A 1,8-Naphthalimide-based Tripodal Fluorescent Chemosensor to Selectively Detect Copper Ions.

A 1,8-naphthalimide-based tripodal fluorescent ligand (L3) was synthesized through the copper (I) catalyzed Huisgen azide-alkyne cycloaddition reaction of 2-(2-azidoethyl)-6-morpholino-1 H-benzo[de]isoquinoline-1,3(2 H)-dione with triproparagylamine. Naphthalimide acts as the fluorophore while the triazole and amine nitrogens chelate the metal ion. L3 showed a selective fluorescence turn-off for Cu(II) over other metal ions in aqueous acetonitrile solution. A Job's plot, Benesi-Hildbrand plot and high-resolution mass spectrometry data confirm a 1:1 binding stoichiometry with a binding constant of 7.8 х105 M- 1 while addition of disodium EDTA demonstrates its reversibility. The structure and stability of the complex was supported by theoretical calculations. The limit of detection for Cu(II) was calculated to be 0.3 µM which is considerably lower than WHO recommended Cu(II) limit in drinking water.

Expanding access to medication treatment for opioid use disorders: Findings from the Washington State hub and spoke effort.

BACKGROUND: Opioid use disorder (OUD) is a leading cause of preventable death and injury nationwide. Efforts to increase the use of medication for opioid use disorder (MOUD) are needed. In 2017, Washington State implemented a Hub and Spoke (HS) model of care with the primary goal of expanding access to MOUD. We examined changes in MOUD utilization among Washington State Medicaid beneficiaries before and after HS implementation. METHODS: We used Medicaid claims data to examine longitudinal changes in MOUD use for beneficiaries with OUD. We conducted a comparative interrupted time series analysis to examine the association between HS policy implementation and rates of MOUD utilization, overall and by type of medication. RESULTS: Between 2016 and 2019, a period of increasing OUD prevalence, rates of MOUD utilization among Washington Medicaid beneficiaries increased overall from 39.7 to 50.5. Following HS implementation, rates of MOUD use grew at a significantly greater rate in the HS cohort than in the non-HS cohort (ß=0.54, SE=0.02, p< 0.0001, 95% CI 0.49, 0.59). Analyses by medication type show that this rate increase was primarily due to buprenorphine use (ß= 0.61, SE= 0.02, p< 0.0001, 95% CI 0.57, 0.65). CONCLUSION: Improved systems of care are needed to make MOUD accessible to all patients in need. The Washington HS model is one strategy that may facilitate and expand MOUD use, particularly buprenorphine. Over the study period, Washington State saw increased use of buprenorphine, which was an emphasis of their HS model.

Noninvasive diagnostic imaging for endometriosis part 1: a systematic review of recent developments in ultrasound, combination imaging, and artificial intelligence.

Endometriosis affects 1 in 9 women and those assigned female at birth. However, it takes 6.4 years to diagnose using the conventional standard of laparoscopy. Noninvasive imaging enables a timelier diagnosis, reducing diagnostic delay as well as the risk and expense of surgery. This review updates the exponentially increasing literature exploring the diagnostic value of endometriosis specialist transvaginal ultrasound (eTVUS), combinations of eTVUS and specialist magnetic resonance imaging, and artificial intelligence. Concentrating on literature that emerged after the publication of the IDEA consensus in 2016, we identified 6192 publications and reviewed 49 studies focused on diagnosing endometriosis using emerging imaging techniques. The diagnostic performance of eTVUS continues to improve but there are still limitations. eTVUS reliably detects ovarian endometriomas, shows high specificity for deep endometriosis and should be considered diagnostic. However, a negative scan cannot preclude endometriosis as eTVUS shows moderate sensitivity scores for deep endometriosis, with the sonographic evaluation of superficial endometriosis still in its infancy. The fast-growing area of artificial intelligence in endometriosis detection is still evolving, but shows great promise, particularly in the area of combined multimodal techniques. We finalize our commentary by exploring the implications of practice change for surgeons, sonographers, radiologists, and fertility specialists. Direct benefits for endometriosis patients include reduced diagnostic delay, better access to targeted therapeutics, higher quality operative procedures, and improved fertility treatment plans.

Acute influence of resistance exercise on basketball shooting mechanics and accuracy.

