Prevalence and Correlates of Cannabis Use among U.S. Veterans during the Second Wave of the COVID-19 Pandemic.

INTRODUCTION: Military veterans are at increased risk of substance use disorders. Limited research is available about veterans' cannabis use (CU) during the coronavirus disease 2019 (COVID-19) pandemic. This study estimated the prevalence of past 30-day CU, investigated individual-level correlates of past 30-day CU, and evaluated the reasons (medical, recreational, or both) of past 30-day CU among U.S. Veterans during the second wave of the COVID-19 pandemic. MATERIALS AND METHODS: We used population-based, cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System Survey Marijuana Use model. The sample included nationally representative military veterans aged 18+ years (n = 11,167). The outcome was past 30-day CU. Individual-level demographic, socioeconomic, behavioral, and clinical correlates were examined. Analyses were weighted to account for the survey's complex design with results generalizable to nearly 2.9 million veterans. We conducted weighted descriptive statistics, prevalence estimates, and multivariable logistic regression analyses. RESULTS: Out of 2.9 million veterans, 11.1% self-reported as non-Hispanic Black, 3.7% Hispanic, and 79.1% non-Hispanic White; 88.5% were men, and 72.8% were aged 50+ years. About 14.6% were current tobacco smokers, 4.7% were current e-cigarette users, 12.5% were binge alcohol drinkers, and 43.4% had three or more comorbid conditions. Overall, 8.5% reported CU in the past 30 days, of which 30.4% used it for medical reasons and 25.8% used it for nonmedical reasons. The prevalence of past 30-day CU decreased with age, education, and income level. Compared to their counterparts, the odds of past 30-day CU were greater among men, those living in urban areas, those with frequent mental distress, infrequent physical distress, and those who had at least one comorbid condition. Non-Hispanic Black veterans had 89% increased odds of past 30-day CU (adjusted odds ratio [AOR] =1.89, 95% confidence interval [CI], 1.19-3.0) compared with non-Hispanic White veterans. Current tobacco smokers had 3.54 (95% CI, 2.40-5.24) and former smokers had 1.78 (95% CI, 1.28-2.47) times higher odds of reporting past 30-day CU than never smokers. Current e-cigarette use (AOR = 3.37, 95% CI, 2.20-5.16) and binge drinking (AOR = 3.18, 95% CI, 2.29-4.41) were also statistically significantly associated with increased odds of past 30-day CU compared to no e-cigarette use and no binge drinking. CONCLUSIONS: CU is prevalent among veterans, and certain subgroups are at higher risk of CU. Thus, identifying high-risk subgroups of veterans and adequately educating them about CU's benefits, risks, and safety is crucial.

Psychometric Evaluation of the Social Isolation Scale in Older Adults.

BACKGROUND AND OBJECTIVES: Social isolation is known to be detrimental to the health of older adults, yet there is no brief instrument to measure it. The objective was to describe the psychometric testing of a brief instrument constructed from theoretical underpinnings to measure social isolation in older adults. RESEARCH DESIGN AND METHODS: A sample of 9,245 participants, all aged 60 years and older, was obtained from 44 states in the United States. Summary descriptive statistics were calculated, followed by exploratory factor analysis using Geomin rotation and subsequently confirmatory factor analysis (CFA). After finding the best model, differential item functioning (DIF) was conducted using a multiple indicator multiple cause structural equation model to determine if item responses differed by gender or race after controlling for level of social isolation. Internal consistency was calculated and validity was assessed by correlating factor scores with 2 external measures. RESULTS: Exploratory factor analysis resulted in all items having statistically significant loadings. CFA showed the 2-factor model demonstrated excellent fit (CFI = 0.997, RMSEA = .038). The 2 factors were labeled connectedness and belongingness. After adjusting for demographic variables, no evidence suggested DIF. Internal consistency was good (alpha = .77) and the scale moderately correlated with the Social Network Index (r = .47). DISCUSSION AND IMPLICATIONS: The Social Isolation Scale has been shown to be an effective measure of social isolation in older adults. Using this concise instrument to quickly measure social isolation in a fast-paced health care environment would be beneficial to health care providers and patients.

Residential relocations among older people over the course of more than 10 years.

