Tobacco use disparities in rural communities

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.

Examining intention to quit using Juul among emerging adults

OBJECTIVES

(1) Describe intention to quit, (2) identify relationships between various factors and intention to quit, (3) explore if Theory of Planned Behavior-informed constructs are associated with intention to quit, and (4) discover if descriptive norms strengthen association with intention to quit among emerging adults currently using Juul. Participants: First-year students currently using Juul at a large public university (N = 182). Methods: A November 2018 online survey assessed sociodemographic characteristics, social influences, patterns of use, quit intention, and attitudes, norms, and perceived behavioral control toward Juul. Results: A quarter of participants reported current use, with nearly half intending to quit within six months. Recent quit attempts was the only factor related to intention. Two models were created that showed association with intention to quit, but only perceived behavioral control was individually significant. Conclusions: Cessation-focused campaigns and interventions are needed on college campuses and could be less tailored than prevention.

The Impact of a Virtual Tobacco Prevention and Advocacy Training Among Youth in Appalachian Kentucky Communities

BACKGROUND

Engaging youth is an important component of comprehensive tobacco control programs.

PURPOSE

This paper describes the impact of a virtual tobacco prevention training program to encourage and prepare youth in Appalachia to support tobacco prevention policies, to strengthen interpersonal confidence to address tobacco use within their communities and enhance advocacy self-efficacy for tobacco control.

METHODS

A two-part evidence-informed peer-led tobacco prevention and advocacy training was implemented among 16 high school students from Appalachian counties in Kentucky. The initial training (January 2021) included an overview of the e-cigarette landscape, advocacy skills related to policy change, developing messages to decision makers, and media advocacy. A follow-up session (March 2021) included a breakdown of advocacy skills and overcoming barriers.

RESULTS

Overall, participants held strong beliefs that tobacco use is an issue that needs to be addressed in their community. There was a statistically significant average difference in student interpersonal confidence between baseline and post-surveys (t = 2.016, P = .062 < .1). Students who participated in at least 1 of the provided advocacy events indicated higher self-reported advocacy.

CONCLUSION

Youth in Appalachia expressed an interest to advocate for stronger tobacco policy in their communities. Youth who participated in the tobacco advocacy policy trainings reported improvements in attitudes, interpersonal confidence, advocacy self-efficacy, and self-reported advocacy. Youth engagement in tobacco policy advocacy is promising and needs to be further supported.

Assessing the Testability of the Multi-Theory Model (MTM) in Predicting Vaping Quitting Behavior among Young Adults in the United States: A Cross-Sectional Survey

PURPOSE

Given the increased exposure to e-cigarettes and nicotine among young adults, difficulty in quitting vaping is likely, which supports the need for effective behavioral interventions. Therefore, this cross-sectional study aims to assess the testability of the contemporary multi-theory model of health behavior change in predicting the vaping quitting behavior among young adults in the United States.

METHODS

A nationally representative sample of 619 young adults engaged in vaping behavior and aged 18-24 years was recruited to complete a 49-item web-based survey. A structural equation model was used to test relationships between MTM constructs. Hierarchical multiple regression was utilized to predict the variance in the initiation and sustenance of vaping quitting behavior by predictor variables, such as demographic characteristics, history of behaviors, and MTM constructs.

RESULTS

Of 619 respondents, over 75% were White and nearly 70% had educational attainment equal to high school or some college. In total, 62% of respondents were using nicotine, followed by 33.3% were using cannabis. About 80% of the respondents reported being engaged in drinking alcohol, and nearly 45% were engaged in cigarette smoking. The predictive effect of all MTM constructs on vaping quitting initiation (adjusted R2 = 0.417, F (23, 595) = 20.215, p < 0.001) and sustenance (adjusted R2 = 0.366, F (23, 595) = 16.533, p < 0.001) was statistically significant.

CONCLUSIONS

The findings of this study point to the usability and applicability of MTM in operationalizing and developing vaping quitting behavior interventions targeting young adults.

