Association between e-cigarette use and depression in US cancer survivors: a cross-sectional study.

PURPOSE: Though prior studies have observed significant association between e-cigarette use and mental health outcomes including depression in the general population, the relationship between e-cigarette use and clinical depression in the cancer survivor subpopulation is unknown. The purpose of this study was to examine the cross-sectional association between e-cigarette use and self-reported clinical depression among cancer survivors. METHODS: Pooled data from the 2017 and 2018 Behavioral Risk Factor Surveillance Survey were used. Multivariable logistic regression was used to analyze the independent association between e-cigarette use and self-reported clinical depression in a sample of 7,498 cancer survivors. RESULTS: Among cancer survivors in this study, 22.1% reported a history of clinical diagnosis of depression. The overall prevalence rates for current and former e-cigarette use were 2.6% and 10.5%, respectively. Analysis showed 51.3% of current users, 40% of former users, and 19.1% of those who had never used e-cigarettes self-reported a history of clinical depression. In the multivariable analysis, the odds of self-reported clinical depression were significantly higher for survivors who were current users (OR = 2.85; 95% CI: 1.38-5.90) and former users (OR = 1.63; 95% CI: 1.05-2.55) compared to never e-cigarette users. CONCLUSION: Findings from this study suggest a statistically significant association between e-cigarette use and depression in cancer survivors. Future studies should focus on examining the longitudinal association between e-cigarette use and depression in cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Study findings reemphasized the need for interventions to support cancer survivors with evidence-based treatments for depression as well as the need for clinicians to screen for psychological distress and/or e-cigarette use and make appropriate recommendations.

Electronic assistive technology use and supported employment.

BACKGROUND: Level of electronic assistive technology use by people with intellectual disabilities is lower than for other disability groups. METHODS: In this mixed-methods exploratory study during the pandemic, staff (online survey) and executive administration (focus group) from a regional supported employment service provider in the Midwest US were surveyed about use of and barriers to use of electronic assistive technology for their clients with intellectual disabilities. RESULTS: Forty percent of staff reported 'not' using any of the assistive technologies with their clients. Executive administration perceived that they should be providing technology resources to clients and staff. Both groups rated expense, access, and complexity as barriers to assistive technology use at the client's worksite. CONCLUSIONS: Identifying the types of assistive technologies that can be most easily accessed and most cost-effective, including lower-cost consumer market devices, as employment supports for people with intellectual disabilities may be a first step in helping to overcome perceived barriers to use.

Association between E-cigarette use and chronic obstructive pulmonary disease in non-asthmatic adults in the USA.

BACKGROUND: Concern about the health impacts of e-cigarette use is growing; however, limited research exists regarding potential long-term health effects of this behavior. This study explored the relationship between e-cigarette use and COPD in a sample of US adults. METHODS: A secondary data analysis using data from the 2018 Behavioral Risk Factor Surveillance Survey in the USA was computed to examine associations between e-cigarette use and COPD controlling for conventional cigarette smoking status, past month leisure physical activity and demographic characteristics including age, sex, education, race, marital status and body mass index. RESULTS: Significant associations between e-cigarette use and COPD among former combustible cigarette smokers and those who reported never using combustible cigarettes were found. Compared with never e-cigarette users, the odds of having COPD were significantly greater for daily e-cigarette users (OR = 1.53; 95% CI: 1.11-2.03), occasional users (OR = 1.43, 95% CI: 1.13-1.80) and former users (OR = 1.46 95% CI: 1.28-1.67). CONCLUSIONS: Findings from this study indicate a potential link between e-cigarette use and COPD. Further research to explore the potential effects of e-cigarette on COPD is recommended.

Effect of a rapid e-learning module and brief interprofessional simulation event on medical and nursing student collaborative attitudes and behaviors.

Objectives Undergraduate nursing and first-year medical students participated in a brief, scenario-based, interprofessional event. The experimental group only was provided an innovative, rapid e-learning instructional module focused on interprofessional roles/responsibilities and communication prior to the event. Methods Pre-post attitudes toward physician-nurse collaboration were surveyed, and collaborative behaviors were observed during the event. Results For the experimental group, a statistically significant (p<0.05) attitude improvement was found between pre-post e-learning module scores as well as pre-e-learning module and post-simulation event scores. For the control group, a statistically significant (p=0.001) attitude improvement was found between pre-post simulation event scores. No statistically significant differences in team collaborative behaviors were observed between experimental and control. Conclusions The combination of module and simulation event was not a more effective option than the event alone. As both interventions present unique challenges in regards to technology and facility requirements, having multiple effective intervention options will be of benefit to educational institutions.

