Online Simulation Model to Estimate the Total Costs of Tobacco Product Waste in Large U.S. Cities.

Tobacco product waste (TPW) is one of the most ubiquitous forms of litter, accumulating in large amounts on streets, highways, sidewalks, beaches, parks, and other public places, and flowing into storm water drains, waste treatment plants, and solid waste collection facilities. In this paper, we evaluate the direct and indirect costs associated with TPW in the 30 largest U.S. cities. We first developed a conceptual framework for the analysis of direct and indirect costs of TPW abatement. Next, we applied a simulation model to estimate the total costs of TPW in major U.S. cities. This model includes data on city population, smoking prevalence rates, and per capita litter mitigation costs. Total annual TPW-attributable mean costs for large US cities range from US$4.7 million to US$90 million per year. Costs are generally proportional to population size, but there are exceptions in cities that have lower smoking prevalence rates. The annual mean per capita TPW cost for the 30 cities was US$6.46, and the total TPW cost for all 30 cities combined was US$264.5 million per year. These estimates for the TPW-attributable cost are an important data point in understanding the negative economic externalities created by cigarette smoking and resultant TPW cleanup costs. This model provides a useful tool for states, cities, and other jurisdictions with which to evaluate a new economic cost outcome of smoking and to develop new laws and regulations to reduce this burden.

Youth Cognitive Empowerment: Development and Evaluation of an Instrument.

Psychological empowerment (PE) is a multicomponent construct that involves the mechanisms through which people and groups gain control over their lives and environments. Psychological empowerment has previously been operationalized using measures of sociopolitical control among young people, with findings indicating links between PE and other positive developmental outcomes. Sociopolitical control, however, is only an indicator for the emotional component of PE. Research has largely neglected the cognitive component of PE, particularly in studies of younger people. In fact, few studies to date have presented and empirically tested measurement instruments for the cognitive component of PE among youth. In this study, we adapted a measure, which previously had been validated and used among adults, for use among young people and tested it in a sample of high school students (53% female, 75% Hispanic) in an urban school in the northeastern U.S. Confirmatory factor analyses were used to assess the hypothesized three-factor structure of cognitive empowerment, and the measure was examined for association with the construct of social justice orientation. Results indicate an adequate fit for the second-order factor, and an expected relationship with the related construct.

Promoting opioid overdose prevention and recovery: An exploratory study of an innovative intervention model to address opioid abuse.

BACKGROUND: Fatal opioid overdose is a national public health concern in the United States and a critical problem confronting New Jersey's addiction treatment system. New Jersey developed an innovative program, the Opioid Overdose Recovery Program (OORP), to address the epidemic and the issue of low treatment admissions following a non-fatal overdose. The OORP utilizes an intervention model with peer recovery specialists (RSs) and patient navigators (PNs) to engage individuals within emergency departments (EDs) immediately following an opioid overdose reversal. The purpose of this exploratory s/tudy was to examine the process through which the OORP was implemented in its first year and determine facilitators and barriers to implementation. METHODS: Data were collected in 2016-2017, through 17 telephone interviews and focus groups with 39 participants. Participants were OORP staff and stakeholders selected through purposeful, non-random sampling. Standardized, open-ended interview guides were used. Thematic analysis was conducted to identify, analyze, and report overall patterns. RESULTS: Participants detailed stories from the field and policymakers illuminated the process of implementation. Findings revealed logistical barriers to treatment including patients' lack of insurance and cell phones, lack of immediately available detox beds, and program ineligibility for some patients due to medical conditions. The model using peers as first responders had a positive impact as their experiences with addiction enabled them to more successfully engage patients. The PNs were critical in addressing high needs for case management and referral and external partners were also important for implementation. CONCLUSIONS: Results underscore the effort needed to integrate this important model within EDs as part of a multi-level approach to address opioid misuse. The identified challenges led to statewide strategic planning and areas for further development. OORP is a promising intervention that might increase the number of individuals suffering with opioid disorders linked to peer support, treatment and recovery.

