COVID-19 Stay-At-Home Orders and Secondhand Smoke in Public Housing.

INTRODUCTION: This study aimed to better understand the inequitable impact of the pandemic by examining the associations between stay-at-home orders and indoor smoking in public housing, measured by ambient particulate matter at the 2.5-micron threshold, a marker for secondhand smoke. METHODS: Particulate matter at the 2.5-micron threshold was measured in 6 public-housing buildings in Norfolk, VA from 2018 to 2022. Multilevel regression was used to compare the 7-week period of the Virginia stay-at-home order in 2020 with that period in other years. RESULTS: Indoor particulate matter at the 2.5-micron threshold was 10.29 µg/m3 higher in 2020 (95% CI=8.51, 12.07) than in the same period in 2019, a 72% increase. Although particulate matter at the 2.5-micron threshold improved in 2021 and 2022, it remained elevated relative to the level in 2019. CONCLUSIONS: Stay-at-home orders likely led to increased indoor secondhand smoke in public housing. In light of evidence linking air pollutants, including secondhand smoke, with COVID-19, these results also provide further evidence of the disproportionate impact of the pandemic on socioeconomically disadvantaged communities. This consequence of the pandemic response is unlikely to be isolated and calls for a critical examination of the COVID-19 experience to avoid similar policy failures in future public health crises.

Virtual engagement of under-resourced communities: Lessons learned during the COVID-19 pandemic for creating crisis-resistant research infrastructure.

The COVID-19 pandemic led to an increased need to conduct research and community engagement using digital methods. Unfortunately, the shift away from in-person research activities can make it difficult to engage and recruit participants from under-resourced communities that lack adequate digital infrastructure. At the beginning of the pandemic, our team recognized that imminent lockdowns would significantly disrupt ongoing engagement with low-income housing resident community partners and that we would ultimately bear responsibility if that occurred. This manuscript outlines the development of methods designed to create capacity for virtual engagement with a community advisory board that were subsequently applied to a longitudinal mixed-methods study. We describe how our experience engaging low-income housing residents during the height of the pandemic influenced the approach and offer guidelines useful for engaging under-resourced communities regardless of setting. Of these, a strong commitment to providing technology, unlimited data connectivity, and basic digital literacy training/technical support is most important. While each of these is essential and failure in any one area will reduce overall effectiveness of the effort, providing adequate technical support while maintaining ongoing relationships with community members is the most important and resource-intensive.

Willingness to Engage in Collective Action After the Police Killing of an Unarmed Black Man: Differential Pathways for Black and White Individuals.

This cross-sectional survey study examined the underlying psychosocial constructs of Black (n = 163) and White (n = 246) university students' willingness to endorse racially motivated collective action. Consistent with the defensive motivation system model, we expected the police shooting of an unarmed Black American to activate concerns about personal safety, thereby eliciting negative affect, lack of forgiveness of the perpetrator, and motivation to engage in collective action. This path model was expected for both Black and White participants, with stronger associations among Black participants. In the full model, Black participants identified more with the victim and indicated greater personal threat, which led to (1) more negative affect and greater endorsement of collective action and (2) greater avoidance of the shooter and greater endorsement of collective action. In the Black participants model, collective action was explained by identifying with the victim and feeling personally threatened. In the White participants model, collective action was explained by three pathways stemming from identifying with the victim and personal threat, including negative affect, seeking avoidance, and seeking revenge. The results indicate different mechanisms to explain Black and White individuals' motivation to endorse collective action to prevent police-involved shootings of unarmed Black Americans.

Hookups Among U.S. College Students: Examining the Association Between Hookup Motives and Personal Affect.