Rapid E-Learning for professional development in school-based diabetes management.

The number of school aged youth in the United States requiring assistance in the management of diabetes has reached over 200,000. School nurses are often charged with the training of personnel and provision of assistance to children with this chronic disease. The need for quick, efficient, and accessible training methods is necessary to ensure school nurses have the most current information necessary to perform their duties. The purpose of this study was to assess the effectiveness of a rapid e-learning module for school nurse professional development in school-based diabetes management. A sample (N = 1977, n = 1127) of school nurses was asked to complete a module addressing current and/or changing information on diabetes management, the training of staff charged with assisting students, and the associated pre- and post-tests for the module. A total of 678 nurses completed the pre-test, while 449 nurses completed the post-test. T-test results for independent samples indicated a significant increase (p < 0.001) in knowledge at post-test. Results support the contention that e-modules are a convenient and effective way to provide professional development opportunities and improve nurses' knowledge.

Factors Associated with School Nurses' and Personnel's Professional Practice to Encourage Parents to Vaccinate Against Human Papillomavirus.

BACKGROUND: School nurses and personnel play a vital role in promoting the human papillomavirus (HPV) vaccine. The purpose of this study was to identify factors associated with school nurses' and personnel's professional practice to provide parents with HPV vaccine information and to encourage parents to vaccinate their child against HPV. METHODS: School nurses and personnel from Ohio and Missouri completed a survey to assess their professional practice in providing HPV vaccine information and encouraging parents to vaccinate their child against HPV. Independent variables included demographics, HPV knowledge/attitudes, perceptions of their as an opinion leader for the HPV vaccine, self-efficacy to provide vaccine education, and perception of school district support. RESULTS: Providing parents with HPV vaccine information was predicted by age, role within the school, grade-serving, knowledge, perceptions, self-efficacy, and district support; accounting for 38% of the variance (p < .000, R2 = .38). Encouraging parents to vaccinate their child against HPV was predicted by perception, self-efficacy, and grade-serving; accounting for 39% of the variance (p < .000, R2 = .39). CONCLUSIONS: To enhance school nurses' and personnel's professional practice, interventions should focus on nurses' and personnel's perception of their role as opinion leaders and self-efficacy to provide HPV education and vaccine recommendation.

Public Health and School Nurses' Perceptions of Barriers to HPV Vaccination in Missouri.

Human Papilloma Virus (HPV) is associated with various forms of cancer and is preventable with vaccination. Nurses are in a unique position to directly influence a person's decision to receive the HPV vaccine. A statewide sample of both school and public health nurses was used to assess knowledge and attitudes related to the HPV vaccine as well as nurse's behaviors and behavioral intentions toward educating parents and recommending the vaccine. Positive attitudes and adequate knowledge levels were found, however, the majority of school nurses did not provide information and resources to parents. Targeted health promotion programs for school nurses are recommended.

An interprofessional education program's impact on attitudes toward and desire to work with older adults.

BACKGROUND: Insufficient numbers of health professions students aspire to work with the increasing numbers of the elderly. Although programs exist to promote interest in serving this population, inadequate numbers of health professionals remain an issue. METHODS: This study sample consisted of medical (n = 75) and health profession students (n = 210) enrolled in a semester-long interprofessional clinical education program designed to enhance interprofessional teamwork and provide positive exposure to elderly in the community. Each team of three visited an assigned elder three times during the semester. Students were acquainted with their elder and also administered a comprehensive geriatric physical and socioemotional battery of assessments. After each visit, the teams met and held a debriefing with faculty. Attitudes toward older adults and the desire to work with older adults were assessed using the Carolina Opinion of Care of Older Adults. The survey was administered twice: before initiating the semester-long program and immediately after program completion. RESULTS: Total score and subscale scores were compared pre- and post-experience. Scores on the subscale "Early Interest in Geriatrics" were significantly higher postexperience compared to pre-experience. Scores on the remaining subscales and the total score remained unchanged. DISCUSSION: Results indicate that exposure to elderly adults may increase the interest in working with this population and does not diminish attitudes toward the elderly. Longer exposure may be needed to invoke attitudinal changes across additional subtests.

Translating interprofessional theory to interprofessional practice.