Critical Hopefulness Among Urban High School Students.

Psychological empowerment encompasses several key aspects of youth civic and sociopolitical development. Most research has focused on psychological empowerment's emotional component, which entails learned hopefulness about one's own ability to participate in and lead community change efforts. Fewer studies have assessed critical awareness of how social power operates-psychological empowerment's cognitive component. The confluence of these two components has been termed critical hopefulness. A complex relationship exists between these two components, and previous research has found relatively small proportions of participants reporting both high levels of critical awareness and simultaneously high levels of hopefulness about their ability to exert influence in the sociopolitical domain. The current study of urban high school students in the Northeastern U.S. (n = 389; 53.5% female) investigates heterogeneity according to these two components of psychological empowerment. Latent class cluster analyses were conducted and seven distinct groups of participants emerged. Students identifying as Hispanic/Latinx were more likely to be classified into a profile group exhibiting critical hopefulness. Differences were observed between psychological empowerment profile groups on self-reported levels of psychological sense of community, civic engagement, and social justice orientation. Furthermore, a larger proportion of this overall sample was classified into groups that exhibited critical hopefulness than in a previous study of adults. These findings provide useful insights for efforts to engage young people in civic life and to promote sociopolitical development.

High-Risk Obtainment of Prescription Drugs by Older Adults in New Jersey: The Role of Prescription Opioids.

OBJECTIVES: To explore the high-risk ways in which older adults obtain prescription opioids and to identify predictors of obtaining prescription opioids from high-risk sources, such as obtaining the same drug from multiple doctors, sharing drugs, and stealing prescription pads. DESIGN: Logistic regression analyses of cross-sectional survey data from the New Jersey Older Adult Survey on Drug Use and Health, a representative random-sample survey. PARTICIPANTS: Adults aged 60 and older (N = 725). MEASUREMENTS: Items such as obtaining prescriptions for the same drug from more than one doctor and stealing prescription drugs were measured to determine high-risk obtainment of prescription opioids. RESULTS: Almost 15% of the sample used high-risk methods of obtaining prescription opioids. Adults who previously used a prescription opioid recreationally had three times the risk of high-risk obtainment of prescription opioids. CONCLUSION: These findings illustrate the importance of strengthening prescription drug monitoring programs to reduce high-risk use of prescription drugs in older adults by alerting doctors and pharmacists to potential prescription drug misuse and interactions.

Assessing Community Participation: Comparing Self-Reported Participation Data with Organizational Attendance Records.

How well do self-reported levels of community and organizational participation align with recorded acts of community and organizational participation? This study explores this question among participants in social action community organizing initiatives by comparing responses on a community participation scale designed to retrospectively assess community participation (T1, n = 482; T2, n = 220) with individual participants' attendance records in various social action organizing activities over two 1-year periods. By testing the self-reported measure's overall and item-by-item association with documented participation in various types of organizing activities, we find that the self-report measure is positively, but weakly correlated with actual participation levels in community organizing activities. Moreover, associations between self-report and recorded acts of participation differ by types of activity. Examining this unique source of data raises important questions about how community participation is conceptualized and measured in our field. Implications are explored for theory and measurement of participation in community and organizational contexts.

Measuring bystander attitudes and behavior to prevent sexual violence.

OBJECTIVE: The purpose of this study is to further investigate the factor structure and strength of the Bystander Attitude Scale-Revised and Bystander Behavior Scale-Revised (BAS-R and BBS-R). PARTICIPANTS: First-year students (N = 4,054) at a large public university in the Northeast completed a survey in 2010 as part of a larger longitudinal study of a sexual violence bystander education intervention program on campus. METHODS: Exploratory structural equation modeling was used to analyze survey responses to the BAS-R and BBS-R. RESULTS: For BAS-R, the best fit was a 4-factor model: (1) high-risk situations, (2) postassault support for victims, (3) postassault reporting of perpetrators, and (4) proactive opportunities. BBS-R was a 2-factor model: (1) intervention opportunities before, during, or after an assault, and (2) proactive opportunities. CONCLUSION: The BAS-R and BBS-R provide reliable tools that can be utilized to evaluate sexual violence bystander programs.