OBJECTIVE: The objective of this study was to describe the rates of residential relocations over the course of 10.5 years and evaluate differences in these relocation rates according to gender and decedent status. DESIGN: Prospective, longitudinal study with monthly telephone follow-up for up to 126 months. SETTING: Greater New Haven, CT. PARTICIPANTS: There were 754 participants, aged 70 years or older, who were initially community-living and nondisabled in their basic activities of daily living. MEASUREMENTS: Residential location was assessed during monthly interviews and included community, assisted living facility, and nursing home. A residential relocation was defined as a change of residential location for at least 1 week and included relocations within (eg, community-community) or between (community- assisted living) locations. We calculated the rates of relocations per 1000 patient-months and evaluated differences by gender and decedent status. RESULTS: Sixty-six percent of participants had at least one residential relocation (range 0-12). Women had lower rates of relocations from nursing home to community (rate ratio [RR] 0.59, P = .02); otherwise, there were no gender differences. Decedents had higher rates of relocation from community to assisted living (RR 1.71, P = .002), from community to nursing home (RR 3.64, P < .001), between assisted living facilities (RR 3.65, P < .001), and from assisted living to nursing home (RR 2.5, P < .001). In decedents, relocations from community to nursing home (RR 3.58, P < .001) and from assisted living to nursing home (RR 3.3, P < .001) were most often observed in the last year of life. CONCLUSIONS: Most older people relocated at least once during 10.5 years of follow-up. Women had lower rates of relocation from nursing home to community. Decedents were more likely to relocate to a residential location providing a higher level of assistance, compared with nondecedents. Residential relocations were most common in the last year of life.

Predictors of diminished levels of social integration in older adults.

The purpose of this secondary analysis of prospective longitudinal data was to determine the variables predictive of diminished social integration in older adults over time. Using generalized estimating equations to model diminished levels of social integration over the 12-year study period, the following variables were predictive of diminished levels of social integration over time: bad overall health (odds ratio [OR] = 2.31, 95% confidence interval [CI] 1.39, 3.83), depressive symptoms (OR = 1.36, 95% CI 1.13, 1.65), positive smoking status (OR = 1.40, 95% CI 1.15, 1.71), and decreased religious engagement (OR = 1.81, 95% CI 1.04, 2.19). A better understanding of predictive factors could positively impact resource allocation, prioritization, and case management for older adults.

Decreasing social isolation in older adults: effects of an empowerment intervention offered through the CARELINK program.

Older adults reporting social isolation are at increased risk for numerous negative health outcomes, including depressive symptoms, decreased quality of life, and cardiovascular disease. The purpose of this study was to test the effects of a university student model of care intervention offered through the CARELINK program on social isolation in a sample of community-dwelling older adults (N = 56). Older adults in the comparison group, who had not yet received the CARELINK program, were nearly 12 times more likely to be socially isolated. Results indicate the empowerment intervention offered through the CARELINK program had positive effects on reducing social isolation in older adults. The CARELINK program has important implications for nursing as it provides an uncomplicated and inexpensive intervention to decrease social isolation for older adults in the community. Given the sample selection limitation in this study, a randomized controlled trial is warranted. Future research should examine specific aspects of the CARELINK program and the amount each aspect affects social isolation.

A review of social isolation: an important but underassessed condition in older adults.

Social isolation is a major and prevalent health problem among community-dwelling older adults, leading to numerous detrimental health conditions. With a high prevalence, and an increasing number of older persons, social isolation will impact the health, well-being, and quality of life of numerous older adults now and in the foreseeable future. For this review, a series of literature searches of the CINAHL, PsycINFO, and Medline databases were conducted, using the key words "social isolation," "social networks," "older adults," "elderly," "belonging," "perceived isolation," "social engagement," "social contacts," and "social integration," for the period of 1995-2010. The results show that there is an overabundance of evidence demonstrating numerous negative health outcomes and potential risk factors related to social isolation. However, there is scarce evidence that public health professionals are assessing social isolation in older persons, despite their unique access to very socially isolated, homebound older adults. Additionally, few viable interventions were found; therefore, it is advisable to focus on the prevention of social isolation in older adults. Public health professionals can take steps toward increasing the early assessment of social isolation and referring at-risk individuals to available community resources in order to prevent social isolation or further isolation, which would serve to reduce the numerous negative health outcomes associated with this condition.

