A demographic comparison and characterization of pediatric poisoning before and after the emergence of COVID-19.

BACKGROUND: To compare relative rates of pediatric poisoning before and after COVID-19, including by demographic and urban-rural status, and by agent identified, using data from one university healthcare system and children's hospital. METHODS: Using retrospective, cross sectional design from deidentified healthcare claims data, we extracted all encounters with the ICD-10-CM for Poisoning by, Adverse effects of, and Underdosing of drugs, medicants and biological substances (T36-T50) and grouped the encounters as those after state mandates regulating activity came into effect (Post-COVID-19 (3/17/2020-3/18/2021)) Pre-COVID-19 (3/18/2019-3/17/2020). We then compared poisoning agent, age at the time of the encounter, recorded sex, race, ethnicity, rural/urban residence, and visit type using Mann-Whitney U test, chi-square test of association, incidence rates and incident rate ratios between the time periods. FINDINGS: The sample included 1608 unique patients 0-17 years of age and 4216 encounters. We also identified IRRs >1 in nearly every demographic subgroup with the exception of Non-Hispanic Blacks. The comparison of specific drugs or medicants identified a significant decrease in poisoning by Systemic antibiotics (T36); but an increase in Hormones and their synthetic substitutes and antagonists (T38), Non opioid analgesics antipyretic and antirheumatic (T39), Psychotropic Drugs (T39) and Systemic and hematologic agents (T45). CONCLUSION: This study identifies pediatric subgroups highly affected by pediatric poisoning during the time-period immediately after the identification of COVID-19 and characterizes the drugs commonly associated with poisonings. APPLICATION TO PRACTICE: With a further understanding nursing has the potential to impact pediatric poisoning in the inpatient, outpatient and public health setting.

Public library lending programs increase radon testing in rural communities.

Radon exposure is the second leading cause of lung cancer, yet few Americans test their homes for radon, particularly in rural areas. The academic team and community partners engaged the public library systems in four rural counties to offer digital radon detectors for check-out as a means of increasing the public's access to free radon testing. The check-out procedures and instructional materials were created through an iterative process, and library personnel were educated on radon and home radon testing prior to launching the lending program. Library patrons reported high usability, feasibility, and acceptability of the program. Library patron-staff interactions mainly included discussions about the logistics of radon testing. Given that public libraries are invested in making communities thrive and promoting health, providing library lending programs for radon detectors is a novel, feasible, and acceptable way to reduce the risk of lung cancer in the community.

Beliefs and knowledge related to human papillomavirus (HPV) vaccine among African Americans and African immigrants young adults.

BACKGROUND: Despite the disparate human papillomavirus (HPV) infection rates among sexually active Black young adults, HPV vaccine uptake remains low among this population. This study aimed to explore HPV beliefs, attitudes, and knowledge among Black young adults and provide recommendations on ways to improve vaccine uptake. METHODS: We used a mixed-method, convergent design to conduct five focus groups and administered a 40-item electronic survey that was developed with health belief model (HBM) constructs. We assessed HPV and vaccine knowledge, barriers, and attitudes toward vaccination. We analyzed quantitative data using descriptive statistics and bivariate methods. Focus group transcripts were analyzed using content analysis. Results were integrated to obtain a better understanding of the topic. RESULTS: Forty individuals participated in the study. The mean age was 22.2 ± 4.5 years and 55% identified as African immigrants. Integrated data revealed themes mapped to relevant HBM constructs. Almost one third (32.5%) of participants were unaware of their susceptibility to HPV infection and its severity. From focus group discussions, the majority (75%) believed that vaccines are beneficial. Major cues to action include promoting HPV vaccine uptake via community wide informational sessions, provider recommendation, and social and mass media campaigns. CONCLUSION: Barriers to vaccine uptake, limited HPV knowledge, and lack of vaccine recommendation are important factors contributing to low vaccine uptake among Black young adults. Interventions to decrease barriers to HPV vaccination, increase HPV knowledge, address misconceptions, and unfavorable beliefs are needed to promote HPV vaccine uptake.

