Prediction of Positive Patient Health Questionnaire-2 Screening Using Area Deprivation Index in Primary Care.

Depression is recognized as a significant public health issue in the United States. The National Survey on Drug Use and Health reports that 21.0 million adults aged 18 or older had major depressive disorder in 2020, including 14.8 million experiencing a major depressive episode with severe impairment. The aim is to predict the positivity of Patient Health Questionnaire-2 (PHQ-2) outcomes among patients in primary care settings by analyzing a range of variables, including socioeconomic status, demographic characteristics, and health behaviors, thereby identifying those at increased risk for depression. Employing a machine learning approach, the study utilizes retrospective data from electronic health records across 15 primary care clinics in South Florida to explore the relationship between social determinants of health (SDoH), including area of deprivation index (ADI) and PHQ-2 positivity. The study encompasses 15 primary care clinics located in South Florida, where a diverse patient population receives care. Analysis included 94,572 patient visits; 74,636 records were included in the study. If a zip+4 was not available or an ADI score did not exist, the visit was not included in the final analysis. Screening involved the PHQ-2, assessing depressed mood and anhedonia, with a cutoff >2 indicating positive screening. ADI was used to assess SDoH by matching patients' residential postal codes to ADI national percentiles. Demographics, sexual history, tobacco use, caffeine intake, and community involvement were also evaluated in the study. Over 40 machine learning algorithms were explored for their accuracy in predicting PHQ-2 outcomes, using software tools including Scikit-learn and stats models in Python. Variables were normalized, scored, and then subjected to predictive regression models, with Random Forest showing outstanding performance. Feature engineering and correlation analysis identified ADI, age, education, visit type, coffee intake, and marital status as significant predictors of PHQ-2 positivity. The area under the curve and model accuracies varied across clinics, with specific clinics showing higher predictive accuracy and others (p > .05). The study concludes that the ADI, as a proxy for SDoH, alongside other individual factors, can predict PHQ-2 positivity. Health organizations can use this information to anticipate health needs and resource allocation.

Impact of Living Arrangements of LGBTQ College Students During COVID-19.

This study examines the relationships between living arrangements and educational outcomes, access to LGBTQ affirming care, sexual and gender minority (SGM) stressors, and mental health. Bivariate analyses were implemented to examine relationships between living arrangements and academic outcomes, SGM stressors, access to care, and alcohol and substance use. Differences between undergraduate and graduate students are also reported. Students who continued living on campus were less likely to report increased family rejection, transphobia, and identity concealment.

Asthma Academy for Family Caregivers: A Quality Improvement Project.

Background: Asthma affects one in every 12 children in United States with significant prevalence in underserved groups. Family caregiver education is essential to improve childhood asthma control. The literature suggests that family caregivers' lack of knowledge about asthma management affects their children's health outcomes. An evidence-based education program that improves caregivers' asthma knowledge may improve the family's well-being. Objectives: The goal of the Asthma Academy project is to improve the disease management of children with asthma by providing an in-person family caregiver education program. The main objectives are to (a) improve family caregivers' asthma knowledge, (b) enhance their confidence in asthma management, and (c) evaluate caregivers' satisfaction with the education program. Method: This quality improvement project used an in-person educational program with an asthma education video resource for caregivers of children with asthma. Results: The family caregivers' asthma knowledge improved significantly after the education. The confidence levels in caring for children with asthma increased. Caregivers' satisfaction with the Asthma Academy education session was favorable. Conclusions: The Asthma Academy was an acceptable and effective delivery method of education for family caregivers of children with asthma in the in-patient setting. Empowering family caregivers of vulnerable children through asthma education may improve child health outcomes and mitigate complications from asthma. Implications for Nursing Nurses and clinicians are steward of providing patient education. Individualized, patient-tailored education is recommended.

The Lived Experience of Parents of Children and Youth With Special Healthcare Needs on Public and Private Insurance: A Phenomenological Study.