Although interprofessional collaborative activities for health professions students have demonstrated increased knowledge of professional roles, interprofessional attitudes and confidence, and team skills; traditional professional role patterns and lack of professional role understanding are still prevalent among health professions students and may continue into professional practice. Between 1 and 10years after they completed their undergraduate studies, practicing community/public health education professionals and registered nurses who participated in an interprofessional patient home-visiting curriculum as undergraduates were surveyed. Most reported current positive attitudes and perceived collaborative abilities regarding interprofessional collaboration. On their perceived interprofessional collaborative abilities, however, community/public health education participants scored significantly higher (t(143)=-2.53, p=0.01) than registered nurse participants. Although it is difficult to generalize the findings from this study to other interprofessional curriculum models, it seems that this curriculum that concentrated on teamwork behaviors and abilities may have contributed to participants' positive translation of interprofessional theory to interprofessional practice.

Effects of an Online Educational Module on School Nurses' Knowledge of HPV Vaccination.

BACKGROUND: Results of a previous state-wide survey revealed generally low knowledge levels about HPV vaccination among school nurses in Missouri. A short, online educational module targeted to address the specific low-scoring items was then created. METHOD: All 440 lead school nurses in Missouri were invited by e-mail to participate in an online HPV educational module and study. The e-mail contained a link to the module that included a consent form, a test, and a downloadable completion certificate. The test consisted of 12 multiple choice and true-or-false items based directly on the content contained in the module. An independent samples t test was used to determine pre-post differences in mean test scores. RESULTS: Scores improved significantly (p < .05) pre-post intervention; however, surveillance or epidemiology-related questions were still commonly missed. CONCLUSION: Using brief, targeted, online trainings to improve knowledge of specific health-related content may be a practical option for busy school nurses. J Contin Educ Nurs. 2017;48(9):431-436.

Practices and Attitudes of Missouri School Nurses Regarding Immunization Records and Select Immunizations of Graduating High School Seniors.

School nurses play a key role in maintaining a healthy student population, and one of their roles includes maintaining vaccination records. Further, they can play an important role in advocating for human papillomavirus (HPV) and meningococcal vaccination for students. All Missouri public high school nurses were sent an electronic survey addressing the knowledge, attitudes, and practices regarding immunization records and HPV and meningococcal vaccination of high school seniors. Approximately 75% of nurses reported their schools did not have or they did not know if the school had a written policy regarding the release of vaccination records. Approximately 1/2 and 1/3 of nurses do not communicate with parents/students about HPV or meningococcal vaccines, respectively. Although most favorable toward meningococcal, nurses had positive attitudes toward both vaccines. Recommendations include establishment of written policies regarding vaccination record release, and future research should focus on evaluating school nurses' communication methods regarding HPV and meningococcal vaccination.

Level of Integration of Community Health Workers in Missouri Health Systems.

The purpose of this study was to describe the level of integration of community health workers (CHWs) into Missouri public healthcare systems using a cross-sectional survey research design. Representatives of all Missouri Local Public Health Agencies, Rural Health Clinics, and Federally Qualified Health Centers were pre-contacted by telephone to provide the electronic mail of the most knowledgeable person in the facility/location to complete a brief electronic survey on their use of CHWs. 103 representatives of the 273 (37.7% response rate) contacted from the health systems completed the Profile of Community Health Workers in Missouri Health Systems to assess role, professional development, and information needs of CHWs used in the key informants' agencies. An Abridged Survey was created for participants who responded to the survey but indicated that CHWs were not currently working for their organization. Descriptive statistics and measures of central tendency were computed. Only 16% (16/103) of participants noted that CHWs were employed in their organizations; and most CHWs connected people with services, served low-income and rural populations, and addressed heart disease issues. Participants who did not currently employ CHWs indicated they did not anticipate needing them in the near future. Of those utilizing CHWs, most perceived CHWs have a vital role in healthcare (M = 4.27/5.0, SD = 0.64) but securing sustainable funding for CHWs was challenging (M = 4.18/5.0, SD = 0.87). Utilization of CHWs in Missouri healthcare systems is limited. If their role in Missouri healthcare systems is to expand, a campaign to educate on their role and value is needed.

Employee Perceptions of Their Organization's Level of Emergency Preparedness Following a Brief Workplace Emergency Planning Educational Presentation.

