College students mandated to substance use courses: Age-of-onset as a predictor of contemporary polysubstance use.

Objective: College campuses report alcohol and other drug policy violations as the most frequent reason students receive disciplinary referrals and, thus, are mandated to programming. This study sought to determine predictors of mandated students' alcohol use frequency, and the likelihood of early-onset alcohol using college students enrolled in mandated programming engaging in current polysubstance use. Methods and participants: Employing a purposive sampling method, n = 822 participants were recruited from a pool of students who violated their university's alcohol policy between October 2019 and July 2021. Results: Data analysis revealed early-onset alcohol use (p < .001), gender ID (p < .01), Greek Affiliation (p < .001), ethnicity (p < .05), and perceived norms (p < .001) significantly predicted alcohol frequency. Analysis also revealed engaging in early-onset alcohol use significantly predicted current participation in polysubstance use (p < 0.01), outside of controls. Conclusions: University programs should consider exploring polysubstance use targeted interventions to mitigate these harmful behaviors and associated negative consequences.

Intentions of Kentucky School Nurses to Delegate Diabetes-Related Tasks to Unlicensed Assistive Personnel.

Many children have diagnosed diabetes that must be safely managed at school. New laws have created the potential for school systems to rely more heavily on unlicensed assistive personnel (UAP) than on nurses to deliver health services, including administration of insulin injections. Using the theory of planned behavior as a framework, aims were to (1) determine the nature and extent to which health services related to diabetes were being delegated to UAP in Kentucky schools, (2) describe the attitudes of Kentucky school nurses regarding the delegation of diabetes health services to UAP, and (3) examine the relationship of selected variables to school nurses' intentions to delegate diabetes health services. Survey results revealed that school nurses in Kentucky intended to delegate some diabetes-related tasks despite their lack of support for delegation of those tasks.

The Theory of Planned Behavior and the USDA Summer Food Service Program.

OBJECTIVE: Examine the impact of the Summer Food Service Program (SFSP) on the intentions to positively change fruit and vegetable consumption in a rural, low-income adolescent population using the Theory of Planned Behavior. DESIGN: Quantitative data collected via a pre-post intervention survey to determine predictors of positive nutrition behaviors and changes in self-reported fruit and vegetable consumption. SETTING: A mid-sized university. PARTICIPANTS: Fifty-seven high school students. Participants were primarily female (n = 36) and white (n = 56). INTERVENTION: Participants followed the standards of the SFSP for 5 weeks and were provided with mandatory and optional nutrition education sessions. MAIN OUTCOME MEASURE: Intentions to change nutrition behaviors. ANALYSIS: Multiple regression. RESULTS: Paired-sample t test showed a significant increase in knowledge from pretest (mean [M] = 11.18, SD = 1.68) to posttest (M = 12.91, SD = 1.76); t[56] = -8.09, P < 0.001; (t[56] = -8.09, P < 0.001) and in self-reported fruit and vegetable intake from pretest (M = 13.96, SD = 4.23) to posttest (M = 16.80, SD = 5.42); (t[56] = -3.20, P = 0.002). Regression demonstrated that all constructs of the Theory of Planned Behavior were significant (F[4, 52] = 14.56, P < 0.001 with an R2 of 0.53) for their effects on behavior intentions with perceived behavioral control being the most salient predictor. CONCLUSIONS AND IMPLICATIONS: Opportunities for shaping adolescent nutrient intake and eating behaviors during enrollment in the SFSP exist. Reinforcing positive attitudes, subjective norms, and perceived behavioral control may help to increase nutrition behavioral intentions and nutrition behaviors.

Tobacco Use Among Rural and Urban US Middle and High School Students: National Youth Tobacco Survey, 2011-2016.