PURPOSE OF THE STUDY: The number of children and youth with special health care needs (CYSHCN) is steadily growing in the United States. There are significant differences between private and public health plans in terms of cost, adequacy, and parent satisfaction. The purpose of this study was to understand the experiences of parents with CYSHCN enrolled in public and private insurance with or without a nurse care coordinator. This study also sought to understand parents' experience of support. PRIMARY PRACTICE SETTING: The primary practice setting was participants' choice of location. METHODOLOGY AND SAMPLE: A qualitative descriptive design was used with 16 parents of children and young adults aged 2 to 21 years. Semistructured interviews were used, and Colaizzi's (1978) eight steps was the selected interpretive method. RESULTS: Five themes emerged for parents navigating their child's insurance in the presence or absence of a nurse care coordinator: (1) Struggle with Self-Preservation, (2) Abandonment and Isolation, (3) Self-Reliance and Advocacy, (4) Interdependence, and (5) Lifeline. These themes were also dependent on the type of insurance and sources of support available. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Models centered on care coordination can also be used as a mechanism to guide nurse care coordinators in practice. Providing care coordination support could help lessen the caregiver burden especially while navigating public or private insurance. Results highlighted how insurance companies can make potential changes within the health plan infrastructure. Incorporating nursing care coordination activities not only results in health care savings for the health plan but also improved health outcomes for its enrollees.

Sexual harassment, sexual assault, violence, self-esteem, and the role of LGBTQ-specific parental support in a sample of Latinx sexual and gender minority youth.

INTRODUCTION: Oftentimes as result of racism, cissexism, and heterosexism, many Latinx and sexual and gender minority (SGM) youth are victims of sexual harassment, sexual assault, and violence. These experiences of victimization are in part related to increased negative mental health outcomes such as decreased self-esteem. Some research links LGBTQ-specific parental support to mental health outcomes among Latinx SGM youth, yet, no research has explored the role of LGBTQ-specific parental support with self-esteem among Latinx SGM youth. METHODS: In a sample of 1,012 Latinx SGM youth (ages 13-17), we assessed: (a) associations between sexual harassment, sexual assault, and violence and self-esteem, (b) association between LGBTQ-specific parental support and self-esteem, and (c) whether LGBTQ-specific parental support moderated the relation between sexual harassment, sexual assault, and violence and self-esteem. Main effect and moderation analyses examined interactions between LGBTQ-specific parental support with sexual harassment, sexual assault, and violence on self-esteem. RESULTS: Latinx SGM youth experienced low levels of LGBTQ-specific parental support and various degrees of sexual harassment, sexual assault, and violence. Also, transgender and nonbinary/genderqueer Latinx youth experienced lower self-esteem than their Latinx cisgender counterparts. Increased LGBTQ-specific parental support was related to increased self-esteem. We also identified a significant interaction between sexual harassment, sexual assault, and violence and LGBTQ-specific parental support, such that parental support was more protective at low levels rather than high levels of sexual harassment, sexual assault, and violence among Latinx SGM youth. CONCLUSIONS: Findings add to a growing body of research about the importance of LGBTQ-specific parental support for Latinx SGM youth, and the need to examine culturally appropriate approaches to understand parent-child relationship among these communities.

Impact of Racist Microaggressions and LGBTQ-Related Minority Stressors: Effects on Psychological Distress Among LGBTQ+ Young People of Color.

