Evaluation of Restrictions on Tobacco Sales to Youth Younger Than 21 Years in Cleveland, Ohio, Area.

Importance: Tobacco 21 (T21) policies raise the minimum legal age to purchase tobacco from 18 to 21 years to curb youth access to tobacco products. While some studies have found that T21 is associated with reducing prevalence of youth tobacco use, little is known about the impact it may have on youth of different racial and ethnic identities. Objective: To evaluate the association of T21 policy with the prevalence of high school youth tobacco use across sex, race, and ethnicity. Design, Setting, and Participants: This survey study used representative survey data collected from the local biennial Youth Risk Behavior Survey from 2013 to 2017 comparing Cleveland, Ohio (which has a T21 policy), to proximal jurisdictions in the first-ring suburbs in Cuyahoga County (which do not have T21 policies). Within-Cleveland demographic information was also collected for 2013 to 2019. Overall high school youth tobacco use rates were compared between Cleveland and the first-ring suburbs and then examined within Cleveland among Hispanic, non-Hispanic Black, and non-Hispanic White high school students. Percentage data were adjusted to more closely align with local population demographics. Data were analyzed from January to June 2022. Exposures: T21 was implemented in Cleveland in 2016 and not adopted in proximal jurisdictions or at the state and federal level until at least 1 year later. Main Outcomes and Measures: The main outcomes were prevalence of past 30-day cigarette, cigar product, or e-cigarette use, measured using geographically representative high school youth survey data from 2013 to 2015 (prelegislation) and 2017 to 2019 (postlegislation) and compared using a difference-in-differences analysis. Results: The unweighted sample included 12 616 high school students (27.0% [95% CI, 26.9%-28.0%] in 10th grade; 50.9% [95% CI, 50.3%-51.6%] females) participating in 1 or more Youth Risk Behavior Surveys from 2013 to 2019, including 7064 students in Cleveland and 5552 students in the first-ring suburbs. Compared with the first-ring suburbs, Cleveland had a greater proportion of younger students (1623 [28.5%] ninth grade students vs 2179 [34.0%] ninth grade students) and Hispanic students (436 students [1.1%] vs 1433 students [12.6%]) and non-Hispanic Black students (2000 students [53.1%] vs 3971 students [75.1%]). Cigars were the most commonly used tobacco product in Cleveland, with use reported by 6201 students (19.8%) in 2013, 5877 students (21.3%) in 2015, and 5784 students (16.8%) in 2019. Compared with the first-ring suburbs, there was a greater decline in prevalence of use of cigars in Cleveland (ß = 0.18 [SE, 0.05]; P < .001). The disparity across race, ethnicity, and sex decreased for all current tobacco product use. For example, the maximum difference between demographic subpopulations in current cigarette use was 11.6 (95% CI, 9.5-13.7) percentage points in 2013 between White females (16.1% [95% CI, 11.3%-20.8%]) and Black males (4.5% [95% CI, 3.5%-5.4%]). This maximum difference in current cigarette use decreased significantly to 5.1 (95% CI, 3.5-6.7) percentage points in 2019 between White females (6.9% [95% CI, 3.4%-10.3%]) and Black females (1.8% [95% CI, 0.7%-2.8%]). Conclusions and Relevance: This survey study found that there was a decline in youth-reported tobacco use across every tobacco product category from 2013 to 2019. This decline changed the trajectory of use among several demographic groups and brought the youth populations with the highest tobacco product use to similar rates of others.

Utilization and physical activity levels at renovated and unrenovated school playgrounds.

OBJECTIVE: This study examined utilization and physical activity levels at renovated compared to unrenovated school playgrounds. METHODS: Ten unrenovated and ten renovated school playgrounds (renovated at least a year prior) in Cleveland, OH were matched on school and neighborhood characteristics. Using direct observation (SOPLAY), the number of persons attending each playground and their physical activity levels were recorded using separate counts for girls, boys, men and women. Each school was observed ten times for 90 min each time outside of school hours in 2005. Paired t-tests, Wilcoxon Signed Ranks tests, and regression analyses were completed to examine differences across school pairs. RESULTS: More persons overall including adults and children utilized the renovated playgrounds compared to the unrenovated playgrounds. The proportion moderately-to-vigorously active was not different between renovated and unrenovated playgrounds although the proportion of children, in particular boys, who were vigorously active was greater at the renovated playgrounds. Although utilization was higher at the renovated playgrounds, absolute utilization was low across all playgrounds. CONCLUSIONS: This study suggests that playgrounds renovations may have the potential to increase the number of children utilizing the playground outside of school hours and may increase the proportion of children, especially boys, who are vigorously active.

A step-by-step guide to home telehealth program planning.

Many home health providers have become familiar with the idea of home telehealth service, but planning its optimal delivery nevertheless presents a challenge. This article presents the first steps agencies need to take before the "televisiting" can begin.

Enhancing communications with multicultural patient populations.

Learning more about clients of ours who are from different cultures is a challenging but necessary task. The very characteristics that make up an individual's beliefs, behaviors, and intellectual and spiritual foundations are intrinsic to a person's overall health and well-being, and we must learn to prepare appropriate patient care services. The authors review the different sources that are available to assist home care workers and their multicultural patients.

Advanced telecare for wound care delivery.

Applying dressings remains the mainstay of wound care, and skilled nursing makes real differences in patient care. Nurses using telehealth tools can better observe and manage wounds meaning interventions are more scientific, cost-effective, and result in better patient outcomes. One agency shares how telehealth works for it.