Examining tobacco outlet concentration in New Jersey: does income and ethnicity matter?

This study examined the geographic association between tobacco outlet density and the demographic indicators of median household income and percentage of Hispanic residents in New Jersey. Tobacco outlet density was assessed by examining all tobacco retailers licensed in 2004 in New Jersey, and demographic variables were based on the 2000 United States Census. Results indicated that the percentage of Hispanic residents and median household income were both salient predictors of tobacco outlet density. We also observed that income level moderated the relationship between the percentage of Hispanics residents and tobacco outlet density. Implications for environmentally based tobacco prevention and control initiatives are discussed.

The influence of participation, gender and organizational sense of community on psychological empowerment: the moderating effects of income.

This study explored the influence of participation, gender and organizational sense of community (SOC) on both the intrapersonal and interactional components of psychological empowerment (PE). Participants were residents (n = 562) involved in community organizing efforts in five U.S. communities. Measures of participation and SOC were tailored to community organization contexts. SOC assessed three dimensions: (1) connection of members to the organization; (2) perceptions about the organization as a bridge to other groups and organizations in the broader community; and (3) bond or attachment to the community at large. Income (low, middle and high-income) was tested as a moderator of these relationships. Results showed significant moderating effects of income on the relationship between participation, gender and SOC on both components of PE. Participation was positively related with intrapersonal empowerment across income levels, but positively related with interactional empowerment only for low-income individuals. Gender was only associated with intrapersonal empowerment, and only for low-income individuals. SOC, as expressed through bridging to the broader community, was positively related with interactional PE for all income levels, but with intrapersonal PE for only low and middle-income individuals. In contrast, member connection to the organization was not related to interactional empowerment and significantly related to intrapersonal empowerment only for individuals with higher income. The importance of participation, gender and SOC for different types of empowerment and the impact of income on the SOC-empowerment relationship are discussed.

Tobacco litter costs and public policy: a framework and methodology for considering the use of fees to offset abatement costs.

OBJECTIVES: Growing concern over the costs, environmental impact and safety of tobacco product litter (TPL) has prompted states and cities to undertake a variety of policy initiatives, of which litter abatement fees are part. The present work describes a framework and methodology for calculating TPL costs and abatement fees. METHODS: Abatement is associated with four categories of costs: (1) mechanical and manual abatement from streets, sidewalks and public places, (2) mechanical and manual abatement from storm water and sewer treatment systems, (3) the costs associated with harm to the ecosystem and harm to industries dependent on clean and healthy ecosystems, and (4) the costs associated with direct harm to human health. The experiences of the City of San Francisco's recently proposed tobacco litter abatement fee serve as a case study. RESULTS: City and municipal TPL costs are incurred through manual and mechanical clean-up of surfaces and catchment areas. According to some studies, public litter abatement costs to US cities range from US$3 million to US$16 million. TPL typically comprises between 22% and 36% of all visible litter, implying that total public TPL direct abatement costs range from about US$0.5 million to US$6 million for a city the size of San Francisco. The costs of mitigating the negative externalities of TPL in a city the size of San Francisco can be offset by implementing a fee of approximately US$0.20 per pack. CONCLUSIONS: Tobacco litter abatement costs to cities can be substantial, even when the costs of potential environmental pollution and tourism effects are excluded. One public policy option to address tobacco litter is levying of fees on cigarettes sold. The methodology described here for calculating TPL costs and abatement fees may be useful to state and local authorities who are considering adoption of this policy initiative.

The importance of income in the link between tobacco outlet density and demographics at the tract level of analysis in New Jersey.

