Adult Vaccination.

Adult vaccination rates are low in the United States, despite clear benefits for reducing morbidity and mortality. Vaccine science is evolving rapidly, and family physicians must maintain familiarity with the most recent guidelines. The recommended adult immunization schedule is updated annually by the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention. All eligible patients should receive SARS-CoV-2 vaccines according to the current guidelines. Adults without contraindications should also receive an annual influenza vaccine. Hepatitis A vaccine is recommended for adults with specific risk factors. All pregnant patients, adults younger than 60 years, and those 60 years and older who have risk factors should receive a hepatitis B vaccine. A 15- or 20-valent pneumococcal conjugate vaccine is recommended for all patients who are 65 years and older. Patients who receive 15-valent pneumococcal conjugate vaccine should receive a dose of 23-valent pneumococcal polysaccharide vaccine one year later. Adults 19 to 64 years of age should receive a pneumococcal vaccination if they have medical risk factors. A single dose of measles, mumps, and rubella vaccine is recommended for adults without presumptive immunity, and additional doses are recommended for patients with HIV and postdelivery for pregnant patients who are not immune to rubella. A tetanus and diphtheria toxoids booster is recommended every 10 years. For pregnant patients and those in close contact with young infants, a tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis vaccine should be administered. The human papillomavirus vaccine is recommended for all people through 26 years of age. Herpes zoster vaccine is indicated for all adults 50 years and older. .

Attitudes and perceptions about cigarette smoking among nonsmoking high school students.

PURPOSE: To explore the association between cigarette smoking intention and attitude, subjective norm, and perceived behavioral control as identified by the Theory of Planned Behavior (TPB) in a cohort of nonsmoking teenagers. METHODS: A convenience sample of 76 nonsmoking students from a rural Northeastern Pennsylvania high school completed a self-administered questionnaire based on the TPB, which included cigarette smoking behavior, intention, and the direct measures of attitude, subjective norm, and perceived behavioral control. CONCLUSIONS: Regression analyses demonstrated that all three independent variables (attitude, subjective norm, and perceived behavioral control) contributed significantly to the respondents' intention to not smoke cigarettes, accounting for 64% of the variance. These findings may have implications for promoting nonsmoking behavior. IMPLICATIONS FOR PRACTICE: This is the first study to examine the efficacy of the TPB in predicting the intention to not smoke in a cohort of all nonsmokers. The intention to not smoke was significantly correlated with the respondents' negative general attitudes toward cigarette smoking, belief that significant others would disapprove of their cigarette smoking, and positive tobacco refusal self-efficacy. Understanding the factors associated with nonsmoking behavior in teenagers is important information for nurse practitioners, as we develop strategies to encourage and reinforce cigarette smoking abstinence.

Interprofessional Graduate Students' Perspectives on Caring for Vulnerable Populations.

The purpose of this focus group study was to explore graduate students' clinical experiences with vulnerable populations, perceived barriers to care, and ethical issues related to caring for disenfranchised groups. Furthermore, based on their experiences, the students were asked to share suggestions for curricular changes that could enhance care for vulnerable populations through interdisciplinary collaboration and multidisciplinary projects. The responses of the participants add to what is known about the care of vulnerable populations, offering a first-hand description of students' preparation for work with vulnerable populations and the interdisciplinary team.

An examination of ethnic differences in cigarette smoking intention among female teenagers.

PURPOSE: To describe and compare predictors of cigarette smoking intention, as defined by the theory of planned behavior, among African American, Puerto Rican, and non-Hispanic white female teenagers. DATA SOURCES: A convenience sample of 430 English-speaking female teenagers (141 African American, 146 Puerto Rican, and 143 non-Hispanic white teenagers), aged 13-19 years, who were patients at family planning clinics in eastern Pennsylvania. The data were obtained through a self-administered questionnaire. CONCLUSIONS: Regression analyses demonstrated attitude, subjective norm, and perceived behavioral control predicted 70% of the variance in smoking intention in African American, 69% in Puerto Rican, and 88% in non-Hispanic white teenagers. In addition, ethnic group differences were identified. For African Americans, smoking intention was mediated principally by perceived behavioral control, whereas for Puerto Rican and non-Hispanic white teenagers, attitudes were the greatest predictor of intention to smoke. Moreover, non-Hispanic white smokers had a stronger intention to smoke than either the African American or Puerto Rican smokers. IMPLICATIONS FOR PRACTICE: Cigarette smoking is the leading preventable cause of death in the United States, with the majority of smokers initiating the habit in their teen years. Nurse practitioners are in key positions to counsel young women about the dangers of smoking. The identification of cultural-specific predictors of smoking will assist in the development of tailored antismoking messages.