Training Appalachian Kentucky Youth Cancer Advocates

OBJECTIVES

Kentucky has the highest cancer incidence and mortality rates in the United States, with the Appalachian region experiencing the highest of those rates. Cancer advocacy, which is defined as providing support to cancer patients and their communities, represents a means of decreasing the cancer cases in Appalachian Kentucky. This exploratory study examined the effects of advocacy training and experiential learning on Appalachian high school students' cancer advocacy attitudes and self-efficacy.

METHODS

The design of this study was a mixed-methods, one-group repeated measure with a group of participants from the Appalachian Career Training in Oncology (ACTION) Program (N = 9). The study assessed advocacy attitudes and self-efficacy before and after participants were provided advocacy training and participated in an advocacy event.

RESULTS

Participating students' attitudes and self-efficacy did not substantially change following the training and their participation in an advocacy event. Through their comments after the event, however, students seem eager to use their voices to influence the actions of state legislators. At the same time, they worry about the apathy of their community members to their cancer advocacy message.

CONCLUSIONS

Youth represent potentially powerful agents of advocacy that could help address the cancer burden in Kentucky. Participants in this study likely overestimated their advocacy abilities before learning more about advocacy and participating in the process. As such, additional trainings are likely necessary to increase students' self-efficacy, encourage them to share their stories, and help them overcome perceived barriers.

Identifying current Juul users among emerging adults through Twitter feeds

INTRODUCTION

Juul is the most popular electronic cigarette on the market. Amid concerns around uptake of e-cigarettes by never smokers, can we detect whether someone uses Juul based on their social media activities? This is the central premise of the effort reported in this paper. Several recent social media-related studies on Juul use tend to focus on the characterization of Juul-related messages on social media. In this study, we assess the potential in using machine learning methods to automatically identify Juul users (past 30-day usage) based on their Twitter data.

METHODS

We obtained a collection of 588 instances, for training and testing, of Juul use patterns (along with associated Twitter handles) via survey responses of college students. With this data, we built and tested supervised machine learning models based on linear and deep learning algorithms with textual, social network (friends and followers), and other hand-crafted features.

RESULTS

The linear model with textual and follower network features performed best with a precision-recall trade-off such that precision (PPV) is 57 % at 24 % recall (sensitivity). Hence, at least every other college-attending Twitter user flagged by our model is expected to be a Juul user. Additionally, our results indicate that social network features tend to have a large impact (positive) on classification performance.

CONCLUSION

There are enough latent signals from social feeds for supervised modeling of Juul use, even with limited training data, implying that such models are highly beneficial to very focused intervention campaigns. This initial success indicates potential for more involved automated surveillance of Juul use based on social media data, including Juul usage patterns, nicotine dependence, and risk awareness.

Tobacco-Free Ambassador Partnership: Empowering Youth Advocates in Appalachian Communities

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.

Student Tobacco Use Behaviors on College Campuses by Strength of Tobacco Campus Policies

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.

Readiness for Tobacco-Free Policy in a Statewide University System

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.

Truth® ads, receptivity, and motivation to use or quit tobacco among college students

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.

Support for Tobacco 21 in a Tobacco-Growing State

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.

Short- and Long-Term Effects of a Tobacco-Free Executive Order on Employee Tobacco Use

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.

Online readiness assessment for Smoke- and Tobacco-free campus policies

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.

Readiness to Adopt Physical Activity Policies in Rural Communities

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.

Employee Adherence to a Tobacco-Free Executive Order in Kentucky

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.

Intention to quit smoking and polytobacco use among college student smokers

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.

An Incentivized, Workplace Physical Activity Intervention Preferentially Increases Daily Steps in Inactive Employees

Although physical activity (PA) is associated with decreased risk of chronic diseases, fewer than half of American adults meet the recommendations for daily PA, in part, due to large amounts of sedentary time in the workplace.

PURPOSE

To determine the efficacy of an incentivized workplace PA intervention.

DESIGN

Retrospective cohort design.

SETTING

Large southeastern university.