The State of Health and Intentions for Action to Advance Mental Health and Well-being for the Nursing Workforce.

OBJECTIVE: The aims of this study were to explore the health of nurse leaders and assess intentions to integrate workplace mental health/wellness practices. BACKGROUND: National efforts address high rates of poor mental health and lifestyle behaviors among nurses. Few studies describe the extent to which nurse leaders in academic and clinical environments can influence a strategic mission for health/well-being among the nursing workforce. METHODS: Two hundred seventeen email invitations were distributed to nurse leaders from 5 Kentucky nursing organizations to complete a 1-time 46-item online survey assessing individual health behaviors and intentions to build a culture of workplace health/well-being. RESULTS: Most respondents reported positive physical health (86%), positive mental health/intentions for action to change behaviors (80%), improved self-care practices (86%), integration of self-care practices in the workplace (79%), and commitment to integrate suicide prevention training (55%). CONCLUSIONS: Overall, nurse leaders reported positive healthy behaviors. The finding that the highest intentions were reported to integrate, sustain, and/or advance lifestyle behaviors for self-care practices as well as to integrate practices for mental health and well-being in the work environment is encouraging. Enhanced strategies and efforts are needed to prioritize workplace cultures of wellness to benefit nurses and further promote well-being among nurse leaders.

Unintended pregnancy and childhood maltreatment: The protective effect of positive relationships.

BACKGROUND: Childhood maltreatment is associated with sexual risk-taking behaviors in adulthood but can also have generational effects on maternal/child health. METHODS: This cross-sectional study examined the relationship between childhood abuse and neglect and unintended pregnancy, and then assessed the effect of relationship attributes on this outcome. RESULTS: Findings indicate parenting women (n = 153) in long-term relationships who experienced childhood emotional abuse had higher scores of unintended pregnancies (p = .023). Yet women with moderate/high partner appraisal (perceptions of their partner's attributes used to assess interpersonal conflicts) showed no difference in unintended pregnancies between those with and without emotional abuse in childhood. Women with emotional abuse and low partner appraisal had higher unintended pregnancy scores (p = .002). DISCUSSION/CONCLUSION: This study has implications for public health nursing and life course research demonstrating that a positive adult interpersonal environment can reduce the sequelae of adverse health outcomes associated with childhood emotional abuse. The results reinforce the importance of screening adults for childhood maltreatment to establish early risk for unintended pregnancy.

Municipal smoke-free laws and preterm birth.

BACKGROUND: Smoking during pregnancy and prenatal secondhand smoke exposure increase the risk of preterm birth. As Kentucky has the second highest rate of smoking in the United States and no statewide smoke-free law, an examination of the effect of municipal smoke-free legislation on preterm birth is warranted. OBJECTIVE: This study used state-level live birth data and county-level municipal smoke-free legislation status to assess the association between the presence and strength of smoke-free laws and the likelihood of preterm birth. Moreover, this study hypothesized that pregnant persons living in counties with comprehensive municipal smoke-free laws prohibiting smoking inside all workplaces and enclosed public places would exhibit a lower likelihood of preterm birth than those living in counties with weak or moderate laws (ie, smoke-free laws with exemptions that do not cover all workplaces and enclosed public places) or no smoke-free law. STUDY DESIGN: Using live birth data from the Kentucky Office of Vital Statistics with birth years ranging from 2004 to 2020, a total of 894,372 live births were recorded that indicated that a childbearing person was between the ages of 18 and 49 years and a resident of Kentucky; these live births formed the sample for the study. Municipal ordinances implemented during a given calendar year were coded in the model as present starting with the following calendar year, as the birth records were time deidentified except for the year of birth. This lagged law convention maximized the likelihood that pregnant persons included in the study were exposed to the smoke-free policy for at least a portion of their pregnancy. Multilevel logistic regression was used to assess the effect of smoke-free ordinances on the likelihood of preterm birth, with personal- and county-level variables included as potential covariates and pregnant persons nested within the county of residence. Data analysis was conducted using SAS (version 9.4; SAS Institute, Cary, NC), with an alpha level of .05. RESULTS: Nearly all personal-level variables were associated with preterm birth status. Personal factors associated with an increased likelihood of preterm birth included being older (relative to 18-24 years old; odds ratios [95% confidence intervals]: 1.02 [1.01-1.04] and 1.27 [1.24-1.31] for ages 25-34 and 35-49 years, respectively); having a history of preterm birth (odds ratio, 4.65; 95% confidence interval, 4.53-4.78); and smoking before pregnancy (odds ratio, 1.14; 95% confidence interval, 1.12-1.16). Pregnant persons living in counties with comprehensive laws were 9% less likely to have a preterm birth than those living in counties without a smoke-free ordinance (odds ratio, 0.91; 95% confidence interval, 0.89-0.94; P<.001). There was no difference in the likelihood of preterm birth between those living in counties with moderate or weak laws and those unprotected by any smoke-free ordinance in their county of residence. CONCLUSION: This study demonstrated that comprehensive municipal smoke-free laws are associated with reduced risk of preterm birth and that moderate or weak smoke-free laws are not. The findings have major implications for public health policy and underscore the potential influence of healthcare providers' advocacy for strong smoke-free policies, prohibiting smoking in all workplaces (including restaurants, bars, and casinos), to support healthy pregnancies.

