Predicting COVID-19 Vaccination Intentions to Inform Evidence-Based Messaging for Building Vaccine Confidence Among Rural Americans.

PURPOSE: Examine possible message topics to promote rural vaccination using psychosocial antecedents of vaccination. DESIGN: Cross-sectional survey administered by Research America, Inc. SETTING: West Virginia (WV). SAMPLE: 756 WV adults via convenience sample (n = 370; ∼2% response rate from online panel of ∼20 000 WV residents), and random digit dial of landlines (n = 174; ∼1% response rate from 18 432 numbers) and cellphones (n = 212; ∼1% response rate from 20 486 numbers). MEASURES: Outcome measures included self-reported vaccination intention and behavior. Predictor measures, rooted in theories of social and behavioral science that have been found to be predictive of vaccination outcomes (i.e., Reasoned Action Approach, Extended Parallel Process Model), included perceived severity and susceptibility, negative affect, instrumental and affective attitudes, social norms, self-efficacy, response efficacy, and perceived control. ANALYSIS: Multivariate linear regression for intention and logistic regression for behavior. RESULTS: Intention was positively predicted by affective attitude, ß = .30, P < .05, instrumental attitude, ß = .19, P < .05, response efficacy, ß = .19, P < .05, negative affect, ß = .16, P < .05, self-efficacy, ß = .13, P < .05, and subjective norm, ß = .13, P < .05, F(10, 267) = 30.12, Adj. R2 = .53. Vaccination status was predicted by instrumental attitude, exp(B) = 2.09, and subjective norm, exp(B) = 2.00, Pseudo R2 = .29, log likelihood = 125.11, χ2(10) = 38.34, P < .05. Promising message targets were instrumental attitude, M = 3.21, SD = 1.46, and subjective norms, M = 3.76, SD = 1.71. CONCLUSION: COVID-19 vaccine confidence messages should address (1) positive feelings and safety perceptions, (2) vaccination's effectiveness in preventing serious COVID-19, and (3) subjective vaccination norms.

Telemedicine versus in-Person Primary Care: Impact on Visit Completion Rate in a Rural Appalachian Population.

INTRODUCTION: The use of telemedicine increased during the global Coronavirus disease 2019 (COVID-19) pandemic. Rural populations often struggle with adequate access to care while simultaneously experiencing multiple health disparities. Yet, telemedicine use during the COVID-19 pandemic has been understudied on its effect on visit completion in rural populations. The primary purpose of this study is to understand how telemedicine delivery of family medicine care affects patient access and visit completion rates in a rural primary care setting. METHODS: We performed a retrospective cohort study on primary care patient visits at an academic family medicine clinic that serves a largely rural population. We gathered patient demographic and visit type and completion data on all patients seen in the West Virginia University Department of Family Medicine between January 2019 and November 2020. RESULTS: The final sample included 110,999 patient visits, including 13,013 telemedicine visit types. Our results show that telemedicine can increase completion rates by about 20% among a sample of all ages and a sample of adults only. Working-aged persons are more likely to complete telemedicine visits. Older persons with higher risk scores are more likely to complete their visits if they use telemedicine. CONCLUSIONS: Telemedicine can be a tool to improve patient access to primary care in rural populations. Our findings suggest that telemedicine may facilitate access to care for difficult-to-reach patients, such as those in rural areas, as well as those who have rigid work schedules, live longer distances from the clinic, have complex health problems, and are from areas of higher poverty and/or lower education.

Predicting Adolescent Electronic Cigarette Use: Differences by Never, Ever, and Current Users.

OBJECTIVE: Rising rates of adolescent electronic cigarette (ECIG) use is concerning because it can lead to adverse health outcomes and increased risk behavior. There are known predictors of ever versus never ECIG use, but less are known about risk factors for ever versus current use of ECIGs. Problem behavior theory (PBT) was used to evaluate possible risk factors for different ECIG use status. METHODS: Participants were 573 high school students who completed questionnaires measuring ECIG use, as well as constructs within the Social Environment, Perceived Environment, Personality, and Behavior domains of PBT. Multinomial logistic regression was used to evaluate how predictor variables differentiated between participants who reported (a) never use, (b) ever ECIG use, or (c) current ECIG use. RESULTS: Adolescents were more likely to endorse ever ECIG use than never use if they reported peer ECIG use, perceived more benefits and fewer costs (e.g., health) of ECIG use, higher extraversion, alcohol and cigarette use (never vs. ever vs. past 30 days), or attended a school with a higher percentage of socioeconomically disadvantaged students. Adolescents were more likely to report current ECIG use than ever ECIG use if they perceived fewer costs of ECIG use or used cannabis in their lifetime (yes/no). CONCLUSIONS: PBT variables differentiated between ever ECIG use and never ECIG use. However, these variables did not differentiate between ever and current ECIG use. Identifying unique risk factors for current versus ever ECIG use is important to understanding persistent ECIG use and subsequent targeted prevention and intervention programs.

