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Hahn EJ, Bucher A, Rademacher K, Beckett W, Taylor L, Darville A, Ickes MJ. Tobacco use disparities in rural communities. J Rural Health 2024. [PMID: 38602299 DOI: 10.1111/jrh.12838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/26/2024] [Accepted: 03/27/2024] [Indexed: 04/12/2024]
Abstract
PURPOSE This exploratory study described facilitators and barriers to reducing tobacco disparities in 2 small rural communities and identified ways to reduce tobacco use. METHODS This was a descriptive design using qualitative methods. We created a resource database for 2 rural Kentucky counties, using a Culture of Health Framework. We recruited 16 organizational stakeholders serving low-socioeconomic populations and conducted focus groups and key informant interviews. We also completed key informant interviews with 7 tobacco users. Lastly, we tailored Community Action Plans for each county based on the data and then solicited feedback from the key stakeholders. FINDINGS The 2 counties were similar in population size, but County A had fewer resources than County B, and the stakeholders expressed differences toward tobacco use and quitting. County A stakeholders talked most about the protobacco culture and that tobacco users accept the risks of smoking outweighing the benefits of quitting; they also expressed concerns about youth use and the influences of family, society, and industry. County B stakeholders described ambivalence about the health effects of use and quitting. County A's Action Plan identified an opportunity to build Community Health Worker-delivered tobacco treatment into a new school-based health center. County B's Action Plan focused on reaching tobacco users by providing incentives for participation and tailoring messages to different audiences. CONCLUSIONS Tobacco control resources and stakeholder perspectives vary in small rural communities, implying a need for tailored approaches. Tobacco users in rural areas are a critical population to target with cessation resources.
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Affiliation(s)
- Ellen J Hahn
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Amanda Bucher
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Kathy Rademacher
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Whitney Beckett
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - LeeAnn Taylor
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Audrey Darville
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
| | - Melinda J Ickes
- BREATHE, College of Nursing, University of Kentucky, Lexington, Kentucky, USA
- Department of Kinesiology & Health Promotion, College of Education, University of Kentucky, Lexington, Kentucky, USA
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Stanifer SR, Rademacher K, Beckett W, Simpson K, Rayens MK, Thaxton-Wiggins A, Hahn EJ. Public library lending programs increase radon testing in rural communities. Libr Inf Sci Res 2024; 46:101283. [PMID: 38463029 PMCID: PMC10919551 DOI: 10.1016/j.lisr.2024.101283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Radon exposure is the second leading cause of lung cancer, yet few Americans test their homes for radon, particularly in rural areas. The academic team and community partners engaged the public library systems in four rural counties to offer digital radon detectors for check-out as a means of increasing the public's access to free radon testing. The check-out procedures and instructional materials were created through an iterative process, and library personnel were educated on radon and home radon testing prior to launching the lending program. Library patrons reported high usability, feasibility, and acceptability of the program. Library patron-staff interactions mainly included discussions about the logistics of radon testing. Given that public libraries are invested in making communities thrive and promoting health, providing library lending programs for radon detectors is a novel, feasible, and acceptable way to reduce the risk of lung cancer in the community.
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Affiliation(s)
- Stacy R Stanifer
- College of Nursing, 751 Rose Street, University of Kentucky, Lexington, Kentucky, USA 40536
| | - Kathy Rademacher
- College of Nursing, 751 Rose Street, University of Kentucky, Lexington, Kentucky, USA 40536
| | - Whitney Beckett
- College of Nursing, 751 Rose Street, University of Kentucky, Lexington, Kentucky, USA 40536
| | - King Simpson
- Logan County Public Library, 225 Armory Drive, Russellville, KY, USA 42276
| | - Mary Kay Rayens
- College of Nursing, 751 Rose Street, University of Kentucky, Lexington, Kentucky, USA 40536
- College of Public Health, 111 Washington Ave., University of Kentucky, Lexington, Kentucky, USA 40536
| | - Amanda Thaxton-Wiggins
- College of Nursing, 751 Rose Street, University of Kentucky, Lexington, Kentucky, USA 40536
| | - Ellen J Hahn
- College of Nursing, 751 Rose Street, University of Kentucky, Lexington, Kentucky, USA 40536
- College of Public Health, 111 Washington Ave., University of Kentucky, Lexington, Kentucky, USA 40536
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Stanifer S, Delidow B, Rademacher K, Huntington-Moskos L, Kennoy K, Thaxton-Wiggins A, Wilmhoff C, Hahn EJ. Evaluation of a Faculty Fellows Program in Science Communication. J Appalach Health 2023; 5:85-99. [PMID: 38022491 PMCID: PMC10629883 DOI: 10.13023/jah.0502.07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
Introduction Science communication plays a crucial role in tackling pressing regional, national, and global health issues. Effective communication with various audiences is integral to dissemination of science findings. Purpose This study evaluates changes in self-efficacy and attitudes toward science communication skills over time and also assesses program outcomes and satisfaction with a Faculty Fellows in Science Communication (FFSC) program among faculty (N = 30) with interest in environmental health science and/or education in Appalachia Kentucky. Methods A mixed methods program evaluation was employed using longitudinal data on behaviors, attitudes, and program outcomes from three cohorts of Faculty Fellows who participated in the year-long UK-CARES Faculty Fellows in Science Communication (FFSC) program from 2018 to 2021. Repeated Measures Analysis of Variance was used to evaluate changes over time in self-efficacy and attitude scores. Results A total of 30 Fellows enrolled in the program. Participation in the FFSC program significantly increased self-efficacy in communicating with peers in one's own department (F = 7.6, p = 0.002), outside department (F = 7.3, p = 0.002 ), and lay audiences (F = 5.8, p = 0.006) and evaluations of the program were positive. Qualitative feedback from participants offered insights into how program participation helped them communicate with different audiences, incorporate narratives or stories to engage audiences, and develop innovative methods of communicating with lay audiences. Implications The FFSC program provides a useful framework for other institutions and supports faculty as they build the communication skills necessary to effectively translate science with various audiences.
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Hahn EJ, Haneberg WC, Stanifer SR, Rademacher K, Backus J, Rayens MK. Geologic, seasonal, and atmospheric predictors of indoor home radon values. Environ Res Health 2023; 1:025011. [PMID: 37701077 PMCID: PMC10496436 DOI: 10.1088/2752-5309/acdcb3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
Exposure to tobacco smoke and radon cause lung cancer. Radioactive decay of naturally occurring uranium in bedrock produces radon. Seasonality, bedrock type, age of home, and topography have been associated with indoor radon, but the research is mixed. The study objective was to examine the relationships of geologic (soil radon and bedrock) and seasonal (warm and cold times of the year) factors with indoor home radon values in citizen scientists' homes over time, controlling for atmospheric conditions, topography, age of home, and home exposure to tobacco smoke. We collected and analyzed indoor radon values, soil radon gas concentrations, and dwelling- and county-level geologic and atmospheric conditions on 66 properties in four rural counties during two seasons: (1) summer 2021 (n = 53); and (2) winter/spring 2022 (n = 52). Citizen scientists measured indoor radon using Airthings radon sensors, and outdoor temperature and rainfall. Geologists obtained soil radon measurements using RAD7 instruments at two locations (near the dwelling and farther away) at each dwelling, testing for associations of indoor radon values with soil values, bedrock type, topography, and atmospheric conditions. Bedrock type, near soil radon levels, home age, and barometric pressure were associated with indoor radon. Dwellings built on carbonate bedrock had indoor radon values that were 2.8 pCi/L (103.6 Bq m-3) higher, on average, compared to homes built on siliclastic rock. Homes with higher near soil radon and those built <40 ago were more likely to have indoor radon ⩾4.0 pCi/L (148 Bq m-3). With higher atmospheric barometric pressure during testing, observed indoor radon values were lower. Seasonality and topography were not associated with indoor radon level. Understanding relationships among bedrock type, soil radon, and indoor radon exposure allows the development of practical predictive models that may support pre-construction forecasting of indoor radon potential based on geologic factors.
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Affiliation(s)
- Ellen J Hahn
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, United States of America
| | - William C Haneberg
- Kentucky Geological Survey, University of Kentucky, Lexington, KY, United States of America
| | - Stacy R Stanifer
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, United States of America
| | - Kathy Rademacher
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, United States of America
| | - Jason Backus
- Kentucky Geological Survey, University of Kentucky, Lexington, KY, United States of America
| | - Mary Kay Rayens
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, United States of America
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Ashford KB, Blair LM, McCubbin AK, Wiggins AT, Rayens MK, Hahn EJ. Municipal smoke-free laws and preterm birth. Am J Obstet Gynecol 2022; 227:767.e1-767.e10. [PMID: 35932874 DOI: 10.1016/j.ajog.2022.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Smoking during pregnancy and prenatal secondhand smoke exposure increase the risk of preterm birth. As Kentucky has the second highest rate of smoking in the United States and no statewide smoke-free law, an examination of the effect of municipal smoke-free legislation on preterm birth is warranted. OBJECTIVE This study used state-level live birth data and county-level municipal smoke-free legislation status to assess the association between the presence and strength of smoke-free laws and the likelihood of preterm birth. Moreover, this study hypothesized that pregnant persons living in counties with comprehensive municipal smoke-free laws prohibiting smoking inside all workplaces and enclosed public places would exhibit a lower likelihood of preterm birth than those living in counties with weak or moderate laws (ie, smoke-free laws with exemptions that do not cover all workplaces and enclosed public places) or no smoke-free law. STUDY DESIGN Using live birth data from the Kentucky Office of Vital Statistics with birth years ranging from 2004 to 2020, a total of 894,372 live births were recorded that indicated that a childbearing person was between the ages of 18 and 49 years and a resident of Kentucky; these live births formed the sample for the study. Municipal ordinances implemented during a given calendar year were coded in the model as present starting with the following calendar year, as the birth records were time deidentified except for the year of birth. This lagged law convention maximized the likelihood that pregnant persons included in the study were exposed to the smoke-free policy for at least a portion of their pregnancy. Multilevel logistic regression was used to assess the effect of smoke-free ordinances on the likelihood of preterm birth, with personal- and county-level variables included as potential covariates and pregnant persons nested within the county of residence. Data analysis was conducted using SAS (version 9.4; SAS Institute, Cary, NC), with an alpha level of .05. RESULTS Nearly all personal-level variables were associated with preterm birth status. Personal factors associated with an increased likelihood of preterm birth included being older (relative to 18-24 years old; odds ratios [95% confidence intervals]: 1.02 [1.01-1.04] and 1.27 [1.24-1.31] for ages 25-34 and 35-49 years, respectively); having a history of preterm birth (odds ratio, 4.65; 95% confidence interval, 4.53-4.78); and smoking before pregnancy (odds ratio, 1.14; 95% confidence interval, 1.12-1.16). Pregnant persons living in counties with comprehensive laws were 9% less likely to have a preterm birth than those living in counties without a smoke-free ordinance (odds ratio, 0.91; 95% confidence interval, 0.89-0.94; P<.001). There was no difference in the likelihood of preterm birth between those living in counties with moderate or weak laws and those unprotected by any smoke-free ordinance in their county of residence. CONCLUSION This study demonstrated that comprehensive municipal smoke-free laws are associated with reduced risk of preterm birth and that moderate or weak smoke-free laws are not. The findings have major implications for public health policy and underscore the potential influence of healthcare providers' advocacy for strong smoke-free policies, prohibiting smoking in all workplaces (including restaurants, bars, and casinos), to support healthy pregnancies.
