Vaccination Motivators and Deterrents Among Undervaccinated Older Adults in North Dakota.

Despite increased risk of morbidity and mortality among older adults due to preventable infectious diseases such as influenza, shingles, pneumonia, and COVID-19, many forego receiving some, if not all, of these vaccinations. This study examines vaccination motivators and deterrents for undervaccinated older adults in North Dakota (ND). Adults aged 65+ in ND were mailed a survey (n = 901) with questions gauging vaccination behaviors and perceptions, with 132 of these indicating not receiving certain vaccinations. Further questions assessed reasons they have not been vaccinated against the following diseases: influenza, shingles, pneumonia, and COVID-19 (e.g., "Concerned about side effects", "Vaccines are dangerous", "I'm healthy and I do not need it") and what would make it more likely to get a vaccine (e.g., "More information", "Doctor recommendation", "Easy access to vaccines"). Reasons for remaining unvaccinated varied by vaccine. For influenza and pneumococcal vaccines, respondents were more likely to indicate they are healthy and do not need the vaccine. For shingles and COVID-19, respondents were more likely to indicate concerns about side effects. Factors reported to motivate increasing the likelihood of getting a vaccine were receiving a doctor recommendation, receiving more information, and having a vaccine provided at no cost. These results contribute to our understanding of vaccination behaviors among older adults and underscore specific issues around which to frame interventions tailored to increase vaccine uptake for this population.

Reliance on sources of immunization information and vaccine uptake among older adults in a rural state: The mediating role of trust.

Older adults are more vulnerable to the negative impacts of infectious diseases than younger individuals. However, regardless of the importance and effectiveness of vaccines to reduce morbidity and mortality, issues remain with vaccine hesitancy among this population. Older adults' sources of immunization information and their level of trust in those sources may play a role in their vaccination behaviors. This research aimed to better understand the role of information sources and related issues of trust as related to vaccine uptake among older adults. A community-based, cross-sectional survey was conducted with 901 older adults in North Dakota in May-July 2022. Measures included extent of reliance on specific sources of immunization information, levels of trust, and uptake for influenza, pneumonia, shingles, and COVID-19 vaccinations. Immunization information sources were grouped into medical experts, informal, and public outlets. Results indicated older adults were more likely to rely on medical experts than informal sources or public outlets for immunization information. Greater reliance on medical experts was associated with a greater likelihood of vaccine uptake for all vaccines, while reliance on public outlets was associated with a greater likelihood of vaccine uptake only for COVID primary series and boosters. Reliance on informal sources for immunization information was associated with a reduced likelihood of vaccine uptake for all vaccines except shingles. Nearly half of respondents were uncertain who to trust for vaccine information. Uncertainty who to trust for immunization information significantly mediated the associations between reliance on medical experts and uptake for most vaccines indicating that trust in medical experts fosters vaccine uptake. Increasing reliance on medical experts as sources of immunization information is vital to increasing vaccine uptake among older adults. Additionally, this population must be assisted in increasing their ability to successfully assess the trustworthiness of immunization information sources.

"Stronger Than I Thought I Was": Older Adults' Coping Across Two Years of the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: Throughout the coronavirus disease 2019 (COVID-19) pandemic, older adults developed coping strategies to adapt to the necessary social distancing precautions; however, over time, especially as vaccines became available, their need and ability to adapt and cope shifted. This longitudinal, mixed-methods study investigates changes in older adults' perceptions of coping across the first 2 years of the pandemic. RESEARCH DESIGN AND METHODS: Between April 2020 and June 2022, 5 waves of interviews were conducted with 76 Midwestern older adults aged 70-97. At each timepoint, participants rated their level of perceived coping. They also answered a series of open-ended questions about their current daily life, experiences, and perceptions during the pandemic. RESULTS: Repeated-measure ANOVA indicated participants' perceived coping significantly increased over 2 years and qualitative explanations contextualized these shifts. Thematic coding of interview transcripts identified themes of: (1) taking problem-focused approaches and (2) cultivating emotional resiliency, with multiple subthemes nested within each. Subtheme meanings shifted once vaccines were available, as participants adapted to a "new normal" lifestyle and appreciated their own resilience. DISCUSSION AND IMPLICATIONS: Findings suggest older adults had nuanced and shifting coping experiences throughout the initial 2 years of the pandemic, but overall coped by drawing on life experiences. Our discussion highlights variability in older adults' coping over time and directions for future study and practice.

