Prevalence of Positive Childhood Experiences Among Adults - Behavioral Risk Factor Surveillance System, Four States, 2015-2021.

Positive childhood experiences (PCEs) promote optimal health and mitigate the effects of adverse childhood experiences, but PCE prevalence in the United States is not well-known. Using Behavioral Risk Factor Surveillance System data, this study describes the prevalence of individual and cumulative PCEs among adults residing in four states: Kansas (2020), Montana (2019), South Carolina (2020), and Wisconsin (2015). Cumulative PCE scores were calculated by summing affirmative responses to seven questions. Subscores were created for family-related (three questions) and community-related (four questions) PCEs. The prevalence of individual PCEs varied from 59.5% (enjoyed participating in community traditions) to 90.5% (adult in respondents' household made them feel safe), and differed significantly by race and ethnicity, age, and sexual orientation. Fewer non-Hispanic Black or African American (49.2%), non-Hispanic Alaska Native or American Indian (37.7%), and Hispanic or Latino respondents (38.9%) reported 6-7 PCEs than did non-Hispanic White respondents (55.2%). Gay or lesbian, and bisexual respondents were less likely than were straight respondents to report 6-7 PCEs (38.1% and 27.4% versus 54.7%, respectively). A PCE score of 6-7 was more frequent among persons with higher income and education. Improved understanding of the relationship of PCEs to adult health and well-being and variation among population subgroups might help reduce health inequities.

Predictors of Corporal Punishment during the COVID-19 Pandemic.

Although current policies discourage the use of corporal punishment (CP), its use is still widespread in the US. The objective of this study was to assess the proportion of parents who used CP during the pandemic and identify related risk and protective factors. We analyzed results of a nationwide cross-sectional internet panel survey of 9000 US caregivers who responded in three waves from November 2020 to July 2021. One in six respondents reported having spanked their child in the past week. Spanking was associated with intimate partner violence and the use of multiple discipline strategies and not significantly associated with region or racial self-identification. Parents who spanked sought out more kinds of support, suggesting an opportunity to reduce spanking through more effective parenting resources. Additionally, these results suggest that parents who report using CP may be at risk for concurrent domestic violence.

Childcare Disruptions and Parental Stress During the COVID-19 Pandemic.

OBJECTIVE: Families in the United States experienced tremendous disruptions during the COVID-19 pandemic. This study evaluated the relationship of parental stress during the pandemic with interruptions in availability of services (childcare, after-school activities, and medical appointments) for children. METHODS: We analyzed data from 2 waves of the Measuring the Impact of Violence Against Children and Women During a Pandemic survey 1 to develop a multivariable logistic regression model of the association between caregivers' stress and pandemic-related disruptions in children's lives. Caregivers' past experiences of childhood abuse, recommended stress-relieving activities, and responses to the statement "helping my child(ren) with their education, including remote schoolwork, has been very stressful and/or has resulted in increased tension at home" were included as covariates. Demographic and socioeconomic variables were examined as potential confounders. RESULTS: In total, 3479 (73.3%) of 4659 respondents reported feeling stressed since the start of the pandemic. For every one-item increase in the number of COVID disruptions in children's lives, the odds of feeling stressed increased by 20% (OR 1.20: p value < 0.0001, 95% confidence interval [CI], 1.14-1.27). Compared with men, women had 60% higher odds of feeling stressed (odds ratio [OR] 1.60: p value < 0.0001, 95% CI, 1.32-1.93). The covariates listed earlier were all statistically significant. CONCLUSION: Pandemic-related disruptions in children's lives were significantly associated with caregiver stress. Women were more likely to feel stressed than men. Sex, education, marital status, and family income were also associated with parental stress. These results suggest that childcare continuity and parental support should be part of disaster planning.

Pharmacy on-site overdose protocols and prevention of overdose.