"Hooking up" is prevalent on college campuses and is related to both positive and negative outcomes for students. The current study was an exploratory examination of hookup motives, and positive and negative affect, related to the most recent hookup experience. Participants were 256 U.S. college students who reported hooking up in the last 12 months. Students completed a 30-min anonymous online survey assessing behaviors and cognitions during their most recent hookup, including alcohol use at the time of the hookup, motives for hooking up, and post-hookup affect. The model demonstrated that gender, conformity motives, and social-relationship motives significantly and positively predicted negative affect, whereas enhancement motives negatively predicted negative affect. Coping and enhancement motives significantly and positively predicted positive affect, whereas alcohol use negatively predicted positive affect. This study was a unique examination of hookup motives, with important findings that explained large portions of variance in post-hookup affect. The overall model explained approximately 23% of the variance in negative affect and 49% of the variance in positive affect. Findings highlight that, depending on the hookup motive, hooking up can be associated with positive outcomes, such as positive affect.

Stemming the tide of distrust: A mixed-methods study of vaccine hesitancy.

Public distrust in the US pandemic response has significantly hindered its effectiveness. In this community-based participatory research mixed-methods study, based on two datasets, we examined how distrust in COVID-19 vaccines relates to institutional distrust. We found that the Johnson & Johnson vaccine pause undermined trust in COVID-19 vaccines in general. Findings also suggest that vaccine distrust developed after participating in a study on COVID-19 testing. Increased distrust may be an unintended consequence of how healthcare and public health activities are presented and delivered, and research participation is structured. Both will continue without proactively addressing the root causes of distrust.

High dose intravenous vitamin C treatment in Sepsis: associations with acute kidney injury and mortality.

BACKGROUND: The effects of vitamin C on clinical outcomes in critically ill patients remain controversial due to inconclusive studies. This retrospective observational cohort study evaluated the effects of vitamin C therapy on acute kidney injury (AKI) and mortality among septic patients. METHODS: Electronic medical records of 1390 patients from an academic hospital who were categorized as Treatment (received at least one dose of 1.5 g IV vitamin C, n = 212) or Comparison (received no, or less than 1.5 g IV vitamin C, n = 1178) were reviewed. Propensity score matching was conducted to balance a number of covariates between groups. Multivariate logistic regressions were conducted predicting AKI and in-hospital mortality among the full sample and a sub-sample of patients seen in the ICU. RESULTS: Data revealed that vitamin C therapy was associated with increases in AKI (OR = 2.07 95% CI [1.46-2.93]) and in-hospital mortality (OR = 1.67 95% CI [1.003-2.78]) after adjusting for demographic and clinical covariates. When stratified to examine ICU patients, vitamin C therapy remained a significant risk factor of AKI (OR = 1.61 95% CI [1.09-2.39]) and provided no protective benefit against mortality (OR = 0.79 95% CI [0.48-1.31]). CONCLUSION: Ongoing use of high dose vitamin C in sepsis should be appraised due to observed associations with AKI and death.

A Qualitative Study of Unfairness and Distrust in Smoke-free Housing.

Objectives: Whereas smoke-free housing (SFH) has the potential to protect residents from tobacco smoke, evidence suggests that SFH could lead to increased indoor smoking. In this study, we examine how perceptions of a residential smoking ban could be related to non-compliance. Methods: We conducted 8 focus group interviews of low-income housing residents living in Norfolk, Virginia (N=53). Interviews were semi-structured and based on a list of guided questions related to SFH compliance, developed in partnership with a standing community advisory board comprised of low-income housing residents. Results: Several themes emerged, including pervasive non-compliance, perceived unfairness and shame, barriers to compliance, and distrust of the housing authority. Smokers reported behavior primarily motivated by punishment avoidance, rather than out of any perceived obligation to comply with the ban. Conclusions: Results led us to consider Procedural Justice Theory as a conceptual framework, in which compliance is directly related to perceptions about the legitimacy of a rule or authority. When compliance is low due to a lack of perceived legitimacy, SFH should be adapted to promote changes in smoking behavior. We offer specific theory-supported adaptations to SFH focused on trust-building and improving perceived fairness.

Implementation and Evaluation of a Team-Based Approach to Hospital Discharge Transition of Care.