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Affiliation(s)
- Kristin B Ashford
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, KY.
| | - Lisa M Blair
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, KY
| | - Andrea K McCubbin
- Perinatal Research and Wellness Center, University of Kentucky College of Nursing, Lexington, KY
| | | | | | - Ellen J Hahn
- University of Kentucky College of Nursing, Lexington, KY
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Darville A, Williams L, Edward J, Butler K, Rademacher K, Gray B, Tischner CM, Keeler H, Hahn EJ. Enhancing Tobacco Treatment for Medicaid Recipients. South Med J 2022; 115:603-610. [PMID: 35922046 DOI: 10.14423/smj.0000000000001431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Medicaid recipients are vulnerable to increased morbidity and mortality secondary to high tobacco use prevalence and barriers to accessing tobacco treatment. The purpose of the pilot study was to explore managed care administrators' perceptions of the facilitators and barriers to tobacco treatment for Medicaid recipients. METHODS Focus groups with key informants (n = 14) from managed care organizations were conducted in fall 2018. Participants included case, integrated care, quality and field care managers, and individuals working in provider and network relations. RESULTS Facilitators to tobacco treatment were universal quality reporting requirements, access to medications, and the role of case management in identifying and engaging tobacco users in treatment. Barriers included bias regarding smokers' ability to quit, communication challenges, and competing priorities. CONCLUSIONS The analysis provided data to support the development of a policy brief and recommendations to the Department for Medicaid Services for enhancing tobacco dependence treatment.
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Affiliation(s)
- Audrey Darville
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Lovoria Williams
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Jean Edward
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Karen Butler
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Kathy Rademacher
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Brittney Gray
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Clair M Tischner
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Hannah Keeler
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
| | - Ellen J Hahn
- From the College of Nursing and College of Pharmacy, University of Kentucky, Lexington, and Radford University, Radford, Virginia
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Abstract
Home radon testing is a primary lung cancer prevention strategy, yet the majority of Americans have not tested their home. This descriptive, ecological study uses 54,683 observed radon values collected in Kentucky homes from 1996 to 2016 to examine the association of county-level social determinants of health and environmental exposures on home radon testing rates. Multivariate linear regression analysis indicates that as median home value, rurality, and radon risk potential increased, counties experienced an increase in annual home radon testing rates. As adult smoking prevalence increased, counties experienced a decrease in annual rates of residential radon testing. These findings indicate that counties with low median home values, high adult smoking prevalence, and high incidence of lung cancer may benefit most from prevention interventions aimed at promoting home radon testing, adopting radon- and smoke-free home policies, and integrating radon risk reduction messaging into tobacco cessation and lung cancer screening programs.
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Affiliation(s)
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Amanda Wiggins
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J. Hahn
- College of Nursing, University of Kentucky, Lexington, KY, USA
- College of Public Health, University of Kentucky, Lexington, KY, USA
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Stanifer S, Hoover AG, Rademacher K, Rayens MK, Haneberg W, Hahn EJ. Citizen Science Approach to Home Radon Testing, Environmental Health Literacy and Efficacy. Citiz Sci 2022; 7:26. [PMID: 36845873 PMCID: PMC9949773 DOI: 10.5334/cstp.472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Exposure to radon is a leading cause of lung cancer worldwide. However, few test their homes for radon. There is a need to increase access to radon testing and decrease radon exposure. This longitudinal, mixed-methods study using a citizen science approach recruited and trained a convenience sample of 60 non-scientist homeowners from four rural Kentucky counties to test their homes for radon using a low-cost continuous radon detector, report back findings, and participate in a focus group to assess their testing experience. The aim was to evaluate changes in environmental health literacy (EHL) and efficacy over time. Participants completed online surveys at baseline, post-testing, and 4-5 months later to evaluate EHL, response efficacy, health information efficacy, and self-efficacy related to radon testing and mitigation. Mixed modeling for repeated measures evaluated changes over time. Citizen scientists reported a significant increase in EHL, health information efficacy, and radon testing self-efficacy over time. While there was a significant increase in citizen scientists' confidence in their perceived ability to contact a radon mitigation professional, there was no change over time in citizen scientists' beliefs that radon mitigation would reduce the threat of radon exposure, nor was there a change in their capacity to hire a radon mitigation professional. Further research is needed to understand the role of citizen science in home radon mitigation.
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Rayens MK, McGeeney T, Wiggins AT, Bucher A, Ickes M, Huntington-Moskos L, Clark P, Hahn EJ. Smoke-free Ordinances and Youth Tobacco Use in Kentucky. Am J Health Promot 2022; 36:673-677. [PMID: 35081759 DOI: 10.1177/08901171211066913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE Determine associations of strength of local smoke-free laws and urban/rural location with cigarette and smokeless tobacco use among high school students in grades 10 and 12. DESIGN Secondary data analysis from the 2004-2018 biennial Kentucky Incentives for Prevention Survey. SETTING Public high schools in Kentucky. SAMPLE N = 353502 10th/12th graders. MEASURES County-level smoke-free law status from the Kentucky Center for Smoke-free Policy; Rural Urban Continuum Codes; self-reported last 30-day alcohol, marijuana, cigarette, and smokeless tobacco use. ANALYSIS Generalized estimating equations modeling assessed the association of law status and urban/rural location with tobacco use across cohorts, controlling for demographics and other substance use. RESULTS Students in counties with a comprehensive smoke-free law were 23% less likely to smoke cigarettes and 16% less likely to use smokeless, compared to those in counties without a law. Students in counties with moderate/weak laws did not differ in likelihood of use for either product, compared to those in counties without a law. Students in urban counties were 14% less likely to smoke, but there was no difference in likelihood of smokeless use by urban/rural location. CONCLUSION Comprehensive smoke-free laws are associated with a lower likelihood of youth cigarette and smokeless use. Rural youth may be at increased risk of cigarette smoking relative to youth in urban areas.
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Affiliation(s)
- Mary Kay Rayens
- University of Kentucky Colleges of Nursing and Public Health, Lexington, KY, USA
| | | | - Amanda T Wiggins
- Ringgold ID: 4530University of Kentucky College of Nursing, Lexington, KY, USA
| | - Amanda Bucher
- Ringgold ID: 4530University of Kentucky College of Nursing, Lexington, KY, USA
| | - Melinda Ickes
- Ringgold ID: 5170University of Kentucky College of Education, Lexington, KY, USA
| | | | - Patti Clark
- Kentucky Cabinet for Health and Family Services, Frankfort, KY, USA
| | - Ellen J Hahn
- University of Kentucky Colleges of Nursing and Public Health, Lexington, KY, USA
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Darville A, Rademacher K, Wiggins AT, Lenhof MG, Hahn EJ. Training Tobacco Treatment Specialists through Virtual Asynchronous Learning. Int J Environ Res Public Health 2022; 19:3201. [PMID: 35328889 PMCID: PMC8955214 DOI: 10.3390/ijerph19063201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 11/16/2022]
Abstract
Tobacco dependence is a prevalent, chronic, and complex addiction that often leads to long-term disease and death. However, few healthcare providers are sufficiently trained and feel comfortable in delivering tobacco dependence treatment. The purpose of the study was to examine the effectiveness of an accredited online Tobacco Treatment Specialist (TTS) training program that uses a novel, asynchronous approach. We compared the characteristics of participants who completed the program to those who did not complete the program. Changes in knowledge and attitudes in providing tobacco dependence treatment were measured, and satisfaction with the program and intent to pursue national certification were assessed. Participants who were more likely to complete the program were those who discussed quitting less frequently with patients prior to course enrollment. These participants had a significant increase in knowledge and high satisfaction with the course. Approximately half of participants who completed the program indicated that they would pursue obtaining a national certificate in tobacco dependence treatment in the next 2 years.
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Affiliation(s)
- Audrey Darville
- College of Nursing, University of Kentucky, Lexington, KY 40504, USA; (K.R.); (A.T.W.); (M.G.L.); (E.J.H.)
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Hahn EJ, Rademacher K, Bucher A, Sine K, Wiggins AT, Rayens MK. Smoke-Free Policy Disparities in Long-Term Care Facilities. Am J Health Promot 2022; 36:403-409. [DOI: 10.1177/08901171211051333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Older adults in long-term care (LTC) facilities suffer disproportionately from health conditions caused or worsened by secondhand smoke. Long-term care facilities in many states and municipalities permit smoking. Americans for Nonsmokers’ Rights compiles data on smoke-free policies only in institutional facilities (e.g., nursing homes), but not in transitional (e.g., independent living) or community-based settings (e.g., adult day). A cross-sectional, observational study was conducted of smoke-free policies using cluster random sampling in Kentucky to compare differences in policy location of coverage and strength of smoke-free policies in institutional, transitional, and community-based LTC facilities by rural/urban status. Online or phone surveys of LTC administrators representing 306 facilities were conducted. Of the facilities sampled, 35.5% were institutional, 33.4% transitional, 25.1% community-based, and 6.0% multi-type. Only one in five (19.6%) facilities restricted smoking indoors and outdoors. Only 17.3% of the policies were comprehensive (i.e., prohibiting use of all tobacco products by all persons living, frequenting, or working in LTC facilities). Compared to transitional facilities, institutional and community-based facilities were more likely to have comprehensive policies and restrict smoking indoors and outdoors. Facilities located in rural communities were less likely to restrict smoking indoors or outdoors and less likely to have comprehensive smoke-free policies, reflecting a disparity in policy protections. Strong, consistent smoke-free policies and policy enforcement are needed to reduce the disparity in smoke-free protections for older adults, LTC employees, and visitors. More research is needed to investigate the best strategies for implementing and enforcing policies that completely restrict smoking in all LTC facilities.
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Affiliation(s)
- Ellen J. Hahn
- College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
| | | | - Amanda Bucher
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Karlee Sine
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | | | - Mary Kay Rayens
- College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
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Abstract
PURPOSE This study compared differences in sociodemographic characteristics, personal risk perception of lung cancer, lung cancer worry, and synergistic risk perception among rural Appalachia residents who completed home radon testing with those who did not, after receiving a free long-term test kit at a rural primary care clinic. The study also examined the association between the Teachable Moment Model constructs and home radon testing. METHODS The study was an exploratory correlational design with a convenience sample of (N = 58) adult participants recruited from 2 rural primary care clinics in Appalachia Kentucky. Participants completed a brief survey and were given a free long-term home radon test kit. Multiple logistic regression was used to determine characteristics associated with home radon testing. FINDINGS Twenty-eight participants (48%) completed home radon testing. There were no differences in personal risk perception of lung cancer, lung cancer worry, or synergistic risk perception between those who completed home radon testing and those who did not. Age was the only significant factor associated with completion of radon testing (B = 0.077, P = .005). For every 5-year increase in age, participants were 47% more likely to test their home for radon. CONCLUSION Providing free home radon test kits in the primary care setting shows promise in prompting radon testing in rural Appalachia. As radon-induced lung cancer risk increases with exposure over time, health care providers in rural Appalachia need to encourage patients of all ages to test their home for radon, especially those who smoke or report smoking in the home.