BACKGROUND: College students situated at the nexus of racial and sexual and gender minority (SGM) identities may experience multiple identity-related oppressions. We assessed whether racist microaggressions and lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ)-related minority stressors (ie, family rejection, identity concealment, racialized heterosexism and/or cisgenderism, internalized LGBTQ-phobia, and victimization) are associated with greater psychological distress among SGM college students of color (SOC) (students who identified as Hispanic/Latinx and/or any nonwhite race). METHODS: Participants were a subset of SOC (n = 200) from a larger nonprobability cross-sectional study of SGM college students. Participants were recruited by using online social media platforms and university email listserves from May through August 2020. Participants completed an online Qualtrics survey using previously validated measures of minority stress, racist microaggressions, and psychological distress. Simple and covariate-adjusted multiple linear regression models were used to examine the associations between racist microaggressions and LGBTQ-related minority stressors with psychological distress. RESULTS: In simple linear regression models, racist microaggressions and all LGBTQ-related stressors (ie, family rejection, identity concealment, racialized heterosexism and/or cisgenderism, internalized LGBTQ-phobia, and victimization) were significantly and positively associated with greater psychological distress. In covariate-adjusted multiple linear regression, racist microaggressions, internalized LGBTQ-phobia, and LGBTQ-related family rejection (but not identity concealment, racialized heterosexism and/or cisgenderism, and victimization) were independently and significantly associated with greater psychological distress. CONCLUSION: Study findings reveal that racist microaggressions, along with LGBTQ-related family rejection and internalized LGBTQ-phobia, have a significant impact on psychological distress among SGM SOC. Public health leaders have an important opportunity for policy and program development and reform to address the identity-related mental health needs of SGM SOC.

LGBTQ Caregiver Acceptance Scale (LCAS): Development and validation with a Latinx sample.

Caregiver acceptance and rejection is crucial to the well-being of lesbian, gay, bisexual, transgender, and queer (LGBTQ) people. Research shows that caregivers are affected by having an LGBTQ child/family member, yet studies have neglected to capture the experiences of Latinx caregivers. We present the development and initial validation of the LGBTQ Caregiver Acceptance Scale (LCAS) with a Latinx sample. We developed items based on a review of the literature, expert feedback (N = 9), and community member feedback (N = 9; Study 1). We then assessed the factor structure through exploratory factor analysis (EFA) in a sample of 215 Latinx caregivers of LGBTQ people (Study 2). The final LCAS consists of 40 items and six dimensions of Latinx caregivers' acceptance and rejection of their LGBTQ child/family member: Outness, Caregiver Acceptance, Concealment, Respeto, Attitudes Toward Queer Parenting, and Supportive Actions. Convergent and divergent validity was performed to compare the LCAS to other constructs of caregiver acceptance and rejection, family conflict and cohesion, and attitudes toward the LGBTQ community. As hypothesized, all subscale scores and total score were found to be significantly correlated with the constructs used for comparison. This validated measure of LGBTQ-specific acceptance and rejection among caregivers provides a rich opportunity to understand family processes and help inform evidence-based interventions. We provide implications for clinicians working with Latinx caregivers of LGBTQ youth. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Predictors and social determinants of HIV treatment engagement among post-partum Black women living with HIV in southeastern United States.

AIM: Guided by Mcleroy's socio-ecological model, this study explored the predictors and social determinants of HIV treatment engagement among Black post-partum women living with HIV. METHOD: Quantitative, research methodology. DESIGN: We conducted a retrospective, secondary data analysis of 143 Black post-partum women living with HIV who received peripartum care in South-Florida, United States, from 2009 to 2017. We examined odds of immediate post-partum engagement at 3 months post-partum, and ongoing primary care engagement at 12 months post-partum. RESULTS: The independent group analyses showed low levels of immediate post-partum (32.9%) and ongoing primary care engagement (24.5%). At the intrapersonal level, maternal prenatal health significantly affected both immediate post-partum and ongoing primary care engagement; and at the interpersonal level, HIV disclosure and intimate partner violence/abuse significantly affected immediate post-partum engagement. Also, immediate post-partum disengagement was a significant predictor for ongoing primary care disengagement. CONCLUSION: This study provides timely and critical information to address recent calls for awareness and interventions to address issues on health disparities and inequities among racialized communities. IMPACT: The study provides significant evidence on the effects of social determinants of health on health outcomes for Black women living with HIV. Critical understanding and assessment of these factors, together with proper, proactive interventions may help to gauge such negative effects. Healthcare providers taking care of Black women living with HIV ought to be cognizant of these factors, assess at-risk women and intervene accordingly to ensure that their care is not marginalized. PATIENT/PUBLIC CONTRIBUTION: This study includes direct patient data from Black post-partum women living with HIV who were seen at prenatal and post-partum clinics wherein data for this study were obtained. The study results were presented locally, nationally and internationally to communities, organizations of healthcare providers, stakeholders and service-users, who further corroborated our findings, and provided insights and future recommendations.