Nursing Faculty Resilience During a Time of Disruption and Change.

ABSTRACT: Assessing the resilience level of nursing faculty during a time of unprecedented change in nursing education was the focus of this study. A descriptive cross-sectional survey that incorporated demographic data and the 10-item Connor-Davidson Resilience Scale was used. Participants ( n = 78) had an average resilience score of 32.6. No correlation was found between resilience and demographic variables such as age, years of teaching experience, and type of nursing program. Resilience is important because it helps faculty assimilate various protective factors and persist during times of rapid change.

Social support reduces the risk of unintended pregnancy in a low-income population.

Almost half of all pregnancies (45%) in the United States (US) are unintended, with the highest concentration in women with low incomes. Targeted research is warranted to identify risk and protective factors that influence pregnancy intention to improve maternal/child health. PURPOSE: To identify individual and interpersonal level associations to pregnancy intention to use as leverage points to build resilience. METHOD: A cross-sectional, secondary analysis of Medicaid eligible pregnant women in Kentucky (n = 309). RESULTS: Sixty-two percent reported their current pregnancy was unintended. Older age, partnered, negative drug screen, and increased social support were associated with decreased odds of unintended pregnancy. For every 1 unit increase of belonging and tangible social support, women were 13% and 14% (respectively) less likely to have an unintended pregnancy (OR = 0.87, 95% CI = 0.78-0.97, p = .011, OR = 0.86, 95% CI = 0.77-0.95, p = .005). A positive drug screen was associated with an almost three-fold increase in the odds of unintended pregnancy (OR = 2.88, 95% CI = 1.49-5.58, p = .002). CONCLUSION: Public health nurses can play a critical role in reducing unintended pregnancy rates by promoting social support, inclusion, and acceptance. There remains a critical need to identify barriers and facilitators to pregnancy planning for persons who use illicit drugs.

Readiness for Tobacco-Free Policy in a Statewide University System.

Background. Almost 2,000 campuses have adopted tobacco-free (TF) policies across the United States. However, there is not a systematic process to help campuses implement successful policies. Readiness assessments can help provide assistance as campuses work to implement successful policies. Purpose. We assessed readiness for TF policies among campuses of a statewide university system and determined factors associated with readiness. Participants. Stakeholders from 23 campuses without 100% TF policies were invited to participate in an online survey. Method. System administrators provided contacts for five to eight stakeholders per campus. Included in the analysis were 10 of 23 campuses (43.5%) with at least three stakeholders completing the survey. Results. Of the 10 campuses, one was in Preplanning, five were in Preparation, and four were in the Initiation stage of readiness. Political Climate was the highest scored dimension on seven campuses (0.74-1.0); Resources was the lowest on eight campuses (0.0-0.67). Campus size and county rurality were each associated with one dimension score. Conclusions. Despite being part of a statewide university system, campuses are in varying stages of readiness for TF policies. Stage-based strategies to advance TF campus policies must be implemented to set campuses up for successful policies.