Vaccine attitudes and acceptance among older adults in North Dakota: Understanding demographic characteristic variability.

OBJECTIVES: Older adults face increased risks from infectious diseases which are often preventable with vaccines. The current study examines demographic variation in vaccine hesitancy among older adults in North Dakota. METHODS: A mailed survey assessing age, gender, years of education, self-rated health, rurality, and political leaning as well as vaccine attitudes and vaccine acceptance was conducted with 739 older adults (65+), oversampled from rural counties. RESULTS: Vaccine hesitant attitudes were significantly higher among rural and politically-conservative older adults; whereas, vaccine acceptance was significantly higher among older, healthier, and politically-liberal older adults. Vaccine attitudes were significantly associated with vaccine acceptance and mediated the association between political leaning and vaccine acceptance. DISCUSSION: These findings highlight the demographic characteristics predictive of older adults' vaccine attitudes and acceptance. By better understanding the nuanced factors leading to hesitation to be vaccinated, practitioners can develop strategies to increase vaccination rates among this at-risk population.

Patient Experience and Satisfaction with Opioid-Related Screening and Intervention in North Dakota Community Pharmacies.

Background: Screening for patient-level opioid-related risk in the community pharmacy setting has increased patient education about opioids and naloxone distribution, helping to mitigate the impact of the opioid epidemic. However, patient experience and satisfaction with opioid screening and education is unknown. Fear of patient dissatisfaction may limit pharmacists' willingness to implement screening activities. Objective: To report patient experience and satisfaction of a convenience sample of patients undergoing screening and intervention for opioid-related risk as a part of the ONE Program (formerly ONE Rx). Methods: Patients who received ONE Program screening and intervention from their community pharmacist were recruited to participate in a 9 item survey regarding their experience and satisfaction. Results were analyzed by urban and rural location of participants. Results: Urban (n = 42) and rural (n = 32) patients who completed the survey reported positive experiences namely feeling comfortable with the ONE process (86.5%), the process taking an appropriate amount of time (93.2%) and feeling safer as a result of their pharmacist's attention to their opioid-related medication risk (86.3%). Urban patients were significantly more likely than rural patients to report positive attitude and behavior changes as a result of the ONE process. Conclusion: High levels of patient satisfaction and positive experience with the ONE Program screening and intervention process for patient-level opioid-related risks may encourage community pharmacists to more broadly implement such activities.

Shifts in Older Adults' Social Connections Throughout the Initial Year of the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic exposed older adults to increased health risks, yet social distancing precautions also heightened risks to their social well-being. This mixed-methods study explores changes in older adults' satisfaction with social engagement and interpersonal connections throughout the first year of the COVID-19 pandemic. RESEARCH DESIGN AND METHODS: A Midwestern sample of 76 older adults aged 70-97 completed a series of 4 interviews from March 2020 through April 2021 about their experiences with COVID-19 social distancing precautions. Participants reported social engagement satisfaction and frequency of contact with family and friends. Additionally, they responded to open-ended questions about social connection experiences. RESULTS: Satisfaction with social engagement rebounded with significant increases across the year of the pandemic, whereas frequency of contact shifted from high remote contact early in the pandemic to greater in-person contact over time, with nuanced distinctions between family and friends. Qualitative thematic analysis identified themes including: (1) shifts in family support, (2) adaptable and flexible friendships, (3) social isolation fatigue, and (4) communication through technology. Within each theme, perceptions of interpersonal connections shifted over time. DISCUSSION AND IMPLICATIONS: Findings suggest diverse social connection experiences among older adults, yet general patterns of strong social connections and adaptation over time. Future research should build upon these findings to better understand older adults' social needs and seek to explore ways to best foster social connections during instances of forced social isolation or historical crises.

