Using the integrated behavioral model to explain and predict cannabis vaping among college students.

Background: Cannabis vaping has become increasingly popular among college students. The purpose of this study was to use the Integrated Behavioral Model to better understand students' motivations for engaging in this high-risk behavior. Methods: A survey instrument was developed to assess six IBM constructs, as well as past use of cannabis and nicotine, and cannabis vaping behavior changes related to COVID-19. A structural equation model was used to assess the effects of IBM predictors on Behavioral Intention. Results: The IBM predictors accounted for 54.2% of the variance in Behavioral Intention. The strongest path coefficients on Behavioral Intention were Perceived Norm and Experiential Attitude. Conclusion: The results from this study can be used to design interventions to decrease cannabis vaping use among college students. More specifically, social norm interventions and addressing other misconceptions about vaping cannabis, appears to be a promising theoretical approach to help ameliorate this unique public health challenge.

A Cost-Benefit Analysis of School Nursing in One Large Urban School District.

This study is a cost-benefit analysis examining an urban district's partial school nurse coverage conversion to full-time coverage. Through a partnership with a health care system, the district received funding, resulting in the hiring of full-time nurses to cover all K-8 elementary schools. Researchers compared the cost of nursing services to the savings in teacher, secretary, principal, and parent productivity, reduced medical procedure costs, and grants nurses managed. The year before implementing additional nurses, the return on investment (ROI) to the community for nursing services was calculated to be $1.59 for every dollar invested in schools with full-time coverage and $1.29 for schools with partial coverage. After implementing full-time nurses in each school, there was an ROI of $1.50 during the 2015-2016 school year, $1.64 for 2016-2017, and $1.67 for 2017-2018. The analysis provides evidence that full-time coverage could result in a positive ROI for schools and the community.

Do Stressful Events and Racial Discrimination Explain Racial Gaps in Exclusive Breastfeeding Duration? A Qualitative Interview Study with Black, Hispanic, and White Mothers Living in Ohio.

OBJECTIVES: This study aimed to understand why breastfeeding and exclusive breastfeeding rates substantially decrease shortly after birth among mothers in the USA. Specifically, we aimed to illuminate the impact of stressful life events and racial discrimination on mothers' breastfeeding behaviors and duration. METHODS: We conducted a qualitative analysis of semi-structured telephone interviews with women (N = 66; 47 White, 16 Black, and 3 Hispanic) who gave birth between 2019 and 2021 in Ohio. Interviews were conducted between March 2022 and May 2022. Interviews were digitally recorded, transcribed verbatim, analyzed, coded, and organized into themes. RESULTS: After thematic analysis of the data, five key themes were identified: (1) stress, (2) breastfeeding barriers, (3) policy and system change to support breastfeeding mothers, (4) racial discrimination, and (5) breastfeeding motivators. Our study found that the breastfeeding experience was both a positive bonding experience and a challenging practice, characterized by physical, mental, and sociocultural struggles. CONCLUSION FOR PRACTICE: Addressing stress during pregnancy, equitable access to culturally sensitive lactation support, improved parental leave, and enhanced workplace breastfeeding regulations are essential to increasing breastfeeding duration among racially marginalized women.

Factors that influence cannabis vaping habits of college students: A qualitative study.

Objective: The purpose of this study is to examine the attitudes and perceptions of college undergraduates regarding cannabis vaping. Participants: Twenty-one, predominantly male (71.4%; Mage = 22, SD = 2.09), undergraduate college students who reported vaping cannabis in the past 30 days. Methods: Participants were interviewed to determine their attitudes and perceptions regarding cannabis vaping. Findings: Thematic analysis uncovered six primary themes and eighteen subthemes. Main themes included (1) Convenience, (2) Discreetness, (3) Mood-Altering Experience, (4) Social Acceptability, (5) Health and Safety, and (6) COVID-19 Pandemic Impact. Conclusion: College students who use cannabis tend to both vape and use combustible methods, depending upon social and physical environment. This population tends to vaporize cannabis for its perceived mood-altering properties. Additional research is needed to further examine the behaviors and attitudes surrounding cannabis vaping among college undergraduates, as well as the development of interventions specific to this demographic.

