent alcohol use among 1,763 Middle Eastern students nationwide. Weighted univariate analyses were conducted to determine significant predictors of recent alcohol use. Nearly half (45.5%) of Middle Eastern college students reported using alcohol in the past 2 weeks (recent alcohol use). Those at highest risk for recent alcohol use were in their 4th year of schooling (p < .001), living in a fraternity or sorority house (p < .001), and reported that religion was not a big part of their life (p < .001). Students who lived with their parents were less likely to drink alcohol (p < . 001). Recent alcohol use among Middle Eastern college students is a national public health concern. Interventions are warranted to decrease this growing public health anomaly and to more effectively deal with this current public health crisis.

Cost Analysis of Robotic Roux-en-Y Gastric Bypass in a Single Academic Center: How Expensive Is Expensive?

BACKGROUND: Although the use of da Vinci robotic platforms in bariatric surgery is gaining momentum, it is still controversial because of financial concerns. OBJECTIVES: The objective of our study is to evaluate the cost of robotically assisted Roux-en-Y gastric bypass (R-RYGB) versus conventional laparoscopic Roux-en-Y gastric bypass (L-RYGB). METHODS: We analyzed consecutive primary bariatric patients who underwent R-RYGB and compared them with patients who underwent L-RYGB during the same time period. Primary outcomes were overall cost for length of stay, operating time, and supplies. Direct cost data was generated using the StrataJazz reporting module, which is fed daily from EPIC, our electronic health record system, and contains hospital-based data only. Secondary outcomes were 30-day rates of complications, reoperations, and readmissions. RESULTS: We found no difference in primary or secondary outcomes following R-RYGB and L-RYGB. The overall cost for R-RYGB and L-RYGB was not statistically different (median total cost for R-RYGB and L-RYBG was $6431.34 and $6349.09, P > 0.05, respectively). Operating time cost was significantly higher for R-RYGB compared with L-RYGB ($2248.51 versus $19,836.29, respectively, P < 0.0001, respectively). R-RYGB had lower cost of supplies as well as a shorter length of stay compared with L-RYGB (mean 1.5 versus 1.7 days, respectively). CONCLUSIONS: Our study revealed no cost difference between R-RYGB and L-RYGB, with a decreased cost of supplies and trend toward lower hospital stay favoring R-RYGB. Further studies are needed to evaluate the outcomes of R-RYGB compared with L-RYGB; however, the cost of robotic surgery may not be a prohibitive factor.

Health Beliefs Describing Patients Enrolling in Community Pharmacy Disease Management Programs.

OBJECTIVES: The purpose of this study was to survey new enrollees in a community pharmacy, employer-based diabetes and hypertension coaching program to describe the characteristics, health beliefs, and cues to action of newly enrolled participants. METHODS: A 70-question, 5-point Likert-type survey was developed using constructs from the Health Belief Model (HBM), Theory of Planned Behavior (TPB), and Theory of Reasoned Action (TRA). New enrollees in the coaching programs completed the survey. Survey responses between controlled and uncontrolled patients and patient demographics were compared. RESULTS: Between November 2011 and November 2012, 154 patients completed the survey. Patients were fairly well controlled with a mean hemoglobin A1C of 7.3% and a mean blood pressure of 134/82 mm Hg. The strongest cue to action for enrollment was the financial incentives offered by the employer (mean: 3.33, median: 4). White patients were significantly more motivated by financial incentives. More patients indicated they had not enrolled previously in the program because they were unaware it was available (mean: 2.89, median 3.0) and these patients were more likely to have an uncontrolled condition (P ≤ 0.050). CONCLUSION: A top factor motivating patients to enroll in a disease management coaching program was the receipt of financial incentives. Significant differences in HBM, TPB, and TRA responses were seen for patients with different demographics.

Emotionally troubled teens' help-seeking behaviors: an evaluation of surviving the Teens® suicide prevention and depression awareness program.

Many school-based suicide prevention programs do not show a positive impact on help-seeking behaviors among emotionally troubled teens despite their being at high risk for suicide. This study is a secondary analysis of the Surviving the Teens(®) program evaluation to determine its effect on help-seeking behaviors among troubled youth. Results showed significant increases in mean scores of the Behavioral Intent to Communicate with Important Others Regarding Emotional Health Issues subscale (p < .0005) from pretest to 3-month follow-up. There was a significant increase (p = .006) in mean scores of the Behavioral Intent Regarding Help-Seeking Behaviors when Suicidal subscale from pretest to posttest, but not at 3-month follow-up. Also, there was a significant increase (p = .016) in mean scores in the item "I would tell an adult if I was suicidal" from pretest to 3-month follow-up. These findings suggest that the Surviving the Teens program has a positive effect on help-seeking behaviors in troubled youth.