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Affiliation(s)
- Stacy R. Stanifer
- College of Nursing, University of Kentucky, Lexington, Kentucky
- University of Kentucky Center for Appalachian Research in Environmental Sciences (UK-CARES), Lexington, KY
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, Kentucky
- College of Public Health, University of Kentucky, Lexington, Kentucky
| | - Amanda Wiggins
- College of Nursing, University of Kentucky, Lexington, Kentucky
| | - David Gross
- Northeast Kentucky Area Health Education Center, St. Claire Healthcare, Morehead, Kentucky
| | - Ellen J. Hahn
- College of Nursing, University of Kentucky, Lexington, Kentucky
- University of Kentucky Center for Appalachian Research in Environmental Sciences (UK-CARES), Lexington, KY
- College of Public Health, University of Kentucky, Lexington, Kentucky
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Huntington-Moskos L, Rayens MK, Wiggins AT, Butler KM, Hahn EJ. Use of Theory-Driven Report Back to Promote Lung Cancer Risk Reduction. Int J Environ Res Public Health 2021; 18:10648. [PMID: 34682394 PMCID: PMC8536114 DOI: 10.3390/ijerph182010648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 09/28/2021] [Accepted: 10/04/2021] [Indexed: 11/19/2022]
Abstract
Report back is active sharing of research findings with participants to prompt behavior change. Research on theory-driven report back for environmental risk reduction is limited. The study aim is to evaluate the impact of a stage-tailored report back process with participants who had high home radon and/or air nicotine levels. An observational one-group pre-post design was used, with data collection at 3, 9, and 15 months post intervention. Participants from the parent study (N = 515) were randomized to the treatment or control group and this sample included all 87 treatment participants who: (1) had elevated radon and/or air nicotine at baseline; and (2) received stage-tailored report back of their values. Short-term test kits measured radon; passive airborne nicotine samplers assessed secondhand smoke (SHS) exposure. Stage of action was categorized as: (1) 'Unaware', (2) 'Unengaged', (3) 'Deciding', (4) 'Action', and (5) 'Maintenance'. Interventions were provided for free, such as in-person radon and SHS test kits and a brief telephonic problem-solving consultation. Stage of action for radon mitigation and smoke-free policy increased from baseline to 3 months and remained stable between 3 and 9 months. Stage of action for radon was higher at 15 months than baseline. Among those with high baseline radon, observed radon decreased by 15 months (p < 0.001). Tailored report back of contaminant values reduced radon exposure and changed the health behavior necessary to remediate radon and SHS exposure.
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Affiliation(s)
| | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, KY 40504, USA; (M.K.R.); (A.T.W.); (K.M.B.); (E.J.H.)
| | - Amanda T. Wiggins
- College of Nursing, University of Kentucky, Lexington, KY 40504, USA; (M.K.R.); (A.T.W.); (K.M.B.); (E.J.H.)
| | - Karen M. Butler
- College of Nursing, University of Kentucky, Lexington, KY 40504, USA; (M.K.R.); (A.T.W.); (K.M.B.); (E.J.H.)
| | - Ellen J. Hahn
- College of Nursing, University of Kentucky, Lexington, KY 40504, USA; (M.K.R.); (A.T.W.); (K.M.B.); (E.J.H.)
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McEvoy JW, Ziaeian B, Joseph Y, Williams KA, Virani SS, Sidney C. Smith SCS, Daniel M, Miedema MD, Michos ED, Arnett DK, Lloyd-Jones D, Khera A, Hahn EJ, Goldberger ZD, Himmelfarb CD, Buroker AB, Albert MA, Blumenthal RS. Рекомендации - 2019 Американского колледжа кардиологии (АСС) / Американской ассоциации сердца (АНА) по первичной профилактике сердечно-сосудистых заболеваний. Hypertension 2021. [DOI: 10.22141/2224-1485.2.64.2019.168753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
No abstract
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Ickes MJ, Sampson S, Parsons J, Rayens MK, Xiao M, Fisher A, Mundy M, Hahn EJ. Tobacco-Free Ambassador Partnership: Empowering Youth Advocates in Appalachian Communities. Health Promot Pract 2020; 21:98S-109S. [PMID: 31908203 DOI: 10.1177/1524839919880563] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Kentucky youth (14.3%) smoke more cigarettes as compared to the U.S. average (8.8%), and Appalachian communities suffer disproportionately from tobacco-related diseases such as lung cancer. Training youth to become advocates is an effective strategy to improve health equity. This article describes the development and impact of a youth advocacy program to promote tobacco control policies in Appalachian Kentucky. Phase I (2017-2018): two ½-day trainings followed by monthly meetings with one high school (n = 20 youth). Trainings provided information on tobacco use, consequences, industry tactics, evidence-based tobacco control, and advocacy skills. Results provided support for expansion to Phase II (2018-20119): A 1-day training followed by monthly information sharing implemented in three counties (N = 80). Youth were surveyed before and 6-months posttraining during both phases. Phase I: At posttraining, 85% of youth believed they could reduce the amount of tobacco use in their community versus 66% at baseline. More students tried at least once to convince school or government officials to be more concerned about tobacco use (77% vs. 47%). Phase II: More students supported tobacco policies at posttraining survey and realized policies are an effective strategy to reduce tobacco use. At posttraining survey, students reported greater interpersonal confidence talking with others about tobacco-related issues, with a 24% increase in confidence talking with adults in their communities, as well as greater advocacy self-efficacy. Youth in Appalachia demonstrate desire to influence tobacco use and policy to improve health equity. Findings reinforce the need for collaborative public health interventions to promote ongoing training and support for youth living in high-risk communities.
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Affiliation(s)
| | | | | | | | - Min Xiao
- University of Kentucky, Lexington, KY, USA
| | - Amy Fisher
- University of Kentucky, Lexington, KY, USA
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Hahn EJ, Wilmhoff C, Rayens MK, Conley NB, Morris E, Larck A, Allen T, Pinney SM. High School Students as Citizen Scientists to Decrease Radon Exposure. Int J Environ Res Public Health 2020; 17:ijerph17249178. [PMID: 33302585 PMCID: PMC7763282 DOI: 10.3390/ijerph17249178] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 12/04/2020] [Accepted: 12/06/2020] [Indexed: 11/17/2022]
Abstract
Residents in rural Kentucky (KY) and suburban Ohio (OH) expressed concerns about radon exposure and lung cancer. Although 85% of lung cancer cases are caused by tobacco smoke, radon exposure accounts for 10–15% of lung cancer cases. Academic and community members from the University of KY and the University of Cincinnati developed and pilot-tested a family-centered, youth-engaged home radon testing toolkit. The radon toolkit included radon information, and how to test, interpret, and report back findings. We educated youth as citizen scientists and their teachers in human subjects protection and home radon testing using the toolkit in the classroom. Youth citizen scientists explained the study to their parents and obtained informed consent. One hundred students were trained in human subjects protection, 27 had parental permission to be citizen scientists, and 18 homeowners completed surveys. Radon values ranged from < 14.8 Bq/m3 to 277.5 Bq/m3. Youth were interested and engaged in citizen science and this family-centered, school-based project provided a unique opportunity to further the healthy housing and quality education components of the Sustainable Development Goals for 2030. Further research is needed to test the impact of student-led, family-centered citizen science projects in environmental health as part of school curricula.
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Affiliation(s)
- Ellen J. Hahn
- UK-CARES and BREATHE, College of Nursing, University of Kentucky, Lexington, KY 40504 USA
- Correspondence: ; Tel.: +859-257-2358
| | - Craig Wilmhoff
- Perry County Central High School, Hazard, KY 41701, USA;
| | - Mary Kay Rayens
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY 40504 USA; (M.K.R.); (N.B.C.)
| | - Nicholas B. Conley
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY 40504 USA; (M.K.R.); (N.B.C.)
| | - Emily Morris
- Kentucky Geological Survey, University of Kentucky, Lexington, KY 40505, USA;
| | - Angela Larck
- Center for Environmental Genetics, University of Cincinnati, Cincinnati, OH 45267, USA; (A.L.); (S.M.P.)
| | - Trista Allen
- Fairfield Senior High School, Fairfield, OH 45014, USA;
| | - Susan M. Pinney
- Center for Environmental Genetics, University of Cincinnati, Cincinnati, OH 45267, USA; (A.L.); (S.M.P.)
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Haneberg WC, Wiggins A, Curl DC, Greb SF, Andrews WM, Rademacher K, Rayens MK, Hahn EJ. A Geologically Based Indoor-Radon Potential Map of Kentucky. Geohealth 2020; 4:e2020GH000263. [PMID: 33283125 PMCID: PMC7682569 DOI: 10.1029/2020gh000263] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 10/29/2020] [Accepted: 11/02/2020] [Indexed: 05/04/2023]
Abstract
We combined 71,930 short-term (median duration 4 days) home radon test results with 1:24,000-scale bedrock geologic map coverage of Kentucky to produce a statewide geologically based indoor-radon potential map. The test results were positively skewed with a mean of 266 Bq/m3, median of 122 Bq/m3, and 75th percentile of 289 Bq/m3. We identified 106 formations with ≥10 test results. Analysis of results from 20 predominantly monolithologic formations showed indoor-radon concentrations to be positively skewed on a formation-by-formation basis, with a proportional relationship between sample means and standard deviations. Limestone (median 170 Bq/m3) and dolostone (median 130 Bq/m3) tended to have higher indoor-radon concentrations than siltstones and sandstones (median 67 Bq/m3) or unlithified surficial deposits (median 63 Bq/m3). Individual shales had median values ranging from 67 to 189 Bq/m3; the median value for all shale values was 85 Bq/m3. Percentages of values falling above the U.S. Environmental Protection Agency (EPA) action level of 148 Bq/m3 were sandstone and siltstone: 24%, unlithified clastic: 21%, dolostone: 46%, limestone: 55%, and shale: 34%. Mississippian limestones, Ordovician limestones, and Devonian black shales had the highest indoor-radon potential values in Kentucky. Indoor-radon test mean values for the selected formations were also weakly, but statistically significantly, correlated with mean aeroradiometric uranium concentrations. To produce a map useful to nonspecialists, we classified each of the 106 formations into five radon-geologic classes on the basis of their 75th percentile radon concentrations. The statewide map is freely available through an interactive internet map service.