The purpose of the present study was to examine the acute impact of resistance exercise on basketball shooting mechanics and accuracy. Ten resistance-trained recreationally active men with previous basketball playing experience (x̄ ± SD; height = 182.6 ± 9.7 cm; body mass = 79.2 ± 13.9 kg; age = 25.6 ± 5.5 years) performed control, upper-body, and lower-body training sessions in randomized order followed by 5 sets of stationary free-throw (4.57 m), two-point (5.18 m) and three-point (6.75 m) basketball shooting drills in 30 min time increments. Each testing session was separated 3-7 days apart. Kinematic variables during both the preparatory and release phases of the shooting motion were derived from a high-definition camera recording at 120 fps positioned 10 m away perpendicular to the participant's shooting plane of motion. Restricted maximum likelihood linear mixed-effects model analysis revealed that a combination of all fixed effects could account for <1% of the total variance in each dependent variable pertaining to basketball shooting mechanics. A 9.9-11.8% decrease in two-point and three-point shooting accuracy was observed immediately following an upper-body training session. However, the observed performance suppression disappeared 30 min post-exercise completion. Overall, the findings suggest that performing upper-body or lower-body resistance training prior to on-court practice sessions has no impact on free-throw, two-point, and three-point biomechanical parameters examined in the present study and a minor acute impact on mid-range and long-range shooting accuracy in male basketball players.

Factors Associated with Physical Activity Increases and Decreases Among a Sample of Appalachian Residents During the COVID-19 Pandemic: A Cross-Sectional Study.

Introduction: Physical activity (PA) can prevent and reduce the deleterious physical and mental health effects of COVID-19 and associated lockdowns. Research conducted early in the pandemic demonstrates that a greater proportion of adults in the U.S. have decreased than increased PA, and the effects vary by sociodemographic factors. Ongoing evidence is important to identify patterns in PA changes during the pandemic. Purpose: This study aims to identify factors associated with increases and decreases in PA during the COVID-19 pandemic in a convenience sample of adults residing in Appalachia. Methods: Surveys were collected from a convenience sample of adults from eight counties in West Virginia from January to March 2021. Logistic regression analysis was used to identify sociodemographic, health, and rurality factors associated with (1) increased PA and (2) decreased PA during the pandemic, assessed retrospectively via self-report. Results: Analysis of 1,401 survey responses revealed that better self-rated health, lower body mass index, and higher income and education were associated with a greater likelihood of more time spent doing PA during the pandemic ( p ≤ .05). Respondents with lower self-rated health, higher body mass index, lower income, and lower levels of education-plus females and those living in a more urban county-were more likely to spend less time doing PA during the pandemic ( p ≤ .05). Implications: Analyses suggest that pre-pandemic disparities in PA by health, wealth, and education were exacerbated during the pandemic. These must be addressed before physical inactivity and ill health become endemic to the Appalachian Region.

Kinematic Differences Based on Shooting Proficiency and Distance in Female Basketball Players.

The purpose of the present study was to examine differences in kinematic characteristics between (a) proficient and non-proficient two-point and three-point shooters, (b) made and missed two-point and three-point shots within a proficient group of shooters, and (c) shots attempted from two-point and three-point shooting distances. Eighteen recreationally active females with previous basketball playing experience attempted 10 two-point (5.10 m) and 10 three-point shots (6.32 m) while facing directly to the basket. To eliminate the possible influence of fatigue, each shot was separated by a 5-10 s rest interval. Participants who made ≥50% of their two-point and ≥40% of their three-point shooting attempts were classified as proficient. A high-definition video camera recording at 30 fps and video analysis software (Kinovea) were used to obtain the kinematic variables of interest during both the preparatory phase (PP) and release phase (RP) of the shooting motion. The results indicate that proficient two-point shooters attained less hip and shoulder flexion during the PP and had greater release height and vertical displacement during the RP. Hip angle differentiated made from missed two-point shots within the proficient group of shooters, with made shots being depicted by less hip flexion. Significantly greater vertical displacement was observed in proficient three-point shooters during the RP. Additionally, the greater elbow and release angles separated made from missed three-point shots within the proficient group of shooters. In response to an increase in shooting distance, hip, knee, ankle, and shoulder angles during the PP all decreased. Moreover, an increase in shooting distance caused a decrease in release angle and an increase in vertical displacement during the RP, while the relative release height remained unchanged.

Fatigue-Induced Neuromuscular Performance Changes in Professional Male Volleyball Players.