PURPOSE: Rural adolescents engage in higher smoking and smokeless tobacco use rates than those from urban communities; urban adolescents are more likely to use e-cigarettes. The study investigated whether place of residence (rural vs urban) is associated with tobacco use prevalence and change in prevalence among middle and high school students over time. METHODS: We analyzed data from the National Youth Tobacco Survey (2011-2016). Multiple logistic regression methods for weighted survey data assessed the relationship of place of residence with current tobacco product use over time, adjusting for demographics. FINDINGS: There was no difference in rate of change in use of any tobacco product between rural and urban middle or high school students. Adjusting for age, sex, race/ethnicity, and survey year, both middle and high school rural students were more likely to use cigarettes and smokeless tobacco, whereas urban high school students were more likely to use hookah. Significant polynomial trends were observed for e-cigarette and hookah use patterns, whereas linear changes in use patterns were detected for cigarette and smokeless tobacco use over time. CONCLUSIONS: Rural high school students are more likely to smoke cigarettes and use smokeless tobacco than their urban counterparts, although prevalence rates have decreased over time. However, use of hookah and e-cigarettes among middle and high school students has increased over time regardless of place of residence. To stem the rapid increase in use of hookah and e-cigarettes, comprehensive tobacco control policies are needed regardless of rural or urban location.

The Role of School Nurses, Challenges, and Reactions to Delegation Legislation: A Qualitative Approach.

Passage of new laws, national standards regarding delegation, and the recommendation for at least one full-time nurse in every school have provided more visibility to the role of school nurses. Recent legislative amendments in Kentucky presented an opportunity to examine how the role of the school nurse is changing. Aims were to describe the (1) role of school nurses in Kentucky, (2) impact of school nurses, (3) challenges faced by school nurses, and (4) impact of budget cuts and legislation. Three focus groups were conducted. School nurses faced challenges of limited time and resources, communication barriers, and multiple documentation requirements. Nurses' greatest impacts were their availability, recognition of psychosocial problems and health concerns, and connection with resources. Nurses had not yet encountered many changes due to new legislation that expanded delegation of diabetes-related tasks to unlicensed school personnel, but some had concerns about possible negative effects while others expressed support.

Current Use of E-Cigarettes and Conventional Cigarettes Among US High School Students in Urban and Rural Locations: 2014 National Youth Tobacco Survey.

PURPOSE: Adolescent tobacco use is higher in rural than in urban areas. While e-cigarette use is increasing rapidly among this age group, differences in prevalence between rural versus urban populations for this relatively novel product have not been explored. The purpose is to investigate whether location of school (rural-urban) is associated with e-cigarette use and dual use (defined as the use of both e-cigarettes and conventional cigarettes) among high school students. DESIGN: Cross-sectional survey obtained using a stratified, 3-stage cluster sample design. SETTING: United States. PARTICIPANTS: A nationally representative sample of US high school students (N = 11 053) who completed the 2014 National Youth Tobacco Survey (NYTS); slightly more than half were urban (54%). MEASURES: The NYTS measures tobacco-related knowledge, attitudes, and use behavior and demographics of students in the United States. ANALYSIS: Weighted logistic regression assessed the relationships of urban-rural location with current e-cigarette use and dual use, adjusting for demographic factors, perceived risk, and social norms. RESULTS: There were clear differences in patterns of adolescent e-cigarette and cigarette use in rural versus urban areas. Social norms and perceptions may play a role in understanding these differences. CONCLUSION: Urban youth current cigarette smokers were nearly twice as likely as rural cigarette smokers to also use e-cigarettes. Reasons for urban-rural differences need to be taken into account when designing prevention programs and policy changes.

Social influences on use of cigarettes, e-cigarettes, and hookah by college students.

OBJECTIVES: (1) Compare social norms and perceived peer use between college student cigarette, e-cigarette, and/or hookah users and nonusers; and (2) determine variables associated with social influences. PARTICIPANTS: Undergraduate students attending a large university in the Southeast United States (N = 511). METHODS: An April 2013 online survey assessed use of 3 types of tobacco, social norms, perception of peer use, number of smokers in life, exposure to secondhand smoke, and demographic characteristics. RESULTS: Participants indicated greater acceptance of emerging tobacco products than for cigarettes and consistently overestimated the percent of peers who use various tobacco products. Males and current users had higher social norm scores for all 3 forms of tobacco. CONCLUSION: To counter marketing of alternative tobacco products, education about the dangers of their use needs to be implemented across college campuses as part of a comprehensive tobacco control strategy that also includes tobacco-free campus policies.