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Affiliation(s)
| | - Amanda Wiggins
- BREATHE, College of NursingUniversity of KentuckyLexingtonKYUSA
| | - Douglas C. Curl
- Kentucky Geological SurveyUniversity of KentuckyLexingtonKYUSA
| | - Stephen F. Greb
- Kentucky Geological SurveyUniversity of KentuckyLexingtonKYUSA
| | | | | | - Mary Kay Rayens
- BREATHE, College of NursingUniversity of KentuckyLexingtonKYUSA
| | - Ellen J. Hahn
- BREATHE, College of NursingUniversity of KentuckyLexingtonKYUSA
- Center for Appalachian Research in Environmental SciencesUniversity of KentuckyLexingtonKYUSA
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Abstract
PURPOSE To examine the association between strength of policy and self-reported tobacco use behavior, controlling for demographic characteristics, polytobacco use, knowledge of campus tobacco policy, and perceived policy compliance by others. DESIGN Cross-sectional, online survey. SETTING Ten participating State University of New York (SUNY) campuses; 5 with designated smoking/tobacco use areas and 5 with 100% tobacco-free policies. SUBJECTS Convenience sample of students from SUNY campuses: only tobacco users (N = 576 students) included for analysis. MEASURES Items assessing tobacco use behaviors on campus, policy knowledge, and observation of others using tobacco on campus. ANALYSIS T tests and chi-square tests of association used to compare responses between tobacco users across campuses. Generalized estimating equations modeling used to evaluate predictors of tobacco use on campus; model estimated with students nested within campus. RESULTS Those on campuses without a comprehensive policy were more likely to report (in the past week) having seen others smoke on campus (98% vs 69%, P < .001), having personally smoked on campus (65% vs 36%, P < .001), and seeing others use tobacco products on campus (88% vs 67%, P < .001), compared to those on tobacco-free campuses. CONCLUSION Tobacco-free campus policies provide numerous protective factors for tobacco users and nonusers. However, compliance strategies are imperative for intended policy success.
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Affiliation(s)
- Melinda J. Ickes
- Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY, USA
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Amanda T. Wiggins
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J. Hahn
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
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Ickes M, Hester JW, Wiggins AT, Rayens MK, Hahn EJ, Kavuluru R. Prevalence and reasons for Juul use among college students. J Am Coll Health 2020; 68:455-459. [PMID: 30913003 PMCID: PMC6763357 DOI: 10.1080/07448481.2019.1577867] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/17/2018] [Accepted: 01/29/2019] [Indexed: 06/01/2023]
Abstract
Objective: Examine Juul use patterns, sociodemographic and personal factors associated with Juul use, and reasons for Juul initiation and current use, among college students. Participants: Convenience sample of 371 undergraduates at a large university in the southeast; recruited April 2018. Methods: Cross-sectional design using an online survey. Logistic regression identified the personal risk factors for current use. Results: Over 80% of participants recognized Juul; 36% reported ever use and 21% past 30-day use. Significant risk factors for current Juul use were: male, White/non-Hispanic, lower undergraduate, and current cigarette smoker. Current Juul users chose ease of use and lack of a bad smell as reasons for use. Ever Juul users most commonly endorsed curiosity and use by friends as reasons for trying Juul. Conclusions: Given the propensity for nicotine addiction among youth and young adults, rates of Juul use are alarming and warrant immediate intervention.
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Affiliation(s)
- Melinda Ickes
- Kinesiology and Health Promotion, Tobacco Policy, BREATHE, University of Kentucky, Lexington, KY, USA
| | - Jakob W. Hester
- Health Promotion, College of Education, University of Kentucky, Lexington, KY, USA
| | - Amanda T. Wiggins
- Data Management & Outcomes, BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J. Hahn
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ramakanth Kavuluru
- Division of Biomedical Informatics, Department of Internal Medicine, College of Medicine, University of Kentucky, Lexington, KY, USA
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Abstract
Background. Almost 2,000 campuses have adopted tobacco-free (TF) policies across the United States. However, there is not a systematic process to help campuses implement successful policies. Readiness assessments can help provide assistance as campuses work to implement successful policies. Purpose. We assessed readiness for TF policies among campuses of a statewide university system and determined factors associated with readiness. Participants. Stakeholders from 23 campuses without 100% TF policies were invited to participate in an online survey. Method. System administrators provided contacts for five to eight stakeholders per campus. Included in the analysis were 10 of 23 campuses (43.5%) with at least three stakeholders completing the survey. Results. Of the 10 campuses, one was in Preplanning, five were in Preparation, and four were in the Initiation stage of readiness. Political Climate was the highest scored dimension on seven campuses (0.74-1.0); Resources was the lowest on eight campuses (0.0-0.67). Campus size and county rurality were each associated with one dimension score. Conclusions. Despite being part of a statewide university system, campuses are in varying stages of readiness for TF policies. Stage-based strategies to advance TF campus policies must be implemented to set campuses up for successful policies.
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Affiliation(s)
- Melinda J Ickes
- College of Education, University of Kentucky, Lexington, KY, USA
| | | | - Mary Kay Rayens
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J Hahn
- College of Nursing, University of Kentucky, Lexington, KY, USA
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R Stanifer S, Hahn EJ. Analysis of Radon Awareness and Disclosure Policy in Kentucky: Applying Kingdon's Multiple Streams Framework. Policy Polit Nurs Pract 2020; 21:132-139. [PMID: 32393114 DOI: 10.1177/1527154420923728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this article is to analyze radon awareness and disclosure policy proposed during the 2018 Kentucky General Assembly using Kingdon's Multiple Stream Framework. Radon gas is the second leading cause of lung cancer. Exposure to radon occurs largely in the home. The proportion of homeowners who have completed radon testing remains low, and home radon testing is voluntary in most states. The Environmental Law Institute recommends states enact policies to promote radon awareness and testing. The most common radon awareness policy mandates radon disclosure during a real estate transaction. A bill to mandate radon disclosure during a real estate transaction was proposed during the 2018 Kentucky General Assembly but was met with opposition and was not filed. As a policy alternative, an administrative regulation to amend the Form for Seller's Disclosure of Conditions was proposed to the Kentucky Real Estate Commission. Administrative regulations set forth by government regulatory agencies are equally enforceable and may be a more politically feasible alternative to enacting public policy. Nurses are positioned to promote the health of patients and populations. Nurses advocating for radon control legislation and/or administrative regulations may push radon control policy higher on the governmental decision agenda leading to policy change to decrease the development of lung cancer.
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Affiliation(s)
| | - Ellen J Hahn
- University of Kentucky, College of Nursing, Lexington, KY, USA
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Ickes MJ, Butler K, Wiggins AT, Kercsmar S, Kay Rayens M, Hahn EJ. Truth® ads, receptivity, and motivation to use or quit tobacco among college students. J Am Coll Health 2020; 68:366-373. [PMID: 30645188 DOI: 10.1080/07448481.2018.1549559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/02/2018] [Accepted: 11/11/2018] [Indexed: 06/09/2023]
Abstract
Objective: Examine receptivity and motivation to use/quit tobacco among college students after viewing Truth ads. Participants: Random sample of 10,000 college students invited to complete online survey February 2016 (8.5% response rate). Methods: Quasi-experimental. Participants (N = 854) watched four ads and answered survey items for each ad. Results: Students rated ad receptivity and decreased motivation to use tobacco higher for the Catmageddon ad than the others. Regardless of ad, men and current cigarette smokers reported lower receptivity. Younger age was associated with lower motivation to use tobacco for all ads. Tobacco users reported greater motivation to quit with the Catmageddon ad. Conclusions: College students were receptive to the Truth ads, and many indicated lower motivation to use tobacco. Men, older college students, and current cigarette smokers were less receptive to the ads, reinforcing the need to develop tailored campaigns to reach these subgroups.
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Affiliation(s)
- Melinda J Ickes
- College of Education & BREATHE, University of Kentucky, Lexington, KY, USA
| | - Karen Butler
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Amanda T Wiggins
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Sarah Kercsmar
- Health Sciences, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J Hahn
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
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Chiavacci SJ, Shapiro CD, Pindilli EJ, Casey CF, Rayens MK, Wiggins AT, Andrews WM, Hahn EJ. Economic valuation of health benefits from using geologic data to communicate radon risk potential. Environ Health 2020; 19:36. [PMID: 32197610 PMCID: PMC7083012 DOI: 10.1186/s12940-020-00589-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/05/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Radon exposure is the second leading cause of lung cancer worldwide and represents a major health concern within and outside the United States. Mitigating exposure to radon is especially critical in places with high rates of tobacco smoking (e.g., Kentucky, USA), as radon-induced lung cancer is markedly greater among people exposed to tobacco smoke. Despite homes being a common source of radon exposure, convincing homeowners to test and mitigate for radon remains a challenge. A new communication strategy to increase radon testing among Kentucky homeowners utilizes fine-scale geologic map data to create detailed radon risk potential maps. We assessed the health benefits of this strategy via avoided lung cancer and associated premature mortality and quantified the economic value of these benefits to indicate the potential utility of using geologic map data in radon communication strategies. METHODS We estimated the change in radon testing among all 120 counties in Kentucky following a new communication strategy reliant on geologic maps. We approximated the resultant potential change in radon mitigation rates and subsequent expected lung cancer cases and mortality avoided among smokers and non-smokers exposed to 4 pCi/L of radon in the home. We then applied the value of a statistical life to derive the economic value of the expected avoided mortality. RESULTS The new communication strategy is estimated to help 75 Kentucky residents in 1 year avoid exposure to harmful radon levels via increased testing and mitigation rates. This equated to the potential avoidance of approximately one premature death due to lung cancer, with a net present value of $3.4 to $8.5 million (2016 USD). CONCLUSIONS Our analysis illustrates the potential economic value of health benefits associated with geologic map data used as part of a communication strategy conveying radon risk to the public. Geologic map data are freely available in varying resolutions throughout the United States, suggesting Kentucky's radon communication strategy using geologic maps can be employed in other states to educate the public about radon. As this is only a single application, in a single state, the economic and health benefits of geologic map data in educating the public about radon are likely to exceed our estimates.