BACKGROUND: Opioid overdose is a preventable injury leading to high morbidity and premature mortality in communities across the United States. Overdoses take place where people use drugs, including commercial and public locations like community pharmacies, and necessitate swift detection and response to avoid harm and, even more seriously, death. The presence of emergency and safety protocols improves occupational health and safety for all in the workplace. The aim of this study was to assess the prevalence of experience with on-site pharmacy overdose and to explore pharmacist and site characteristics associated with having a known protocol for responding to on-site overdose emergencies.Methods: An anonymous, online survey about naloxone provision and opioid safety was delivered by email, through professional pharmacy associations and continuing education attendance lists, to 3,100 pharmacists in Massachusetts and Rhode Island between October 2017 and January 2018. Survey items gauged socio-demographics, practice site characteristics, safer opioid dispensing and naloxone provision. Summary statistics and bivariate analyses were conducted to describe characteristics associated with items pertaining to on-site overdose policy awareness.Results: Of the 357 respondents (11.5% response rate), 154 (5.0%) answered the questions of interest: 17.5% reported having at least one suspected overdose on-site at their practice location, while 42.9% reported that they were knowledgeable about and could locate at their practice location an on-site overdose protocol detailing how to respond to an overdose. Pharmacists who were knowledgeable about protocols were also more likely to offer naloxone to patients (p = 0.02) and did not practice at a chain pharmacy (p = 0.01).Conclusions: Community pharmacies that stock and distribute naloxone are key parts of community efforts to address the opioid crisis. Pharmacies and other healthcare settings should develop and implement on-site overdose response protocols and cultivate a norm of naloxone provision to patients.

Revisiting pharmacy-based naloxone with pharmacists and naloxone consumers in 2 states: 2017 perspectives and evolving approaches.

OBJECTIVES: Pharmacies provide accessible sources of naloxone to caregivers, patients taking opioids, and individuals using drugs. While laws permit expanded pharmacy naloxone access, prior work identified barriers like concerns about stigma of addiction and time constraints that inhibit scale-up. We sought to examine similarities and differences in experiences obtaining naloxone at the pharmacy over a 1-year period in 2 states, and to explore reactions from people with opioid use disorder, patients taking opioids for chronic pain, caregivers of opioid users, and pharmacists to communication tools and patient outreach materials designed to improve naloxone uptake. DESIGN: Eight focus groups (FGs) held December 2016 to April 2017 in Massachusetts and Rhode Island. SETTING AND PARTICIPANTS: Participants were recruited from pharmacies, health clinics, and community organizations; pharmacists were recruited from professional organizations and pharmacy colleges. OUTCOME MEASURES: The FGs were led by trained qualitative researchers using a topic guide and prototypes designed for input. Five analysts applied a coding scheme to transcripts. Thematic analysis involved synthesis of coded data and connections between themes, with comparisons across groups and to first-year findings. RESULTS: A total of 56 individuals participated: patients taking opioids for chronic pain (n = 13), people with opioid use disorders (n = 15), caregivers (n = 13), and pharmacists (n = 16). Fear of future consequences and stigma in the pharmacy was a prominent theme from the previous year. Four new themes emerged: experience providing pharmacy naloxone, clinician-pharmacist-partnered approaches, naloxone coprescription, and fentanyl as motivator for pharmacy naloxone. Prototypes for prompting consumers about naloxone availability, materials facilitating naloxone conversations, and posters designed to address stigma were well received. CONCLUSIONS: Experiences dispensing naloxone are quickly evolving, and a greater diversity of patients are obtaining pharmacy naloxone. Persistent stigma-related concerns underscore the need for tools to help pharmacists offer naloxone, facilitate patient requests, and provide reassurance when getting naloxone.

Pharmacy leaders' beliefs about how pharmacies can support a sustainable approach to providing naloxone to the community.

BACKGROUND: Naloxone is an antidote to opioid overdose, and community pharmacies nationwide now provide broad access to this medication. OBJECTIVE: The aim of this qualitative study was to understand how leaders in pharmacy organizations perceive pharmacies and pharmacy staff can optimize dispensing of naloxone. METHODS: In-depth interviews were conducted with 12 pharmacy leaders in Massachusetts and Rhode Island. Participants were recruited from three types of community pharmacies: (1) chain; (2) independent; and (3) hospital outpatient. Theory-driven immersion crystallization, using Brownlee et al.'s model of healthcare quality improvement, was used to inform coding of the interview data, with predetermined categories of staff; organization; and process. RESULTS: Five main themes were identified: (1) Importance of staff training to increase comfort; (2) Strength through coordination of efforts; (3) Pharmacy as a community leader in the opioid crisis; (4) Persisting stigma; and (5) Ongoing workflow challenges. CONCLUSIONS: The results uniquely reflect the experiences and insights of pharmacy leaders implementing public health initiatives during the opioid crisis and can be used for gaining insight into how pharmacists can efficiently provide naloxone to their communities.