Energy drink expectancies among college students.

ObjectiveSince the late '90 s, energy drink consumption has increased. The purpose of this investigation was to examine energy drink expectancies of college students. Participants: The university registrar randomly selected fifty university classes to be surveyed. Methods: A cross-sectional research design was used to assess the prevalence of energy drink consumption and energy drink expectancies. Binary logistic regression analyses were conducted to ascertain which expectancies explained energy drink consumption. Results: The expectancy factors of 1,246 participants accounted for 25.8% of the variance in past 30-day energy drink consumption. Energy enhancement, anxiety/negative physical effects, withdrawal, and appetite suppression were each found to be significantly related to energy drink consumption. Conclusions: Energy enhancement and anxiety/negative effects were the strongest predictors of energy drink consumption among college students. The results from this study can be used to design interventions to challenge erroneous expectancies and reinforce others that promote moderation or abstinence.

Parent Perceptions regarding High School Drug Testing.

BACKGROUND: Adolescent drug use remains a critical public health issue. Almost 38 percent of school districts currently implement student drug testing, and more schools may be considering implementation due to emerging recreational drug use laws. Parents are an essential key stakeholder and decision-maker in school policies. Purpose: The purpose of this study was to examine Colorado parents' perceptions regarding high school drug testing. Methods: A cross-sectional research design was used to assess parental support for implementing drug testing in public high schools. A total of 205 participants completed a survey evaluating support, attitude, and beliefs regarding this policy. Descriptive statistics, chi-square, and logistic regression analyses were conducted to examine the data. Results: The majority of parents perceived that alcohol (68.3%), cannabis (77.6%), and illicit drugs (51.2%) were a problem amongst students at their child's high school. Parents overall were supportive of drug testing students (61.9%), except for parents who were current cannabis users (p = .002). The majority of parents are supportive of drug testing because they believe it could help students resist peer pressure (65.9%), facilitate early intervention (e.g. counseling; 71.2%), while not violating student privacy rights (57.6%) or creating a negative school climate (50.7%). Conclusions/Importance: Parents recognize there may be an adolescent drug use problem. Parental support of drug testing is an important consideration for superintendents/school districts who are contemplating implementation of a drug testing policy for high schools.

Sex Education, Condom Access, and Contraceptive Referral in U.S. High Schools.

In the United States, sex education in schools varies significantly across districts. Many schools operate without state-guided health education curricula, leaving decisions up to individual districts. The purpose of this study was to explore what type of sex education is being offered in U.S. high schools in addition to assessing the frequency of condom access and contraceptive referral. A total of 772 high school superintendents were surveyed with a response rate of 40.4% (n = 297). Data show most districts teach comprehensive sex education (63%), while only 7% of districts offer condoms to high school students. Twenty-nine percent of superintendents reported their district refers out for contraceptive services to a variety of agencies. School nurses can use this information to inform health policy discussions in their district as well as advocate for awareness among district officials regarding existing health service offerings.

Promoting Health Literacy Through Defining and Measuring Quality School Health Education.

Changes in national and state policies in the past two decades have had a negative impact on school health education. During this same time, significant gains have been made in our understanding of the relationship between health and academic outcomes. This article proposes three challenges that could help refocus our country's efforts toward the positive impacts quality school health education can have on our population. Each of these challenges has corresponding recommendations to guide stakeholder efforts to help bring about these changes.

Smoking cessation education and training in obstetrics and gynecology residency programs in the United States.