Economic valuation of health benefits from using geologic data to communicate radon risk potential.

BACKGROUND: Radon exposure is the second leading cause of lung cancer worldwide and represents a major health concern within and outside the United States. Mitigating exposure to radon is especially critical in places with high rates of tobacco smoking (e.g., Kentucky, USA), as radon-induced lung cancer is markedly greater among people exposed to tobacco smoke. Despite homes being a common source of radon exposure, convincing homeowners to test and mitigate for radon remains a challenge. A new communication strategy to increase radon testing among Kentucky homeowners utilizes fine-scale geologic map data to create detailed radon risk potential maps. We assessed the health benefits of this strategy via avoided lung cancer and associated premature mortality and quantified the economic value of these benefits to indicate the potential utility of using geologic map data in radon communication strategies. METHODS: We estimated the change in radon testing among all 120 counties in Kentucky following a new communication strategy reliant on geologic maps. We approximated the resultant potential change in radon mitigation rates and subsequent expected lung cancer cases and mortality avoided among smokers and non-smokers exposed to 4 pCi/L of radon in the home. We then applied the value of a statistical life to derive the economic value of the expected avoided mortality. RESULTS: The new communication strategy is estimated to help 75 Kentucky residents in 1 year avoid exposure to harmful radon levels via increased testing and mitigation rates. This equated to the potential avoidance of approximately one premature death due to lung cancer, with a net present value of $3.4 to $8.5 million (2016 USD). CONCLUSIONS: Our analysis illustrates the potential economic value of health benefits associated with geologic map data used as part of a communication strategy conveying radon risk to the public. Geologic map data are freely available in varying resolutions throughout the United States, suggesting Kentucky's radon communication strategy using geologic maps can be employed in other states to educate the public about radon. As this is only a single application, in a single state, the economic and health benefits of geologic map data in educating the public about radon are likely to exceed our estimates.

Readiness to Adopt Physical Activity Policies in Rural Communities.

The purpose was to explore community readiness to adopt physical activity (PA) policies by adapting and pilot testing an online survey (Physical Activity Readiness Survey [PARS]). PARS was adapted from the previously tested Community Readiness Survey-Short. In February/April 2016, key informants (N = 17) involved in PA activities from two rural communities were invited to complete the PARS, representing six dimensions: knowledge, leadership, resources, community climate, existing voluntary PA policies, and political climate. First, participants were asked to respond to a presurvey to screen for overall readiness for up to four evidence-based PA policies. A main survey readiness score (0-6) was determined by averaging the key informants' ratings across items: Raw scores were rescaled to range from 0 to 1, and dimension scores were summed. Participants identified two PA policies in the presurvey: neighborhood availability and point-of-decision prompts. For both policies, political climate had the highest dimension score (1.0) and the knowledge dimension scored lowest (0.05-0.38). Overall readiness scores ranged from 3.19 to 3.62, revealing the preparation stage for both policies. Readiness for the two PA policies were similar, but specific dimension scores varied by policy type and community, reinforcing the need for tailored interventions.

The relationship between indicators of lumbo-pelvic coordination and pain, disability, pain catastrophizing and depression in patients presenting with non-chronic low back pain.

This study examined associations and changes overtime in low back kinematics and disability, pain, pain catastrophizing, and depression and assessed whether associations and changes overtime varied between individuals who meet the classification criteria for chronic low back pain at 6 months and those who do not. Findings suggested that those persons with a higher ratio of lumbar contribution to thorax motion and smaller pelvic tilt during forward bending had higher scores on measures of disability, pain and pain catastrophizing. This same association was found in those who met classification criteria for chronic low back pain at 6 months. Opposing associations were found in the group not meeting classification criteria for chronic low back pain, specifically, increased pelvic tilt was positively associated with higher pain catastrophizing scores. Practitioner summary This study examined associations and changes overtime in low back kinematics and psychosocial and clinical factors and whether associations and changes overtime varied between individuals who meet the classification criteria for chronic low back pain at 6 months and those who do not, Results suggest that associations exist between psychological factors and kinematic changes during the time between an acute low back pain episode to meeting classification for chronic low back pain at 6 months.