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Affiliation(s)
- Scott J. Chiavacci
- Science and Decisions Center, United States Geological Survey, 12201 Sunrise Valley Dr, Reston, VA 20191 USA
| | - Carl D. Shapiro
- Science and Decisions Center, United States Geological Survey, 12201 Sunrise Valley Dr, Reston, VA 20191 USA
| | - Emily J. Pindilli
- Science and Decisions Center, United States Geological Survey, 12201 Sunrise Valley Dr, Reston, VA 20191 USA
| | - Clyde F. Casey
- Science and Decisions Center, United States Geological Survey, 12201 Sunrise Valley Dr, Reston, VA 20191 USA
| | - Mary Kay Rayens
- University of Kentucky College of Nursing, BREATHE, Lexington, KY 40536 USA
| | - Amanda T. Wiggins
- University of Kentucky College of Nursing, BREATHE, Lexington, KY 40536 USA
| | - William M. Andrews
- Kentucky Geological Survey, University of Kentucky, Lexington, KY 40506 USA
| | - Ellen J. Hahn
- University of Kentucky College of Nursing, BREATHE, Lexington, KY 40536 USA
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Goodin A, Talbert J, Freeman PR, Hahn EJ, Fallin-Bennett A. Appalachian disparities in tobacco cessation treatment utilization in Medicaid. Subst Abuse Treat Prev Policy 2020; 15:5. [PMID: 31959212 PMCID: PMC6971922 DOI: 10.1186/s13011-020-0251-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/06/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Kentucky Medicaid enrollees, particularly those in the rural Appalachian region, face disproportionate smoking rates and tobacco-related disease burden relative to the rest of the United States (US). The Affordable Care Act (ACA) mandated tobacco cessation treatment coverage by the US public health insurance program Medicaid. Medicaid coverage was also expanded in Kentucky, in 2013, with laxer income eligibility requirements. This short report describes tobacco use incidence and tobacco cessation treatment utilization, comparing by Appalachian status before and after ACA-mandated cessation treatment coverage. METHODS The study design was a retrospective cross-sectional analysis from 2013 to 2015. Subjects were Medicaid enrollees with 1) diagnosis of any tobacco use (2013 n = 541,349; 2014 n = 864,183; 2015 n = 1,090,274); and/or (2) procedure claim for tobacco cessation counseling, and/or (3) pharmaceutical claim for varenicline or any nicotine replacement product. Primary measures included tobacco use incidence and proportion of users receiving cessation treatment. Analysis was via chi square testing of change by year. RESULTS Overall, the proportion of tobacco users utilizing cessation treatment decreased (4.75% tobacco users in 2013; 3.15% in 2015). Tobacco users receiving counseling decreased from 2.06% pre-ACA (2013) to 1.06% post-ACA (2015, p < 0.001), as did the proportion receiving nicotine replacement products post-ACA (2.69% in 2013 to 1.55% by 2015; p < 0.001). More Appalachians received cessation treatment than non-Appalachians in 2013 (2.72% vs. 2.03%), but by 2015 non-Appalachians received more treatment overall (1.50% vs. 1.65%; p < 0.001). Appalachians received more counseling and NRT, but less varenicline, than non-Appalachians. CONCLUSIONS Utilization of all forms of tobacco cessation treatment throughout Kentucky, and particularly in rural Appalachia, remained limited despite Medicaid enrollment as well as coverage expansions. These findings suggest that barriers persist in access to tobacco cessation treatment for individuals in Medicaid.
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Affiliation(s)
- Amie Goodin
- University of Florida, College of Pharmacy, Gainesville, FL, USA.,Center for Drug Evaluation and Safety (CoDES), Gainesville, FL, USA
| | - Jeffery Talbert
- University of Kentucky, College of Pharmacy, Lexington, KY, USA
| | | | - Ellen J Hahn
- University of Kentucky, College of Nursing, Lexington, KY, USA
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Al-Mrayat YD, Okoli CTC, Studts CR, Rayens MK, Hahn EJ. The Psychometric Properties of the Minnesota Tobacco Withdrawal Scale Among Patients With Mental Illness. Biol Res Nurs 2019; 22:247-255. [PMID: 31854206 DOI: 10.1177/1099800419895573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVES Approximately 65% of psychiatric inpatients experience moderate-to-severe nicotine withdrawal (NW), a set of symptoms appearing within 24 hr after an abrupt cessation or reduction of use of tobacco-containing products in those using nicotine daily for at least a couple of weeks. The Minnesota Tobacco Withdrawal Scale (MTWS) is a widely used instrument for detecting NW. However, the psychometric properties of the MTWS have not previously been examined among patients with serious mental illness (SMI) undergoing tobacco-free hospitalization. The objective of this study was to examine the validity and reliability of the MTWS among patients with SMI during tobacco-free psychiatric hospitalization. METHODS Reliability was tested by examining Cronbach's α and item analysis. Validity was examined through hypothesis testing and exploratory factor analysis (N = 255). RESULTS The reliability analysis yielded a Cronbach's α coefficient of .763, an inter-item correlations coefficient of .393, and item-total correlations between .291 and .691. Hypothesis testing confirmed the construct validity of the MTWS, and an exploratory factor analysis yielded a unidimensional scale. CONCLUSION The MTWS demonstrated adequate reliable and valid psychometric properties for measuring NW among patients with SMI. Nurses and other health-care professionals may use this instrument in clinical practice to identify patients with SMI experiencing NW. The MTWS is psychometrically sound for capturing NW during tobacco-free psychiatric hospitalization. Future research should examine the efficacy of the MTWS in measuring NW in this population over an extended period of hospitalization.
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Affiliation(s)
| | | | | | - Mary K Rayens
- The University of Kentucky College of Nursing, Lexington, KY, USA
| | - Ellen J Hahn
- The University of Kentucky College of Nursing, Lexington, KY, USA
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Fallin-Bennett A, Parker KA, Miller A, Ashford K, Hahn EJ. Smoking and Tobacco-Free Policies in Women's Residential Substance Use Disorder Treatment Facilities: A Community-Engaged Approach. Nicotine Tob Res 2019; 20:1386-1392. [PMID: 29059449 DOI: 10.1093/ntr/ntx211] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 09/15/2017] [Indexed: 01/23/2023]
Abstract
Introduction The purpose of this study was to (1) describe the role of smoking in the lives of women in residential substance use disorder (SUD) treatment and (2) explore perceptions of the facilitators and barriers to tobacco-free policy among women in residential SUD treatment. Methods This was a community-engaged study using qualitative descriptive methods. We first recruited women in a residential SUD treatment facility to participate on a community research team. Interviews with staff (N = 10) and focus groups with clients (N = 42) were conducted using guides informed by the community research team. Interviews and focus groups were analyzed using content analysis. Results There were two themes related to the role of smoking in the women's lives: (1) smoking facilitates socialization and (2) smoking as a coping mechanism. There were three themes related to the benefits of tobacco-free policy: (1) improved health, (2) support for continued abstinence from a previous tobacco-free placement (eg, prison), and (3) less grounds up-keep. Barriers to tobacco-free policy included (1) lack of an alternative coping mechanism to smoking, (2) fear that a tobacco-free policy would drive clients away, and (3) anticipation of implementation challenges. Conclusions Many women in residential SUD treatment smoke, which they attribute to the fact that smoking is used to facilitate socialization and cope with stress. Future research is needed to develop and test messages to counter the misperception that smoking is an effective method to cope with stress. Ultimately, evidence-based tobacco-free policies are needed to reduce tobacco-related disease among women with SUDs. Implications To promote smoking cessation among women with substance use disorders through evidence-based tobacco policy, it is necessary to first understand the role of smoking in their lives as well as facilitators and barriers to tobacco-free policy in residential treatment facilities. Participants reported that smoking facilitated socialization and served as a coping mechanism. Tobacco-free policies have many benefits, including improved health, support for continued abstinence from a previous tobacco-free placement (eg, prison), and less grounds up-keep. Barriers include the lack of an alternative coping mechanism, fear that a tobacco-free policy would drive away clients and anticipation of implementation challenges. To reduce the burden of tobacco-related morbidity and mortality among women and their children, it is necessary to catalyze a culture change in behavioral health settings to prioritize the treatment of tobacco alongside treatment of other addictions.
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Affiliation(s)
| | - Kimberly A Parker
- College of Communication and Information, University of Kentucky, Lexington, KY
| | - Alana Miller
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY
| | - Kristin Ashford
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY
| | - Ellen J Hahn
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY
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Hahn EJ, Wiggins AT, Rademacher K, Butler KM, Huntington-Moskos L, Rayens MK. FRESH: Long-Term Outcomes of a Randomized Trial to Reduce Radon and Tobacco Smoke in the Home. Prev Chronic Dis 2019; 16:E127. [PMID: 31517597 PMCID: PMC6745895 DOI: 10.5888/pcd16.180634] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Introduction Tobacco smoke and radon are the leading causes of lung cancer. The FRESH intervention was a randomized controlled trial of 515 homeowners to promote stage of action to reduce radon and air nicotine levels. Methods We studied 515 participants, 257 in a treatment group and 258 in a control group. Treatment participants received free radon and air nicotine test kits, report back, and telephone support, and those participants whose homes had high radon levels received a voucher for $600 toward mitigation. Both groups were asked to retest 15 months post intervention. We examined differences in stage of action to test for and mitigate radon and adopt a smoke-free–home policy and in observed radon and air nicotine values by study group over time. Results Homeowners in the treatment group scored higher on stage of action to test for radon and air nicotine and to mitigate for radon during follow-up than those in the control group at 3 months and 9 months, but the effect of the intervention diminished after 9 months. We saw no difference between groups or over time in observed radon or air nicotine values. Of homeowners in the treatment group with high radon levels at baseline, 17% mitigated, and 80% of them used the voucher we provided. Conclusion The null finding of no significant change in observed radon or air nicotine values from baseline to 15 months may reflect the low proportion of radon mitigation systems installed and the decline in stage of action to adopt a smoke-free home policy. Including a booster session at 9 months post intervention may improve the remediation rate.
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Affiliation(s)
- Ellen J Hahn
- University of Kentucky Colleges of Nursing and Public Health, 2265 Harrodsburg Road, Lexington, KY 40504.
| | | | | | - Karen M Butler
- University of Kentucky College of Nursing, Lexington, Kentucky
| | | | - Mary Kay Rayens
- University of Kentucky Colleges of Nursing and Public Health, Lexington, Kentucky
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Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 74:e177-e232. [PMID: 30894318 PMCID: PMC7685565 DOI: 10.1016/j.jacc.2019.03.010] [Citation(s) in RCA: 882] [Impact Index Per Article: 176.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 74:1376-1414. [PMID: 30894319 PMCID: PMC8344373 DOI: 10.1016/j.jacc.2019.03.009] [Citation(s) in RCA: 691] [Impact Index Per Article: 138.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation, the American Geriatrics Society, the American Society of Preventive Cardiology, and the Preventive Cardiovascular Nurses Association
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Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 140:e596-e646. [PMID: 30879355 PMCID: PMC7734661 DOI: 10.1161/cir.0000000000000678] [Citation(s) in RCA: 1242] [Impact Index Per Article: 248.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 140:e563-e595. [PMID: 30879339 PMCID: PMC8351755 DOI: 10.1161/cir.0000000000000677] [Citation(s) in RCA: 320] [Impact Index Per Article: 64.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
1. The most important way to prevent atherosclerotic vascular disease, heart failure, and atrial fibrillation is to promote a healthy lifestyle throughout life. 2. A team-based care approach is an effective strategy for the prevention of cardiovascular disease. Clinicians should evaluate the social determinants of health that affect individuals to inform treatment decisions. 3. Adults who are 40 to 75 years of age and are being evaluated for cardiovascular disease prevention should undergo 10-year atherosclerotic cardiovascular disease (ASCVD) risk estimation and have a clinician–patient risk discussion before starting on pharmacological therapy, such as antihypertensive therapy, a statin, or aspirin. The presence or absence of additional risk-enhancing factors can help guide decisions about preventive interventions in select individuals, as can coronary artery calcium scanning. 4. All adults should consume a healthy diet that emphasizes the intake of vegetables, fruits, nuts, whole grains, lean vegetable or animal protein, and fish and minimizes the intake of trans fats, processed meats, refined carbohydrates, and sweetened beverages. For adults with overweight and obesity, counseling and caloric restriction are recommended for achieving and maintaining weight loss. 5. Adults should engage in at least 150 minutes per week of accumulated moderate-intensity physical activity or 75 minutes per week of vigorous-intensity physical activity. 6. For adults with type 2 diabetes mellitus, lifestyle changes, such as improving dietary habits and achieving exercise recommendations are crucial. If medication is indicated, metformin is first-line therapy, followed by consideration of a sodium-glucose cotransporter 2 inhibitor or a glucagon-like peptide-1 receptor agonist. 7. All adults should be assessed at every healthcare visit for tobacco use, and those who use tobacco should be assisted and strongly advised to quit. 8. Aspirin should be used infrequently in the routine primary prevention of ASCVD because of lack of net benefit. 9. Statin therapy is first-line treatment for primary prevention of ASCVD in patients with elevated low-density lipoprotein cholesterol levels (≥190 mg/dL), those with diabetes mellitus, who are 40 to 75 years of age, and those determined to be at sufficient ASCVD risk after a clinician–patient risk discussion. 10. Nonpharmacological interventions are recommended for all adults with elevated blood pressure or hypertension. For those requiring pharmacological therapy, the target blood pressure should generally be <130/80 mm Hg.