A Latent Class Analysis of the Co-occurrence of Risk Behaviors among Adolescents.

Objectives: In this study, we examined the co-occurrence of multiple health-risk behaviors to determine whether there are any differences in the pattern of co-occurrence by sex. Methods: We conducted latent class analysis using the national 2013 Youth Risk Behavior Survey data for the overall sample, and separately by sex (N = 13,583). Results: Over half of the sample (53%) belonged to the low risk subgroup (Class 1). Class 2 accounted for 15% of adolescents, and over 40% in this subgroup reported riding with a drunk driver, and 63% reported texting while driving a vehicle. Over 14% belonged to Class 3, which had a higher probability of being depressed and suicidal (81% and 64%, respectively). Class 4 accounted for over 9% of adolescents who reported high probabilities for current cigarette (97%), tobacco (99%), and alcohol use (73%); and over half reported current marijuana use (52%). Class 5 accounted for 8.5% of adolescents identified as high-risk polysubstance users. Analyses showed differences by sex in the pattern of co-occurrences. Conclusion: Several adolescent risk behaviors are interrelated regardless of sex. However, sex differences in the higher probability of depressive symptoms and suicidality among girls highlight the need for interventions that consider the demographic composition of adolescents.

Barriers to Parent Support for Physical Activity in Appalachia.

BACKGROUND: Parent support for child physical activity is a consistent predictor of increased childhood activity. Little is known about factors that prevent or facilitate support. The purpose of this research was to identify barriers to parent support for child physical activity in Appalachian parents. METHODS: A cross-sectional study assessed parents whose children participated in Coronary Artery Risk Detection in Appalachian Communities (CARDIAC) screenings in a rural Appalachian state. Barriers to parental support for physical activity, demographics, geographic location, and parental support for activity were measured. RESULTS: A total of 475 parents completed surveys. The majority were mothers (86.7%), parents of kindergarteners (49.5%), white (89.3%), and living in a nonrural area (70.5%). Community-level factors were most frequently cited as barriers, particularly those related to the built environment. Rural and low-income parents reported significantly higher barriers. Community, interpersonal, and intrapersonal barriers were negatively correlated with parent support for child physical activity. Parents of girls reported a higher percentage of barriers related to safety. CONCLUSIONS: Reported barriers in this sample differed from those reported elsewhere (Davison, 2009). Specific groups such as low-income and rural parents should be targeted in intervention efforts. Future research should explore gender differences in reported barriers to determine the influence of cultural stereotypes.

Parent health risk and support for child physical activity.

OBJECTIVES: To explore the influence of health risk on support for physical activity in parents of boys and parents of girls. METHODS: The influence of parent BMI, physical activity, smoking, and fruit and vegetable consumption was explored in child gender-specific hierarchical linear regression models. RESULTS: Positive predictors of support included physical activity in parents of boys and parents of girls. In parents of girls, child BMI and parent BMI were also significant. CONCLUSION: Higher BMI in parents of girls and higher BMI in girls predicted higher levels of parental supportive behavior.

Adolescent smoking cessation: promising strategies and evidence-based recommendations.

Most adult smokers began smoking as teenagers, and an estimated 6.4 million young people will eventually suffer premature mortality and/or diminished quality of life as a result of smoking-related diseases. Most teens who smoke want to stop but fail within a month of trying to quit independently. Reaching teens with effective treatments for smoking cessation is essential to their current and future health. This article highlights evidence-based interventions and provides practice recommendations to address adolescent smoking. These include behavioral approaches and initial research regarding pharmacotherapy as well as strategies for individual patient encounters, practice management, and public advocacy.