Recall and Believability of the Tips From Former Smokers Campaign Among University Students.

BACKGROUND: Tobacco media campaigns are effective, but less is known regarding the impact on college students. PURPOSE: The purpose was to test the effects of an on-campus Tips television campaign on frequency and believability of ads recalled and to assess demographic and personal factors associated with believability. METHODS: A quasi-experimental pre-post design was used to assess the 8-week campaign with three Tips ads. Two randomly-selected cohorts of college students (N = 1,593) from a large public university completed online surveys pre- and post-campaign. Group comparisons using chi-square tests, two-sample t-tests, and logistic regression, controlling for residence or cohort; predictors of believability using proportional odds modeling. RESULTS: Ads were recalled by significantly more students (68%) post-campaign. Believability for one or more ads was lower for males, undergraduates, those belonging to fraternity/sorority, and current polytobacco users (p<.05). Believability was greater for those who recalled seeing the ads more often (p<.05). DISCUSSION: Sub-groups of college students, including males and undergraduates, reported less ad believability, which should be considered when designing communication strategies. TRANSLATION TO HEALTH EDUCATION PRACTICE: Considering the potential impact and cost-effective nature of on-campus TV media campaigns, these ads need to be integrated into current campus tobacco control strategies.

The contribution of recess to children's school-day physical activity.

BACKGROUND: Recess is an important component of a Comprehensive School Physical Activity Program, providing approximately 1268 and 914 steps for boys and girls, respectively, within a 15-minute time period. The purpose of this study was to determine the contribution of unstructured recess on children's school-day physical activity levels and to examine if recess and school-day physical activity levels varied by BMI, gender, and grade level. METHODS: One-hundred sixty third- to fifth-grade students from 2 elementary schools wore pedometers during 4 recess periods. RESULTS: Recess accounted for 17% to 44% of school-day step counts. There was a significant main effect for grade level, but not for BMI or gender, on the percentage of school-day steps accumulated during recess. CONCLUSIONS: A 15-minute recess makes a valuable contribution to children's school-day physical activity, especially for the least active children. More research is warranted to determine environmental influences on children's recess physical activity.

Effect of a low-cost, teacher-directed classroom intervention on elementary students' physical activity.

BACKGROUND: Effective physical activity (PA) interventions are warranted for youth, and schools have been identified as logical locations for such involvement. Experts and professionals in the field promote comprehensive school PA programs, including classroom PA. The purpose of this study was to determine the effect of a low-cost, teacher-directed classroom-based intervention on the school PA of elementary children. METHODS: Nine classroom teachers were provided inexpensive curricula and trained to implement and instruct PA breaks (2 × 30 minute training sessions). The teachers were encouraged to lead 1 activity break per day after the training. One hundred and six elementary students wore pedometers up to 12 days over 3 monitoring periods during the school year (baseline, follow-up, post follow-up) to assess the effectiveness and the sustainability of the intervention. The teachers self-reported the frequency of activity breaks instructed. RESULTS: The teachers (n = 5) who complied with the recommended 1 activity break per day had students who accrued ∼33% more mean school steps/day at follow-up (∼1100) and post follow-up (∼1350) compared to controls. Teachers (n = 4) in the intervention who did not comply with the 1 activity break per day recommendation had students accrue similar mean school steps/day as controls. CONCLUSION: Inexpensive, teacher-directed classroom-based PA interventions can be effective in improving children's PA levels if teachers implement 1 activity break per school day. We recommend promoting the notion of 1 activity break per day in the classroom as part of a comprehensive school PA program that includes quality physical education, recess, and before/after school programs.

The effects of prenatal secondhand smoke exposure on preterm birth and neonatal outcomes.