BACKGROUND: OB/GYN physicians should be involved in providing smoking cessation counseling to their patients who smoke, especially pregnant patients. However, the smoking cessation practices of OB/GYN physicians seem to be dependent on their education and training and not much is known about their training during medical school. Therefore, the purpose of this study was to assess the smoking cessation education provided by OB/GYN residency training programs in the United States. METHODS: The investigators developed and mailed a valid and reliable survey to all allopathic and osteopathic OB/GYN Residency Directors in the US (n = 275). The internal reliability coefficients (Cronbach alpha) for the four major subscales ranged from 0.63 to 0.90. Best practices in survey research were used to achieve a final response rate of 58%. RESULTS: The majority of residency programs (60%) did not have a formal, structured curriculum in tobacco topics and/or smoking cessation. In contrast, 40% of programs reported having a formal, structured tobacco education curriculum. Sixty-five percent of programs did not formally evaluate residents' competence in providing smoking cessation counseling to patients. A range of 42% to 57% of residency programs reported spending less than one hour/year on teaching various basic science and clinical science topics related to tobacco use. The majority of residency programs spent no time teaching residents about the socio-political aspects of tobacco use cessation. Lack of teaching time was identified by the majority (51%) of the residency directors as a barrier to teaching smoking cessation. CONCLUSION: Although OB/GYN physicians are expected to provide smoking cessation counseling to their patients, the majority of OB/GYN residency programs in the United States provide minimal education and training in this area. Therefore, continuing medical education on smoking cessation counseling should be broadly implemented for OB/GYN physicians.

State Minority Health Officers' Perceptions of their Successes and Barriers to Reducing Racial and Ethnic Health Disparities.

BACKGROUND: Minimal research has been conducted to examine the impact and reach of state offices of minority health (SOMH) and their role in reducing racial and ethnic health disparities within their states. Accordingly, the purpose of this study was to describe the shared experiences of SOMH officers to provide context for why these individuals believe that state organizational efforts have not yielded much success in reducing racial and ethnic health disparity gaps. METHODS: Using a telephone interview guide, the investigators conducted telephone interviews with SOMH officers. Data were analyzed thematically based on emergent patterns in participant responses. A total of 47 of 50 state officers (94%) completed the interview. RESULTS: Though many officers were encouraged by increased awareness regarding health disparities, nearly every officer listed inadequate resources as the most impactful barrier impeding the success of their offices' missions. CONCLUSION: SOMH continue to be severely underfunded and are concerned about their potential for success, leaving them with minimal ability to engage in activities beyond educational awareness campaigns. For SOMH officers to be successful in eliminating disparities, legislators must provide them with adequate funding so they can engage in wider-reaching interventions targeting the social determinants of health.

Predicting Racial and Ethnic Disparities in Advance Care Planning Using the Integrated Behavioral Model.

Purpose To explain and predict racial or ethnic disparities in advance care planning (ACP) behaviors among American adults by using the Integrated Behavioral Model (IBM) and the Precaution Adoption Process Model. Methods A randomized, observational, nonexperimental, cross-sectional study design was used to survey American adults between 40 and 80 years of age ( n = 386). Results The majority of respondents (75%) had not completed ACP. Significant differences were found by race or ethnicity: 33% of Whites had completed ACP versus Hispanics (18%) and Blacks (8%). Whites had statistically significantly higher levels of most IBM constructs compared with Blacks and Hispanics. The IBM predicted 28% of the variance in behavioral intention. After controlling for sociodemographic variables, direct attitudes, indirect attitudes, and indirect perceived norms were significant predictors of behavioral intention. Conclusion The IBM and the Precaution Adoption Process Model are useful frameworks for interventions designed to increase ACP among racial or ethnic minorities in the United States.

A national assessment of colleges and university school health education methods courses.

BACKGROUND: Across the United States, school health education programs provide a wide variety of knowledge and skills to their students. There are currently no guidelines for school health methods courses. METHODS: Using a 2-wave mailing followed by a third wave e-mail reminder, a final population of 226 university school health methods instructors at school health preparation programs were surveyed. RESULTS: A total of 138 completed surveys (61%) were returned. The topics taught in school health education methods courses emphasized the most included aligning objectives, instruction, and assessment (79%); development of lesson plans (73%); teaching methods that engage learners (72%); and application of the National Health Education Standards and performance indicators (69%). The content taught and how the instructors assessed their students differed statistically by 1 or more of the following: whether they had a health education degree, had experience teaching in the public schools, and if their program was accredited. CONCLUSIONS: This study provides information regarding what school health methods instructors across the United States are teaching in their classes. Using this information as a baseline can serve as a guide for preservice faculty teaching a school health methods course.