Potential effects of active parental consent: Enrolling teen smokers into a school-based cessation program.

INTRODUCTION: Research on effective teen smoking cessation interventions is critical to reducing the tobacco-related disease burden and risk of lifetime negative health outcomes for youth. However, informed consent procedures requiring active parental consent may restrict or influence teen participation in critical teen cessation programs. METHODS: Not On Tobacco (N-O-T) is a teen smoking cessation intervention that has been implemented under both active parental consent and passive parental consent conditions. The present study determined if there are differences in characteristics of youth enrolled under each condition. Data were available for active consent (n = 968) and passive consent (n = 4,924) participants aged 14-18 who completed the N-O-T program between 1998 and 2006 across several states. RESULTS: Participants enrolled under active consent conditions were more likely to be older, White/non-Hispanic, live in father-only or grandparent-headed household, start smoking at an earlier age, smoke more on weekdays, have previous unsuccessful quit attempts, and have siblings and friends who smoke. Additional differences were found between active and passive consent conditions in motivation to quit smoking, confidence in quitting, and stage of change. DISCUSSION: Results highlight important differences between youth who enroll in a smoking cessation program under active and passive consent conditions, often a distinguishing feature of research and non-research implementation.

School-based programs: lessons learned from CATCH, Planet Health, and Not-On-Tobacco.

Establishing healthy habits in youth can help prevent many chronic health problems later in life that are attributable to unhealthy eating, sedentary lifestyle, and overweight. For this reason, many public health professionals are interested in working with school systems to reach children in school settings. However, a lack of familiarity with how schools operate can be a substantial impediment to developing effective partnerships with schools. We describe lessons learned from three successful school health promotion programs that were developed and disseminated through collaborations between public health professionals, academic institutions, and school personnel. The programs include two focused on physical activity and good nutrition for elementary and middle school children--Coordinated Approach to Child Health (CATCH) and Planet Health--and one focused on smoking cessation among adolescents--Not-On-Tobacco (N-O-T). Important features of these school health programs include 1) identification of staff and resources required for program implementation and dissemination; 2) involvement of stakeholders (e.g., teachers, students, other school personnel, parents, nonprofit organizations, professional organizations) during all phases of program development and dissemination; 3) planning for dissemination of programs early in the development and testing process; and 4) rigorous evaluation of interventions to determine their effectiveness. The authors provide advice based on lessons learned from these programs to those who wish to work with young people in schools.

Appalachian teen smokers: not on tobacco 15 months later.

High school smokers from 2 central Appalachian states received the American Lung Association's 10-session Not On Tobacco (N-O-T) program or a 15-minute brief self-help intervention. Our study compared the efficacy of N-O-T with that of the brief intervention by examining group differences in the 15-month-postbaseline (12-month-postprogram) smoking quit rates. N-O-T youths had higher overall quit rates. Review of end-of-program (3-month-postbaseline) and 3-month-postprogram (6-month-postbaseline) follow-up data showed state-level differences and positive cessation trends over time, regardless of treatment intensity. Quit rates were lower than rates found in other N-O-T studies of nonrural youths, suggesting that Appalachian youths are a recalcitrant smoking sample. Findings suggest that N-O-T is one option for long-term smoking cessation among rural teens.

Recruitment barriers and successes of the American Lung Association's Not-On-Tobacco Program.

This paper explores recruitment barriers and successes with research involving Not-On-Tobacco, the American Lung Association's (ALA) teen smoking cessation program. Forty-six program facilitators across four N-O-T studies completed a questionnaire to assess recruitment methods used, effectiveness of chosen methods, and recruitment barriers. Facilitators reported the most effective recruitment methods were "one-on-one conversation with students" (53.3%) and interpersonal contact where students received lollipops and information about N-O-T (33.3%; "lick-the-habit table"). The most frequently reported barriers to recruitment were "students not interested" (60.9%) and "active parental consent" (28.3%). The greatest barrier to obtaining active parental consent, as reported by facilitators, was "students did not want to tell parents they smoked" (78.3%). Findings suggest that recruitment presented a challenge to N-O-T research partners, including investigators, ALA staff, and program facilitators. However, recruitment was effective when active recruitment techniques such as maximized interpersonal contact involving one-on-one conversation were used.