The purpose of the present study was to assess pre-post practice changes in countermovement vertical jump (CVJ) force-time metrics and to determine the relationship between internal and external load variables within a cohort of professional male volleyball players. Ten elite athletes competing in one of the top professional European leagues participated in the present study. While standing on a uni-axial force plate, each athlete performed three CVJs immediately prior to the regular training session. Each athlete wore an inertial measurement unit (VertTM) through an entire practice from which the following external load metrics were obtained: Stress (i.e., an algorithm-derived metric used to quantify the percentage of high-impact movements), Jumps (i.e., the total number of jumps performed during the practice session), and Active Minutes (i.e., the total amount of time performing dynamic movements). Immediately post-practice, each athlete completed another set of three CVJs and reported their subjective measure of internal load using a Rating of Perceived Exertion (RPE) scale (Borg CR-10). While no statistically significant differences were observed in any of the force-time metrics examined in the present study pre-post practice (e.g., eccentric and concentric peak and mean force and power, vertical jump height, contraction time, countermovement depth), our findings indicate a strong positive association between RPE and Stress (r = 0.713) and RPE and Jumps (r = 0.671). However, a weak non-statistically significant correlation was observed between RPE and Active Minutes (r = -0.038), indicating that internal load seems to be more dependent on the intensity rather than the duration of the training session for this sport.

Immunogenicity of a Third Dose of BNT162b2 Vaccine among Lung Transplant Recipients-A Prospective Cohort Study.

Two doses of mRNA SARS-CoV-2 vaccines elicit an attenuated humoral immune response among immunocompromised patients. Our study aimed to assess the immunogenicity of a third dose of the BNT162b2 vaccine among lung transplant recipients (LTRs). We prospectively evaluated the humoral response by measuring anti-spike SARS-CoV-2 and neutralizing antibodies in 139 vaccinated LTRs ~4-6 weeks following the third vaccine dose. The t-cell response was evaluated by IFNγ assay. The primary outcome was the seropositivity rate following the third vaccine dose. Secondary outcomes included: positive neutralizing antibody and cellular immune response rate, adverse events, and COVID-19 infections. Results were compared to a control group of 41 healthcare workers. Among LTRs, 42.4% had a seropositive antibody titer, and 17.2% had a positive t-cell response. Seropositivity was associated with younger age (t = 3.736, p < 0.001), higher GFR (t = 2.355, p = 0.011), and longer duration from transplantation (t = -1.992, p = 0.024). Antibody titer positively correlated with neutralizing antibodies (r = 0.955, p < 0.001). The current study may suggest the enhancement of immunogenicity by using booster doses. Since monoclonal antibodies have limited effectiveness against prevalent sub-variants and LTRs are prone to severe COVID-19 morbidity, vaccination remains crucial for this vulnerable population.

Prevalence of Meeting Aerobic, Muscle-Strengthening, and Combined Physical Activity Guidelines During Leisure Time Among Adults, by Rural-Urban Classification and Region - United States, 2020.

The healthful effects of physical activity on a multitude of physical and mental health outcomes are well documented (1). Despite promising increases in the percentage of U.S. adults meeting aerobic and muscle-strengthening physical activity guidelines (guidelines)* (1) during leisure time in nearly all demographic and regional subgroups 1998-2018 (2,3), differences by rurality and U.S. Census Bureau region (Northeast, Midwest, South, and West), persist (4). Before 2020, analyses of rural-urban differences were dichotomized into nonmetropolitan (rural) versus metropolitan (urban) areas; however, in 2020 a four-category rural-urban variable† to classify rural-urban status was included in the National Health Interview Survey (NHIS) public-use dataset. NHIS 2020 data were used to conduct multivariate logistic regression analyses by rural-urban status and U.S. Census Bureau region of the prevalence of meeting the aerobic, muscle-strengthening, and combined aerobic and muscle-strengthening guidelines during leisure time among adults aged ≥18 years, controlling for demographic characteristics. Prevalence of meeting the aerobic, muscle-strengthening, and combined aerobic and muscle-strengthening guidelines was consistently the lowest in Nonmetropolitan counties (38.2%, 21.1%, and 16.1%, respectively) and highest in the West region (52.1%, 35.3%, and 28.5%, respectively). Regardless of rural-urban classification and region, no more than 28% of adults met combined aerobic and muscle-strengthening guidelines. Adults in the most rural category were significantly less likely to meet aerobic, muscle-strengthening, and combined guidelines than were adults in each of the three other categories (adjusted odds ratio [aOR] range = 0.68-0.89). In addition, adults in medium and small metropolitan counties were less likely to meet guidelines than were adults in the two most urban categories (aOR range = 0.85-0.89). Adults in the Northeast, Midwest, and South U.S. Census Bureau regions were less likely to meet guidelines than were adults in the West region (aOR range = 0.75-0.82). These analyses identify geographic disparities in leisure-time physical activity where focused population-level intervention efforts could help reduce or eliminate the consequent disparities in chronic conditions (e.g., cardiovascular diseases) and the resulting mortality (5,6).