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Hahn EJ, Butler KM. Tobacco and Social Justice. West J Nurs Res 2019; 41:1099-1102. [DOI: 10.1177/0193945919849530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Abstract
This study investigated the association between sociodemographic characteristics and public attitudes toward Tobacco 21 laws. Through a random telephone survey in 2017, 1,675 Kentucky adults were asked if they favored/opposed increasing the minimum legal age to purchase tobacco products from 18 to 21 years of age. Over half (57.9%) favored raising the minimum legal age for tobacco sales to 21 (95% confidence interval: [54.5, 61.2]). Multivariable logistic regression for weighted survey data was used to determine factors associated with support. In the adjusted analysis, older age, female sex, non-White, conservative political ideology (versus moderate), and support for a statewide smoke-free policy were each significantly associated with greater support for Tobacco 21. The results suggest multiple demographic and personal factors associated with support, even in a tobacco-growing state. Health care professionals, including nurses, must understand existing public attitudes to effectively advocate for tobacco policies in states with high tobacco use.
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Affiliation(s)
- Melinda J Ickes
- 1 College of Nursing, BREATHE, University of Kentucky, Lexington, KY, USA
| | - Karen Butler
- 1 College of Nursing, BREATHE, University of Kentucky, Lexington, KY, USA
| | - Amanda T Wiggins
- 1 College of Nursing, BREATHE, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- 1 College of Nursing, BREATHE, University of Kentucky, Lexington, KY, USA
| | - Ellen J Hahn
- 1 College of Nursing, BREATHE, University of Kentucky, Lexington, KY, USA
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Abstract
OBJECTIVES Many local communities in Kentucky, a state with one of the highest smoking prevalence rates in the United States, have enacted smoke-free ordinances that prohibit smoking in workplaces and enclosed buildings open to the public. Research has shown that such ordinances are clearly beneficial for public health, but their influence on smoking prevalence in the populations they cover remains unclear. This study explores the effect of local smoke-free ordinances on smoking prevalence in Kentucky. METHODS We used a database of smoke-free ordinances maintained by the Kentucky Center for Smoke-Free Policy, Kentucky Behavioral Risk Factor Surveillance System survey data, and US Census data. We estimated the proportion of Kentucky adults living in counties with smoke-free ordinances of varying strength; examined bivariate associations between smoke-free ordinances and smoking prevalence; and fit regression models that adjusted for various county-level demographic, socioeconomic, and geographic factors. RESULTS Smoking prevalence was approximately 5% lower in counties with smoke-free ordinances, even after adjusting for other relevant factors, including a trend in decreasing prevalence throughout the study region. There was a slight dose-response effect related to the strength of smoke-free ordinances after adjustment for these covariates. Smoke-free ordinances appear to have a modest effect on smoking prevalence across the span of several years. CONCLUSIONS Findings demonstrate that although smoking prevalence fell throughout the state during the study period, counties with smoke-free ordinances experienced a greater decline. Future research should examine the strength of smoke-free ordinances in greater detail to better understand their influence on smoking prevalence.
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Affiliation(s)
- W Jay Christian
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Courtney J Walker
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Bin Huang
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
| | - Ellen J Hahn
- From the Department of Epidemiology, College of Public Health, the Markey Cancer Center, College of Medicine, and BREATHE, College of Nursing, University of Kentucky, Lexington
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Hahn EJ, Ickes MJ, Wiggins A, Kay Rayens M, Polivka BJ, Whelan Parento E. Short- and Long-Term Effects of a Tobacco-Free Executive Order on Employee Tobacco Use. Policy Polit Nurs Pract 2019; 20:74-81. [PMID: 30922206 DOI: 10.1177/1527154419833174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Smoke-free workplace policies encourage cessation, reduce tobacco consumption, and shift the pro-tobacco norm. However, no research exists evaluating the impact of mandated tobacco-free policies on government property. The purpose of our study was to examine short- and long-term effects of a tobacco-free policy (executive order 2014-747) implemented in November 2014, prohibiting tobacco use on state executive property. Cross-sectional online surveys were administered at two time points to a total of 27,000 employees of the executive branch of the Commonwealth of Kentucky. The short-term evaluation (March 2015) comprised 4,170 employees and the long term (August 2015) included 3,070. Tobacco use, plans to quit using tobacco, personal characteristics, whether the county of their workplace was covered by a smoke-free policy, and social norms for tobacco use were assessed 4- and 9-month post-policy implementation. Current tobacco use and plans to quit were compared between short- and long-term evaluations using multiple logistic regression with relevant covariates included. Controlling for demographics and employment location, employees reported lower rates of tobacco use and higher rates of planning to quit in the long term than in the short term. Tobacco-free policies reduce tobacco use prevalence and promote plans to quit, particularly over time. We found differences in tobacco use prevalence and plans to quit using tobacco products from 4 to 9 months after the policy took effect, as reported by employees following implementation of the tobacco-free policy. These findings support the potential for avoiding long-term health care costs as a result of reduced tobacco use from these policies. Nurses can play an important advocacy and policy evaluation role to promote and assess the impact of tobacco-free policies.
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Affiliation(s)
- Ellen J Hahn
- 1 College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Melinda J Ickes
- 2 Department of Kinesiology and Health Promotion, College of Education, University of Kentucky, Lexington, KY, USA
| | - Amanda Wiggins
- 1 College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- 1 College of Nursing, University of Kentucky, Lexington, KY, USA
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Abstract
PURPOSE OF REVIEW Electronic cigarettes, commonly known as electronic nicotine delivery systems (ENDS), e-cigarettes, or vapes, are growing in use and popularity. E-cigarettes are not one distinct type of product. These devices have evolved from the initial "cigarette-alike" designs to larger tank-style devices and most recently, smaller "mod-pods" that can be easily hidden. E-cigarettes can deliver nicotine at levels similar to conventional cigarettes. RECENT FINDINGS As with conventional cigarettes, e-cigarettes expose users to chemicals and particulates that affect many biological systems including the heart, lungs, and circulation. Most e-cigarettes contain and emit potentially toxic but highly variable substances. Only by using them in total abstinence from combustible tobacco products can users reduce (not eliminate) their exposure to these harmful chemicals. However, most adults smoking e-cigarettes are dual users, meaning they smoke both conventional and e-cigarettes. This review of the current cardiovascular-specific literature related to e-cigarette use explores what is known (and unknown) about the short- and long-term effects of using these devices. Specifically, the effects of nicotine, oxidizing agents, and particulates in e-cigarettes are examined in the context of cardiovascular and lung health. The goal is to assist clinicians when discussing e-cigarettes with their patients and to help them analyze the impact of use on cardiovascular health. Recommendations are provided related to clinical treatment and research to address gaps in the literature.
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Affiliation(s)
- Audrey Darville
- Tobacco Prevention and Treatment Division, BREATHE, College of Nursing, University of Kentucky, 2265 Harrodsburg Road, Suite 202, Lexington, KY, 40504, USA.
| | - Ellen J Hahn
- BREATHE, College of Nursing, University of Kentucky, 2265 Harrodsburg Road, Suite 202, Lexington, KY, 40504, USA
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Wiggins AT, Huntington‐Moskos L, Rayens EA, Rayens MK, Noland M, Butler K, Hahn EJ. Tobacco Use Among Rural and Urban US Middle and High School Students: National Youth Tobacco Survey, 2011‐2016. J Rural Health 2019; 36:48-54. [DOI: 10.1111/jrh.12356] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Emily A. Rayens
- Center for Vaccines and ImmunologyUniversity of Georgia Athens Georgia
| | - Mary Kay Rayens
- College of NursingUniversity of Kentucky Lexington Kentucky
- College of Public HealthUniversity of Kentucky Lexington Kentucky
| | - Melody Noland
- College of EducationUniversity of Kentucky Lexington Kentucky
| | - Karen Butler
- College of NursingUniversity of Kentucky Lexington Kentucky
| | - Ellen J. Hahn
- College of NursingUniversity of Kentucky Lexington Kentucky
- College of Public HealthUniversity of Kentucky Lexington Kentucky
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Unrine JM, Slone SA, Sanderson W, Johnson N, Durbin EB, Shrestha S, Hahn EJ, Feltner F, Huang B, Christian WJ, Mellon I, Orren DK, Arnold SM. A case-control study of trace-element status and lung cancer in Appalachian Kentucky. PLoS One 2019; 14:e0212340. [PMID: 30811496 PMCID: PMC6392268 DOI: 10.1371/journal.pone.0212340] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/31/2019] [Indexed: 12/31/2022] Open
Abstract
Appalachian Kentucky (App KY) leads the nation in lung cancer incidence and mortality. Trace elements, such as As, have been associated with lung cancers in other regions of the country and we hypothesized that a population-based study would reveal higher trace element concentrations in App KY individuals with cancer compared to controls. Using toenail and drinking water trace element concentrations, this study investigated a possible association between lung cancer incidence and trace-element exposure in residents of this region. This population-based case-control study had 520 subjects, and 367 subjects provided toenail samples. Additionally, we explored the relationship between toenail and fingernail trace-element concentrations to determine if fingernails could be used as a surrogate for toenails when patients are unable to provide toenail samples. We found that, contrary to our initial hypothesis, trace element concentrations (Al, As, Cr, Mn, Co, Fe, Ni, Cu, Se, and Pb) were not higher in cancer cases than controls with the exception of Zn where concentrations were slightly higher in cases. In fact, univariate logistic regression models showed that individuals with lower concentrations of several elements (Al, Mn, Cr, and Se) were more likely to have lung cancer, although only Mn was significant in multivariate models which controlled for confounding factors. While drinking water concentrations of Al, Cr and Co were positively related to cancer incidence in univariate models, only Co remained significant in multivariate models. However, since the drinking water concentrations were extremely low and not reflected in the toenail concentrations, the significance of this finding is unclear. We also found that fingernail concentrations were not consistently predictive of toenail concentrations, indicating that fingernails should not be used as surrogates for toenails in future studies.