BACKGROUND: Transitional care management (TCM) programs guide patients from hospital discharge to outpatient follow-up with the goal to decrease hospital readmissions and the cost of care. In 2017, the department of primary care internal medicine (PCIM) at Eastern Virginia Medical Group implemented TCM. We aimed to evaluate the efficacy and self-sustainability of this TCM program. METHODS: The TCM team contacted patients upon discharge to schedule the follow-up appointment. We coded patient contact as (1) no successful phone-call contact, patient did not attend appointment; (2) successful phone-call contact, patient did not attend appointment; and (3) patient attended appointment. We collected patient demographics, readmissions, and visit costs using manual chart review and electronic health record (EHR) data extraction. We conducted χ 2 analysis, one-way analysis of variance, and unpaired t tests to assess associations between readmission rates or costs and TCM care. RESULTS: Initial analysis did not indicate significant associations between readmission rates and level of TCM care at 30 (χ 2=1.40, P=.50), 60 (χ 2=5.48, P=.06), or 90 (χ 2=4.23, P=.12) days or significant differences in patient charges at 30 (F[2,59]=2.85, P=.06), 60 (F[2,91]=2.00, P=.14), or 90 (F[2,126]=1.39, P=.25) days. Follow-up analysis indicated significant associations between readmission rates and any level of TCM care at 60 (χ 2=5.40, P=.02) and 90 (χ 2=4.21, P=.04) days, but not at 30 days (χ 2=1.39, P=.28). CONCLUSIONS: Our TCM program review suggests that the benefits of transitional care extend beyond 30 days by decreasing readmission rates at 60 and 90 days after hospital discharge.

Variations in utilization and clinical outcomes for endoscopic sphenopalatine artery ligation and endovascular arterial embolization in a single multi-hospital network.

PURPOSE: Endoscopic sphenopalatine artery ligation (ESPAL) and endovascular arterial embolization (EAE) are increasingly common treatment options for patients with refractory epistaxis. The objective of this study was to compare the utilization pattern and clinical outcomes between these interventions within our single multi-hospital network. MATERIALS AND METHODS: A retrospective study of all patients undergoing ESPAL and/or EAE within any of the hospitals in a single healthcare network between 2008 and 2017 was conducted. We compared differences in procedure utilization with various hospital characteristics. Secondarily, we evaluated clinical outcomes and costs associated with each procedure. RESULTS: Forty-three ESPAL and 33 EAE procedures were performed across 7 hospitals, with the majority of procedures being performed at teaching institutions (65% and 91%, p = .013). The majority of both interventions were performed in larger hospitals and EAE patients were more likely to undergo inter-hospital transfer compared to ESPAL patients (48.5% and 16.3%, p = .02). Success rates for ESPAL and EAE were comparable (95% and 93%); however, the median direct cost of treatment for EAE was significantly higher than the cost for ESPAL ($12984.89 and $5002.02, p < .0001). CONCLUSIONS: The majority of both ESPAL and EAE interventions were performed at teaching and larger hospitals. Transfers occurring prior to EAE may have been due to the limited availability of interventional radiology services, and likely contributed to the increased cost of treatment. ESPAL is a known cost-effective management strategy and should be considered early in treatment algorithms of refractory epistaxis.

Association of Racial Disparity of Cannabis Possession Arrests Among Adults and Youths With Statewide Cannabis Decriminalization and Legalization.