Menstruation Experiences of Middle and High School Students in the Midwest: A Pilot Study.

The purpose of this pilot study was to expand understanding of the experience of menstruation for girls in the United States and its impact in the school setting. A qualitative approach was used to gather data from focus group interviews. Descriptive content analysis was used to categorize the range and types of menstruation experiences described by 12 participants aged 12-16 years. Findings revealed four main themes: (1) learning about menstruation, (2) experiencing menstruation, (3) managing menstruation, and (4) social norms and meaning of menstruation. Participants described multiple challenges faced learning about and experiencing menstruation, especially in the school setting. Participants described the limited understanding of menstruation experiences and confusion about the use of menstrual hygiene products. Challenges experienced at school included not having adequate access to menstrual hygiene products, limited time for changing products, fear of leaking menstrual blood, and impacts on school attendance. School nurses are well-positioned to contribute to creating school environments that are supportive of menstruation.

Older Adults' Loneliness in Early COVID-19 Social Distancing: Implications of Rurality.

OBJECTIVES: Older adults face greater health risks due to coronavirus disease 2019 (COVID-19), yet preventative social distancing measures may cause increased social isolation, potentially heightening risk of loneliness. In this mixed-methods study we examine changes in older adults' loneliness due to social distancing, explore variability in perceptions, and identify whether such changes differ by rurality. METHODS: A Midwestern sample of 76 older adults aged 70-97 (mean age = 82; 74% female; 95% White; 39% rural) completed a phone interview about their experiences with social distancing due to COVID-19. Interviews were conducted during early weeks of regional social distancing. Participants completed retrospective and current assessments of loneliness, including providing explanations of their responses. RESULTS: On average, loneliness increased during early social distancing, yet variability was evident. Those experiencing increased loneliness described a feeling of loss or lack of control, whereas those experiencing stability in loneliness identified adaptability in social connection modes or feeling accustomed to social isolation. Rural older adults experienced a significantly smaller increase in loneliness than their nonrural counterparts. DISCUSSION: These findings suggest nuanced experiences among older adults, but generally negative implications for loneliness. Interventions to address older adults' social isolation and loneliness during COVID-19 are warranted.

Teacher Perceptions of and Experiences with Student Menstruation in the School Setting.

BACKGROUND: Menstrual hygiene management is an important public health issue for adolescents. The objective of this study was to explore teacher perceptions and experiences addressing adolescent menstruation experiences at school and examine their perception of the impact of menstruation on student learning. METHODS: Teachers in a Midwest school district participated in an online survey about their perceptions of adolescent school-based menstruation experiences, including: experience and comfort-level with providing menstruation assistance, presence of menstrual products in classroom/office for students, perceptions about adolescent school-based menstruation experiences, and perceptions on the impact of menstruation on student learning. RESULTS: Two hundred and nine teachers participated in this study. Teachers perceived students' school-based menstruation experiences to be mostly negative, stressful, embarrassing, and focused on concealment. Teachers described school-based menstruation events as a distraction to learning and responded by offering emotional support and menstrual products, typically purchased by teachers. CONCLUSION: Teachers' negative perception of about menstruation and distractions in the classroom are amplified by social norms associated with overall menstruation-related stigma. Findings emphasize the importance of educating teachers on how to more positively address student menstruation experiences to foster a more supportive environment conducive to learning for these students.

Untapped Insight: A Longitudinal Qualitative Analysis of Older Adults' Advice During the COVID-19 Pandemic.