One step at a time: self-management and transitions among women with ovarian cancer.

PURPOSE/OBJECTIVES: To describe experiences of self-management and transitioning among women with ovarian cancer. RESEARCH APPROACH: Interpretive description. SETTING: Participants' homes. PARTICIPANTS: Purposive sample of 10 women with ovarian cancer. METHODOLOGIC APPROACH: Individual interviews about women's self-management and transition experiences. MAIN RESEARCH VARIABLES: Self-management, transitions, and ovarian cancer. FINDINGS: Participants self-managed to increase their sense of control and to self-advocate. They managed their care one step at a time to prevent becoming overwhelmed. Common transitions were diagnosis, surgery and recovery, starting chemotherapy, managing symptoms, and recurrence. Transitions were challenging, even if previously experienced, and influenced the ability and willingness of women to self-manage. Barriers and facilitators to self-management were identified. CONCLUSIONS: The approach to self-management of one step at a time is somewhat illusory, as women face multiple transitions simultaneously. The short trajectory of ovarian cancer leaves little time between transitions and an awareness of mortality. Women are forced to confront goals of care quickly, which may affect their ability to self-manage. INTERPRETATION: Women with ovarian cancer need clinical and social support to prioritize and manage transitions. Introducing palliative care shortly after diagnosis could facilitate women's anticipation of and adjustment to transitions.

Expanding the knowledge base of resident and facility outcomes of care delivered by advanced practice nurses in long-term care: expert panel recommendations.

In 2003, a panel of nationally recognized experts in geriatric practice, education, research, public policy, and long-term care convened to examine and make recommendations about care quality and safety issues related to advanced practice nurses (APNs) in nursing home practice. This article reports on the panel recommendation that addressed expanding the evidence base of resident and facility outcomes of APN nursing home practice. A review of the small but important body of research related to nursing home APN practice suggests a positive impact on resident care and facility outcomes. Recommendations are made for critically needed research in four key areas: (a) APN nursing home practice, (b) relative value unit coding, (c) outcomes related to geropsychiatric and mental health nursing services, and (d) outcomes related to geriatric specialization. The APN role could be significantly enhanced and executed if its specific contribution to resident and facility outcomes was more clearly delineated through the recommended rigorous research.

Social isolation in older adults: an evolutionary concept analysis.

AIM: This paper is a report of an analysis of the concept of social isolation as experienced by older adults. BACKGROUND: Social isolation is a serious problem with older adults that is expected to increase in the future. Although strong correlations exist between social isolation and negative health consequences, few interventions exist. One contributing factor to this is a lack of conceptual clarity. DATA SOURCES: The CINAHL, PsycINFO and Medline databases and the Web of Science were searched using the key terms social isolation, social networks, older adults, elderly and social integration for publications between 1983 and 2007. REVIEW METHODS: An evolutionary concept analysis was undertaken. References were read in their entirety and analysed based on the summary of surrogate terms, related concepts, attributes, antecedents and consequences. FINDINGS: Five attributes were identified: number of contacts, feeling of belonging, fulfilling relationships, engagement with others and quality of network members. Antecedents included: lack of relationships, psychological barriers, physical barriers, low financial and resource exchange, and prohibitive environment. Roy's Adaptation Model is proposed as a theoretical context into which social isolation fits. CONCLUSION: Numerous definitions are used to describe social isolation, but they lack uniformity, consistency and clarity; this impairs the further development and refinement of the concept. This concept analysis can offer additional understanding and a starting point for future research related to social isolation.

Dietary supplement information and intention to continue and recommend supplements.

This posttest only two-group design study with 113 adults tested how reading a pamphlet based on the United States' Federal Drug Administration (FDA) Tips for the Savvy Supplement User affects intention to use and recommend supplements. A total of 23.7% fewer people with health problems who prior to reading the pamphlet believed that supplements were safer than medications planned to recommend their dietary supplement to family and friends after reading the pamphlet than in the comparison group. A lower probability of recommending dietary supplements is a helpful starting point for safer dietary supplement use by consumers.