Reasons for synthetic THC use among college students.

Synthetic THC, also known as fake marijuana, is used by college students in the United States. The present study examined reasons for recent synthetic THC use among college students (N = 339). Students completed a 3-page survey during regularly scheduled class times. Results indicated students reported using synthetic THC for curiosity, to get high, and the fun of feeling high. No significant differences in reasons for use were found based on sex and grade. College students reported most often obtaining synthetic THC from head shops. Study findings may be beneficial to college health professionals and others working with college students. High rates of lifetime use may suggest that educational and intervention programs are needed.

Clinical psychologists' firearm risk management perceptions and practices.

The purpose of this study was to investigate the current perceptions and practices of discussing firearm risk management with patients diagnosed with selected mental health problems. A three-wave survey was mailed to a national random sample of clinical psychologists and 339 responded (62%). The majority (78.5%) believed firearm safety issues were greater among those with mental health problems. However, the majority of clinical psychologists did not have a routine system for identifying patients with access to firearms (78.2%). Additionally, the majority (78.8%) reported they did not routinely chart or keep a record of whether patients owned or had access to firearms. About one-half (51.6%) of the clinical psychologists reported they would initiate firearm safety counseling if the patients were assessed as at risk for self-harm or harm to others. Almost half (46%) of clinical psychologists reported not receiving any information on firearm safety issues. Thus, the findings of this study suggest that a more formal role regarding anticipatory guidance on firearms is needed in the professional training of clinical psychologists.

Risk and protective factors for recent alcohol use among African-American youth.

A total of 7488 7th-12th grade African-American students completed a survey assessing factors associated with recent alcohol use. Results indicated that 13.6% used alcohol in the past month. A series of odds ratios revealed that making good grades, participating in school activities, attending church, and having parents/teachers talk about the dangers of alcohol and set/enforce rules regarding alcohol were associated with decreased recent use. Participating in risky behaviors such as getting into trouble, skipping school, and having friends who use alcohol and other drugs was directly related to recent use. Prevention specialists should encourage parents/teachers to engage youth in family, school, and community activities to deter alcohol use. Results may assist youth health professionals in developing prevention programs aimed at African-American youth.

Effect of social support on adolescents' perceptions of and engagement in physical activity.

BACKGROUND: Social support can influence physical activity among some individuals. This study examined the effect that social support has on adolescents' physical activity and their perceived barriers and benefits to exercising. METHODS: A survey was completed by adolescents (N = 535) at 2 single-sex (1 male, 1 female) high schools in Ohio. RESULTS: Adolescents who received parental encouragement to exercise and who had an exercising friend engaged in significantly more days of physical activity in the past week than did their counterparts. Perceived benefits of physical activity differed significantly based on whether the respondent received parental encouragement and had a friend who exercised. Social support for physical activity significantly affected adolescents' perceptions of and engagement in physical activity. CONCLUSIONS: Parents should encourage their children to become physically active and partner with peers when exercising.

Teaching adolescents safe driving and passenger behaviors: effectiveness of the You Hold the Key Teen Driving Countermeasure.

PROBLEM: Unsafe driving and passenger behaviors place teens at increased risk for fatal and nonfatal crashes. This study evaluated the short-and long-term efficacy of the You Hold the Key (YHTK) Teen Driving Countermeasure. METHOD: A two-page survey was completed by high school students at pretest, posttest, and long-term (6-month) posttest. RESULTS: YHTK was associated with significant immediate and long-term improvements in teen seatbelt use, safe driving, and perceived confidence in preventing drunk driving. Compared to pretests, students at immediate and long-term posttest more frequently wore seatbelts when driving or riding, required passengers to wear seatbelts, and limited the number of passengers to the number of seatbelts in the vehicle. Students were more likely at both posttests to avoid drinking and driving and to say no to riding with a friend who had been drinking. SUMMARY: YHTK was associated with increases in safe teen driving and passenger behaviors. IMPACT ON INDUSTRY: Success of YHTK is most notably due to its comprehensive nature. Future programs should consider comprehensive strategies when attempting to modify teen behaviors.

Influence of paper color and a monetary incentive on response rate.

This study examined whether survey response rate differed based on the color of the paper the survey was printed on (blue vs green) and presence of a monetary incentive. A 4-page survey on eating disorders was mailed to Division 1A and 1AA college head athletic trainers (N=223) with half of the surveys on blue paper and half on green paper. Half of the athletic trainers (n = 111) received a $1.00 monetary incentive, and half (n = 112) received no monetary incentive. A total of 166 (71%) athletic trainers returned completed surveys. Response rates did not differ based on survey color but did differ based on presence of a monetary incentive. Athletic trainers who received a monetary incentive were significantly more likely than those who did not to return completed surveys (86% vs 63%, respectively).