OBJECTIVE: To examine the relationship between prenatal secondhand smoke (SHS) exposure, preterm birth and immediate neonatal outcomes by measuring maternal hair nicotine. DESIGN: Cross-sectional, observational design. SETTING: A metropolitan Kentucky birthing center. PARTICIPANTS: Two hundred and ten (210) mother-baby couplets. METHODS: Nicotine in maternal hair was used as the biomarker for prenatal SHS exposure collected within 48 hours of birth. Smoking status was confirmed by urine cotinine analysis. RESULTS: Smoking status (nonsmoking, passive smoking, and smoking) strongly correlated with low, medium, and high hair nicotine tertiles (ρ=.74; p<.001). Women exposed to prenatal SHS were more at risk for preterm birth (odds ratio [OR]=2.3; 95% Confidence Interval [CI] [.96, 5.96]), and their infants were more likely to have immediate newborn complications (OR=2.4; 95% CI [1.09, 5.33]) than nonexposed women. Infants of passive smoking mothers were at increased risk for respiratory distress syndrome (RDS) (OR=4.9; 95% CI [1.45, 10.5]) and admission to a Neonatal Intensive Care Unit (NICU) (OR=6.5; CI [1.29, 9.7]) when compared to infants of smoking mothers (OR=3.9; 95% CI [1.61, 14.9]; OR=3.5; 95% CI [2.09, 20.4], respectively). Passive smokers and/or women with hair nicotine levels greater than .35 ng/ml were more likely to deliver earlier (1 week), give birth to infants weighing less (decrease of 200-300 g), and deliver shorter infants (decrease of 1.1-1.7 cm). CONCLUSIONS: Prenatal SHS exposure places women at greater risk for preterm birth, and their newborns are more likely to have RDS, NICU admissions, and immediate newborn complications.

Factors related to adolescent drinking in Appalachia.

OBJECTIVES: To examine the relationships among parental monitoring, perceptions of peer drinking, and adolescent alcohol consumption. METHODS: Tenth- and 12th-grade students (N=648) in a rural, Appalachian county were surveyed. RESULTS: A binomial logistic regression revealed a composite of those who had perceptions that many peers drank, low parental monitoring, and no biological male guardian in the home were 8.496 times more likely to have ever been drunk. Other characteristics resulted in lower odds. CONCLUSIONS: Parental monitoring and perceptions of peer drinking were important predictors of drinking in this rural sample. Prevention efforts in school and at home should address both variables.

Measuring prenatal secondhand smoke exposure in mother-baby couplets.

INTRODUCTION: Pregnant women often underreport their smoking status and extent of secondhand smoke (SHS) exposure. Biomarker confirmation is the recommended method to assess smoking behaviors and SHS exposure in both mothers and infants. OBJECTIVES: The primary aims are to (a) examine the relationship between smoking behaviors and SHS exposure in mother-baby couplets using maternal and infant hair nicotine and maternal urine cotinine analyses and (b) determine whether there is an association between maternal and infant hair nicotine samples obtained shortly after birth. DISCUSSION: A cross-sectional study with a multiethnic sample of 210 mother-baby couplets assessing SHS exposure. RESULTS: The level of maternal hair nicotine (MHN) was significantly different among three groups: nonsmoking, nonsmoking/passive exposed, and smoking (p < .0001), with nonsmoking and nonexposed women having the lowest level. Urine cotinine was strongly associated with self-reported smoking status (rho = .88; p < .0001). Maternal and infant hair nicotine were correlated, although MHN correlated more strongly with smoking status (rho = .46, p < .0001) than infant hair nicotine (rho = .39, p < .0001). CONCLUSIONS: MHN was a more precise biomarker of prenatal SHS exposure than infant hair nicotine; mothers' urine cotinine was strongly correlated with self-reported smoking status.

Postpartum smoking relapse and secondhand smoke.