African American legislators' perceptions of firearm violence prevention legislation.

Firearm mortality is the leading cause of death for young African American males, however, few studies have focused on racial/ethnic minority populations and firearm violence. The National Black Caucus of State Legislators advocates for legislation that promotes the health of African Americans. Thus, the purpose of this study was to collect baseline data on African American legislators' perceptions regarding firearm violence in the African American community. A cross-sectional study of African American legislators (n = 612) was conducted to investigate the research questions. Of the 612 questionnaires mailed, 12 were not deliverable, and 170 were returned (28%). Utilizing a three wave mailing process, African American legislators were invited to participate in the study. The majority (88%) of respondents perceived firearm violence to be very serious among African Americans. Few (10%) legislators perceived that addressing legislative issues would be an effective strategy in reducing firearm violence among African Americans. The majority (72%) of legislators perceived the most effective strategy to reducing firearm violence in the African American community should focus on addressing societal issues (e.g. crime and poverty). After adjusting for the number of perceived barriers, the number of perceived benefits was a significant predictor of legislators' perceived effectiveness of firearm violence prevention legislation for 8 of the 24 potential firearm violence prevention legislative bills.

A national survey of emergency nurses and avian influenza threat.

INTRODUCTION: The purpose of this study was to determine the perceived likelihood of emergency nurses reporting to work during an avian influenza outbreak, to consider options if nurses decided not to report work, and to explore Protection Motivation Theory constructs as predictors of reporting to work. METHODS: A descriptive, nonexperimental, cross-sectional survey of emergency nurses within the United States. RESULTS: A total of 332 nurses (46%) responded. Most emergency nurses (84%) reported they would report to work (1 in 6 would not). The likelihood of reporting to work differed by education level, nurses' avian influenza information sources, and nurses who had family living with them. Of the nurses who decided not to report to work, the majority were willing to provide health information (90%), administer vaccinations (82%), and triage (74%) neighbors/friends from home. One third of nurses had not attended a disaster-preparedness drill within the past year. Only 20% identified formal training while on the job as a source of avian influenza information. A third of emergency nurses would be worried about getting an avian influenza vaccination because of potential adverse effects. Protection Motivation Theory accounted for almost 40% of the variance of likelihood to report to work, with response costs being the largest predictor. DISCUSSION: Disaster drills, avian influenza job training, and vaccination education are necessary to prepare emergency nurses for an outbreak. The findings support emergency nurses' willingness to work from home if they are unable to report to work. This finding is new and may have implications for disaster planning, staffing, and ED operations.

Student perceptions and practices regarding carrying concealed handguns on university campuses.

OBJECTIVE: This multisite study assessed college student's perceptions and practices regarding carrying concealed handguns on campus. PARTICIPANTS: Undergraduate students from 15 public midwestern universities were surveyed (N = 1,800). METHODS: Faculty members distributed the questionnaire to students in general education classes or classes broadly representative of undergraduate students. RESULTS: Useable questionnaires were returned by 1,649 students (92%). The majority (78%) of students was not supportive of concealed handguns on campuses, and 78% claimed that they would not obtain a permit to carry a handgun on campus, if it were legal. Those who perceived more disadvantages to carrying handguns on campus were females, who did not own firearms, did not have a firearm in the home growing up, and were not concerned with becoming a victim of crime. CONCLUSIONS: The majority of students was not supportive of concealed handguns on campus and claimed that they would not feel safer if students and faculty carried concealed handguns.

Providing assistance to the victims of adolescent dating violence: a national assessment of school nurses' practices.