FRESH: Long-Term Outcomes of a Randomized Trial to Reduce Radon and Tobacco Smoke in the Home.

INTRODUCTION: Tobacco smoke and radon are the leading causes of lung cancer. The FRESH intervention was a randomized controlled trial of 515 homeowners to promote stage of action to reduce radon and air nicotine levels. METHODS: We studied 515 participants, 257 in a treatment group and 258 in a control group. Treatment participants received free radon and air nicotine test kits, report back, and telephone support, and those participants whose homes had high radon levels received a voucher for $600 toward mitigation. Both groups were asked to retest 15 months post intervention. We examined differences in stage of action to test for and mitigate radon and adopt a smoke-free-home policy and in observed radon and air nicotine values by study group over time. RESULTS: Homeowners in the treatment group scored higher on stage of action to test for radon and air nicotine and to mitigate for radon during follow-up than those in the control group at 3 months and 9 months, but the effect of the intervention diminished after 9 months. We saw no difference between groups or over time in observed radon or air nicotine values. Of homeowners in the treatment group with high radon levels at baseline, 17% mitigated, and 80% of them used the voucher we provided. CONCLUSION: The null finding of no significant change in observed radon or air nicotine values from baseline to 15 months may reflect the low proportion of radon mitigation systems installed and the decline in stage of action to adopt a smoke-free home policy. Including a booster session at 9 months post intervention may improve the remediation rate.

Poor sleep quality is associated with obesity and depression in farmers.

BACKGROUND: Farmers' work schedules can result in inconsistent sleep patterns which negatively impact health. PURPOSE: To explore the relationships between sleep, obesity, and depression in working, older farmers and their spouses. Covariates included body mass index (BMI), age, and gender. METHODS: Sleep quality, BMI, and depression were assessed in farmers (n = 1,394) 50 years and older. Bivariate associations among all covariates (i.e., age, gender, BMI, sleep) and dependent variable (i.e., depression) were analyzed using Pearson's correlation. Multivariable associations of the Center for Epidemiologic Studies Depression Scale (CESD). BMI with other study variables were assessed using linear regression. RESULTS: BMI was positively associated with sleep apnea symptoms (p ≤ 0.0001) and CESD scores (p = 0.0006). Participants with difficulty falling asleep were more likely to have poor sleep quality (p ≤ 0.0001) and higher CESD scores (p ≤ 0.0001). Poor sleep quality was associated with higher CESD scores (p ≤ 0.0001). Increased age, female gender, higher BMI, sleep apnea symptoms, and poorer sleep quality were all predictive of higher depressive symptoms. DISCUSSION: Farmers have unique lifestyles that increase the risk of poor sleep. Screening for sleep pattern disruption and understanding its impact could result in lower rates of depression and obesity in this group of high-risk individuals.

Short- and Long-Term Effects of a Tobacco-Free Executive Order on Employee Tobacco Use.

Smoke-free workplace policies encourage cessation, reduce tobacco consumption, and shift the pro-tobacco norm. However, no research exists evaluating the impact of mandated tobacco-free policies on government property. The purpose of our study was to examine short- and long-term effects of a tobacco-free policy (executive order 2014-747) implemented in November 2014, prohibiting tobacco use on state executive property. Cross-sectional online surveys were administered at two time points to a total of 27,000 employees of the executive branch of the Commonwealth of Kentucky. The short-term evaluation (March 2015) comprised 4,170 employees and the long term (August 2015) included 3,070. Tobacco use, plans to quit using tobacco, personal characteristics, whether the county of their workplace was covered by a smoke-free policy, and social norms for tobacco use were assessed 4- and 9-month post-policy implementation. Current tobacco use and plans to quit were compared between short- and long-term evaluations using multiple logistic regression with relevant covariates included. Controlling for demographics and employment location, employees reported lower rates of tobacco use and higher rates of planning to quit in the long term than in the short term. Tobacco-free policies reduce tobacco use prevalence and promote plans to quit, particularly over time. We found differences in tobacco use prevalence and plans to quit using tobacco products from 4 to 9 months after the policy took effect, as reported by employees following implementation of the tobacco-free policy. These findings support the potential for avoiding long-term health care costs as a result of reduced tobacco use from these policies. Nurses can play an important advocacy and policy evaluation role to promote and assess the impact of tobacco-free policies.

