Associations in Cigarette Smoking and Health Conditions by Race/Ethnicity Among a Diverse Sample of Patients Receiving Treatment in a Federally Qualified Health Care Setting in Chicago.

Purpose: To examine the association of cigarette use and smoking-related health conditions by race/ethnicity among diverse and low-income patients at a federally qualified health center (FQHC). Methods: Demographics, smoking status, health conditions, death, and health service use were extracted from electronic medical data for patients seen between September 1, 2018, and August 31, 2020 (n=51,670). Smoking categories included everyday/heavy smoker, someday/light smoker, former smoker, or never smoker. Results: Current and former smoking rates were 20.1% and 15.2%, respectively. Males, Black, White, non-partnered, older, and Medicaid/Medicare patients were more likely to smoke. Compared with never smokers, former and heavy smokers had higher odds for all health conditions except respiratory failure, and light smokers had higher odds of asthma, chronic obstructive pulmonary disease, emphysema, and peripheral vascular disease. All smoking categories had more emergency department visits and hospitalizations than never smokers. The associations between smoking status and health conditions differed by race/ethnicity. White patients who smoked had a greater increase in odds of stroke and other cardiovascular diseases compared with Hispanic and Black patients. Black patients who smoked had a greater increase in odds of emphysema and respiratory failure compared with Hispanic patients. Black and Hispanic patients who smoked had a greater increase in emergency care use compared with White patients. Conclusion: Smoking was associated with disease burden and emergency care and differed by race/ethnicity. Health Equity Implications: Resources to document smoking status and offer cessation services should be increased in FQHCs to promote health equity for lower income populations.

The Use of Navigators to Increase Patient Portal Enrollment among Patients in a Federally Qualified Health Care System.

Purpose: To describe the training, preliminary results, and lessons learned from using patient navigators to increase the enrollment of low-income patients in a health system-supported and electronic health record-linked patient portal. Methods: Patient navigators (n=4) were trained to assist patients in a federally qualified health center to enroll in and use patient portals. Patient navigators were stationed at 3 clinic locations. Data from the electronic health record system (Epic) were used to compare MyChart patient portal activation rates and use among patients for the 8 months before and after patient navigation services were offered. Results: Navigators offered 83% of eligible patients with activation assistance. Sixty-four percent of the patients (n=1062) offered MyChart enrollment assistance accepted help. Seventy-four percent of assisted patients with no prior MyChart enrollment activated their accounts during that clinic visit. The primary reason for declining MyChart assistance was a lack of access to or comfort with technology. Patient portal activation increased during the 8 months when navigators were at the clinics (51%) compared to the previous 8 months (44%). Most new users viewed lab results and read a message [χ2(1)=49.3, p<.001], with significant increases evident for African Americans [44% before, 49% during; χ2(1)=40.4, p<.001] and Latinx patients [52% before, 60% during; χ2(1)=6.15, p=.013]. Conclusion: Study results suggest that using patient navigators is feasible and beneficial for increasing patient enrollment in the Federally Qualified Health Centers context. However, patient-, clinic-, and system-level factors were identified as barriers and should be addressed in future research studies.

Sexual minority status, school-based violence, and current tobacco use among youth.

INTRODUCTION: Sexual minority individuals experience elevated risk for smoking and violence due to a combination of general and unique identity-based risk factors. This study examined associations among sexual minority status, school-based violence, and tobacco use, among youth. METHODS: Data for this secondary data analysis consisted of Chicago-specific data from the 2019 Youth Risk Behavior Surveillance System (n=1562). Current use (≥1 day during the previous 30 days) of any tobacco product (cigarettes, e-cigarettes, smokeless tobacco, and cigars) and school-based violence (avoided school because they felt unsafe, were threatened/injured with a weapon, were in a physical fight, and were bullied) were estimated by sexual orientation (heterosexual vs gay, lesbian, bisexual, and unsure). A chi-squared test was used to investigate associations among the variables. Path analysis was employed to examine possible mediation effects of school-based violence. RESULTS: Thirty percent of sexual minority youth and 11.5% of heterosexual youth reported current tobacco use (χ2=55.91; p<0.001). Nearly one-third (31.8%) of youth reported school-based violence, with a higher rate (41.2%) reported by sexual minority youth compared to heterosexual youth (28.1%; χ2=19.48; p<0.001). Path analysis confirmed these associations, controlling for sex, age, and race/ethnicity. The model showed that sexual minority status increased odds of current tobacco use by a factor of 1.8 (95% CI: 1.3-2.6) via its relationship with school-based violence, explaining 33.8% of the total association between sexual minority status and tobacco use. CONCLUSIONS: Tobacco use was higher among sexual minority youth. School-based violence partially mediated the association between sexual minority status and tobacco use. Findings highlight the need for tobacco prevention and treatment efforts for sexual minority youth and school-based interventions to reduce exposure to violence.