OBJECTIVE: There has been an abundance of research evaluating prenatal and postnatal smoking abstinence programs. However, few researchers have tested postpartum relapse interventions that address secondhand smoke (SHS) exposure. Pregnant women exposed to SHS are more likely to relapse. This article explores the similarities and differences among postpartum interventions that incorporate SHS education. Generating knowledge about the components of postpartum relapse prevention interventions that do and do not achieve prolongation of abstinence is integral to the development of effective SHS interventions that help women achieve lifelong abstinence. METHODS: We used a methodological review of 11 randomized, controlled trials testing the efficacy of relapse prevention interventions that address SHS exposure. We compared intervention strength, biomarker validation of home smoking and SHS, as well as abstinence and relapse rates. We examined three predictors of postpartum relapse: (1) partner smoking in the home, (2) adoption of home smoking restrictions, and (3) motivation/confidence to remain abstinent. RESULTS: Findings revealed a need for more comprehensive SHS interventions and a clear delineation of abstinence/relapse terminology. Biomarker validation of home smoking and SHS was primarily measured by self-report, passive nicotine monitors, and hair nicotine levels. Furthermore, studies using nurse- and pediatrician-led interventions resulted in the lowest relapse rates. CONCLUSION: A comprehensive intervention that specifically prioritizes parental education on the health effects of SHS on the family, empowerment of the mother and family members to remain abstinent and adopt a smoke-free home smoking policy, and partner influence on smoking could result in a significant reduction in postpartum relapse rates.

Social influences on cigarette initiation among college students.

OBJECTIVES: To examine the relationship of demographic and social influence with initiation of cigarette use among undergraduates. METHODS: Students were mailed anonymous surveys including 437 participants who indicated that they had not smoked cigarettes before age 18. Of those, 107 became late initiators (24%), and 330 remained never smokers (76%). RESULTS: Those who drank alcohol in college and had at least 1 parent with a college education were more likely to initiate smoking than were those who did not drink and neither parent had attended college. CONCLUSIONS: Strategies that focus on reducing alcohol and tobacco use need to be tested.

Prevalence and correlates of HIV testing among college students: an exploratory study.

OBJECTIVES: Whether college students who are most at-risk of HIV infection are being tested is unknown. This exploratory study identified the prevalence and correlates of ever having an HIV test among college students. METHODS: A cross-sectional survey was conducted among a probability sample of 903 college students. Measures of sexual risk behaviour were assessed. RESULTS: Of the students surveyed, 22.5% reported they had been tested for HIV. Testing was more likely among those 20 years of age or older (27.8% v. 14.7%; P = 0.0001), females (25.4% v. 17.8%; P = 0.01), and members of racial/ethnic minorities (42.7% v. 20.3%; P = 0.0001). After adjusting for these covariates, those who reported ever having vaginal sex (AOR = 5.5; 95% CI = 3.1-9.6); anal sex (AOR = 2.4; 95% CI = 1.6-3.6), and oral sex (AOR = 6.3; 95% CI = 3.0-13.3) were significantly more likely to report being tested. Students having vaginal sex in the past 12 months were significantly more likely to report testing (AOR = 5.3; 95% CI = 3.1-9.1). Those reporting vaginal sexual debut (AOR = 1.9; 95% CI = 1.2-3.1) or oral sexual debut (AOR= 1.7; 95% CI = 1.1-2.5) < or = age 15 were significantly more likely to be tested. Students reporting four or more sex partners were significantly more likely to be tested than sexually experienced students reporting fewer partners (AOR = 3.2; 95% CI = 2.2-4.6). Finally, those reporting at least one episode of forced vaginal sex (AOR = 3.9; 95% CI = 2.1-7.2) and reporting at least one episode of any forced sex (vaginal, anal, oral) (AOR = 3.0; 95% CI = 1.8-5.0) were significantly more likely to report being tested. CONCLUSIONS: Within this population, demographically controlled findings suggest that those most at-risk of HIV infection are indeed being tested for the virus.

Efficacy of training and fidelity of implementation of the life skills training program.

This study assessed the effectiveness of a model for diffusing the Life Skills Training (LST) Program into middle schools, examined implementation fidelity, and explored factors associated with involvement in training and program implementation. A convenience sample of master trainers (n = 44) and teachers (n = 45) from 16 Kentucky counties participated. Teachers were observed for content and process fidelity, and trainers and teachers completed questionnaires to assess factors related to training and program implementation. More than one-fourth (27%) of master trainers conducted training sessions, and 60% of teachers taught the curriculum. While implementation fidelity was relatively high, teachers were less likely to use the more innovative elements of the program. Trainers and teachers who conducted training and/or taught the LST Program were more enthusiastic toward the program than those who did nothing beyond being trained.