PARTICIPANTS

Of the 16 588 eligible employees working ≥8 h/wk, 6246 (37.6%) participated and 2206 (13.3%) were included in data analysis.

INTERVENTION

Six-week PA intervention with tiered incentives (value: $10.50-$29.00).

MEASURES

Steps/day measured via consumer-grade PA monitors for 1-week pre-, 6-weeks during, and 1-week postintervention.

ANALYSIS

Participants were grouped by preintervention PA into 4 groups: <6000 (I); 6000 to 7999 (II); 8000 to 9999 (III); and ≥10 000 (IV) steps/d ( n = 481, 540, 485, and 700, respectively) in accordance with the tiered incentive schedule. Statistical comparisons were made by repeated-measures analysis of variance.

RESULTS

During the intervention, participants achieving ≥10 000 steps/d increased by 60%. Groups I, II, and III significantly increased steps/day during the intervention (46%, 24%, and 11%, respectively), which was partially maintained in groups I and II 1-week postintervention. Group IV did not increase steps/day during the intervention and significantly decreased steps/day 1-week postintervention. The estimated cost per participant of this intervention increased with from group I ($55.41) to IV ($71.90).

CONCLUSION

An incentivized, workplace PA intervention preferentially increases PA and is most cost-effective among university employees with low initial PA who may benefit substantially from increased levels of PA.

University students' perceived risk of and intention to use waterpipe tobacco

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.

Students' Beliefs About and Perceived Effectiveness of a Tobacco-Free Campus Policy

Tobacco-free (TF) college campus policies have potential to be a high-impact tobacco control strategy. The purposes of the study presented here were to (a) determine the demographic and personal characteristics associated with students' beliefs about and perceived effectiveness of a TF campus policy and (b) assess whether tobacco use status and exposure to secondhand smoke (SHS) predicted beliefs and perceived effectiveness. Five thousand randomly selected students from a large southeastern university were invited by e-mail to participate in an online survey in April 2013, three and a half years after policy implementation. Students held positive beliefs about the policy (average rating 84% of the maximum possible score). Sixty-one percent believed that the policy was successful at reducing SHS exposure; and 40% thought the policy encouraged quitting. Males were less likely than females to believe the policy was effective in reducing SHS exposure and encouraging quitting. Lower undergraduates were more likely to perceive the policy as less effective in reducing SHS exposure; international students were more likely than domestic students to perceive the policy as more effective at encouraging quitting. Students most exposed to SHS were less likely to perceive the policy was effective. Compared with nonusers, those who smoked cigarettes were less likely to perceive the policy as effective in encouraging quitting. Tailored messaging regarding policy benefits are necessary. Perceived effectiveness of TF policies may be related to compliance with the policy and should be further investigated. Objective measures of effectiveness and tobacco use behaviors are needed to fully measure the success of TF campus policies.

Testing multi-theory model (MTM) in predicting initiation and sustenance of physical activity behavior among college students

BACKGROUND

Most college students do not adequately participate in enough physical activity (PA) to attain health benefits. A theory-based approach is critical in developing effective interventions to promote PA. The purpose of this study was to examine the utility of the newly proposed multi-theory model (MTM) of health behavior change in predicting initiation and sustenance of PA among college students.

METHODS

Using a cross-sectional design, a valid and reliable survey was administered in October 2015 electronically to students enrolled at a large Southern US University. The internal consistency Cronbach alphas of the subscales were acceptable (0.65-0.92). Only those who did not engage in more than 150 minutes of moderate to vigorous intensity aerobic PA during the past week were included in this study.

RESULTS

Of the 495 respondents, 190 met the inclusion criteria of which 141 completed the survey. The majority of participants were females (72.3%) and Caucasians (70.9%). Findings of the confirmatory factor analysis (CFA) confirmed construct validity of subscales (initiation model: χ2 = 253.92 [df = 143], P < 0.001, CFI = 0.91, RMSEA = 0.07, SRMR = 0.07; sustenance model: χ2= 19.40 [df = 22], P < 0.001, CFI = 1.00, RMSEA = 0.00, SRMR = 0.03). Multivariate regression analysis showed that 26% of the variance in the PA initiation was explained by advantages outweighing disadvantages, behavioral confidence, work status, and changes in physical environment. Additionally, 29.7% of the variance in PA sustenance was explained by emotional transformation, practice for change, and changes in social environment.