This study analyzed associations between tobacco outlet density and demographic correlates (median household income and minority population percentages) within two New Jersey counties. The study was conducted using variables developed from state licenses for tobacco outlets and data from residential census tracts. Results showed that tracts with lower median household income and higher percentages of minority residents had greater densities of tobacco-selling retail outlets. Results also demonstrated that median household income was the strongest predictor of tobacco outlet density across both counties. Implications of the study and directions for future research, specifically the interaction between income and race/ethnicity, are discussed.

Paths to leisure physical activity among adults with intellectual disabilities: self-efficacy and social support.

PURPOSE: This study tested a path model that included perceptions of social support and self-efficacy for leisure physical activity and leisure physical activity participation among adults with intellectual disabilities. DESIGN: A cross-sectional design was used. Data was collected via oral interview. SETTING: Community-based group, supported-living settings in one Midwestern state. SAMPLE: A total of 152 adults with mild to moderate intellectual disabilities, which provided a 39% response rate. MEASURES: Self-efficacy and social support (from family, residential staff and peers with disabilities) for leisure physical activity were assessed using self-reported scales. Leisure physical activity participation was measured with a self-reported checklist of the frequency of leisure physical activity participation. ANALYSIS: Path analysis was conducted for the entire sample and was repeated for younger and older age groups. RESULTS: The hypothesized model fit the data from each group. Social support and self-efficacy predicted physical activity participation, and self-efficacy served as a mediator between social support and physical activity. Significant sources of social support differed between groups; among younger participants, social support from family predicted physical activity, whereas, for the older group, social support from staff and peers predicted physical activity. CONCLUSION: Self-efficacy and social support for leisure physical activity are related to leisure physical activity participation among adults with intellectual disabilities who are receiving supported-living services. The results provide information to guide health promotion programs for this group.

Empowerment and sense of community: clarifying their relationship in community organizations.

The research reported here tested the factor structure of a measure for sense of community in community organizations, and it evaluated sense of community's potential as an empowering organizational characteristic within an organizational empowerment framework. Randomly selected community organization participants (N=561) were surveyed as part of a study of a substance abuse prevention initiative located in the northeastern United States. Confirmatory factor analysis verified the putative structure of the sense of community measure tailored to community organizations. Hierarchical regression analyses indicated that community organization sense of community significantly predicted intrapersonal empowerment after controlling for demographics, participation, alienation, and other empowering organizational characteristic. Findings imply that organizational sense of community should be considered as an empowering organizational characteristic in community-based health education.

The effect of physician and health plan market concentration on prices in commercial health insurance markets.

The objective of this paper is to describe the market structure of health plans (HPs) and physician organizations (POs) in California, a state with high levels of managed care penetration and selective contracting. First we calculate Herfindahl-Hirschman (HHI) concentration indices for HPs and POs in 42 California counties. We then estimate a multivariable regression model to examine the relationship between concentration measures and the prices paid by HPs to POs. Price data is from Medstat MarketScan databases. The findings show that any California counties exhibit what the Department of Justice would consider high HHI concentration measures, in excess of 1,800. More than three quarters of California counties exhibit HP concentration indices over 1,800, and 83% of counties have PO concentration levels in excess of 1,800. Half of the study counties exhibited PO concentration levels in excess of 3,600, compared to only 24% for plans. Multivariate price models suggest that PO concentration is associated with higher physician prices (p < or = 0.05), whereas HP concentration does not appear to be significantly associated with higher outpatient commercial payer prices.

Clinical practice guidelines and organizational adaptation: a framework for analyzing economic effects.