Rurality and differences in pharmacy characteristics and community factors associated with provision of naloxone in the pharmacy.

BACKGROUND: Pharmacies are the most accessible healthcare settings across urban, suburban, and rural areas of the United States and, thus a key venue in the overdose risk environment. Pharmacy dispensing of naloxone is part of the public health response to the opioid overdose crisis, yet little is known about the pharmacy- and community-level characteristics with which naloxone provision is associated. METHODS: We conducted a longitudinal analysis of pharmacy-level quarterly naloxone dispensed from one large US community pharmacy chain from the 1st quarter of 2013 to the 2nd quarter of 2017, examining associations between naloxone provision and pharmacy-level characteristics and community factors in two US states, Rhode Island and Massachusetts. Rurality was defined using the rural urban commuting area (RUCA) scale scores, calculated based on US 2010 Census variables. Pharmacy-level characteristics (e.g., 24 h store, average daily volumes of total prescriptions, nonprescription syringe sales, buprenorphine prescriptions) derived from the pharmacy chain; community factors (e.g., RUCA score, ZIP-code level age, race distributions, and median household income) were obtained from the decennial census files. The linear mixed effects methods modeled dispensing history and the number of naloxone doses dispensed through binomial and negative binomial distributions respectively, accounting for trend and covariates. RESULTS: Adjusted analyses of dispensing data from 449 pharmacies in two states indicated that more rural pharmacies (i.e., stores in areas with higher RUCA scores), pharmacies with higher volumes of all prescriptions and of buprenorphine, that sell more nonprescription syringes, that have drive-throughs and longer weekend hours, and that are located in communities with younger age distributions were associated with increased likelihood of ever dispensing naloxone and a greater number of naloxone doses dispensed (all p<.05). CONCLUSION: Pharmacies are a key evolving element in the overdose risk environment, striving to develop reputations as sources of wellness, prevention, and harm reduction supplies, like naloxone. Pharmacy naloxone dispensing may be an especially effective strategy to alter the overdose risk environment in rural communities.

Pharmacist attitudes toward pharmacy-based naloxone: A cross-sectional survey study.

OBJECTIVE: The aim of this study was to evaluate pharmacist attitudes regarding recommending pharmacy-based naloxone (PBN). The influence of gender, practice setting, the number of years of practice, state, and PBN involvement were explored. Barriers to, and facilitators of, provision of PBN were also assessed. DESIGN: A 71-question survey was designed to assess experience with, and attitudes toward, PBN. We employed a cross-sectional study design and utilized the online survey site Qualtrics (Qualtrics International Inc, Provo, UT). SETTING AND PARTICIPANTS: The survey was e-mailed to approximately 2900 licensed pharmacists from all practice settings in Massachusetts (approximately 1400) and Rhode Island (approximately 1500) and was open from April 5, 2016, until July 13, 2016. OUTCOME MEASURES: Attitudes toward opioid overdose prevention (12 questions) were used to develop the Opioid Overdose Prevention Attitude (OOPA) scale which consisted of 3 subscales: Opioid Overdose Prevention Attitude, Public Health Attitude, and Naloxone Dispensing Attitude. RESULTS: Of the approximately 2900 pharmacists who received the survey, 402 responded (13%), and 245 (137 from Massachusetts and 108 from Rhode Island) were included in the analyses. The majority (79%) identified as White or Caucasian, and 127 (51.8%) stated they had ever dispensed naloxone. Of those, 85 (67%) had done so in the past 30 days. We examined differences in the OOPA subscales by pharmacists' characteristics and pharmacy practice settings. Working in a pharmacy that had a standing order or collaborative practice agreement allowing pharmacists to dispense naloxone without a physician's prescription, or in a pharmacy that stocked naloxone resulted in more positive attitudes toward opioid overdose prevention and public health prevention. CONCLUSION: Respondents who practiced in a pharmacy with a standing order or collaborative practice agreement were more likely to have dispensed naloxone. Both stocking naloxone and ever having dispensed naloxone were associated with higher OOPA scores. More research is needed to better understand how pharmacist attitudes influence the distribution of naloxone.