CONCLUSION

Based on this study's findings, MTM appears to be a robust theoretical framework for predicting PA behavior change. Future research directions and development of suitable intervention strategies are discussed.

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

OBJECTIVES

(1) Compare social norms and perceived peer use between college student cigarette, e-cigarette, and/or hookah users and nonusers; and (2) determine variables associated with social influences.

PARTICIPANTS

Undergraduate students attending a large university in the Southeast United States (N = 511).

METHODS

An April 2013 online survey assessed use of 3 types of tobacco, social norms, perception of peer use, number of smokers in life, exposure to secondhand smoke, and demographic characteristics.

RESULTS

Participants indicated greater acceptance of emerging tobacco products than for cigarettes and consistently overestimated the percent of peers who use various tobacco products. Males and current users had higher social norm scores for all 3 forms of tobacco.

CONCLUSION

To counter marketing of alternative tobacco products, education about the dangers of their use needs to be implemented across college campuses as part of a comprehensive tobacco control strategy that also includes tobacco-free campus policies.

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

BACKGROUND

Tobacco media campaigns are effective, but less is known regarding the impact on college students.

PURPOSE

The purpose was to test the effects of an on-campus Tips television campaign on frequency and believability of ads recalled and to assess demographic and personal factors associated with believability.

METHODS

A quasi-experimental pre-post design was used to assess the 8-week campaign with three Tips ads. Two randomly-selected cohorts of college students (N = 1,593) from a large public university completed online surveys pre- and post-campaign. Group comparisons using chi-square tests, two-sample t-tests, and logistic regression, controlling for residence or cohort; predictors of believability using proportional odds modeling.

RESULTS

Ads were recalled by significantly more students (68%) post-campaign. Believability for one or more ads was lower for males, undergraduates, those belonging to fraternity/sorority, and current polytobacco users (p<.05). Believability was greater for those who recalled seeing the ads more often (p<.05).

DISCUSSION

Sub-groups of college students, including males and undergraduates, reported less ad believability, which should be considered when designing communication strategies.

TRANSLATION TO HEALTH EDUCATION PRACTICE

Considering the potential impact and cost-effective nature of on-campus TV media campaigns, these ads need to be integrated into current campus tobacco control strategies.

Secondhand tobacco smoke exposure and susceptibility to smoking, perceived addiction, and psychobehavioral symptoms among college students

OBJECTIVE

To examine the association of secondhand smoke (SHS) exposure with susceptibility to smoking, perceived addiction, and psychobehavioral effects of exposure among never- and ever-smoking college students.

PARTICIPANTS

Participants were 665 college students at a large, southeastern university in the United States.

METHODS

This study is a secondary analysis of online cross-sectional survey data from randomly selected students in April 2013.

RESULTS

Thirty-eight percent of the sample had moderate to high SHS exposure. Among never-smokers, SHS exposure was associated with increased susceptibility to initiating smoking. Among ever-smokers, SHS exposure was not associated with their perceived addiction to tobacco. In the total sample, SHS exposure was associated with greater psychobehavioral symptoms of exposure.

CONCLUSIONS

SHS exposure may the increase risk of smoking, especially among never-smoking college students. This study strengthens the need for prevention strategies that limit SHS exposure in college environments.