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Affiliation(s)
- Jason M. Unrine
- Department of Plant and Soil Sciences, University of Kentucky, Lexington, KY, United States of America
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY, United States of America
| | - Stacey A. Slone
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States of America
| | - Wayne Sanderson
- Department of Preventative Medicine and Environmental Health, University of Kentucky, Lexington, KY, United States of America
- Department of Epidemiology, University of Kentucky, Lexington, KY, United States of America
| | - Nancy Johnson
- Department of Preventative Medicine and Environmental Health, University of Kentucky, Lexington, KY, United States of America
| | - Eric B. Durbin
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States of America
- Kentucky Cancer Registry, University of Kentucky, Lexington, KY, United States of America
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States of America
| | - Shristi Shrestha
- Department of Plant and Soil Sciences, University of Kentucky, Lexington, KY, United States of America
| | - Ellen J. Hahn
- BREATHE, College of Nursing, University of Kentucky, Lexington, KY, United States of America
| | - Fran Feltner
- Center of Excellence in Rural Health, University of Kentucky, Hazard, KY, United States of America
| | - Bin Huang
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States of America
- Kentucky Cancer Registry, University of Kentucky, Lexington, KY, United States of America
- Department of Biostatistics, University of Kentucky, Lexington, KY, United States of America
| | - W. Jay Christian
- Department of Epidemiology, University of Kentucky, Lexington, KY, United States of America
| | - Isabel Mellon
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY, United States of America
| | - David K. Orren
- Department of Toxicology and Cancer Biology, University of Kentucky, Lexington, KY, United States of America
| | - Susanne M. Arnold
- Markey Cancer Center, University of Kentucky, Lexington, KY, United States of America
- Department of Internal Medicine, University of Kentucky, Lexington, KY, United States of America
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Kavuluru R, Han S, Hahn EJ. On the popularity of the USB flash drive-shaped electronic cigarette Juul. Tob Control 2019; 28:110-112. [PMID: 29654121 PMCID: PMC6186192 DOI: 10.1136/tobaccocontrol-2018-054259] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Ramakanth Kavuluru
- Division of Biomedical Informatics, Department of Internal Medicine, University of Kentucky, Lexington, Kentucky, USA
- Department of Computer Science, University of Kentucky, Lexington, Kentucky, USA
| | - Sifei Han
- Department of Computer Science, University of Kentucky, Lexington, Kentucky, USA
| | - Ellen J Hahn
- College of Nursing, University of Kentucky, Lexington, Kentucky, USA
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Ickes MJ, Wiggins A, Hahn EJ. Online readiness assessment for Smoke- and Tobacco-free campus policies. J Am Coll Health 2018; 66:817-820. [PMID: 29447622 DOI: 10.1080/07448481.2018.1440570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 12/21/2017] [Accepted: 02/09/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Develop and test an online survey to assess campus readiness to adopt smoke- and tobacco-free (SF/TF) policies. PARTICIPANTS Key informants (N = 18) at four campuses in Kentucky without a SF/TF policy recruited April 2015. METHODS Cross-sectional design. The survey assessed six dimensions: knowledge about SF/TF policies; leadership for campus policy; resources for policy development; campus climate surrounding tobacco issues; existing tobacco policies; and political climate for campus policy development. Dimension raw scores were rescaled to range from 0-1 and summed to determine overall stage of readiness (0-6). RESULTS Political climate was highest dimension across all campuses (0.83-1.0). Knowledge dimension ranked lowest (0.0-0.50). Overall readiness scores ranged from 2.53-3.94; two campuses in preplanning and two in preparation. CONCLUSIONS Development of the online measure is timely considering the impetus to implement SF/TF policies. Findings reinforce that campuses are at varying stages of implementing these policies, and stage-based interventions are necessary.
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Affiliation(s)
- Melinda J Ickes
- a Go Tobacco-free, BREATHE Department of Kinesiology and Health Promotion, University of Kentucky , Lexington , Kentucky , USA
| | - Amanda Wiggins
- b Data Management and Outcomes, BREATHE, College of Nursing, University of Kentucky, Lexington , Kentucky , USA
| | - Ellen J Hahn
- c BREATHE and Kentucky Center for Smoke-free Policy, College of Nursing and College of Public Health, University of Kentucky, Lexington , Kentucky , USA
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Ickes MJ, Wiggins A, Hahn EJ. Readiness to Adopt Physical Activity Policies in Rural Communities. Health Promot Pract 2018; 21:430-439. [PMID: 30318919 DOI: 10.1177/1524839918807449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose was to explore community readiness to adopt physical activity (PA) policies by adapting and pilot testing an online survey (Physical Activity Readiness Survey [PARS]). PARS was adapted from the previously tested Community Readiness Survey-Short. In February/April 2016, key informants (N = 17) involved in PA activities from two rural communities were invited to complete the PARS, representing six dimensions: knowledge, leadership, resources, community climate, existing voluntary PA policies, and political climate. First, participants were asked to respond to a presurvey to screen for overall readiness for up to four evidence-based PA policies. A main survey readiness score (0-6) was determined by averaging the key informants' ratings across items: Raw scores were rescaled to range from 0 to 1, and dimension scores were summed. Participants identified two PA policies in the presurvey: neighborhood availability and point-of-decision prompts. For both policies, political climate had the highest dimension score (1.0) and the knowledge dimension scored lowest (0.05-0.38). Overall readiness scores ranged from 3.19 to 3.62, revealing the preparation stage for both policies. Readiness for the two PA policies were similar, but specific dimension scores varied by policy type and community, reinforcing the need for tailored interventions.
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Butler KM, Huntington-Moskos L, Rayens MK, Wiggins AT, Hahn EJ. Perceived Synergistic Risk for Lung Cancer After Environmental Report-Back Study on Home Exposure to Tobacco Smoke and Radon. Am J Health Promot 2018; 33:597-600. [DOI: 10.1177/0890117118793886] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: To examine the short-term impact of a personalized environmental report-back intervention to reduce home exposure to tobacco smoke and radon on perception of synergistic risk for lung cancer. Radon-induced lung cancer is more common among those exposed to tobacco smoke. Design: Randomized controlled trial. Setting: Primary care clinics and a pharmacy waiting area at a University Medical Center in the Southeastern United States and community events. Participants: Five hundred sixty adult homeowners and renters (3-month follow-up, n = 334). Intervention: Personalized environmental report back. Measures: Single-item synergistic risk perception measure using 5-point Likert-type scale. Analysis: Change in synergistic risk from baseline to 3 months was evaluated using a generalized estimating equation model containing main effects of treatment group and time. Covariates in the model included age, gender, education, and home smoking status. Results: For treatment and control groups combined, there was a significant increase in perception of synergistic risk from baseline to 3 months, but the study groups did not differ. There was no association between perceived synergistic risk and whether or not there were smokers at home. Conclusion: Learning about combined risks for lung cancer, with or without dual home screening for secondhand smoke and radon and environmental report-back, may enhance perceived risk for combined environmental exposures. Evaluation of perceived synergistic risk with a single item is a study limitation.
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Affiliation(s)
- Karen M. Butler
- Radon Policy Division, BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | | | - Mary Kay Rayens
- BREATHE, College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Amanda T. Wiggins
- Data Management and Outcomes, BREATHE, College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Ellen J. Hahn
- BREATHE, College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
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Hahn EJ, Huntington-Moskos L, Mundy M, Rademacher K, Wiggins AT, Rayens MK, Studts JL, Butler KM. A Randomized Trial to Test Personalized Environmental Report Back to Reduce Lung Cancer Risk. Health Educ Behav 2018; 46:165-175. [PMID: 30078335 DOI: 10.1177/1090198118788602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND More radon-related lung cancers occur among those exposed to tobacco smoke. OBJECTIVES To test the effects of a personalized environmental report back intervention on change in stage of action for air nicotine testing and adopting a smoke-free home and radon testing and mitigation from baseline to 3 months postintervention. METHODS The study design used a two-arm parallel groups randomized controlled trial with stratified quota sampling. The treatment group received free air nicotine and radon home test kits and a brief problem-solving phone intervention; the control group received a coupon for free test kits. A sample of 515 homeowners were enrolled; 319 completed the 3-month follow-up. Stage of action to test and remediate the home was measured consistent with the precaution adoption process model. Linear mixed modeling assessed whether the main and interaction effects of treatment and time were associated with the testing and remediation outcomes; multiple covariates were included in the models. RESULTS The models for the four stages of action outcomes (testing and remediating for radon and secondhand smoke) each had a significant treatment-by-time effect. The general pattern was an increase in stage of action from baseline to 3 months. The degree of change was generally larger among the treatment group participants relative to the controls, indicating that those in the treatment group were more ready to take action. For all the models, participants with higher self-efficacy for radon/air nicotine testing and radon/secondhand smoke remediation were more ready to take action to test and remediate. Synergistic risk perception was associated with stage of action for radon mitigation. CONCLUSIONS Homeowners who were provided free radon and air nicotine test kits, given their results, and engaged in a brief telephonic problem-solving consultation tended to show a greater increase in readiness to take action to test and remediate by 3 months compared with those who received standard public health practice. Both groups showed an increase in stage of action for all four outcomes over time.
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Pauly N, Talbert J, Parsley S, Gray B, Hahn EJ. Kentucky’s Smoking Cessation Quitline: Annual Estimated Return on Investment to Employers. Am J Health Promot 2018; 33:285-288. [DOI: 10.1177/0890117118784875] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose: State-based smoking cessation telephone quitlines offer a cost-effective method of providing tobacco treatment at no cost to participants. The study objective was to assess the annual return on investment (ROI) to employers if they were to bear the entire responsibility from the Kentucky quitline. Design: A retrospective design was used to estimate the annual ROI to employers from the Kentucky quitline. Setting: The telephone quitline (1-800-QUIT-NOW) provided intake and follow-up data for all Kentucky participants who enrolled in the program from 2012 to 2014. Participants: All individuals aged 18+ who enrolled in the Kentucky quitline from 2012 to 2014. Measures: Successful tobacco cessation was assessed from follow-up surveys that took place after individuals completed the program. Cost savings to employers associated with tobacco cessation were gleaned from a published meta-analysis. The Kentucky quitline provided estimates for annual program expenses. Analysis: The annual ROI was calculated as the difference between estimated annual cost savings due to smoking cessation and annual program expenses. Results: From 2012 to 2014, 5425 individuals were enrolled in the quitline. The annual ROI to employers was estimated to be $998 680, with an ROI ratio of 6.2:1. Conclusions: Employers may receive a substantial ROI if they were to fund the Kentucky quitline. Study results may be used as evidence to support cost-sharing partnerships between public health agencies and employers to sustain funding for telephone quitlines.