Background and Objectives: Due to a lifetime of experience, older adults are uniquely positioned to contribute advice and insight to others during a historical, societal crisis such as the coronavirus disease 2019 (COVID-19) pandemic. This qualitative study explores the solicited advice older adults offered their peers, family members, and communities throughout the first year of the pandemic. Research Design and Methods: A sample of 72 older adults aged 70-97 from Minnesota and North Dakota were asked what advice they would provide to others in June 2020 and again in April/May 2021. Participants were asked to provide advice on individual coping and how community members should support older adults during the pandemic, as well as how others should adjust after the pandemic. Responses were coded and developed into overarching themes. Results: Older adults advised others during the pandemic to foster mental and physical well-being, develop positive life perspectives, and connect to others as strategies to cope through the pandemic. Participants advised that after the pandemic people should remain vigilant, return to normal, and emerge as better people. Advice targeted to meeting the needs of older adults during the pandemic included: adopt selfless attitudes, take intentional actions, and maintain balance. A longitudinal approach revealed that advice remained consistent over time, despite the circumstances caused by COVID-19 changing. Discussion and Implications: Findings suggest that older adults utilize their life experiences and coping strategies as sources for drawing advice. These findings also suggest that older adults are sources of insight during crises. Future research should investigate additional advice older adults can offer and how willingly communities listen. Applied work should give older adults opportunities to provide far-reaching advice as well as develop interventions aimed at decreasing ageist perceptions of older adults in times of crisis.

Associations between oil development and sexually transmitted infections: Public health nurse perspectives.

BACKGROUND: Oil development (OD) has been associated with increased sexually transmitted infection (STI) rates, with limited focus on the North Dakota (ND) oil boom. Public health (PH) nurse experiences can provide context related to health challenges during OD-related population booms. OBJECTIVE: To compare reported STI rates in ND oil-producing (OP) and non-oil-producing (NOP) counties before, during, and after the oil boom and describe PH nurse experiences during this time. DESIGN: We conducted secondary data analysis of oil production data and reported rates for chlamydia and gonorrhea, and conducted interviews with ND PH nurses. SAMPLE: PH nurses within ND counties geographically located in or near OD in the state. MEASUREMENTS: ND county-level OD data trends were compared to similarly timed reported rates of chlamydia and gonorrhea in OP and NOP counties. PH nurse interviews were conducted addressing their STI-related experiences working in PH during the oil boom. RESULTS: Significant findings include a correlation between OD and gonorrhea rates. PH nurses described a limited PH infrastructure to meet the health needs of a transient, increasing population. CONCLUSIONS: Expanding the role of PH nurses in ND to implement STI screening and treatment would improve access to STI testing allowing for comprehensive reporting of STIs.

Lessons in Resilience: Initial Coping Among Older Adults During the COVID-19 Pandemic.

BACKGROUND AND OBJECTIVES: In addition to increased physical health risks, older adults may also experience risks to their mental health and social well-being due to coronavirus disease 2019 (COVID-19). Yet, older adults may be uniquely able to cope given their life experiences and coping mechanisms. This study explores older adults' coping experiences and strategies during the initial weeks of the COVID-19 pandemic. RESEARCH DESIGN AND METHODS: A Midwestern sample of 76 older adults aged 70-97 years completed a phone interview about their experiences with social distancing due to COVID-19. Interviews were conducted during the early weeks of regional social distancing (March 28-April 20, 2020). Participants rated their level of perceived coping and responded to open-ended questions about their daily life and coping. RESULTS: Mean perceived coping level (on a scale from 1 to 10) was 7.9, with 87% of participants rating their coping positively. Primary themes that emerged included (a) staying busy, (b) seeking social support, and (c) having a positive mindset. These emotion-focused coping strategies appeared adaptive in the early weeks of the pandemic for most older adults. DISCUSSION AND IMPLICATIONS: Contrary to predominant messaging about the vulnerability of older adults, these findings highlight the resilient nature of older adults in terms of their psychological coping and adaptability during COVID-19. Future research should build upon these findings to better understand and promote late-life coping during crises. Practitioners should seek to support older adults' engagement in such proactive coping, and social policies should be developed to acknowledge the variable needs of older adults.

Parental perceptions of child placement within vehicles: a focus group study.

Although rear-seating children in motor vehicles results in fewer injuries and fatalities in motor vehicle crashes, many children continue to be front-seated. This study seeks to identify parental barriers to rear-seating children in motor vehicles and strategies to increase child rear seat placement. Focus groups were conducted with parents of children 12 or younger to determine barriers to rear seating and strategies to increase child rear seat placement. Barriers to rear seat placement identified include the logistics of transporting multiple children with limited rear seat availability, the potential of children to harm themselves if rear-seated, and peer pressure. Parents felt there should be no option to sit elsewhere within the vehicle to help normalize rear-seating. Successful interventions to increase child rear seat placement should focus on parental barriers to rear-seat their children in vehicles, including normalizing rear seat placement, and determining approaches to make rear-seat placement with multiple children uncomplicated.