Differences between Undergraduate and Graduate Students in Stress and Coping Strategies

Background and Purpose: Stress among college students, and the related health and academic consequences, remains an important issue for college health professionals. Yet, less is known about the reported coping strategies among both undergraduate and graduate students. Purpose: This crosssectional study examined differences between undergraduate and graduate college students in stress levels and coping behaviors. Methods: An online health behavior survey was administered to a random sample of 1,139 college students enrolled in 2011. Chi-square test of independence examined demographic differences, stress levels and coping strategies. Classification and Regression Tree analysis further explored coping strategies which differentiated groups. Results: Participants were primarily white (87.2%), graduate students (58.5%), and female (59.8%). Almost 80% reported moderate, much or great deal of stress, with no significant differences between undergraduate and graduate students. Sleep (69.6%), exercise (66.1%), and food (56.8%) were the most common coping strategies, regardless of academic classification. Social support as a coping strategy was the most important variable explaining differences between undergraduate and graduate students. Conclusion: Undergraduate and graduate college students cope with stress in a similar manner. However, social support was more likely among graduate students and may be an important strategy for future college health programming.

Polytobacco Use Among College Students

INTRODUCTION

Use of more than one tobacco product among college students is increasing in popularity, leading to nicotine addiction and additional health risks. The study (1) examined polytobacco use patterns among college students who had ever used tobacco; and (2) assessed the sociodemographic and personal factors associated with current polytobacco use, compared to current single product use and former tobacco use among college students.

METHODS

Of 10,000 randomly selected college students from a large public university in the Southeast, a sample of 1593 students age 18 or older completed an online survey assessing tobacco use and attitudes. Ever tobacco users were included in this study (n = 662, or 41.6% of survey completers).

RESULTS

About 15% of ever users reported current polytobacco use, and more than 70% of polytobacco users smoked cigars, little cigars, or clove cigarettes in combination with one or more products. Cigarettes were the most commonly-used product among single users, followed by hookah. Males, underclassmen, and students with greater acceptance of cigarette use were more likely to be polytobacco users. Race/ethnicity was marginally related to polyuse status, with white/non-Hispanics 28% less likely to be polytobacco users versus single product users.

CONCLUSIONS

Polytobacco users were more likely than single users to consume emerging tobacco products, (ie, hookah and electronic cigarettes). Males, underclassmen, and racial/ethnic minorities were more at risk for polytobacco use. As young people are particularly prone to nicotine addiction, there is a need to further investigate polytobacco use among college students.

A tobacco-free campus ambassador program and policy compliance

OBJECTIVE

Assess impact and feasibility of a Tobacco-Free Ambassador Program on campus policy compliance.

PARTICIPANTS

Trained Ambassadors made 253 visits to campus sites over 15 months to observe and/or approach violators.

METHODS

Policy violators were observed at 23 locations during Wave 1 (April-June 2012) and/or Wave 2 (April-June 2013). For locations with at least 5 visits, average violators per visit were compared between the 2 waves using a paired t test. Attributes of violators were summarized. Cigarette butts were collected over 3-day periods in 4 campus hotspots during each wave. Personnel time and cost to implement the program were determined.

RESULTS

There were declines in observed violators per Ambassador visit and number of cigarette butts over time. Rate of violators per visit declined from 5.47 to 1.93, a 65% decrease. Personnel time was equal to 1.5 full-time equivalents annually.

CONCLUSIONS

The Ambassador Program was a feasible and potentially effective strategy to increase policy compliance.

Purchasing condoms near a college campus: environmental barriers

Background Given the propensity for college students to engage in sexual activity and the subsequent lack of consistent condom use, there is a need to determine environmental factors that may be motivating or deterring factors for college students to access condoms. This study aimed to determine the number of businesses available to purchase condoms from near a large, south-eastern college campus and investigate environmental differences between types of businesses.

METHODS

Environmental factors (e.g. distance from campus, barriers to purchasing, selection availability and price) were collected among businesses within a 2-mile radius of the campus. Both χ(2) and ANOVA determined significant differences between types of businesses (P≤0.05).

RESULTS

Forty-two businesses sold condoms, 66.7% of which were convenience-type stores. The average distance from the campus was 1.33 miles (s.d.=0.58). The average unit price of male condoms was significantly higher in drug store/pharmacies (M=1.68) compared with convenience-type stores (M=1.22) and grocery stores (M=0.97); P=0.005. Assistance was needed to purchase condoms in 25% of businesses. Barriers to purchasing condoms were significantly higher in convenience stores/gas stations (P<0.05).