Impact of family rejection and racism on sexual and gender minority stress among LGBTQ young people of color during COVID-19.

OBJECTIVE: Given the inequitable impact of COVID-19 on sexual and gender minority (SGM) youth and current sociopolitical racial justice concerns in the United States, this study examines the impact of SGM-related family rejection and racism since the start of COVID-19 on SGM-related internalized homophobia and identity concealment among SGM college students of color (SOC). METHOD: Participants were a subset of SOC (n = 200) from a larger nonprobability cross-sectional study about minority stress and COVID-19 pandemic experiences among SGM college students. Participants completed survey items specifically related to changes in minority stress and racism experiences since the start of COVID-19. Logistic regression models were used to examine the independent and interactive effects of racism and family rejection on identity concealment and internalized homophobia since the start of COVID-19 (adjusting for covariates). RESULTS: Main effects models revealed that increased racism and family rejection were significantly associated with greater odds of experiencing identity concealment since the start of COVID-19. The interaction of increased racism and family rejection was also significantly associated with greater odds of experiencing identity concealment since the start of COVID-19. CONCLUSIONS: Study findings suggest that the intersection of racism and family rejection since the start of COVID-19 consequently translates to increased experiences of identity concealment. Such experiences are known to negatively impact mental health across the life course among SGM young people. Public health, medical, mental health, and higher education stakeholders must implement SGM-affirmative and antiracist practices and interventions to support SGM SOC during COVID-19 and beyond its containment. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Psychological distress, social support, and family satisfaction among family members of non-COVID-19 critical care patients: A cross-sectional study.

PURPOSE: This study aims to explore the associations among psychological distress, perceived social support, and family satisfaction among family members of non-COVID-19 intensive care unit (ICU) patients during the COVID-19 pandemic. DESIGN: A cross-sectional study. METHODS: Family members of patients with at least 48 h in the ICU and without a COVID-19 diagnosis were screened between January and March 2021. For enrolled ICU family members, five questionnaires for perceived stress (Perceived Stress Scale), anxiety symptoms (General Anxiety Disorder-7), depressive symptoms (Patient Health Questionnaire-9), perceived social support (Medical Outcomes Study Social Support Survey), and family satisfaction (Family Satisfaction with Care in the Intensive Care Unit-24) were administered by phone either in English or Spanish language. Sociodemographic and patient clinical data were also collected. Data were analyzed using descriptive statistics, Pearson's correlations, Mann-Whitney U, and Fisher's exact tests. FINDINGS: Of 87 eligible ICU family members, 63 were enrolled (72.4%); 27% of the sample presented with clinically significant symptoms of anxiety, 25.4% with depression, and 76.2% had a high perception of social support. ICU family members with low/fair perceived social support reported statistically significantly higher perceived stress and lower family satisfaction. Perceived stress was negatively correlated with family satisfaction. Clinically significant symptoms of anxiety and depression were not statistically associated with family satisfaction or perceived social support. CONCLUSIONS: While ICU admission-related stress may undermine family satisfaction, perceived social support may be positively associated with the way that ICU family members of non-COVID-19 patients evaluate the quality of care in the ICU. Knowing the factors that influence family satisfaction in the ICU may assist stakeholders and policy developers to improve family-centered care in the hospital setting. CLINICAL RELEVANCE: Early screening for psychological distress and social support levels during admission should be included in updates of visiting and communication policies in the ICU. Prompt identification of family members at risk of a poor ICU experience may enhance efforts to support them, particularly in acute care settings where differentiated approaches to COVID-19 and non-COVID-19 ICU family members are established.