Relationship between Upper and Lower Body Strength and Basketball Shooting Performance.

Strength is one of the key physiological performance attributes related to optimal on-court basketball performance. However, there is a lack of scientific literature studying how strength relates to shooting proficiency, as a key basketball skill capable of discriminating winning from losing game outcomes. Thus, the purpose of the present study was to examine the relationship between maximal upper and lower body strength and free-throw, two-point, and three-point shooting accuracy. Ten males and seven females performed bench press and back squat one repetition maximum (1RM) and basketball shooting testing during two laboratory visits. The shooting protocol consisted of five sets of 15 free-throw, two-point, and three-point shots performed in sequential order. Each set was separated by a 30 min rest interval to minimize the influence of fatigue. Each subject attempted 225 shots, combining for a total of 3825 shots. The average free-throw, two-point, and three-point shooting accuracy for men were 74.5 ± 11.9, 68.4 ± 9.9, and 53.3 ± 14.9%, and for women 79.2 ± 11.2, 65.5 ± 8.4, and 51.2 ± 15.3%, respectively. The average bench press and back squat 1RM for men was 88.2 ± 18.6 and 117.0 ± 21.2 kg, and for women, 40.6 ± 7.5 and 66.9 ± 9.9 kg, respectively. The findings of the present study revealed no significant relationships between maximal upper and lower body strength and basketball shooting performance for both male and female participants. Neither bench press nor back squat 1RM was a good predictor of free-throw, two-point, and three-point shooting performance.

Using adverse childhood experiences to explore the usefulness of community health needs assessments to monitor complex determinants of health at the local level.

BACKGROUND: Hospital led community health needs assessments (CHNAs) are intended to help medical care organizations assess determinants of health within the communities they serve. This study demonstrates the utility of data from non-profit hospital CHNAs to monitor complex health issues such as adverse childhood events (ACEs) at the local-level. METHODS: CHNA data were collected from August to November 2019 and analyzed July 2021. A series of logistic regressions were used to analyze associations between ACEs, mental health conditions, and self-rated health from a convenience sample of 2831 adults from two regional hospitals that service five counties located in central Appalachia. RESULTS: ACEs were associated with increased odds of experiencing all metal health conditions after adjusting for other exposures and demographics, including: bipolar disorder (AOR: 2.42, CL: 1.78, 3.30), chronic pain (AOR: 1.61, CL: 1.438, 1.87), depression (AOR: 2.05, CL: 1.76, 2.36), PTSD (AOR: 3.83, CL: 2.95, 4.98), and poor self-rated health (AOR: 1.88, CL: 1.65, 2.15). CONCLUSION: Findings suggest hospital CHNAs are a useful way to assess local data and should include factors known to antecede disease including associated risks and outcomes. CHNAs may provide an opportunity to fill important gaps in community surveillance and inform local prevention and treatment strategies.

Faster Form of Electron Magnetic Reconnection with a Finite Length X-Line.

Observations in Earth's turbulent magnetosheath downstream of a quasiparallel bow shock reveal a prevalence of electron-scale current sheets favorable for electron-only reconnection where ions are not coupled to the reconnecting magnetic fields. In small-scale turbulence, magnetic structures associated with intense current sheets are limited in all dimensions. And since the coupling of ions are constrained by a minimum length scale, the dynamics of electron reconnection is likely to be 3D. Here, both 2D and 3D kinetic particle-in-cell simulations are used to investigate electron-only reconnection, focusing on the reconnection rate and associated electron flows. A new form of 3D electron-only reconnection spontaneously develops where the magnetic X-line is localized in the out-of-plane (z) direction. The consequence is an enhancement of the reconnection rate compared with two dimensions, which results from differential mass flux out of the diffusion region along z, enabling a faster inflow velocity and thus a larger reconnection rate. This outflow along z is due to the magnetic tension force in z just as the conventional exhaust tension force, allowing particles to leave the diffusion region efficiently along z unlike the 2D configuration.