Self-Description of a University-Community Partnership to Advocate for Restroom Access Policy Change in Chicago.

BACKGROUND: Transgender, nonbinary, and gender-non-conforming individuals face significant obstacles accessing public restrooms, resulting in negative mental and physical health consequences. OBJECTIVES: We describe the Chicago Restroom Access Project, a university and community partnership aimed at reforming restroom laws in Chicago and the state of Illinois. METHODS: A range of community-engagement approaches were used, including recruiting, mobilizing, and partnering with diverse stakeholders, amplifying the voices of under-represented members of the impacted community, collecting data for evidence-based decision-making, fluid membership, and diffuse leadership. RESULTS: Outcomes included developing resources for public education, changing the City of Chicago Human Rights Ordinance, changing Illinois state law on single-occupancy restrooms, and implementing restroom reform at an educational institution. Lessons learned are also described. CONCLUSIONS: The methods and principles of this partnership provide approaches that can be used to advocate for reform and policy change for restroom access throughout the country.

The Association between Resilience and Psychological Distress during the COVID-19 Pandemic: A Systematic Review and Meta-Analysis.

This study examined the association between resilience and psychological distress in healthcare workers, the general population, and patients during the COVID-19 pandemic. We searched the PubMed, Web of Science, PsycInfo, Science Direct, and Nursing and Allied Health databases. Included articles examined healthcare workers (e.g., physicians and nurses), the general population, and patients during the COVID-19 pandemic. Studies of exposure to other infectious diseases related to epidemics or pandemics (e.g., SARS and MERS) were excluded. This study was performed following the Cooper matrix review method and PRISMA guidelines, followed by a meta-analysis of study results using R version 4.1.2. A random effect model was used for the pooled analysis. This study was registered with PROSPERO (registration No. CRD42021261429). Based on the meta-analysis, we found a moderate negative relationship between overall resilience and psychological distress (r = -0.42, 95% confidence interval [CI]: -0.45 to -0.38, p < 0.001). For the subgroup analysis, a moderately significant negative relationship between overall resilience and psychological distress was found among healthcare workers (r = -0.39, 95% CI: -0.44 to -0.33, p < 0.001), which was weaker than in the general population (r = -0.45, 95% CI: -0.50 to -0.39, p < 0.001) and in patients (r = -0.43; 95% CI: -0.52 to -0.33; p < 0.001). This association was robust, although the heterogeneity among individual effect sizes was substantial (I2 = 94%, 99%, and 74%, respectively). This study revealed a moderate negative relationship between resilience and psychological distress in healthcare workers, the general population, and patients. For all these populations, interventions and resources are needed to improve individuals' resilience and ability to cope with psychological distress during the COVID-19 pandemic and in future disease outbreaks.

Corrigendum: A Study Protocol for Increasing Access to Smoking Cessation Treatments for Low-Income Minority Smokers.

[This corrects the article DOI: 10.3389/fpubh.2021.762784.].

Effectiveness of Interventions to Promote Medication Adherence in Schizophrenic Populations in Thailand: A Systematic Review.

Medication non-adherence is a leading cause of poor treatment outcomes among Thai patients with psychiatric disorders and creates challenges for psychiatric nurses. This systematic review synthesized research on intervention effectiveness for antipsychotic medication adherence in Thai schizophrenic populations. Following PRISMA guidelines, searches were completed in seven databases, including PubMed, PsycINFO, CINAHL, Web of Science, Scopus, ThaiJO, and Google Scholar. No restriction dates were used. Screening and extraction of data were performed systematically. Eligible studies consisted of nine quasi-experimental and two randomized control trial studies. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) was used to assess the studies' methodological quality. This review revealed that individual counseling combined with cognitive-behavioral therapy (CBT) and motivational interviewing (MI) techniques improved and maintained medication adherence behavior over time. Post-testing after intervention completion and at 3- and 6-month follow-ups showed that treatment group participants were more adherent than control group participants (p < 0.01). These findings suggest that incorporating CBT and MI into clinical practice can enhance medication adherence behavior. Booster session efficacy for reinforcing and sustaining adherence should be investigated. Greater rigor is warranted in future intervention studies based on a quality appraisal of previous studies.

Thai oncology nurses' perspectives toward survivorship care plan components and implementation for colorectal cancer survivors.