Relationships Between Colorectal Cancer Survivors' Positive Psychology, Symptoms, and Quality of Life.

This cross-sectional study examined colorectal cancer (CRC) survivors' symptom and symptom cluster characteristics (occurrence, frequency, and severity), positive psychology (benefit-finding and post-traumatic growth), and quality of life (QoL), and determined whether positive psychology moderates symptoms and QoL relationship during acute cancer survivorship, time from diagnosis to treatment completion. A total of 117 CRC survivors completed demographics, symptoms, QoL, and positive psychology questionnaires. Descriptive statistics, multiple linear regression, and moderation analyses were performed. Participants reported high QoL (94%, M = 5.15) and moderate-high positive psychology (75%, M = 3.21). Nineteen symptoms and five symptom clusters were inversely related to QoL (p < .05). Positive psychology (M = ~≥3.24) moderated the relationship of QoL (p < .05) with symptoms occurrence (n = 10), symptom severity (n = 1), and with the generalized symptom cluster (weakness, fatigue, dizziness, drowsy, sleep disturbances, and pain). Positive psychology aids in symptom management and improves QoL. Nurses are poised to identify, prevent, promote, and advocate self-management skills to improve health-related outcomes.

Symptom Occurrence, Frequency, and Severity During Acute Colorectal Cancer Survivorship.

OBJECTIVES: To examine colorectal cancer (CRC) survivors' symptom characteristics (occurrence, frequency, and severity) during acute cancer survivorship. PARTICIPANTS & SETTING: A cross-sectional study of 117 CRC survivors was conducted at a National Cancer Institute-designated cancer center in South Florida. METHODS & VARIABLES: Symptom characteristics were assessed by the Therapy-Related Symptom Checklist. Participants completed a 25-item demographic questionnaire. Mann-Whitney U and Kruskal-Wallis H tests assessed between-group differences based on sex, age, education, and months since diagnosis. Exploratory factor analysis was performed to identify preliminary symptom clusters. RESULTS: 117 CRC survivors completed the study (age range = 21-88 years, 56% male, and 79% stage IV). Common symptoms included peripheral neuropathy, fatigue/feeling sluggish, and skin changes. Significance was found between months since diagnosis and number of symptoms (p = 0.03), suggesting that symptoms accumulate with time. Chemotherapy (85%) was the most common treatment type, and exploratory factor analysis identified two chemotherapy-related symptom clusters. IMPLICATIONS FOR NURSING: Nurses are poised to identify, prevent, and promote self-management skills to reduce symptoms.

The revised Humpty Dumpty Fall Scale: An update to improve tool performance and predictive validity.

PURPOSE: The purpose of this study was to identify potential modifications to the Humpty Dumpty Fall Scale (HDFS) in order to enhance the accuracy of fall prediction in the pediatric population, thus contributing to the safest possible environment for the hospitalized child. DESIGN AND METHODS: A secondary analysis of data collected by Gonzalez et al. (2020), including a total of 2428 patients, was conducted for this study. Multiple logistic regression was used to examine the relationship between each parameter of the HDFS (e.g., age, gender, diagnosis, cognitive impairments, environmental factors, response to surgery/sedation/anesthesia, and medication usage) and the outcome of fall status. RESULTS: After reviewing associations between HDFS parameters and fall risk, neither gender nor medication use were found to be associated with fall risk. These two parameters were removed from the scoring algorithms, and the HDFS was modified to a minimum score of 5 and maximum score of 20, with a score of 12 or above indicative of high risk of fall. The modified scale demonstrated a sensitivity of 84% and specificity of 57%. CONCLUSIONS: These revisions are anticipated to help support clinical practice and improve fall prevention, thus supporting a safer pediatric environment for the hospitalized child.

Positive psychology mediates the relationship between symptom frequency and quality of life among colorectal cancer survivors during acute cancer survivorship.