Environmental Factors Associated with Physical Activity in Rural U.S. Counties.

BACKGROUND: Rural U.S. adults' prevalence of meeting physical activity (PA) guidelines is lower than urban adults, yet rural-urban differences in environmental influences of adults' PA are largely unknown. The study's objective was to identify rural-urban variations in environmental factors associated with the prevalence of adults meeting PA guidelines. METHODS: County-level data for non-frontier counties (n = 2697) were used. A five-category rurality variable was created using the percentage of a county's population living in a rural area. Factor scores from Factor Analyses (FA) were used in subsequent Multiple Linear Regression (MLR) analyses stratified by rurality to identify associations between environmental factor scores and the prevalence of males and females meeting PA guidelines. RESULTS: FA revealed a 13-variable, four-factor structure of natural, social, recreation, and transportation environments. MLR revealed that natural, social, and recreation environments were associated with PA for males and females, with variation by sex for social environment. The natural environment was associated with PA in all but urban counties; the recreation environment was associated with PA in the urban counties and the two most rural counties. CONCLUSIONS: Variations across the rural-urban continuum in environmental factors associated with adults' PA, highlight the uniqueness of rural PA and the need to further study what succeeds in creating active rural places.

Field Test of a Passive Infrared Camera for Measuring Trail-Based Physical Activity.

Introduction: Trails are ubiquitous and far-reaching, but research on the impact trails have on physical activity is limited by the lack of resource-efficient, accurate, and practical systematic observation tools. Commonly used infrared trail sensors count trail use and may broadly differentiate activity (i.e., bicyclist vs. pedestrian), but cannot detect nuances needed for outcomes research such as frequency, intensity, time, and type of activity. Motion-activated passive infrared cameras (PICs), used in ecological research and visitor management in wildlife areas, have potential applicability as a systematic observation data collection tool. Materials and Methods: We conducted a 7-month field test of a PIC as a systematic observation data collection tool on a hiking trail, using photos to identify each trail user's physical activity type, age, sex, and other characteristics. We also tallied hourly trail use counts from the photos, using Bland-Altman plots, paired t-tests, Concordance Correlation Coefficient, Kendall's Tau-b, and a novel inter-counter reliability measure to test concordance against concurrent hourly counts from an infrared sensor. Results: The field test proved informative, providing photos of 2,447 human users of the trail over 4,974 h of data collection. Nearly all of the users were walkers (94.0%) and most were male (69.2%). More of the males used the trail alone (44.8%) than did females (29.8%). Concordance was strong between instruments (p < 0.01), though biased (p < 0.01). Inter-counter reliability was 91.1% during the field study, but only 36.2% when excluding the hours with no detectable trail use on either device. Bland-Altman plots highlighted the tendency for the infrared sensor to provide higher counts, especially for the subsample of hours that had counts >0 on either device (14.0%; 694 h). Discussion: The study's findings highlight the benefits of using PICs to track trail user characteristics despite the needs to further refine best practices for image coding, camera location, and settings. More widespread field use is limited by the extensive amount of time required to code photos and the need to validate the PICs as a trail use counter. The future potential of PICs as a trail-specific PA research and management tool is discussed.

Systematic Observation of Physical Distancing Behaviors of Trail Users During the COVID-19 Pandemic.

During the early months of the COVID-19 pandemic, opportunities for indoor and sometimes outdoor recreation were restricted across the world. Despite restrictions, many greenways and rail-trails saw increased use. Messaging from the federal and state public health authorities stressed the importance of social distancing and other preventive measures in reducing spread of the coronavirus. Little is known about actual behaviors of individuals and groups using these outdoor recreational opportunities. This study used passive infrared cameras to systematically observe physical distancing behaviors on multi-user trails in Boone, North Carolina, and Morgantown, West Virginia, to assess safety implications of trail use during June 2020. Most interactions (72.2%) occurred with the recommended six feet of distance between users. Maintaining six feet of distance is more likely to occur when a single individual passes another single individual (88.2%), users pass while traveling in opposite directions (75.9%), and trails are wider (76.8% on 12 ft width trail vs. 62.6% on a 10 ft width trail). Messaging on multi-user trails should target how groups pass other groups, such as "keep six feet" and "pass single file."