A Full-Thickness Burn in a Teenager Resulting from Prolonged Contact with a Mobile Phone Charging Cube: A Case Report.

We present a case of a teenager who suffered a full-thickness burn following prolonged contact with a mobile phone charging cube. The patient required primary surgical excision and closure of the wound resulting in a good clinical outcome. There have been multiple reports in the literature of burns resulting from lithium batteries; however, this appears to be the first case report of a full thickness burn resulting from a mobile phone charging cube. Given the ubiquity of mobile phone use among teenagers, primary care providers should warn patients about the risks of sleeping with an electronic device while it is connected to a charger.

Attitudes and perceptions of naloxone dispensing among a sample of Massachusetts community pharmacy technicians.

OBJECTIVES: There is limited research on the attitudes of pharmacy technicians toward pharmacy naloxone provision, despite their widespread role in the pharmacy. We examined attitudes and perceptions of pharmacy technicians in the provision of naloxone in a sample of Massachusetts pharmacies. DESIGN: Thirty-nine community retail pharmacies from 1 U.S. chain were purposely sampled in 13 municipalities across Massachusetts. Pharmacies were divided into high-risk municipalities (HRMs) versus low-risk municipalities (LRMs) based on the state average opioid-related death rate from 2011 to 2015. SETTING AND PARTICIPANTS: A pharmacy technician working in each pharmacy was administered an in-person survey. Survey topics included technician beliefs about current naloxone provision practices; patient groups at greater risk of overdose; whether individuals filling prescriptions would benefit from naloxone; and whether individuals purchasing syringes would benefit from naloxone. OUTCOME MEASURES: Closed-ended responses were analyzed by Mann-Whitney U, Fisher exact, and chi-square tests. Open-ended responses were summarized for themes and then contrasted by municipality risk status. RESULTS: Technician participation was 100% (n = 39). Technicians in both groups believed they could identify patient groups at risk of overdose in their practice, but HRM technicians recognized the need for naloxone for more of their at-risk patients (81% in HRM vs. 33% in LRM believed > 25% of patients need naloxone, P < 0.01). A willingness to provide naloxone was high (> 89%) in both groups. Open-ended responses revealed commonalities between groups, including the belief that patients need lower-cost naloxone, and a lack of patient and technician awareness that naloxone could prevent overdose in individuals at risk through use of prescription opioids not just through use of illicit drugs. CONCLUSION: Pharmacy technicians would benefit from overdose prevention training and are well positioned to recognize overdose risk and offer preventive interventions, such as naloxone. Among technicians, there is a high willingness to be involved in implementing broader naloxone access in pharmacies.

Beliefs Associated with Pharmacy-Based Naloxone: a Qualitative Study of Pharmacy-Based Naloxone Purchasers and People at Risk for Opioid Overdose.