PURPOSE: Colorectal cancer (CRC) survivors are living longer; therefore, factors that improve outcomes, like symptom management and quality of life (QoL), have increasingly become important. This study examined CRC survivors' symptom(s) characteristics, positive psychology (benefit finding and post-traumatic growth), and QoL, and determined whether positive psychology mediates symptom(s) and QoL relationship during acute cancer survivorship. METHODS: A cross-sectional study of 117 CRC survivors was conducted at a National Cancer Institute-Designated Cancer Center. Data were collected by demographic questionnaire, Therapy-Related Symptom Checklist, QoL Inventory, and positive psychology assessed by Carver Benefit-Finding Scale and Post-Traumatic Growth Inventory. Descriptive statistics, between-group differences, multiple linear regression, and mediation analyses were performed. RESULTS: Top common symptoms were peripheral neuropathy, fatigue/feeling sluggish, skin changes, sleep disturbances, and weakness. Psychological distress symptoms were reported in 38.46% of CRC survivors, and moderate-to-high positive psychology (3.21 ± 1.09) and QoL (5.15 ±0 .52) levels were reported during acute cancer survivorship. Significant (p < 0.05) relationships were observed between QoL and (a) number of symptoms, (b) psychological distress symptoms, (c) benefit finding, (d) post-traumatic growth, and (e) positive psychology. Positive psychology partially mediated the relationship between symptom frequency and QoL (p < 0.05). CONCLUSION: Our study's findings suggest that CRC survivors positively cope with their cancer and treatment, and positive psychology partially mediates the relationship between symptoms frequency (almost daily and daily vs. random) and QoL across acute cancer survivorship. Identifying how CRC survivors adjust to their cancer may help healthcare teams provide tailored self-management skills to promote QoL and reduce symptom burden throughout cancer survivorship.

Family Rejection During COVID-19: Effects on Sexual and Gender Minority Stress and Mental Health Among LGBTQ University Students.

This study examines the relationship between family rejection and moderate to severe psychological distress during COVID-19 among LGBTQ university students. Data were obtained from a national cross-sectional electronic survey of LGBTQ university students (N = 565) collected in the summer of 2020. Hierarchical logistic regression models were used to examine the predictive association between increased family rejection and moderate to severe psychological distress. Respondents who reported increased rejection were more than twice as likely to report moderate to severe psychological distress, with social isolation and LGBTQ identity concealment being significant covariate predictors in the model. These results demonstrate the importance of public health, medical, mental health, and higher education stakeholders understanding the significance of LGBTQ-identity related family rejection when addressing the mental health and well-being of LGBTQ young people.

The Relationship Between Colorectal Cancer Survivors' Positive Psychology, Symptom Characteristics, and Prior Trauma During Acute Cancer Survivorship.

OBJECTIVES: To examine colorectal cancer survivors' positive psychology and symptom characteristics, and to assess for potential impact of prior trauma on these relationships during acute cancer survivorship. SAMPLE & SETTING: A cross-sectional study of 117 colorectal cancer survivors was conducted at a National Cancer Institute-designated cancer center. METHODS & VARIABLES: Participants completed a demographic questionnaire, and the Carver Benefit Finding Scale and Posttraumatic Growth Inventory assessed positive psychology. Descriptive statistics and multiple linear regression analyses were performed. RESULTS: 49 symptoms were reported and varied based on prior trauma. Significance was found between positive psychology and symptom frequency (p < 0.001); symptoms reported almost daily and daily were inversely related to positive psychology. IMPLICATIONS FOR NURSING: Nurses should prioritize symptoms; less frequent symptoms improve positive psychology. Early identification of positive changes may promote survivors' self-awareness and management skills to mitigate adverse symptoms.

The significance of breastfeeding practices on postpartum depression risk.