CONCLUSION

Environmental barriers related to purchasing condoms exist and must be considered when targeting sexual health promotion on college campuses.

Global school-based childhood obesity interventions: a review

BACKGROUND

The issue of childhood overweight and obesity has become a global public health crisis. School-based interventions have been developed and implemented to combat this growing concern. The purpose of this review is to compare and contrast U.S. and international school-based obesity prevention interventions and highlight efficacious strategies.

METHODS

A systematic literature review was conducted utilizing five relevant databases. Inclusion criteria were: (1) primary research; (2) overweight or obesity prevention interventions; (3) school-based; (4) studies published between 1 January 2002 through 31 December 2013; (5) published in the English language; (6) child-based interventions, which could include parents; and (7) studies that reported outcome data.

RESULTS

A total of 20 interventions met the inclusion criteria. Ten interventions each were implemented in the U.S. and internationally. International interventions only targeted elementary-aged students, were less likely to target low-income populations, and were less likely to be implemented for two or more years in duration. However, they were more likely to integrate an environmental component when compared to U.S. interventions.

DISCUSSION

Interventions implemented in the U.S. and internationally resulted in successful outcomes, including positive changes in student BMI. Yet, varying approaches were used to achieve success, reinforcing the fact that a one-size-fits-all approach is not necessary to impact childhood obesity. However, building on successful interventions, future school-based obesity prevention interventions should integrate culturally specific intervention strategies, aim to incorporate an environmental component, and include parents whenever possible. Consideration should be given to the potential impact of long-term, frequent dosage interventions, and subsequent follow-up should be given attention to determine long-term efficacy.

The Role and Impact of Nurses in American Elementary Schools

School nurses are tasked with the critical job of keeping students safe and well. Due to competing demands for resources in schools, the impact of school nurses must be demonstrated to secure their jobs. A systematic review of the literature from 1937 to 2013 was conducted to show the efficacy of school nursing activities in American elementary schools. While some studies of immunization compliance, attendance rates, body mass index screening, vision screening, and follow-up are promising, results are mixed and additional evidence is needed. The impact of school nurses on educational and health outcomes must continue to be evaluated and more rigorous evaluation methods should be explored. Suggestions for future research and collaborations are discussed.

Tobacco-free Take Action!: Increasing Policy Adherence on a College Campus

INTRODUCTION

One in five college students report tobacco use, thus universities are making strides to reduce tobacco use by adopting smoke- or tobacco-free policies.

PURPOSE

Describe an innovative ambassador program to increase adherence with a tobacco-free campus policy.

METHODS

The Tobacco-Free Take Action! (TFTA!) Ambassador program was created to form an environment of compliance. Hot spots were targeted by Ambassadors, who were trained to use scripted messages. Ambassadors completed an online documentation form to assess the number of violators observed and approached. The Tobacco-Free Compliance Assessment Tool (TF-CAT) was used to collect pre- and post-cigarette butt data at each hot spot.

RESULTS

During the 4-week intervention period, Ambassadors approached 332 violators (529 observed), of which 68% responded positively and complied with the policy. The number of cigarette butts declined by 25%.

DISCUSSION

Adherence with campus tobacco-free policies remains a challenge. Lessons learned from this innovative approach will benefit those currently implementing and planning tobacco-free campus policies.

Does Behavioral Intention Predict Nutrition Behaviors Related to Adolescent Obesity?