A brief emergency planning educational presentation was taught during work hours to a convenience sample of employees of various workplaces in Northern Missouri, USA. Participants were familiarized with details about how an emergency plan is prepared by management and implemented by management-employee crisis management teams - focusing on both employee and management roles. They then applied the presentation information to assess their own organization's emergency preparedness level. Participants possessed significantly (p < 0.05) higher perceptions of their organization's level of emergency preparedness than non-participants. It is recommended that an assessment of organizational preparedness level supplement emergency planning educational presentations in order to immediately apply the material covered and encourage employees to become more involved in their organization's emergency planning and response. Educational strategies that involve management-employee collaboration in activities tailored to each workplace's operations and risk level for emergencies should be implemented.

Effect of interprofessional clinical education programme length on students' attitudes towards teamwork.

This article reports on a study involving a range of health professions students who participated in similar one-semester (short) or two-semester (long) interprofessional clinical education programmes that focused on clinical assessment of senior citizens living independently in the community. Students' attitudes towards teamwork skills and perceptions of their own teamwork skills both before and after the programmes were assessed using two validated scales. Osteopathic medical student participants reported no significant changes in attitudes towards interprofessional healthcare teamwork skills or their perceptions of their own interprofessional teamwork skills after either the one- or two-semester programmes. For athletic training, speech-language pathology, exercise sciences, public health, and nursing students, though, attitudes towards teamwork skills significantly improved (p < .05) after the one-semester programme; and perceptions of their own team skills significantly improved (p < .05) after both the one- and two-semester programmes. Overall, this study provides some support for interprofessional teamwork attitude change, but with a significant difference between medical as compared to nursing, allied health, and public health students.

Influence of professional preparation and class structure on sexuality topics taught in middle and high schools.

BACKGROUND: This study examined the impact of professional preparation and class structure on sexuality topics taught and use of practice-based instructional strategies in US middle and high school health classes. METHODS: Data from the classroom-level file of the 2006 School Health Policies and Programs were used. A series of multivariable logistic regression models were employed to determine if sexuality content taught was dependent on professional preparation and /or class structure (HE only versus HE/another subject combined). Additional multivariable logistic regression models were employed to determine if use of practice-based instructional strategies was dependent upon professional preparation and/or class structure. Years of teaching health topics and size of the school district were included as covariates in the multivariable logistic regression models. RESULTS: Findings indicated professionally prepared health educators were significantly more likely to teach 7 of the 13 sexuality topics as compared to nonprofessionally prepared health educators. There was no statistically significant difference in the instructional strategies used by professionally prepared and nonprofessionally prepared health educators. Exclusively health education classes versus combined classes were significantly more likely to have included 6 of the 13 topics and to have incorporated practice-based instructional strategies in the curricula. CONCLUSIONS: This study indicated professional preparation and class structure impacted sexuality content taught. Class structure also impacted whether opportunities for students to practice skills were made available. Results support the need for continued advocacy for professionally prepared health educators and health only courses.

Food safety education: child-to-parent instruction in an immigrant population.

A quasi-experimental pretest-posttest design was used to examine increases in food handling knowledge among eastern European refugee restaurant candidates as a result of educational material taught either by the employee's child or the Salt Lake Valley Health Department. Participants were nonrandomly assigned to a study (n = 15) or control group (n = 17). The study group was taught by their children in their native language. The control group was taught by an SLVHD instructor in English. All participants completed pre- and posttests that measured four areas of food handling knowledge: personal hygiene and hand washing (PHHW), cooking and holding time/temperature (COOKTT), cooling and holding time/temperature (COOLTT), and cross-contamination (CC). Both groups demonstrated a significant increase in knowledge of PHHW, but only the study group demonstrated significant improvements in COOKTT and CC knowledge. These study results suggest that food handling education programs are effective in increasing knowledge and mode of delivery may be an important factor.

Health contract with sedentary older adults.

PURPOSE: Health educators used health contracts with sedentary older adults for the purpose of increasing exercise or physical activity. DESIGN AND METHODS: Two health educators helped 25 sedentary older adults complete health contracts, and then they conducted follow-up evaluations. The percentage of scheduled exercise sessions successfully completed by older adults was calculated. Participants were asked if each of five components of the health contract-motivation, goal setting, social support, memory techniques, and problem solving-was helpful in achieving their exercise goals. RESULTS: Of the 25 participants, 20 achieved at least 75% of their exercise goals and 15 had a 100% success rate. Most of the older adults reported that several behavioral, social, and cognitive strategies were helpful to them. IMPLICATIONS: This technique may be applied by health educators or clinicians in a variety of settings and can be focused on one of several potential risk factors.