Risky Driving Behaviors for Older Adults: Differences by Veteran's Status.

Veterans are at an increased risk of being injured or killed in motor vehicle crashes, potentially due to their proclivity to engage in risky driving behaviors. However, most research in this area has focused on driving behaviors of veterans who have recently returned home after deployment. No research has focused on risky driving behaviors of older veterans (aged 65 or older) and if risky driving behaviors extend beyond the time period immediately following return from deployment. The purpose of this research is to determine if differences exist in risky driving behaviors of veterans and non-veterans aged 65 or older. This study used data from the 2011 National Health and Aging Trend Study (NHATS), a nationally representative, longitudinal survey of community-dwelling, Medicare beneficiaries aged 65 or older. Binary logistic regression analyses were conducted in 2017 to determine if veteran's status was predictive of specific risky driving behaviors. Veteran's status was found to be predictive of specific driving behaviors for adults aged 65 and older, with non-veterans significantly more likely than veterans to: not currently drive; avoid driving at night; avoid driving alone; avoid driving on busy roads or highways; and avoid driving in bad weather. The results of this study highlight the need to further understand the effects of veteran's status on risky driving behaviors among older adults, specifically, whether veteran's status compounds driving-related risks associated with aging-related physical and mental changes.

Differences in Child Passenger Safety Counseling Frequency and Attitudes by Health Care Provider Specialty.

Many children are not being properly restrained in motor vehicles, resulting in unnecessary injury and fatalities. Health care provider (HCP) education is effective at increasing proper child restraint within vehicles. However, differences exist by HCP specialty in regards to frequency of child passenger safety (CPS) counseling. This study of a sample of 255 HCPs examined differences in CPS counseling by HCP specialty (pediatric vs. non-pediatric). HCPs from several upper Midwest states were surveyed about how frequently they provide CPS counseling in their practice by patient age and their attitudes toward CPS-related issues. Pediatric HCPs were twice as likely as non-pediatric HCPs to always provide CPS counseling to parents/guardians of children aged 5 or older. Non-pediatric HCPs were more likely than pediatric HCPs to feel that counseling is ineffective at increasing child seat/booster (p = 0.001) or seat belt use (p = 0.006). Non-pediatric HCPs were more likely than pediatric HCPs to feel there is inadequate time to provide CPS counseling in their practice setting (p = 0.001), and were less likely to know where to refer patients if they have questions regarding CPS issues (0.0291). The differences in HCP attitudes toward CPS counseling provision and the resulting differences in counseling frequency by patient age may contribute to disparities for patients who have limited or no access to pediatric HCPs. Additional research is needed to investigate the rationale for counseling differences seen by HCP specialty and patient age, and the potential effect on child motor vehicle injuries and fatalities.

Predictors of health care provider anticipatory guidance provision for older drivers.

OBJECTIVE: The objective of this study was to determine the frequency of health care provider (HCP) driving safety/cessation-related anticipatory guidance provision and predictors of driving safety-related anticipatory guidance provision by HCPs. METHODS: HCPs in several central/upper Midwest states were surveyed about frequency of anticipatory guidance provision (n = 265). RESULTS: More than half of HCPs stated that they frequently or always provide driving safety/cessation-related anticipatory guidance to patients aged 85 or older, 38.7% provided this guidance to patients aged 75 to 84, and 13.7% to patients aged 65 to 74. Predictors of driving safety/cessation-related anticipatory guidance provision differed by patient age. For patients aged 65-74, HCP personal experience with a motor vehicle crash (either the HCP themselves or a friend/family member) was significant in predicting anticipatory guidance provision. However, for patients aged 75 and older, significant predictors included HCP rural practice, HCP age, and percentage of HCP patients who were older adults. CONCLUSION: HCP counseling provision related to driving issues differs by patient age and several HCP characteristics, including HCP rurality, age, and personal experience with motor vehicle crashes. Because aging results in physical and mental changes that affect driving and can be identified by HCPs, HCPs are in a position to counsel patients on the potential impacts of aging on the act of driving. Future research should examine the reasons for the differences in anticipatory guidance provision found in this study.

