Indirect Effects of the COVID-19 Pandemic on Routine Childhood Vaccination in Low-Income Countries: A Systematic Review to Set the Scope for Future Pandemics.

The COVID-19 pandemic halted progress in global vaccine coverage and disrupted routine childhood vaccination practices worldwide. While there is ample evidence of the vaccination decline experienced during the pandemic, it is less clear how low-income countries were affected. We executed a systematic review to synthesize the current literature on the impacts of routine childhood vaccinations in low-income countries from 1 January 2020 to 8 February 2023. We collected data using an extraction form on Covidence and assessed the quality of studies included in the review using the Risk of Bias in Non-Randomized Studies of Interventions (ROBINS-I) tool. Effect estimates for changes in vaccination during the pandemic were reported and summarized. Factors that influenced changes were grouped into descriptive themes. Thirteen studies, encompassing 18 low-income countries and evaluating 15 vaccines at varying doses, were included in the final review. We found that routine childhood vaccinations during the COVID-19 pandemic varied considerably by vaccine type, location, and phase of the pandemic. Nine different themes were identified as factors that influenced changes in vaccination. Documenting past experiences and lessons learned is crucial for informing preparedness efforts in anticipation of future public health emergencies. Failure to effectively address these things in the next public health emergency could result in a recurrence of declining routine childhood vaccinations.

Environmental Health-Related Policies and Practices of Oklahoma Licensed Early Care and Education Programs: Implications for Childhood Asthma.

Little is known about the environmental health-related policies and practices of early care and education (ECE) programs that contribute to childhood asthma, particularly in Oklahoma where child asthma rates (9.8%) and rates of uncontrolled asthma among children with asthma (60.0%) surpass national rates (8.1% and 50.3%, respectively). We conducted a cross-sectional survey with directors of Oklahoma-licensed ECE programs to assess policies and practices related to asthma control and to evaluate potential differences between Centers and Family Childcare Homes (FCCHs). Surveyed ECEs (n = 476) included Centers (56.7%), FCCHs (40.6%), and other program types (2.7%). Almost half (47.2%) of directors reported never receiving any asthma training. More Center directors were asthma-trained than FCCH directors (61.0% versus 42.0%, p < 0.0001). Most ECEs used asthma triggers, including bleach (88.5%) and air fresheners (73.6%). Centers were more likely to use bleach daily than were FCCHs (75.6% versus 66.8%, p = 0.04). FCCHs used air fresheners more than did Centers (79.0% versus 61.0%, p < 0.0001). The majority of ECEs (74.8%) used pesticides indoors. Centers applied indoor pesticides more frequently (i.e., monthly or more often) than did FCCHs (86.0% versus 58.0%, p < 0.0001). Policy, educational, and technical assistance interventions are needed to reduce asthma triggers and improve asthma control in Oklahoma ECEs.

Where college students look for vaping information and what information they believe.

Objective: This convergent mixed methods study examined how information sources influence college students' beliefs and knowledge about vaping. Participants: College students either completed a survey (n = 522; January-April, 2016) or were interviewed (n = 33; 2015-2016). Methods: College students completed an online survey asking 'where' students had heard about e-cigarette and 'what' they had heard. Responses were quantified and a chi-square analysis was conducted. Additional college student e-cigarette users were interviewed about the credibility of information sources. Thematic analysis was conducted with the coded interviews. Results: There was a significant relationship between information sources for e-cigarettes (social sources, media, advertising, education/research) and the messages they recalled. Friends who vaped and e-cigarette users were the most credible information sources. Confirmation bias and scientific impotence bias characterized assessment of e-cigarette information. Conclusions: Health education specialists working on college campuses should provide accurate information via communication channels most unitized by college students.

Improving the Adoption of Advance Directives in Primary Care Practices.

BACKGROUND: Oklahoma's Advance Directive completion rate is less than 10%. We compared the implementation performance of 2 advance directive forms to determine which form could be more successfully disseminated. METHODS: The implementation of the Oklahoma Advance Directive (OKAD) and the Five Wishes form were compared in an 8-month pair-matched cluster randomized study in 6 primary care practices. The outcomes measured during the 22-week implementation included form offering rate, acceptance/completion rate by patients, and documentation in the chart. Twenty semistructured interviews with patients and clinicians were conducted to assess intervention experience. RESULTS: A total of 2748 patient encounters were evaluated. OKAD was offered in 33% of eligible patient visits (493/1494) and accepted 54% of the time (266/493). Five Wishes was offered in 36% of eligible patient visits (450/1254) and accepted 82% of the time (369/450). Unadjusted analyses found no significant difference in offering of advance directive forms between groups. However, the odds of accepting Five Wishes were 3.89 times that of OKAD (95% CI, 2.88 to 5.24; P < .0001). Logistic regression models controlling for several confounders indicated that the acceptance of Five Wishes was favored significantly over OKAD (OR = 1.52; 95% CI, 1.27 to 1.81; P < .0001). Qualitative analyses indicated a clear clinician and patient preference for Five Wishes. CONCLUSIONS: Results suggest that Five Wishes was more readable, understandable, appealing, and usable. It seemed to capture patient preferences for end-of-life care more effectively and it more readily facilitated patient-clinician conversations.