Importance: Despite calls for cannabis decriminalization and legalization, research investigating the association of policy with arrest rates and racial disparities is scarce. Objectives: To examine racial differences in cannabis arrest rates among adults and youths after statewide decriminalization, legalization, and no policy changes. Design Setting and Participants: This case-control study used race-based arrest data from the Uniform Crime Reporting Program and Surveillance, Epidemiology, and End Results county-level population data from January 2000 through December 2019. Data were analyzed in July 2021. Event-study analyses based on the arrest rates from 43 US states were conducted to compare preimplementation and postimplementation differences in arrest rates for states with decriminalization, legalization, and no policy changes. Exposures: Nine states implemented legalization, 8 implemented decriminalization, and 26 had no policy change. Main Outcomes and Measures: Outcome measures were cannabis arrest rates for Black and White adults and youths per year and by state, while controlling for several covariates. Results: Rates were reported per 100 000. When comparing absolute differences in arrests from January to December 2008 (before policy changes) to January to December 2019, legalization was associated with 561 and 195 fewer arrests and decriminalization with 448.6 and 117.1 fewer arrests for Black and White adults, respectively. States without a policy change saw reductions of 47.5 and 33.0 arrests for Black and White adults, respectively. Among youth, legalization was associated with 131.1 and 131.2 fewer arrests and decriminalization with 156.1 and 124.7 fewer arrests for Black and White youths, respectively. Among states without a policy change, arrests reduced by 35 and 52.4 for Black and White youths, respectively. Plotted trends of the arrest ratios from January 2000 through December 2019 suggests racial disparities remained over time. Event-study analyses suggest that decriminalization was associated with an arrest rate reduction for Black and White adults and youths. The timing of reductions suggests differential policy effects. Arrest disparities increased in states that did not have a cannabis policy change. Conclusions and Relevance: In this case-control study of states with and without cannabis decriminalization and legalization policies, increased arrest rate disparities in states without either policy highlight the need for targeted interventions to address racial injustice.

Perioperative Antibiotic Selection and Surgical Site Infection in Elective Colon Surgery.

OBJECTIVES: The highest rates of surgical site infections (SSIs) are associated with colorectal operations (up to 30%). A sentinel paper showed that the use of intravenous (IV) cefazolin and metronidazole was associated with decreased rates of SSI compared with cefoxitin (6% vs 13%). We reviewed the association of SSI with prophylactic antibiotic choice. We specifically investigated the regimens of ceftriaxone and metronidazole IV, cefoxitin IV, or ertapenem. METHODS: We conducted a retrospective review of 532 colon surgeries between 2016 and 2018. Inclusion criteria were patients 18-89 years of age undergoing elective colon surgery who received ceftriaxone/metronidazole, cefoxitin, or ertapenem for prophylaxis. All emergent cases were excluded. This resulted in 241 elective colon cases for review. The primary endpoint was to determine if the use of ceftriaxone/metronidazole decreased the rate of SSI. RESULTS: In total, there were 241 elective colon cases with 21 SSI. We compared SSI rates in the ceftriaxone/metronidazole group to those patients receiving either cefoxitin or ertapenem (4.5% vs 12.2%; P = .035). We then compared SSI in ceftriaxone/metronidazole to SSI in cefoxitin (4.5% vs 10%; P = .13). Finally, we compared SSI in the ceftriaxone/metronidazole group to SSI in the ertapenem group (4.5% vs 14%; P = .03). Comorbidities and underlying factors were similar across all antibiotic groups. CONCLUSION: In our experience, the use of ceftriaxone/metronidazole is associated with a decreased SSI rate. Furthermore, ceftriaxone/metronidazole use is superior to the use of ertapenem, with a trend toward superiority over cefoxitin. Based on this study, we recommend ceftriaxone/metronidazole as antibiotic prophylaxis for elective colon surgery.

LGBTQ-Related Individual Differences Predict Emotional Reactions to the Pulse Nightclub Shootings.

This study examined, among 232 lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ) participants, the association of identity centrality and public regard with negative affect about the Pulse nightclub shootings in Orlando, Florida. Identification with victims and perceived threat to personal safety were sequential mediators. Identity centrality was associated with greater identification with the shooting victims. In turn, identification with the victims was associated with greater perceived threat, followed by more negative affect. Low public regard was associated with greater perceived threat that, in turn, was associated with more negative affect. The results support the notion that LGBTQ-related individual differences increase distress about anti-sexual/gender minority hate crimes, especially for individuals with a strong LGBTQ identity and who believe that the majority, heterosexual society devalues sexual/gender minority persons.