OBJECTIVES: The overall objective of this article was to review the theoretical and conceptual dimensions of how the implementation of clinical practice guidelines (CPGs) is likely to affect treatment costs. METHODS: An important limitation of the extant literature on the cost effects of CPGs is that the main focus has been on clinical adaptation. We submit that the process innovation aspects of CPGs require changes in both clinical and organizational dimensions. We identify five organizational factors that are likely to affect the relationship between CPGs and total treatment costs: implementation, coordination, learning, human resources, and information. We review the literature supporting each of these factors. RESULTS: The net organizational effects of CPGs on costs depends on whether the cost-reducing properties of coordination, learning, and human resource management offset potential cost increases due to implementation and information management. CONCLUSIONS: Studies of the cost effects of clinical practice guidelines should attempt to measure, to the extent possible, the effects of each of these clinical and organizational factors.

The relationship between active living and health-related quality of life: income as a moderator.

This study used a moderator model to examine the relationship between active living and the physical components of health-related quality of life [i.e. overall physical component of quality of life (PQOL), physical functioning and ability to fulfill physical role] among a randomly selected sample of rural residents (n = 407) from the Midwestern US. Results showed that active living was associated with greater increases in health-related quality of life for those reporting lower income. The effect size of the relationship between active living and the PQOL for the low-income group was over 2 times the effect size for the high-income group. For physical functioning, the effect size of active living for the low-income group was greater than 3 times the effect size for the high-income group. Although active living behaviors have been demonstrated to be less prevalent among those of low socioeconomic status, this group may have the most to gain from these activities. Findings highlight the need for increased and specifically targeted promotion of active living interventions.

Tobacco outlet density, cigarette smoking prevalence, and demographics at the county level of analysis.

The geographic associations between tobacco outlet density, cigarette smoking prevalence, and demographic variables at the county unit of analysis were examined. End of year 2002 data were derived from licenses of 4745 tobacco selling retail outlets in all 99 Iowa counties. The 2000 census and the 2002 Iowa Behavioral Risk Factor Surveillance System (IBRFSS) were used to gather data for demographic variables and smoking prevalence rates. The IBRFSS telephone interviews were conducted from January through December in 2002 with a random sample of 3662 Iowa residents. As expected, results showed that counties with higher density of tobacco outlets and smoking prevalence also tended to have a higher percentage of minority residents. Contrary to previous studies, however, counties with higher tobacco outlet density and smoking prevalence also tended to have higher median household income. Findings are discussed in light of the state's low income inequality. Implications of the study and directions for future research are discussed.

Tobacco outlet density and demographics at the tract level of analysis in Iowa: implications for environmentally based prevention initiatives.

This study assessed the geographic association between tobacco outlet density and three demographic correlates-income, race, and ethnicity-at the tract level of analysis for one county in the Midwestern United States. Data for residential census tracts in a Midwestern U.S. county were derived from year 2003 licenses for 474 tobacco outlets. Demographic variables were based on 2000 census data. Census tracts with lower median household income, higher percent of African American residents, and higher percent of Latinos residents had greater density of tobacco selling retail outlets. Areas characterized by lower income and disproportionately more African Americans and Latinos have greater physical access to tobacco products. Physical access to tobacco is a critical public-health issue because, given that smokers have been shown to be price sensitive, lowering access costs (e.g., reduced travel time) is likely to increase consumption. Findings also suggest the need for structural or environmental interventions, i.e., tobacco outlet zoning laws, to mitigate the health consequences associated with tobacco use in certain populations and geographic regions.

Generalizing the alcohol outlet-assaultive violence link: evidence from a U.S. midwestern city.

This study assessed the geographic association between rates of assaultive violence and alcohol-outlet density in Kansas City, Missouri. Data were obtained for sociodemographic factors, alcohol-outlet density, and rates of assaultive violence across 89 inner-city census tracts in Kansas City, Missouri. Hierarchical regression analysis indicated that sociodemographic variables predicted 61% (R2 = 0.61) of the variance in assaultive violence, but that an additional 9% (R2 = 0.09) of the variability in assaultive violence was explained by the density of alcohol outlets. Alcohol-outlet density contributed significantly to the explained variance of the regression model and was associated with higher rates of assaultive violence in this midwestern city.