Health Care Provider Mobility Counseling Provision to Older Adults: A Rural/Urban Comparison.

The current study examined rural-urban differences in health care provider (HCP) perceptions, attitudes, and practices related to driving safety/cessation-related anticipatory guidance provision to older adults. A cross-sectional survey was conducted with HCPs in several north central states. Exploratory factor analysis was used to examine dimensions of HCP perceptions and attitudes related to mobility counseling. Binary logistic regression analyses were conducted to determine if HCP rurality was significantly predictive of HPC provision of mobility counseling by age. Rural HCPs were less likely than urban HCPs to provide mobility counseling to their patients aged 75 or older. Rural HCPs were less likely to refer patients to a driving fitness evaluation resource if they had questions related to driving issues, and were less likely to perceive there were adequate resources to help with driving issues. Rural-urban differences in HCP mobility counseling provision may contribute to potential health disparities between urban and rural patients. Both rural and urban HCPs need training about older driver issues, so they may educate their patients about driving safety/cessation. Future research should examine the association between rural-urban differences in HCP mobility counseling provision and rural older adult overrepresentation in motor vehicle injuries and fatalities statistics.

Socioeconomic differences in the menopausal experience of Chinese women.

OBJECTIVE: This study explores the effect of employment status, occupation and education on menopausal symptoms experienced by women in an urban community in China. STUDY DESIGN: Cross-sectional survey. MAIN OUTCOME MEASURES: Menopausal symptoms, medication/supplement use to relieve menopausal symptoms, sociodemographic variables. RESULTS: Risks for more burdensome menopausal symptoms include less education, non-white collar occupation and unemployment/retirement status. Being employed in a white collar occupation and having higher formal education were protective for hot flashes, dry skin/eyes, heart palpitations and insomnia and were associated with increased usage of medication to alleviate menopausal symptoms. CONCLUSIONS: As Chinese women age and continue working longer, they will spend increasing amounts of time postmenopausal and in the workplace. The development of worksite-based health programmes would be advantageous to female workers of menopausal age in China.

Front versus rear seat placement of children aged 12 or younger within vehicles: a rural/urban comparison in North Dakota.

OBJECTIVE: Research has shown that rear-seated children are 36 to 40 percent safer than front-seated children. Because of the substantial differences in traffic safety culture that appear to exist in rural areas and the limited research regarding seat placement and rurality, this study seeks to contribute to the safety literature by determining at what rate children are riding in the front seat and whether differences exist between rural and urban areas in regards to child front seat placement. METHODS: Current child placement frequencies within vehicles were ascertained through direct observations of morning child drop-offs at randomly selected urban and rural elementary schools in eastern North Dakota during November and December of 2009, with a focus on children aged 12 or younger. Two observers wearing orange safety vests and carrying observation sheets were stationed at each elementary school a minimum of 45 min prior to each school's designated start time. Based on the vehicles that entered the school's parking lot/drop-off circle and from which a minimum of one child exited, observers were instructed to record vehicle type, presence of children in the front seat appearing to be younger than 13 years old, availability of room in the back seat, and placement of other children in the vehicle. RESULTS: During November and December of 2009 a total of 537 vehicles were observed at urban schools and 150 vehicles were observed at rural schools. Of the 537 vehicles observed at urban schools, 28.7 percent had children seated in the front seat, whereas 41.3 percent of the 150 vehicles observed at rural schools had front-seated children. Significant urban/rural differences exist in child seat placement, with vehicles in rural areas much more likely to be carrying front-seated children than vehicles in urban areas. CONCLUSIONS: Based on a sample of vehicles observed at urban and rural elementary schools in North Dakota, the results of this study indicate that there are significant rural/urban differences in child seat placement.