Effect of Diabetes Mellitus on Complication Rates of Coronary Artery Bypass Grafting.

Previous studies have shown that diabetes mellitus (DM) is a risk factor for postoperative coronary artery bypass grafting (CABG) complications. More contemporary studies are needed to guide revascularization decisions in DM patients. We performed a single-center study of patients who underwent CABG. Patients with no DM were compared with patients with DM, subgrouped according to whether or not DM was treated with insulin before admission (Insulin and No Insulin Groups). Multivariable logistic regression was used to determine whether DM was a significant predictor of mortality, combined postoperative events, and specific postoperative complications after controlling for other predictive clinical variables. Of 11,590 consecutive patients who underwent CABG, 5,013 (43%) had DM and 6,577 (57%) had no DM. Of the patients with DM, 3,433 (68%) were not treated with insulin and 1,580 (32%) were treated with insulin before admission. Multivariable logistic regression analyses showed that DM was not significantly associated with in-hospital mortality or combined postoperative events after considering other clinical variables. The No Insulin Group was significantly associated with stroke, and the Insulin Group was significantly associated with surgical site infection and new renal failure. In conclusion, this study of consecutively treated CABG patients shows that DM is not a predictor of in-hospital mortality or combined in-hospital postoperative events after adjusting for other clinical factors. DM is a predictor of permanent stroke, surgical site infection, and new renal failure. These findings may help with case selection and management of DM patients undergoing CABG.

A daily diary investigation of self-reported alcohol-related direct and indirect aggression.

Research supports the relationship between alcohol use and direct aggression, however, scant research has examined the association between alcohol use and indirectly aggressive behavior. Further, extant research has relied on retrospective reporting of behaviors, which may be subject to recall bias. The daily diary methodology enables the assessment of both the between- and within-subject variation, as well as reduces the likelihood of biased reporting. Consequently, the current study utilized a daily diary design to examine (a) associations between daily alcohol use and alcohol-related aggressive behaviors (i.e., direct and indirect); and (b) the co-occurrence of alcohol-related direct and indirect aggression. Participants were 105 (80% female) college student drinkers. Students completed baseline questionnaires and up to 14 consecutive, daily surveys regarding their previous day alcohol use, alcohol-related direct aggression, and alcohol-related indirect aggression. Findings revealed that alcohol use was associated with same day alcohol-related direct and indirect aggression, after controlling for baseline alcohol use. Self-reported alcohol-related direct aggression was more likely to occur on days in which self-reported alcohol-related indirect aggression occurred, after controlling for dispositional aggression, trait self-control, and baseline alcohol use. Results of the study suggest that, similar to alcohol-related direct aggression, alcohol use is associated with an increased likelihood of alcohol-related indirect aggression. Further, the co-occurrence of alcohol-related indirect and direct aggression supports that individuals may be engaging in multiple types of aggressive behaviors. Findings extend previous cross-sectional and qualitative research suggesting that indirect aggression may co-occur, perhaps increasing in severity.

Pain Management: Time to Minimize Variations in Practice.

There continue to be great variations in the management of pain in palliative care. Efforts need to be made within the field develop strategies to address this to avoid undue distress in patients.

An Examination of the Most Recent Episode of Molly Use among College Students.

OBJECTIVE: The current study examined event-level characteristics (e.g., contextual factors, risk behaviors) during the most recent episode of Molly use among a sample of college students who reported previously using Molly. PARTICIPANTS: Participants (N = 151; 66.7% female) were drinkers aged 18 to 25. Data were collected from October to November 2014, February to April 2015, and September to November 2015. METHOD: Participants completed measures regarding typical Molly use and items related to context and behaviors during their most recent episode of Molly use. RESULTS: Findings revealed that our sample most commonly reported using Molly earlier in the evening while hanging out with friends or at a party. Additionally, sexual and other drug use behaviors commonly occurred when using Molly. CONCLUSIONS: Findings provide preliminary information in guiding future work exploring Molly use and potential substance-related issues associated with the context of when and how Molly is consumed.