OBJECTIVE: Examine the relationship between breastfeeding practices (breastfeeding status and breastfeeding length) and postpartum depression (PPD) risk, after controlling for significant risk factors for PPD. DESIGN: A cross-sectional, correlational study design was used. Data was used from a national dataset using a subsample of women (n = 29,682) residing in 26 states in the United States that answered the 2016 Pregnancy Risk Assessment Monitoring System (PRAMS) questionnaire. A secondary analysis was conducted using descriptive and bivariate analyses, and a multiple logistic regression model. RESULTS: Women currently breastfeeding (AOR = 0.87 CI: 0.79-0.95, p = .001), and women who breastfed for longer periods of time (p = < .002) had a statistically significantly lower PPD risk compared to their counterparts, even after accounting for significant covariates. CONCLUSIONS: Study findings suggest breastfeeding as a cost efficient and healthy behavior that can decrease a woman's risk for PPD. Nurses should educate and promote the maternal mental health benefits of breastfeeding in addition to the health benefits for the infant.

Asthma academy: A student nurse-led telehealth education program for low-income family caregivers of children with asthma.

AIMS: The aims of the Asthma Academy study were to (1) evaluate the telehealth performance of DNP students, (2) evaluate the perceived learning experience of DNP students and (3) investigate whether an association exists related to student performance and family caregiver outcomes. DESIGN: A descriptive study was conducted with doctor of nursing practice students. METHODS: Students conducted telehealth visits to help family caregivers of children with asthma and were rated on their performance by two faculty members using a rubric. Student perception data were gathered via survey. RESULTS: Out of a total possible score of 15 points, the mean telehealth performance score of students was 13.38 points. Students indicated the telehealth experience was valuable and that they were satisfied with their learning. This model of leveraging telehealth to bridge nursing students to the community may be adapted to help family caregivers of children with various disease foci.

A Multisite Study Demonstrates Positive Impacts to Systems Thinking Using a Table-top Simulation Experience.

BACKGROUND: Systems thinking (ST) is the ability to recognize, understand, and synthesize interactions and interdependencies in a set of components designed for a purpose. Systems thinking has been shown to improve systems and decrease error. Despite these benefits, ST has not yet been consistently integrated into all health care education programs. PURPOSE: This study examined the impact of Friday Night at the ER (FNER), a table-top simulation designed to teach ST to a variety of prelicensure and postlicensure health care students. METHODS: A multisite study was conducted in 5 academic institutions targeting both graduate and prelicensure students enrolled in nursing, medicine, physical therapy, public health, psychology, and pharmacy programs. RESULTS: The FNER simulation was followed by statistically significant improvements in ST scores. CONCLUSIONS: The FNER table-top simulation was found to improve ST in a wide variety of health-related majors.

Mental Health among LGBTQ Cannabis Users During the COVID-19 Pandemic: Analysis of the COVID-19 Cannabis Health Study.

The purpose of this study is to compare the responses of LGBTQ cannabis consumers and their non-LGBTQ counterparts on anxiety, depression, substance use, and COVID-19 coping and stress during the pandemic. Data from an internet-survey of cannabis users during the COVID-19 pandemic were analyzed (N = 2,319). Approximately 18% of the sample identified as LGBTQ. Bivariate analyses were used to examine the relationship between LGBTQ identity and symptoms of anxiety and depression, substance use, and pandemic-related coping strategies and stressors. Logistic regression models were used to evaluate the association between pandemic stressors and coping strategies with LGBTQ identity, while adjusting for sex, age, and race and ethnicity. Differences in the proportion of medicinal cannabis use among LGBTQ respondents (74.6%) and non-LGBTQ respondents (75.3%) were insignificant. LGBTQ cannabis users were more likely to report COVID-19 related stressors and coping behaviors, including increased alcohol use. After adjustment for covariates, LGBTQ cannabis users were more likely to report symptoms of depression and anxiety than non-LGBTQ cannabis users. These results show that compared to their cisgender heterosexual counterparts, LGBTQ cannabis users are experiencing more problematic mental health outcomes during the COVID-19 pandemic.