World Vaping Day: Contextualizing Vaping Culture in Online Social Media Using a Mixed Methods Approach

Few studies have demonstrated the use of mixed methods research to contextualize health topics using primary data from social media. To address this gap in the methodological literature, we present research about electronic nicotine delivery systems, using Twitter data from “World Vaping Day.” To engage with the quantitative breadth and qualitative depth of 5,149 collected tweets, we utilized a convergent parallel mixed methods framework, integrating thematic prevalence estimates with phenomenological contextualization. Sentiment was more positive than negative across all categories except policy related. A total of 23% of tweets were promotional and relatively few tweets related to tobacco use (4.9%) or health concerns (4.2%). Salient themes included modifying or upgrading electronic nicotine delivery systems devices, and general mistrust of public health advocates and tobacco companies. </jats:p

Caregiver Integration During Discharge Planning for Older Adults to Reduce Resource Use: A Metaanalysis

Objectives To determine the effect of integrating informal caregivers into discharge planning on postdischarge cost and resource use in older adults. Design A systematic review and metaanalysis of randomized controlled trials that examine the effect of discharge planning with caregiver integration begun before discharge on healthcare cost and resource use outcomes. MEDLINE, EMBASE, and the Cochrane Library databases were searched for all English‐language articles published between 1990 and April 2016. Setting Hospital or skilled nursing facility. Participants Older adults with informal caregivers discharged to a community setting. Measurements Readmission rates, length of and time to post‐discharge rehospitalizations, costs of postdischarge care. Results Of 10,715 abstracts identified, 15 studies met the inclusion criteria. Eleven studies provided sufficient detail to calculate readmission rates for treatment and control participants. Discharge planning interventions with caregiver integration were associated with a 25% fewer readmissions at 90 days (relative risk (RR) = 0.75, 95% confidence interval (CI) = 0.62–0.91) and 24% fewer readmissions at 180 days (RR = 0.76, 95% CI = 0.64–0.90). The majority of studies reported statistically significant shorter time to readmission, shorter rehospitalization, and lower costs of postdischarge care among discharge planning interventions with caregiver integration. Conclusion For older adults discharged to a community setting, the integration of caregivers into the discharge planning process reduces the risk of hospital readmission

Organizational and Environmental Context for Including Advanced Practice Providers in UPMC Hospitalist Models

This study qualitatively examines the environmental and organizational context driving the implementation of advanced practice providers (APPs) in hospital medicine at UPMC. We utilized a comparison case study methodology, including field observation and semi-structured interviews at two hospital medicine programs. We identified three distinct models of APPs in hospital medicine, including the Team Approach, Divide and Conquer, and a Hybrid model, and linked the evolution of these models to contextual factors. Our findings present unique insight into the roles of APPs on UPMC hospital medicine teams. We show that environmental pressures, organizational initiatives, and clinician experience can influence APP roles

Pennsylvania policymakers’ knowledge, attitudes and likelihood for action regarding waterpipe tobacco smoking and electronic nicotine delivery systems

INTRODUCTION Use of waterpipe tobacco smoking (WTS, or hookah smoking) and electronic nicotine delivery systems (ENDS, such as e-cigarettes) is rapidly increasing. However, legislatures have been slow to update policy measures related to them. Therefore, we aimed to assess knowledge, attitudes and likelihood to take future action regarding WTS and ENDS among Pennsylvania legislators. METHODS We approached all Standing Members of key Pennsylvania House and Senate health and welfare committees to complete a survey about substances of abuse, including WTS and ENDS. Closed-ended knowledge, attitude and action items used a 100-point scale. Responses to open-ended items were assessed using thematic analysis by three independently working researchers. RESULTS We received responses from 13 of 27 eligible policymakers (48%). Participants answered a mean of only 27% (SD=20%) of knowledge items correctly. When asked to rank by priority eight issues in substance abuse, WTS ranked eighth (least urgent) and ENDS ranked fifth. Participants reported low likelihood to introduce legislation on WTS (mean=29, median=25) and/or ENDS (mean=28, median=10). Thematic analysis revealed that participants readily acknowledged lack of understanding of WTS and ENDS, and were eager for additional information. CONCLUSIONS Policymakers exhibit a lack of knowledge concerning newer forms of tobacco and nicotine delivery systems and consider them to be relatively low legislative priorities. However, respondents expressed a desire for more information, suggesting the potential for public health entities to promote effective policy development via improved dissemination of information

Paid sick days and stay-at-home behavior for influenza.

Access to paid sick days (PSD) differs by workplace size, race/ethnicity, gender, and income in the United States. It is not known to what extent decisions to stay home from work when sick with infectious illnesses such as influenza depend on PSD access, and whether access impacts certain demographic groups more than others. We examined demographic and workplace characteristics (including access to PSD) associated with employees' decisions to stay home from work for their own or a child's illness. Linking the 2009 Medical Expenditure Panel Survey (MEPS) consolidated data file to the medical conditions file, we used multivariate Poisson regression models with robust variance estimates to identify factors associated with missed work for an employee's own or a child's illness/injury, influenza-like-illness (ILI), and influenza. Controlling for gender, race/ethnicity, education, and income, access to PSD was associated with a higher probability of staying home for an employee's own illness/injury, ILI, or influenza, and for a child's illness/injury. Hispanic ethnicity was associated with a lower prevalence of staying home for the employee's own or a child's illness compared to non-Hispanic Whites. Access to PSD was associated with a significantly greater increase in the probability of staying home among Hispanics than among non-Hispanic Whites. Women had a significantly higher probability of staying home for their child's illness compared to men, suggesting that women remain the primary caregivers for ill children. Our results indicate that PSD access is important to encourage employees to stay home from work when sick with ILI or influenza. Also, PSD access may be important to enable stay-at-home behavior among Hispanics. We conclude that access to PSD is likely to reduce the spread of disease in workplaces by increasing the rate at which sick employees stay home from work, and reduce the economic burden of staying home on minorities, women, and families

Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among U.S. young adults

Introduction. While increased social media use (SMU) has been associated with depression and anxiety, the independent role of using multiple social media platforms is unclear. Methods. We surveyed a nationally-representative sample of 1787 U.S. young adults ages 19-32. Dependent variables were both depression and anxiety symptoms measured using the Patient-Reported Outcomes Measurement Information System (PROMIS). We assessed use of multiple social media platform with an adapted Pew Internet Research scale. We used ordered logistic regression models to assess associations between multiple platform use and mental health outcomes while controlling for eight covariates, including overall SMU. Results. Compared to those who used 0-2 social media sites, participants who used 7-11 social media sites had substantially higher odds of having increased levels of both depression (Adjusted Odds Ratio [AOR]=3.0, 95% CI=1.9-4.8) and anxiety symptoms (AOR=3.2, 95% CI=2.0-5.1). Associations were linear (p<.001 for all) and robust to all sensitivity analyses. Conclusions. Use of multiple social media platforms is strongly and independently associated with symptoms of depression and anxiety, even when controlling for overall SMU. Future research should determine directionality and reasons for these associations. In the meantime, associations are strong enough to caution people with depression and anxiety about this potential contributing factor