Lung cancer incidence and the strength of municipal smoke-free ordinances.

BACKGROUND: Smoke-free laws reduce disease prevalence. The impact of municipal smoke-free laws on lung cancer incidence in Kentucky was examined. The authors hypothesized that lung cancer incidence rates would be associated with the strength of smoke-free laws. METHODS: This was a secondary analysis of 83,727 Kentucky residents aged ≥ 50 years who were newly diagnosed with lung cancer from 1995 to 2014. In 2014, 33 municipalities had 1 or more smoke-free laws. County-level characteristics included adult smoking rate, sex, race/ethnicity, income, physician supply, observed radon values, and rurality. RESULTS: Individuals living in communities with comprehensive smoke-free laws were 7.9% less likely than those living in communities without smoke-free protections to be diagnosed with lung cancer. The difference in lung cancer incidence between counties with moderate/weak laws and those without laws was not significant. CONCLUSIONS: Comprehensive smoke-free laws were associated with fewer new cases of lung cancer, whereas weak or moderate smoke-free laws did not confer the same benefit. One hundred percent smoke-free laws, covering all workers and the public with few or no exceptions, may be key in reducing new cases of lung cancer. Cancer 2018;124:374-80. © 2017 American Cancer Society.

Demographic, clinical, dispositional, and social-environmental characteristics associated with psychological response to a false positive ovarian cancer screening test: a longitudinal study.

Cancer screening can facilitate early detection that improves survival, but also can identify an abnormal finding that is not malignant and deemed benign. While such false positive (FP) results can impact a variety of psychological outcomes, little is known about demographic, clinical, dispositional, and social-environmental characteristics associated with psychological outcomes after a FP result. Women participating in an ovarian cancer (OC) screening program and experiencing a FP screening test result (n = 375) completed assessments at baseline and 4-months. Results indicated greater social constraint and less education were linked to greater OC-specific distress at both assessments. Short-term predictors included less optimism and no previous abnormal test, while longer-term predictors were fewer previous screens and the interaction between OC family history and monitoring coping style. Younger age, less education, less optimism, greater social constraint, and family history of OC were associated with greater perceptions of OC risk. Brief interventions prior to screening may minimize the negative impact of a false positive result and not interfere with compliant participation in screening programs.

Patterns of Systemic and Cervicovaginal Fluid Inflammatory Cytokines throughout Pregnancy.

OBJECTIVE: This study describes the normal variations in serum and cervicovaginal fluid (CVF) cytokine levels throughout pregnancy. STUDY DESIGN: This multicenter, prospective study examined trimester-specific maternal serum and CVF cytokines (interleukin [IL]-1α, IL-1ß, IL-6, IL-8, IL-10, tumor necrosis factor-α, and C-reactive protein [CRP]). A two-factor linear mixed modeling approach compared cytokine distribution, while pairwise comparisons evaluated differences over time. RESULTS: Trimester-specific serum cytokine data were available for 288, 243, and 221 patients, whereas CVF cytokine data were available for 273, 229, and 198 patients. CVF had significantly higher concentrations of IL-1α, IL-1ß, IL-6, IL-8, and matrix metalloproteinase-8 (p < 0.001), irrespective of the trimester. At all time points, IL-10 and CRP concentrations were higher in serum than CVF (p < 0.001). Serum IL-10 increased significantly throughout pregnancy (p < 0.001). CONCLUSION: Differences in cytokine distribution across different biological fluids are evident throughout pregnancy. These findings provide a framework for examining patterns of changes in cytokines throughout pregnancy.