Drug overdose is the leading cause of unintentional death in the USA and the majority of deaths involve an opioid. Pharmacies are playing an increasingly important role in getting naloxone-the antidote to an opioid overdose-into the community. The aim of the current study was to understand, from the perspective of those who had obtained naloxone at the pharmacy, whose drug using status and pain patient status was not known until the interviews were conducted, as well as those who had not obtained naloxone at the pharmacy but were at risk for overdose, factors that impact the likelihood of obtaining pharmacy-based naloxone (PBN). Fifty-two participants from two New England states were interviewed between August 2016 and April 2017. We used a phenomenological approach to investigate participants' beliefs about pharmacy-based naloxone. The social contextual model was chosen to structure the collection and analysis of the qualitative data as it takes into account individual, interpersonal, organizational (pharmacy), community, and societal influences on a specific health behavior. Of the 52 people interviewed, 24 participants had obtained naloxone from the pharmacy in the past year, of which 4% (n = 1) self-disclosed during the interview current illicit drug use and 29% (n = 7) mentioned using prescribed opioid pain medication. Of the 28 people who had not obtained naloxone from the pharmacy, 46% (n = 13) had obtained an over the counter syringe from a pharmacy in the past month and had used an opioid in the past month, and 54% (n = 15) had used a prescribed opioid pain medication in the past month but did not report a syringe purchase. Several main themes emerged from the interview data. Individual-level themes were as follows: helplessness and fear, naloxone as empowerment to help, and past experiences at the pharmacy. Interpersonal-level themes were as follows: concern for family and friends, and sources of harm reduction information. Themes associated with pharmacy-level influence were as follows: perceived stigma from pharmacists, confusion at the pharmacy counter, and receptivity to pharmacists' offer of naloxone; community-level themes were as follows: community caretaking and need for education and training. Finally, themes at the societal-level of influence were as follows: generational crisis, and frustration at lack of response to opioid crisis. Overall our findings reveal factors at multiple levels which may play a role in likelihood of obtaining naloxone at the pharmacy. These factors can be used to inform interventions seeking to increase provision of pharmacy-based naloxone.

Child Passenger Safety Technician Consultation in the Pediatric Primary Care Setting.

Correct use of a child safety seat (CSS) can reduce the risk of fatal motor vehicle crash-related injury by up to 71%; however, misuse rates for CSS are as high as 70%. We recruited 189 caregivers at 2 large suburban pediatric office practices; 94 in the intervention group and 95 in the control group. All participants completed a baseline survey and received a CSS safety brochure. Intervention participants had their CSS installation checked at enrollment by a certified child passenger safety (CPS) technician. Follow-up was conducted 4 months post enrollment. Intervention group participants had a 21.3% reduction in critical misuse at follow-up, whereas control participants critical misuse rate at follow-up was identical to the intervention group at baseline. A consult with a certified CPS technician, at the time of a routine visit to the pediatrician, resulted in a reduction in CSS misuse rates.

Perpetuating stigma or reducing risk? Perspectives from naloxone consumers and pharmacists on pharmacy-based naloxone in 2 states.

OBJECTIVES: Little is known about attitudes of pharmacists and consumers to pharmacy naloxone. We examined perceptions and experiences of pharmacy naloxone from people with opioid use disorder, patients taking chronic opioids for pain, caregivers of opioid users, and pharmacists from 2 early pharmacy naloxone adopter states: Massachusetts and Rhode Island. DESIGN: Eight focus groups (4 per state) were held in October to December 2015. SETTING AND PARTICIPANTS: Participants were recruited from pharmacies, health clinics, and community organizations; pharmacists were recruited from professional organizations and pharmacy colleges. OUTCOME MEASURES: Focus groups were led by trained qualitative researchers using a topic guide, and recorded and transcribed for analysis. Five analysts developed and applied a coding scheme to transcripts. Thematic analysis involved synthesis of coded data and connections between key themes, with comparisons across the groups. RESULTS: Sixty-one participants included patients with chronic pain (n = 15), people with opioid use disorders (n = 19), caregivers (n = 16), and pharmacists (n = 11). A majority of pharmacists had dispensed naloxone to patients; a minority of all consumer participants had obtained pharmacy naloxone. Four themes emerged: consumer fear of future consequences if requesting naloxone; pharmacists' concerns about practice logistics related to naloxone; differing perceptions of how opioid safety is addressed in the pharmacy; and solutions to addressing these barriers. Whereas consumer groups differed in awareness of naloxone and availability at pharmacies, all groups expressed support for the pharmacist's role and preferences for a universal offer of naloxone based on clear criteria. CONCLUSION: Pharmacies complement community naloxone provision to patients and caregivers. To overcome stigma of naloxone receipt, increased public awareness of naloxone and pharmacist training about naloxone and addiction are required. Pharmacists should offer naloxone via universal opt-out strategies-where all patients meeting evidence-based criteria are offered naloxone-rather than targeted or opt-in strategies-where only patients perceived as high risk or patients who request it are offered naloxone.