PURPOSE: To describe oncology nurses' perspectives regarding survivorship care plan (SCP) components and implementation for colorectal cancer (CRC) survivors in Thailand. METHODS: A cross-sectional, descriptive online study was conducted between October and November 2020. Thai oncology nurses were recruited using Facebook and the Line application. Study participants (n = 160) rated the usefulness of four standard SCP components (treatment summaries, surveillance, late/long-term effects, and health promotion and psychosocial needs; n = 23 items) and gave input on the implementation of SCPs in clinical practice (n = 11 items). Data were analyzed using descriptive statistics. RESULTS: Most oncology nurses supported providing CRC survivors with SCPs (93.2%) and felt that SCPs were an important part of their practice (93.7%). Nurses rated all four SCP components as "very useful," including treatment summaries (76.4%), surveillance (81.9%), late/long-term effects (85.7%), and health behavior and psychosocial concerns (80.2%). In terms of implementation, most nurses indicated that oncologists should prepare (84.4%) and provide SCPs (95%), but 61.9% and 69.4% of nurses, respectively, also believed that they should perform these tasks. In addition, most nurses indicated that they should play a significant role in the ongoing management of CRC survivors (95.7%) and that evidence-based surveillance guidelines are needed (96.2%). CONCLUSION: Oncology nurses believed that the four SCP components were helpful to the long-term management of CRC survivors, supported SCP provision, and expressed their perceived responsibilities for preparing and delivering SCPs. The findings suggested opportunities for oncology nurses to play a significant role in developing and implementing SCPs. However, additional efforts are needed to expand nurses' roles in survivorship care and establish practice guidelines that will facilitate integration of SCPs into nursing practice.

Perspectives and practices regarding colorectal cancer survivorship care: Online survey results from oncology nurses in Thailand.

PURPOSE: Limited research has highlighted disparities in survivorship care in low- and middle-income countries. However, such care for colorectal cancer (CRC) survivors remains unexplored, especially in Thailand. This study examined Thai oncology nurses' perceptions of responsibility, confidence levels, and frequency of survivorship care practice for CRC survivors and identified factors impeding such care. METHODS: A cross-sectional study utilizing an online survey approach was conducted between October and November 2020. Thai oncology nurses (N = 155) completed the survey's demographic questionnaire, 29-item survivorship care scale, and 16-item impeding factor scale. RESULTS: Oncology nurses had high levels of perceived responsibility (mean = 73.37, SD = 12.12) and confidence (mean = 65.09, SD = 14.89) for providing CRC survivorship care. However, they reported less frequency of practice (mean = 47.60, SD = 21.03), especially concerning sexual, fertility, employment, and financial issues. Nurses with higher education had significantly higher responsibility perceptions, confidence levels, and frequency of practice (all p < .05). Also, nurses with specialty training in cancer care reported higher frequency of practice (p = .013). Common factors impeding survivorship care were lack of physical facilities (60.4%), knowledge/skills (57.4%), and educational resources for family members (52.3%) and survivors (51.6%). CONCLUSIONS: This study revealed inconsistencies between oncology nurses' responsibility perceptions, confidence levels, and frequency of survivorship care practice. The results can guide nurse researchers, educators, leaders, and policymakers in enhancing the quality of CRC survivorship care in low- and middle-income countries such as Thailand. Future efforts should focus on developing educational resources and training programs for survivorship care for oncology nurses and addressing factors impeding such care during healthcare service planning.

Application of Ferrans et al.'s conceptual model of health-related quality of life: A systematic review.

Ferrans, Zerwic, Wilbur, and Larson proposed the conceptual model of health-related quality of life (HRQOL) in 2005 to explicate the constructs associated with HRQOL and to describe the associations among those constructs. In this systematic review, the authors aimed to describe empirical studies that used Ferrans et al.'s model and to examine the evidence related to the hypothesized model concepts. This review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Relevant articles were identified using Crossref, CINAHL, and PubMed. To be included, studies had to employ the model as a theoretical framework and be published in English between 2005 and 2020. Type of theory use was coded using four designations: informed by theory, applied theory, testing theory, and building theory. Thirty-one studies were included. Most studies involved adult patients with chronic illnesses (n = 20) and were conducted in Western countries (n = 22). The most common type of theory use was testing theory (74.19%). Among the seven concepts in Ferrans et al.'s model, all 20 hypothesized associations were tested and 19 were supported by study results. The three associations most frequently supported were between symptoms and functional status (n = 13), environmental characteristics and quality of life (n = 10), and individual characteristics and functional status (n = 8). No studies found an association between environmental characteristics and biological function. Our review found that Ferrans et al.'s model has been used extensively to guide HRQOL research. An emerging body of research provides preliminary support for the associations hypothesized in the model. Additional research is needed to confirm the hypothesized associations among model concepts.