Using the Ecological Model to understand influences on college student vaping.

Objective The Ecological Model was used to examine the social and environmental influences of the college environment on e-cigarette use (vaping) among college students. PARTICIPANTS: Undergraduate college student e-cigarette users (vapers) across three large college campuses in the southwest US from Jan 2015- Aug 2016. METHODS: Thirty-three interviews were conducted. Transcribed interviews were coded then analyzed for themes. RESULTS: College student vapers report multiple levels of influence on their vaping beyond personal beliefs and peer influences, including parents, explicit campus and community messaging, community member requests, and respect for others. College student vapers also describe constant associations with smokers in allowable public places to vape. CONCLUSIONS: Parents, community members, campus policy, and the physical environment all influence where and when college students vape. Health communication messages to prevent college student vaping should incorporate alternative messages that are important to college students, such as respect for others and social image.

Living Outside the Gender Box in Mexico: Testimony of Transgender Mexican Asylum Seekers.

OBJECTIVES: To explore preimmigration experiences of violence and postimmigration health status in male-to-female transgender individuals (n = 45) from Mexico applying for asylum in the United States. METHODS: We used a document review process to examine asylum declarations and psychological evaluations of transgender Mexican asylum seekers in the United States from 2012. We coded documents in 2013 and 2014 using NVivo, a multidisciplinary team reviewed them, and then we analyzed them for themes. RESULTS: Mexican transgender asylum applicants experienced pervasive verbal, physical, and sexual abuse from multiple sources, including family, school, community, and police. Applicants also experienced discrimination in school and in the workplace. Applicants immigrated to the United States to escape persistent assaults and threats to their life. Applicants suffered health and psychological effects from their experiences in Mexico that affected opportunities in the United States for employment, education, and social inclusion. CONCLUSIONS: Additional social protections for transgender individuals and antidiscrimination measures in Mexican schools and workplaces are warranted as are increased mental health assessment and treatment, job training, and education services for asylum seekers in the United States.

Needs of a Silent Minority: Mexican Transgender Asylum Seekers.

Mexican male to female transgender asylum seekers in the United States suffer from serious health issues that can be attributed to stressors related to their transgender, ethnic minority, and socioeconomic status. This study explored these stressors, the resulting health issues, and the needs of this particularly vulnerable population. Asylum seekers' (n = 45) sworn declarations and psychological evaluations were examined by a multidisciplinary research team using a systematic document review process. The review identified stressors that occurred both in Mexico and the United States: verbal, physical, and sexual assaults; unstable environments; fear for safety/security; hiding undocumented status; and economic insecurity. The health issues that resulted in part from these stressors include posttraumatic stress disorder, depression, anxiety, sleep issues, isolation, avoidance, drug/alcohol use, and suicidal tendencies. Despite suffering from multiple health issues, asylum seekers rarely sought health or social services. Health promotion practitioners can play an important role in serving this silent minority by (1) expanding community-based research focused on the intersection of transgender, ethnic minority, and socioeconomic status; (2) using trusted community members to connect this population to necessary resources; (3) providing communication training/resource development for health care providers; and (4) creating a network of service organizations that understand the needs of transgender asylum seekers.

Knowledge and Beliefs About E-Cigarettes in Straight-to-Work Young Adults.

INTRODUCTION: Young adults are a growing segment of electronic cigarette (e-cigarette) users. Young adults who go straight to work (STW) from high school make up a large portion of the young adult population, yet research to date has focused on college-educated young adults. This study explored STW young adult beliefs and knowledge about e-cigarettes. METHODS: Semistructured individual interviews were used to elicit in-depth information from STW young adults ages 19-31 from a state in the southwest United States. Thirty interviews were conducted focusing on beliefs about e-cigarettes, current knowledge, and information-seeking practices. Interviews were recorded, transcribed, and analyzed using NVivo. RESULTS: Nine themes were identified falling into three categories: (1) beliefs about e-cigarettes, (2) knowledge about e-cigarettes, and (3) personal rules about e-cigarettes. STW young adults held positive beliefs about the health and safety of e-cigarettes for themselves, others, and the environment. They reported their social networks and the Internet as reliable sources of information about e-cigarettes, but they reported parents as the best source for advice. Participants had rules about e-cigarettes that contradicted some of their beliefs such as using e-cigarettes around children indicating that their beliefs were not as strongly held as they initially reported. CONCLUSIONS: Industry marketing and contradictory information may contribute to STW young adult knowledge and beliefs about e-cigarettes. Lack of credible public health information may also contribute to this issue. Ensuring that what is known about the benefits and harms of e-cigarettes is conveyed through multichannel communication and continued monitoring of marketing practices of the e-cigarette industry in light of the soon to be implemented regulations should be top priorities for public health. IMPLICATIONS: Beliefs and knowledge of STW young adults have not been explored even though they are heavily targeted by the e-cigarette industry. This group holds strong positive beliefs about the health and safety of e-cigarettes, despite having little credible knowledge about them. This study indicates a need for efforts focused on educating STW young adults on the potential risks and benefits of e-cigarettes and the communication of credible information or at minimum the acknowledgment of the uncertainty regarding the long-term health effects of e-cigarettes. It also indicates a need for continued monitoring and advocacy related to marketing practices of the e-cigarette industry.