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Affiliation(s)
- Nathan Pauly
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Jeffrey Talbert
- Institute for Pharmaceutical Outcomes and Policy, University of Kentucky College of Pharmacy, Lexington, KY, USA
| | - Shannon Parsley
- BREATHE, University of Kentucky College of Nursing, Lexington, KY, USA
| | - Bobbye Gray
- Kentucky Tobacco Prevention and Cessation Program, KY Cabinet for Health and Family Services, Frankfort, KY, USA
| | - Ellen J. Hahn
- BREATHE, University of Kentucky College of Nursing, Lexington, KY, USA
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Ickes MJ, Wiggins A, Rayens MK, Edwards J, Hahn EJ. Employee Adherence to a Tobacco-Free Executive Order in Kentucky. Am J Health Promot 2018; 33:24-29. [PMID: 29747521 DOI: 10.1177/0890117118771310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Examine predictors of short- and long-term adherence to a tobacco-free policy prohibiting all tobacco use inside and outdoors on Executive Branch property in Kentucky. DESIGN Cross-sectional online surveys administered at 2 time points. SETTING Commonwealth of Kentucky. PARTICIPANTS 27 000 employees of the Kentucky Executive Branch were invited to participate in 2 online surveys: March 2015, 4 months postpolicy (N = 4854) and August 2015, 9 months postpolicy (N = 3522). INTERVENTION Executive order prohibiting tobacco use on Executive property implemented November 2014. MEASURES Tobacco use, tobacco users' adherence to the tobacco-free policy, and personal characteristics were assessed. ANALYSIS Two separate logistic regression models used to determine predictors of short- and long-term adherence to the policy. RESULTS In the short term, employees who had seen others violate the policy ( P < .001) and had more tobacco-using friends ( P = .020) were less likely to adhere to the policy. At 9 months after the policy, employees who were older ( P = .038) and those who had seen others violate the policy ( P < .001) were less likely to report adherence to the policy. Tobacco-using employees who worked in a county with a comprehensive smoke-free ordinance ( P = .047) were more likely to adhere to the policy. CONCLUSION This study indicates the need for strong policy compliance procedures, employer-based tobacco treatment programs accompanying tobacco-free policy change, and smoke-free workplace laws to promote prohealth norms.
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Affiliation(s)
- Melinda J Ickes
- 1 Department of Kinesiology and Health Promotion, College of Education, BREATHE Research Team, University of Kentucky, Lexington, KY, USA
| | - Amanda Wiggins
- 2 College of Nursing, BREATHE Research Team, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- 2 College of Nursing, BREATHE Research Team, University of Kentucky, Lexington, KY, USA
| | - Jean Edwards
- 3 Department of Health Sciences, BREATHE Research Team, University of Kentucky, Lexington, KY, USA
| | - Ellen J Hahn
- 2 College of Nursing, BREATHE Research Team, University of Kentucky, Lexington, KY, USA
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Butler KM, Ickes MJ, Rayens MK, Wiggins AT, Ashford K, Hahn EJ. Intention to quit smoking and polytobacco use among college student smokers. Prev Med Rep 2018; 10:72-75. [PMID: 29560301 PMCID: PMC5856666 DOI: 10.1016/j.pmedr.2018.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 11/28/2022] Open
Abstract
Little is known about polytobacco use in college students. One nationally representative survey indicated 51.3% of tobacco-using college students used more than one product, which may increase risk of tobacco-related disease and premature death. The purpose of this study was to examine the association of intention to quit smoking (ITQS) cigarettes with polytobacco use status, controlling for frequency of tobacco product use and cigarette smoking intensity as measured by cigarettes per day (CPD). Data are from a larger quasi-experimental study conducted at a large state university in the Southeastern United States. Analysis is based on the combined sample of current smokers from two randomly selected cohorts surveyed two months apart. Polytobacco users (n = 52) were as likely as cigarette-only users (n = 81) to intend to quit smoking. Compared to students who used tobacco products 1–9 days per month, students using 10–29 days per month or daily reported higher ITQS. Higher intensity smokers (>10 CPD) were 71% less likely to indicate ITQS, compared to lower intensity smokers (≤10 CPD) (p = .025). College student polytobacco users were as likely as those using only cigarettes to intend to quit smoking. Interventions are needed to target college student polytobacco users as well as cigarette smokers as both groups may intend to quit. Smokers using 10 or fewer CPD and those who use tobacco products daily or 10–29 days per month may be more motivated to quit than college students who smoke with more intensity but who use tobacco products less frequently. 44.4% of the sample reported using at least one form of tobacco in addition to cigarettes. Polytobacco users were as likely as cigarette-only users to intend to quit smoking (ITQS). Significant ITQS predictors were sex, academic status, use frequency, cigarettes per day (CPD). Higher intensity smokers (>10 CPD) were 71% less likely than lower intensity (≤10 CPD) to ITQS. Students using tobacco 10–29 days/month or daily (vs. 1–9 days/month) reported greater ITQS.
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Affiliation(s)
- Karen M Butler
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, United States
| | - Melinda J Ickes
- University of Kentucky Department of Kinesiology and Health Promotion, College of Education, 111 Seaton, Lexington, KY 40506-0219, United States
| | - Mary Kay Rayens
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, United States
| | - Amanda T Wiggins
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, United States
| | - Kristin Ashford
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, United States
| | - Ellen J Hahn
- University of Kentucky College of Nursing, 751 Rose Street, Lexington, KY 40536-0232, United States
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Butler KM, Rayens MK, Wiggins AT, Rademacher KB, Hahn EJ. Association of Smoking in the Home With Lung Cancer Worry, Perceived Risk, and Synergistic Risk. Oncol Nurs Forum 2018; 44:E55-E63. [PMID: 28222077 DOI: 10.1188/17.onf.e55-e63] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine the association of smoking in the home with lung cancer worry, perceived risk, and synergistic risk, controlling for sociodemographics, family history of lung cancer, and health-related self-concept. The hypothesis is that participants with smoking in the home would have higher scores for lung cancer worry, perceived risk, and synergistic risk.
. DESIGN Cross-sectional baseline survey.
. SETTING Participants recruited from an outpatient clinic and pharmacy at University of Kentucky HealthCare, an academic medical center.
. SAMPLE 515 homeowners from a larger randomized, controlled trial aimed at reducing exposure to radon and secondhand smoke (SHS).
. METHODS Homeowners were selected via quota sampling so that about half would have a smoker or smokers in the home.
. MAIN RESEARCH VARIABLES Lung cancer worry and perceived risk; perception of synergistic risk of radon and SHS exposure; demographics.
. FINDINGS Participants with smoking in the home had higher rates of lung cancer worry and perceived risk. In addition, those with less education and a family history of lung cancer and who were current smokers had higher lung cancer worry and perceived lung cancer risk scores. Predictors of perception of synergistic risk were marital status and health-related self-concept.
. CONCLUSIONS Homeowners with smoking in the home, less education, and a family history of lung cancer had greater lung cancer worry and perceived lung cancer risk. Lung cancer risk reduction interventions with vulnerable populations are needed.
. IMPLICATIONS FOR NURSING Nurses are in a unique position to target high-risk populations and identify opportunities to create teachable moments to reduce environmental risks of radon and tobacco smoke exposure.
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Hahn EJ, Rayens MK, Wiggins AT, Gan W, Brown HM, Mullett TW. Lung cancer incidence and the strength of municipal smoke-free ordinances. Cancer 2017; 124:374-380. [DOI: 10.1002/cncr.31142] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/07/2017] [Accepted: 08/14/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Ellen J. Hahn
- Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE), College of Nursing; University of Kentucky; Lexington Kentucky
- College of Public Health; University of Kentucky; Lexington Kentucky
| | - Mary Kay Rayens
- Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE), College of Nursing; University of Kentucky; Lexington Kentucky
- College of Public Health; University of Kentucky; Lexington Kentucky
| | - Amanda T. Wiggins
- Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE), College of Nursing; University of Kentucky; Lexington Kentucky
| | - Wenqi Gan
- College of Public Health; University of Kentucky; Lexington Kentucky
| | - Holly M. Brown
- Bridging Research Efforts and Advocacy Toward Healthy Environments (BREATHE), College of Nursing; University of Kentucky; Lexington Kentucky
| | - Timothy W. Mullett
- Markey Cancer Center, College of Medicine; University of Kentucky; Lexington Kentucky
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Rayens MK, Ickes MJ, Butler KM, Wiggins AT, Anderson DG, Hahn EJ. University students' perceived risk of and intention to use waterpipe tobacco. Health Educ Res 2017; 32:306-317. [PMID: 28854575 PMCID: PMC5914365 DOI: 10.1093/her/cyx049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Revised: 04/20/2016] [Accepted: 06/29/2017] [Indexed: 06/07/2023]
Abstract
Emerging tobacco product use is increasing. We evaluated factors associated with perceived risk of and intention to use waterpipe tobacco by surveying students at a large university in the southeastern U.S. (N = 667). Proportional odds modeling assessed whether demographic characteristics and social acceptability are associated with perceived risk of waterpipe tobacco use; and if these factors and perceived risk are related to intention to use waterpipe tobacco. Participants who perceived waterpipe tobacco to be more socially acceptable had lower odds of perceiving it as risky (95% confidence interval [CI] 0.50-0.68). Compared with never users, former tobacco users and current users had lower odds of perceiving waterpipe tobacco use as risky (95% CI 0.38-0.80 and 0.28-0.63, respectively). Similarly, students with greater perceived social acceptability scores had higher odds of intending to use waterpipe tobacco (95% CI 1.41-2.63), while those who perceived greater risk had lower odds of intending to use it (95% CI 0.34-0.64). Compared with never users, former users had higher odds of intending to use waterpipe tobacco (95% CI 1.42-7.21). Among those who had ever used waterpipe tobacco, 90% reported 'to socialize' as the most frequent reason for deciding to do so. Findings underscore the need for future prevention efforts.
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Affiliation(s)
- Mary Kay Rayens
- University of Kentucky College of Nursing, 543 CON, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Melinda J. Ickes
- Department of Kinesiology and Health Promotion, University of Kentucky, 111 Seaton Building, Lexington, KY 40506-0219, USA
| | - Karen M. Butler
- University of Kentucky College of Nursing, 423 CON, 751 Rose Street, Lexington, KY 40536-0232, USA
| | - Amanda T. Wiggins
- University of Kentucky College of Nursing, 501 E2 CON, 751 Rose Street, Lexington, KY 40526-0232, USA
| | - Debra G. Anderson
- University of Kentucky College of Nursing, 551 CON, 751 Rose Street, Lexington, KY 40526-0232, USA
| | - Ellen J. Hahn
- University of Kentucky College of Nursing, 2265 Harrodsburg Road, Suite 202, Lexington, KY 40504, USA
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Noland M, Rayens MK, Wiggins AT, Huntington-Moskos L, Rayens EA, Howard T, Hahn EJ. Current Use of E-Cigarettes and Conventional Cigarettes Among US High School Students in Urban and Rural Locations: 2014 National Youth Tobacco Survey. Am J Health Promot 2017; 32:1239-1247. [PMID: 28731384 DOI: 10.1177/0890117117719621] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Melody Noland
- 1 Department of Kinesiology and Health Promotion, College of Education, University of Kentucky, Lexington, KY, USA
| | - Mary Kay Rayens
- 2 Tobacco Policy Research Division, BREATHE, College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Amanda T Wiggins
- 2 Tobacco Policy Research Division, BREATHE, College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
| | | | - Emily A Rayens
- 4 Department of Infectious Diseases, University of Georgia, Athens, GA, USA
| | - Tiffany Howard
- 5 Department of Health Promotion and Administration, College of Health Sciences, Eastern Kentucky University, Richmond, KY, USA
| | - Ellen J Hahn
- 2 Tobacco Policy Research Division, BREATHE, College of Nursing and College of Public Health, University of Kentucky, Lexington, KY, USA
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