BACKGROUND: This study assessed the perceptions and practices of school nurses regarding adolescent dating violence (ADV). METHODS: The membership list of the National Association of School Nurses was used to identify a national random cross-sectional sample of high school nurses in the United States (N = 750). A valid and reliable survey instrument was developed and a 3-wave postal mailing procedure was used to maximize the return rate (57%). RESULTS: Most school nurses (86.4%) reported that they did not have a protocol in their schools to respond to an incident of ADV. The majority of nurses reported that in the past 2 years, training to assist victims of ADV had not been provided to personnel in their schools (88.1%) and their schools did not conduct periodic student surveys that include questions on teen dating abuse behaviors (71.5%). Nurses who had a school protocol for responding to an incident of ADV perceived significantly fewer barriers to assisting victims of ADV and assisted more victims. Over half (55.3%) of high school nurses reported assisting a victim of ADV in the past 2 years. CONCLUSION: Nurses appear to need more training in ADV. In addition, nurses found a number of barriers (eg, lack of training on ADV, lack of time, and lack of private space) to assisting student victims of ADV. Schools need to establish a means for assessing the status of ADV in their student population. Schools also need to provide in-service education for school personnel regarding prevention, assessment, and interdiction of ADV.

Tobacco training in clinical social work graduate programs.

The leading cause of preventable death, in the most vulnerable segments of society, whom social workers often counsel, is cigarette smoking. The purpose of this study was to assess tobacco smoking cessation training in clinical social work programs. A valid 21-item questionnaire was sent to the entire population of 189 clinical graduate social work programs identified by the Council on Social Work Education. A three-wave mailing process was used to maximize the return rate. Directors from 112 clinical social work programs returned completed questionnaires (61 percent). The majority (91 percent) of directors reported having never thought about offering formal smoking cessation training, and only nine of the programs (8 percent) currently provided formal smoking cessation education. The three leading barriers to offering smoking cessation education were as follows: not a priority (60 percent), not enough time (55 percent), and not required by the accrediting body (41 percent). These findings indicate that clinical social work students are not receiving standardized smoking cessation education to assist in improving the well-being of their clients. The national accrediting body for graduate clinical social work programs should consider implementing guidelines for smoking cessation training in the curriculums.

High school health-education teachers' perceptions and practices related to teaching HIV prevention.

BACKGROUND: HIV/AIDS is one of the leading causes of illness and death in the United States with individuals between the ages of 13 and 19 years being especially vulnerable for infection. The purpose of this study was to examine the attitudes, perceptions, and instructional practices of high school health teachers toward teaching HIV prevention. METHODS: A total of 800 surveys were sent to a national random sample of high school health teachers and 50% responded. RESULTS: There was almost complete agreement (99%) among respondents that HIV prevention instruction is needed. The factors that emerged as significantly influencing the attitudes and perceptions of high school health teachers about teaching HIV prevention were related to teacher preparation, training, and years of experience teaching health education. A state mandate requiring HIV prevention instruction was significantly associated with higher teacher efficacy expectations and more perceived benefits, but did not have a significant influence in relation to practices in the classroom. Characteristics of high school health teachers that were significantly related to attitudes, perceptions, and instructional practices included the instructor's age, sex, and race/ethnicity. CONCLUSIONS: High school health teachers who reported the least experience teaching health education had the least supportive attitudes, perceived the most barriers, and had the lowest efficacy and outcome expectations related to teaching about HIV prevention. Whereas these findings support the importance of teacher preparation and training, they also suggest that more recent college graduates may not be fully prepared to provide effective instruction in HIV prevention.

State legislators' support for evidence-based obesity reduction policies.

OBJECTIVE: This study aimed to gauge state legislators' level of support for evidence-based obesity reduction policies. METHODS: A list of 17 potential obesity reduction measures was sent via a valid and reliable survey questionnaire to a random sample of 800 state legislators from all 50 United States in 2011. Legislators were asked to rate their support for each measure on a three-point Likert-type scale. RESULTS: There were 250 questionnaires returned. Chi-square tests revealed no significant differences between respondents and non-respondents by sex, political affiliation, or chamber designation. Respondents were approximately evenly split between Republicans (n=117) and Democrats (n=122). Overall, public school and community-based measures were supported at approximately the same levels. Linear regression revealed that political affiliation, race, and perceiving obesity as a serious societal problem were significant predictors of legislator support for obesity reduction policies. Legislator body mass index, level of education, and geographic location were not significant predictors of support. CONCLUSIONS: Public health advocates interested in promoting obesity prevention legislation at the state level are most likely to find support among non-white female Democratic legislators regardless of their BMI who perceive obesity to be a serious societal problem.