Electronic Cigarette Use in Straight-to-Work Young Adults.

OBJECTIVE: We explored beliefs about electronic cigarettes (e-cigarettes) as well as social influences on e-cigarette use in straight-to-work (STW) young adults. METHODS: Thirty interviews were conducted with STW young adults ages 19-31 years old. We asked participants about smoking and e-cigarette use, beliefs about e-cigarettes, and influences on decisions to use e-cigarettes. We conducted interviews in community locations and transcribed and coded them using NVivo. RESULTS: We identified 4 themes: benefits of e-cigarette use; dual use/continued smoking; social influences; and quitting smoking and e-cigarettes. STW young adults initiated e-cigarette use to quit smoking but most became dual users or reported cycles of smoking and e-cigarette use. Flavors were a primary attraction for e-cigarette users. Family and friends supported e-cigarette use and often provided participants with their first e-cigarette. Most participants who no longer identified as smokers still smoked occasionally. Users felt they were more positively perceived by others when they used e-cigarettes but were still seen as smokers or former smokers. CONCLUSIONS: E-cigarette use may bring STW young adults closer to their aspirational identity of non-smoker but many may be vulnerable to smoking relapse or increased dependence on nicotine through dual use.

Vapor Store Owner Beliefs and Messages to Customers.

INTRODUCTION: Electronic cigarette (e-cigarette) use is becoming increasingly popular but little is known about the role of the local vapor store in promoting use and influencing customer attitudes and beliefs about vaping. METHODS: Thirty-three vapor store owners were interviewed about their personal beliefs and attitudes about e-cigarettes and what they told customers about the health impact of using e-cigarettes. Interviews were recorded then transcribed, coded, and analyzed for themes. RESULTS: Vapor store owners used the internet to obtain information about vaping, most often from YouTube and industry sources. Owners often did not have the training to critically evaluate research studies posted on the internet. Owners promoted vaping as a healthier alternative to smoking and often compared it to a medical treatment. Owners considered ingredients in the e-liquid as safe to use if it was safe to eat and discussed other foods vapor ingredients were found in. Owners also discussed the safety of secondhand vapor. Owners described the health impact of nicotine in e-liquid by comparing nicotine to caffeine and promoted the nicotine in e-liquid as coming from vegetables rather than tobacco. Finally, owners talked about vaping as a habit rather than a continued addiction to nicotine. CONCLUSIONS: Local store owners are an important source of health information for current and potential e-cigarette users but their messages to customers may be based on incomplete or misinterpreted information. Understanding local store owner messages to customers in addition to internet-based messages is an important area for future public health research.

Marketing practices of vapor store owners.

OBJECTIVES: We examined the marketing strategies for local vapor stores in a large metropolitan area in Oklahoma. METHODS: Vapor store owners or managers (n = 33) participated in individual interviews regarding marketing practices in 2014. We asked owners about their marketing strategies and the groups they targeted. We transcribed the interviews and analyzed them for themes. RESULTS: Store owners used a variety of marketing strategies to bring new customers to their stores and keep current customers coming back. These marketing strategies showed many parallels to tobacco industry strategies. Most owners engaged in some form of traditional marketing practices (e.g., print media), but only a few used radio or television advertising because of budget constraints. Owners used social media and other forms of electronic communication, pricing discounts and specials, and loyalty programs. Owners also had booths at local events, sponsored community events, and hosted them in their stores. Owners attempted to target different groups of users, such as college students and long-term smokers. CONCLUSIONS: Local vapor store marketing practices closely resemble current and former tobacco industry marketing strategies. Surveillance of marketing practices should include local and Web-based strategies.

Smoking and membership in a fraternity or sorority: a systematic review of the literature.

OBJECTIVE: Fraternity and sorority members have higher rates of smoking than other college students. This systematic review examines studies that included fraternity/sorority membership in their investigation of smoking behaviors. PARTICIPANTS/METHODS: Studies identified in MEDLINE, PsychInfo, JSTOR, CINAHL, ERIC, and Google Scholar published between 2003 and 2013 were included if they included fraternity and/or sorority membership, were written in English, published in a peer-reviewed journal, and had smoking as an outcome variable. Nineteen studies were identified for the review. RESULTS: Fraternity/sorority members were more likely to be nondaily smokers. Members who lived in the fraternity/sorority house had higher rates of smoking than members who lived elsewhere. Fraternity/sorority member smoking was associated with alcohol and other substance use. The influence of no-smoking policies on fraternity/sorority member smoking was also examined. CONCLUSIONS: Fraternity/sorority membership was associated with higher rates of smoking, but this association was influenced by other substance use and environmental factors.