Risk Factors for Transfusions Following Total Joint Arthroplasty in Patients With Rheumatoid Arthritis.

BACKGROUND/OBJECTIVE: Despite effective therapies, rheumatoid arthritis (RA) can result in joint destruction requiring total joint arthroplasty to maintain patient function. An estimated 16% to 70% of those undergoing total joint arthroplasty of the hip or knee will receive a blood transfusion. Few studies have described risk factors for blood transfusion following total joint arthroplasty in patients with RA. The aim of this study was to identify demographic and clinical risk factors associated with receiving a blood transfusion following total joint arthroplasty among patients with RA. METHODS: A retrospective study (n = 3270) was conducted using deidentified patient health claims information from a commercially insured, US data set (2007-2009). Data analysis included descriptive statistics and multivariate logistic regression. RESULTS: Females were more likely to receive a blood transfusion (odds ratio [OR], 1.48; 95% confidence interval [CI], 1.16-1.87; p = 0.001). When compared with those in the South, patients residing the Midwest were less likely to receive a blood transfusion following total joint arthroplasty (OR, 0.56; 95% CI, 0.44-0.71). Relative to those receiving total knee arthroplasty, patients who underwent total hip arthroplasty were more likely to receive a blood transfusion (OR, 1.39; 95% CI, 1.14-1.70), and patients who underwent a total shoulder arthroplasty were less likely to receive a blood transfusion (OR, 0.14; 95% CI, 0.05-0.38; p < 0.001). Patients with a history of anemia were more likely to receive a blood transfusion compared with those who did not have this diagnosis (OR, 3.30; 95% CI, 2.62-4.14; p < 0.001). CONCLUSIONS: Risk factors for the receipt of blood transfusions among RA patients who have undergone total joint arthroplasty were identified.

Perinatal Biochemical Confirmation of Smoking Status by Trimester.

INTRODUCTION: Tobacco use during pregnancy is the most modifiable risk factor associated with poor pregnancy outcomes. Self-reported tobacco use has been demonstrated to have high misclassification rates. The aims were to examine misclassification rates of perinatal tobacco use during each trimester of pregnancy and 8 weeks postpartum, and to evaluate characteristics associated with misclassification of tobacco use status. METHODS: This is secondary analysis of a prospective, multicenter trial of pregnant women, and it includes participants who were biochemically identified as tobacco users during their first trimester (N = 103). Each trimester and once postpartum, tobacco use was assessed via self-report and validated using a cutoff of 100 ng/mL for urine cotinine via NicAlert test strips to indicate current use. Those who self-reported as nonusers but were identified as users via urine cotinine were considered misclassified; misclassification rates were determined for each time period. Logistic regression assessed maternal factors associated with misclassification status. RESULTS: Misclassification rates declined from 35.0% at first trimester to 31.9% and 26.6% at the second and third; the postpartum rate was 30.4%. These rates did not differ significantly from each other at the 0.05 level. Race/ethnicity was associated with misclassification status; white/non-Hispanic women were 87% less likely to be misclassified (p < .001). CONCLUSION: Misclassification of prenatal smoking status decreases as pregnancy progresses, though the observed rate change was not significant. Minority women may be at particular risk for non-disclosure of tobacco use. Biochemical validation should be considered when assessing perinatal tobacco use via self-report, given high misclassification rates throughout the perinatal period. IMPLICATIONS: These results demonstrate that regardless of trimester, more than one-quarter of tobacco-using pregnant women may not disclose tobacco use throughout pregnancy and early postpartum. Although the rate of misclassification decreased from first to third trimester and then increased in the immediate postpartum, these changes in misclassification rates were not significant. Minority groups may be at particular risk of misclassification compared with white/non-Hispanic women. Biochemical validation is warranted throughout pregnancy to encourage cessation as tobacco use is one of the most easily-modified risk factors for poor birth outcomes.