The theory of planned behavior (TPB) proposes that the single best predictor of a person’s behavior is intention to perform that behavior. Successful application of the TPB supports that attitudes, subjective norms, and perceived behavioral control are predictive factors of behavioral intention (BI). The purpose of this study was to examine the extent to which BI predicted nutrition behaviors linked to adolescent obesity. A cross-sectional design obtained a convenience sample of 318 middle school students who completed a 129-item validated instrument. Multiple regression was used to establish predictors for fruit and vegetable (FV) consumption and sweetened beverages (SBs) versus water consumption. The mean BI scores were as follows: FV consumption, M = 12.18, standard deviation [SD] = 5.74, and SB versus water consumption, M = 12.42, SD = 6.07. This denotes a moderate intent to participate in the behavior. Regression showed that BI was predictive for consumption of FV among overweight and obese students and consumption of water versus SB in normal weight students (P < .05). BI was linked to nutrition behaviors related to obesity prevention in adolescents. Differences among those students who were considered normal weight and overweight/obese existed and should be considered when working with these populations and designing future interventions.

Health literacy in college students

OBJECTIVE

The purpose of this study was to assess the health literacy levels, and the potential importance of healthy literacy, of college students.

PARTICIPANTS

Courses were randomly selected from all upper level undergraduate courses at a large Research I university to obtain a sample size of N = 399.

METHODS

During the 2007-2008 school year, students were administered the Test of Functional Health Literacy (TOFHLA), which assessed both numeracy and reading comprehension utilizing real-life health care materials. The numeracy scale (n = 17) assessed understanding of prescription labels, appointment slips, and glucose monitoring using actual hospital forms and labels for prescription vials. Ten prompts were given, and participants had to answer quantitatively. The reading comprehension scale (n = 50) assessed understanding of health care texts through 3 reading passages, including instructions for preparation for an upper gastrointestinal (GI) series, Medicaid patient rights and responsibilities, and hospital informed consent agreement. A modified Cloze procedure was employed; every fifth to seventh word in each passage was omitted and the participant selected the best word to fill in the blank from a list of 4 possible choices.

RESULTS

The mean health literacy score was 93.83, which was considered adequate functional health literacy. In terms of importance of health literacy to the students, it was found that a majority valued its importance (89.3%).

CONCLUSIONS

Indeed this group of university students would seem to have good health literacy levels that would allow them to navigate the health care system. However, many students still had problems with individual TOFHLA items, particularly the numeracy questions.

Establishing validity and reliability of an instrument using the theory of planned behavior to predict middle school student obesity-related actions

BACKGROUND

Childhood obesity is of concern to many health professionals, parents, teachers, and school administrators because of the negative impact on the child's physical, psychological, and behavioral health. Lack of structured monitoring and evaluation has hindered the development of an evidence base to disseminate best practices in childhood obesity prevention.

PURPOSE

The purpose of this study was to develop a valid and reliable instrument which affirmed the constructs of the Theory of Planned Behavior in relation to nutrition and physical activity behaviors related to childhood obesity.

METHODS

A convenience sample of 242 students participated in the validation of the 129-item instrument, which was administered during class time, and read to students to increase response rate.

RESULTS

Confirmatory factor analysis established instrument validity, with one factor present for each behavior, and factor loadings greater than 0.32. Reliability and test-retest coefficients achieved apriori criteria of 0.70.

DISCUSSION

Truly learning how to gauge nutrition and physical activity levels in children and adolescents has proved to be difficult, yet it is imperative to understand the relationship of the proposed potentially modifiable behaviors and childhood obesity.

Community, Family and School-based Interventions for HIV/AIDS Prevention in African American Adolescents

A variety of environmental health issues occur within homes along the US/Mexico border region. Individuals living in this region are often not aware that specific issues, including pesticide safety, occur in their homes and may not understand the potential adverse effects of pesticide use on their families’ health. The Environmental Health/Home Safety Education Project created by the Southern Area Health Education Center at New Mexico State University, utilizes promotoras (community health workers) to educate clients on pesticide safety issues. Data from 367 pre/post tests and home assessments were collected from 2002-2005. The data were analyzed to detect changes in clients’ knowledge or behavior as they related to protecting themselves and their families against unsafe pesticide use and storage. Statistically significant changes occurred with both knowledge and behavior in regards to safe pesticide use. Through this culturally appropriate intervention, the promotoras provide practical information allowing clients to make their homes safer.