Caffeinated and non-caffeinated alcohol use and indirect aggression: The impact of self-regulation.

Research shows that heavier alcohol use is associated with physical aggression. Scant research has examined the way in which alcohol relates to other forms of aggression, such as indirect aggression (e.g., malicious humor, social exclusion). Given the possible negative consequences of indirect aggression and the limited evidence suggesting alcohol use can elicit indirectly aggressive responses, research is needed to further investigate the association between drinking behavior and indirect aggression. Additionally, specific alcoholic beverages, such as caffeinated alcoholic beverages (CABs; e.g., Red Bull and vodka), may potentiate aggression above the influence of typical use, and thus warrant examination with regard to indirect aggression. One factor that may impact the strength of the alcohol-indirect aggression and CAB-indirect aggression relationships is one's level of self-regulation. Consequently, our study examined the relationships between (1) alcohol use and indirect aggression, (2) CAB use and indirect aggression, and (3) self-regulation as a moderator. Participants were 733 (67.6% female) undergraduate students who reported their CAB and alcohol use, self-regulation, and aggressive behaviors. Results revealed that heavier alcohol use was associated with more frequent indirect aggression after controlling for dispositional aggression. Heavier CAB use was related to more frequent indirect aggression after accounting for typical use and dispositional aggression. Self-regulation moderated these associations such that for those with lower self-regulation, greater alcohol and CAB consumption was associated with greater indirect aggression. Our findings suggest that heavier alcohol and CAB consumption may be risk factors for engaging in indirect aggression and this risk is impacted by one's regulatory control.

Molly users versus nonusers in a sample of college alcohol drinkers: Differences in substance-related harms and sensation seeking.

BACKGROUND: Molly is one form of MDMA (3,4-methylenedioxymethamphetamine) that is touted to be more "pure" and potentially less harmful than other forms, such as ecstasy. Media reports and case studies suggest that this drug is popular among college students and is related to adverse health problems. The current study sought to address the knowledge gaps about Molly by examining whether users differ in substance use outcomes and sensation seeking than nonusers. Specifically, this study tested whether Molly users engaged in heavier use of other substances and experienced more substance-related harms in general than nonusers. Further, the current study investigated whether Molly users exhibited higher levels of sensation seeking than nonusers. Lastly, this study examined whether Molly user status would be associated with substance-related harms beyond the confounding influence of other substance use and trait sensation seeking. METHODS: Participants were 710 (71.9% female) college alcohol drinkers who completed self-report surveys about substance use (i.e., Molly, alcohol, and other drug use), substance-related problems, and sensation seeking. RESULTS: Results revealed that approximately 12% of the sample reported lifetime Molly use. Molly users compared with nonusers reported higher levels of other drug use, alcohol use, substance-related problems, and sensation seeking. Further, Molly users reported experiencing poorer substance use outcomes (e.g., blacking out, academic/occupational problems, and withdrawal symptoms) after accounting for sensation seeking and other substance use. CONCLUSIONS: These findings indicate that Molly users are higher in sensation seeking and that use is uniquely related to greater risk for substance-related harms. These preliminary findings demonstrate a need for correcting possible misperceptions regarding the purity of Molly and educating users on the potential for experiencing associated harms. Such information could be used to develop efficacious prevention programming for college students.

Intimate partner homicide: new insights for understanding lethality and risks.

Research on covictims, family members, and close friends who have lost loved ones to intimate partner homicide (IPH) is a neglected area of study. We conducted phenomenological interviews with covictims to gain insights into risk and lethality, examined affidavits from criminal case files, and reviewed news releases. The data uncovered acute risk factors prior to the homicide, identified changes in the perpetrators' behavior and the perpetrators' perceived loss of control over the victim, and described barriers that victims faced when attempting to gain safety. Findings suggest that recognizing acute risk factors is an important area for future IPH research.