Associations of physician burnout with organizational electronic health record support and after-hours charting.

In 2017, 43.9% of US physicians reported symptoms of burnout. Poor electronic health record (EHR) usability and time-consuming data entry contribute to burnout. However, less is known about how modifiable dimensions of EHR use relate to burnout and how these associations vary by medical specialty. Using the KLAS Arch Collaborative's large-scale nationwide physician (MD/DO) data, we used ordinal logistic regression to analyze associations between self-reported burnout and after-hours charting and organizational EHR support. We examined how these relationships differ by medical specialty, adjusting for confounders. Physicians reporting ≤ 5 hours weekly of after-hours charting were twice as likely to report lower burnout scores compared to those charting ≥6 hours (aOR: 2.43, 95% CI: 2.30, 2.57). Physicians who agree that their organization has done a great job with EHR implementation, training, and support (aOR: 2.14, 95% CI: 2.01, 2.28) were also twice as likely to report lower scores on the burnout survey question compared to those who disagree. Efforts to reduce after-hours charting and improve organizational EHR support could help address physician burnout.

Associations Between Risk Perceptions and Cigarette, E-cigarette, and Dual-Product Use Among Canadian Adolescents.

INTRODUCTION: The popularity of e-cigarettes has increased significantly in recent years. E-cigarettes are perceived as less harmful than cigarettes, and both dual-use of cigarette and e-cigarette use is common among adolescents. This study assessed cigarette and e-cigarette risk perception and associations with dual-product use among Canadian adolescents. METHODS: We used data from the 2016-2017 Canadian Student Tobacco, Alcohol, and Drugs Survey. Perceived risks of cigarette and e-cigarette use were classified into 4 categories: "high-risk perception," "high-e-cigarette-risk and low-cigarette-risk perception," "low-e-cigarette-risk and high-cigarette-risk perception," and "low-risk perception." Adjusted odds ratios (aOR) were estimated from multinomial logistic regression. RESULTS: Of the population, 92% perceived high risk from cigarettes, and 65% from e-cigarettes. Compared to students with low-risk perception, those with high-risk perception of both products had lower odds of dual-use (aOR: 0.21; 95% confidence interval [CI]: 0.15, 0.28), cigarette-only use (aOR: 0.33; 95% CI: 0.25, 0.45), and e-cigarette-only use (aOR: 0.64; 95% CI: 0.51, 0.79) relative to nonusers. Adolescents with high-e-cigarette and low-cigarette-risk perception had higher odds of e-cigarette-only use, relative to nonusers. Those with high-risk perception were more likely to be e-cigarette-only users relative to cigarette-only users. CONCLUSION: Results highlight that high perceived risk is associated with lower odds of use. However, those with a high-risk perception of both products had higher odds of e-cigarette use relative to cigarette-only users; as did those with high-e-cigarette and low-cigarette-risk perception, relative to nonusers. Future research should assess ways of communicating the risks of adolescent tobacco use.

Psychological well-being and dual-use of cigarettes and e-cigarettes among high school students in Canada.

BACKGROUND: Cigarette and e-cigarette use are prevalent among Canadian adolescents. Evidence shows psychiatric comorbidity with adolescent cigarette smoking, but little is known about psychological well-being among dual users of e-cigarettes and cigarettes. This study examined the association between dual-use status and psychological well-being among high school students. METHODS: We used the 2016-2017 Canadian Student Tobacco, Alcohol, and Drugs Survey. Scales of psychological well-being (relatedness, autonomy, competency, prosocial behavior, and social responsiveness) were derived from self-reported data. Dual-use status was categorized into non-users, cigarette-only smokers, e-cigarette-only users, and four types of dual-users. Multivariable linear regression models examined the association between dual-use and psychological well-being. RESULTS: Among the participants, 6.3% were current dual-users, 4.1% were cigarette-only smokers, 12.6% were e-cigarette-only users, and 77.0% were non-users. Compared to non-users, relatedness and social responsiveness were lower for all users. When compared to e-cigarette users, most other users had lower relatedness (high-frequency dual-users [ß=-6.05], high-frequency cigarette dual-users [ß=-2.27], high-frequency e-cigarette dual-users: [ß=-1.32], low-frequency dual-users [ß=-1.91], and cigarette-only smokers [ß=-1.66]) and social responsiveness. High-frequency dual-users had lower scores for relatedness and social responsiveness, while high-frequency cigarette dual-users had higher autonomy, compared to low-frequency dual-users. CONCLUSION: Dual-users had poorer psychological well-being, which differed among dual-user sub-groups. This study highlights an opportunity for specialized programs to promote psychological well-being and reduce tobacco product use among adolescents. LIMITATIONS: The study is based on respondent self-report, and the use of cross-sectional data precludes us from determining the temporal order between dual-use and psychological well-being.

Single cigarette purchasers among adult U.S. smokers.

Cigarette smoking remains the leading preventable cause of morbidity and mortality. The purchase of single cigarettes, known as loosies, allows for a more affordable cost than a pack of cigarettes. Many of the existing studies on loose cigarettes have used a small non-generalizable sample. This study examined the sociodemographic characteristics of loosie purchasers among adult cigarette smokers in the United States. Data from the 2006/07-2014/15 Tobacco Use Supplement to the Current Population Survey were analyzed. The sociodemographic characteristics of loosie users were examined by multivariable logistic regression. In 2014-2015, approximately 5.4% of adult smokers reported purchasing loosies compared to 3.7% in 2006-2007. Men (OR 1.22, 95% CI 1.10-1.35), non-Hispanic Blacks (OR 3.30, 95% CI 2.89-3.77), Hispanics (OR 1.97, 95% CI 1.67-2.32), and those living in a metropolitan area (OR 1.16, 95% CI 1.02-1.33) had significantly higher odds of single cigarette purchase. Single cigarette use also varied by age, marital status, employment, and geographic region. Menthol cigarette smokers had higher odds of purchasing loosies compared to non-menthol smokers. Likewise, cigarette quit intention was significantly associated with odds of buying loosies. The prevalence of single cigarette purchases among smokers appears to be lower in a national sample compared to previous estimates reported in specific populations. However, certain subpopulations were more likely to purchase a single cigarette and may contribute to persistent disparities among racial and ethnic minorities. Preventing the sale of loosies may improve the health outcomes of underserved communities, specifically those with low socioeconomic status.

Maternal Employment Status and Minimum Meal Frequency in Children 6-23 Months in Tanzania.

As women in developing world settings gain access to formal work sectors, it is important to understand how such changes might influence child nutrition. The purpose of this paper is to examine the relationship between maternal employment status and minimum meal frequency (MMF) among children in Tanzania. Interviews were conducted with 5000 mothers of children ages 0⁻23 months. The questionnaire used in these interviews was developed by adopting questions from Tanzania's latest Demographic and Health Survey (2015⁻2016) where possible and creating additional questions needed for programmatic baseline measurements. MMF was used as proxy for child nutrition. Logistic regression analyses were used to identify associations between employment status and parenting practices of Tanzanian mothers and MMF of their children. After adjusting for confounders, informal maternal employment [OR = 0.58], lack of financial autonomy [OR = 0.57] and bringing the child with them when working away from home [OR = 0.59] were negatively associated with meeting MMF. Payment in cash [OR = 1.89], carrying food for the child [OR = 1.34] and leaving food at home for the child [OR = 2.52] were positively associated with meeting MMF. Informal maternal employment was found to be negatively associated with meeting MMF among Tanzanian children. However, behaviors such as bringing or leaving prepared food, fiscal autonomy and payment in cash showed significant positive associations. These findings could help direct future programs to reduce child stunting.