Energy transfer in reconnection and turbulence.

Reconnection and turbulence are two of the most commonly observed dynamical processes in plasmas, but their relationship is still not fully understood. Using 2.5D kinetic particle-in-cell simulations of both strong turbulence and reconnection, we compare the cross-scale transfer of energy in the two systems by analyzing the generalization of the von Kármán Howarth equations for Hall magnetohydrodynamics, a formulation that subsumes the third-order law for steady energy transfer rates. Even though the large scale features are quite different, the finding is that the decomposition of the energy transfer is structurally very similar in the two cases. In the reconnection case, the time evolution of the energy transfer also exhibits a correlation with the reconnection rate. These results provide explicit evidence that reconnection dynamics fundamentally involves turbulence-like energy transfer.

Using School Climate to Improve Attendance and Grades: Understanding the Importance of School Satisfaction Among Middle and High School Students.

BACKGROUND: Students with chronic absences tend to struggle academically and may not benefit fully from all school has to offer. A positive school climate has been shown to reduce absenteeism and promote academic success. In this study, we explored how a positive school climate and high satisfaction with school may influence absences and academic performance. METHODS: We used mediated path analysis to describe relationships involving school climate, school satisfaction, absences, and grades among 6839 middle school (49% female, 82% white) and 7470 high school (51% female, 85.0% white) students from 26 West Virginia schools. RESULTS: In the middle and high school samples, we found that a positive school climate and high satisfaction with school reduces school absenteeism. Findings also suggest students with more absences tend to perform less well academically; a positive school climate and school satisfaction may promote good grades. CONCLUSIONS: Missing a substantial amount of school days for any reason may hinder students academic success, but "skipping" may require added attention. Improving school climate and student satisfaction with school may contribute to better attendance and grades.

Predicting Student Success on the National Board for Certification in Occupational Therapy® Examination.

IMPORTANCE: A predictive tool to support academic and practice outcomes for occupational therapy students is needed for use in advising students. OBJECTIVE: To determine whether characteristics of academic and professional behavior across cohorts could indicate the likelihood of student success in passing the National Board for Certification in Occupational Therapy® examination. DESIGN: Causal-comparative research. PARTICIPANTS: Master of occupational therapy students (N = 315; eight cohorts). MEASURES: Demographics, college entrance exams, grade point average, program benchmarks (i.e., specific course grades, fieldwork grades, Occupational Therapy Knowledge Exam scores), licensure exam. RESULTS: Baseline and in-program characteristics were used to determine success; for each unit increase in the success score, the odds of passing the exam were 4.11 (95% confidence interval [2.23, 7.60]). CONCLUSIONS AND RELEVANCE: Case studies that have used this success score suggest that additional resources and targeted interventions could be allocated to help students at highest risk of not passing the licensure exam. WHAT THIS ARTICLE ADDS: Using a predictive tool to support student success can enable more effective academic advising throughout an occupational therapy program and result in positive outcomes on the licensure exam.

School Climate as a Universal Intervention to Prevent Substance Use Initiation in Early Adolescence: A Longitudinal Study.

Initiation of substance use often starts during adolescence, with tobacco and alcohol use frequently preceding the use of marijuana and other illicit drugs. Studies suggest that a positive school climate may prevent substance use while promoting healthy student behaviors. The purpose of this study was to determine the longitudinal associations between school climate and substance use initiation in a group of middle school students. Parallel latent growth curve modeling was used to examine changes among study variables longitudinally using a sample of 2,097 sixth-, seventh-, and eighth-grade students across 16 regional schools located in three counties in West Virginia. Results suggest that a positive school climate may prevent substance use initiation (ß = -0.07 to -0.25, p < .01). However, perceptions of school climate decreased on their own over time (ß = -0.28 to -0.66, p < .01). Furthermore, substance use initiation also increased as students grew older (ß = 0.96 to 0.99, p < .01) and reduced the effects of school climate longitudinally (ß = -0.07 to -0.24, p < .01). Early substance use initiation may be a warning sign of other underlying student issues and requires additional school support to foster student success. Findings suggest that a positive school climate may delay substance use initiation and promote school success. School climate may, therefore, be useful as an intervention to support school-based health promotion.