A Wellness Needs Assessment of Persons with Disabilities in Northern Florida: Physical Activity and Nutrition

Engaging an individual with a disability in health promotion activities may be challenging. This challenge is demonstrated by the prevalence of obesity among people with disabilities (PWDs) being higher than those without, and PWD twice as likely to be physically inactive. The combination of physical inactivity and high prevalence of obesity supports a need for health promotion activities. To examine the need for wellness promotion activities for PWDs, we surveyed consumers at a Center for Independent Living in North Central Florida (CILNCF). A survey was developed with items from the Physical Activity Scale for Individuals with Physical Disability (PASIPD) and nutrition items from Florida’s Behavioral Risk Factor Surveillance System (BRFSS). Among 36 participants, 25% reported exercise was difficult due to their disability and only 6% reported their attendant assisted with exercise. Participants reported doing less than the national recommendation of medium-strength exercise (83%) and hard-strength training activities (80%). Participants reported not meeting daily guidelines for fruit (42%) and green vegetable consumption (41%). Results demonstrate a lack of physical activity and adequate nutrition among PWDs. Community service organizations such as the CILNCF represent an ideal location to administer physical activity and nutrition education and interventions

Assessing Attitudes toward Nicotine Replacement Therapy for Adolescent Smoking Cessation

The objective was to ascertain attitudes toward nicotine replacement therapy for adolescent tobacco cessation. The authors created a 17-item survey consisting of demographics, quantitative, and qualitative items which was distributed to middle and high school students in North Central Florida. The authors assessed associations and conducted discriminant analyses to compare results by age. One-hundred ninety-eight students completed the survey (57.6% female, 61.6% white). When asked to select the best way to help teens stop using tobacco, combination of methods was most frequently selected (31.6%), followed by “Cold Turkey” (19.5%), e-cigarettes (16.8%), NRT (14.7%), Counseling (10.5%), and Alternative Therapies (6.8%). Qualitative data from students revealed misconceptions toward tobacco use, but an overall awareness that tobacco is a harmful. High school students were more likely than middle school students to agree that nicotine is harmful and e-cigarettes or chewing tobacco are less harmful than traditional cigarettes. Discriminant analyses were inconclusive. These data highlight misconceptions regarding tobacco use and nicotine that might play a role in attitudes toward NRT for adolescent tobacco cessation. Whereas high school students might be more likely to agree nicotine is harmful, their decreased perception of harm of alternative tobacco products such as e-cigarettes or chewing tobacco could be problematic. Further research in this area remains a priority

The seeds of divergence: the economy of French North America, 1688 to 1760

Generally, Canada has been ignored in the literature on the colonial origins of divergence with most of the attention going to the United States. Late nineteenth century estimates of income per capita show that Canada was relatively poorer than the United States and that within Canada, the French and Catholic population of Quebec was considerably poorer. Was this gap long standing? Some evidence has been advanced for earlier periods, but it is quite limited and not well-suited for comparison with other societies. This thesis aims to contribute both to Canadian economic history and to comparative work on inequality across nations during the early modern period. With the use of novel prices and wages from Quebec—which was then the largest settlement in Canada and under French rule—a price index, a series of real wages and a measurement of Gross Domestic Product (GDP) are constructed. They are used to shed light both on the course of economic development until the French were defeated by the British in 1760 and on standards of living in that colony relative to the mother country, France, as well as the American colonies. The work is divided into three components. The first component relates to the construction of a price index. The absence of such an index has been a thorn in the side of Canadian historians as it has limited the ability of historians to obtain real values of wages, output and living standards. This index shows that prices did not follow any trend and remained at a stable level. However, there were episodes of wide swings—mostly due to wars and the monetary experiment of playing card money. The creation of this index lays the foundation of the next component. The second component constructs a standardized real wage series in the form of welfare ratios (a consumption basket divided by nominal wage rate multiplied by length of work year) to compare Canada with France, England and Colonial America. Two measures are derived. The first relies on a “bare bones” definition of consumption with a large share of land-intensive goods. This measure indicates that Canada was poorer than England and Colonial America and not appreciably richer than France. However, this measure overestimates the relative position of Canada to the Old World because of the strong presence of land-intensive goods. A second measure is created using a “respectable” definition of consumption in which the basket includes a larger share of manufactured goods and capital-intensive goods. This second basket better reflects differences in living standards since the abundance of land in Canada (and Colonial America) made it easy to achieve bare subsistence, but the scarcity of capital and skilled labor made the consumption of luxuries and manufactured goods (clothing, lighting, imported goods) highly expensive. With this measure, the advantage of New France over France evaporates and turns slightly negative. In comparison with Britain and Colonial America, the gap widens appreciably. This element is the most important for future research. By showing a reversal because of a shift to a different type of basket, it shows that Old World and New World comparisons are very sensitive to how we measure the cost of living. Furthermore, there are no sustained improvements in living standards over the period regardless of the measure used. Gaps in living standards observed later in the nineteenth century existed as far back as the seventeenth century. In a wider American perspective that includes the Spanish colonies, Canada fares better. The third component computes a new series for Gross Domestic Product (GDP). This is to avoid problems associated with using real wages in the form of welfare ratios which assume a constant labor supply. This assumption is hard to defend in the case of Colonial Canada as there were many signs of increasing industriousness during the eighteenth and nineteenth centuries. The GDP series suggest no long-run trend in living standards (from 1688 to circa 1765). The long peace era of 1713 to 1740 was marked by modest economic growth which offset a steady decline that had started in 1688, but by 1760 (as a result of constant warfare) living standards had sunk below their 1688 levels. These developments are accompanied by observations that suggest that other indicators of living standard declined. The flat-lining of incomes is accompanied by substantial increases in the amount of time worked, rising mortality and rising infant mortality. In addition, comparisons of incomes with the American colonies confirm the results obtained with wages— Canada was considerably poorer. At the end, a long conclusion is provides an exploratory discussion of why Canada would have diverged early on. In structural terms, it is argued that the French colony was plagued by the problem of a small population which prohibited the existence of scale effects. In combination with the fact that it was dispersed throughout the territory, the small population of New France limited the scope for specialization and economies of scale. However, this problem was in part created, and in part aggravated, by institutional factors like seigneurial tenure. The colonial origins of French America’s divergence from the rest of North America are thus partly institutional

Applying a Social-Ecological Framework to Factors Related to Nicotine Replacement Therapy for Adolescent Smoking Cessation.

Objective: This systematic review synthesizes factors related to nicotine replacement therapy (NRT) use among adolescents seeking to quit smoking, using the social–ecological model as a guiding framework. Data Source: Searches of PubMED, ProQuest, EBSCOhost, and ERIC were conducted in July 2016. Study Inclusion and Exclusion Criteria: Original studies of cigarette smokers younger than 18 years that discussed NRT were included. Data Extraction: Two reviewers individually extracted study purpose, sample, design, and results. Data Synthesis: Factors were categorized by social–ecological model level and summarized. Results: A total of 103 907 articles were identified during initial search. After narrowing to peer-reviewed articles in English and eliminating reviews and adult-only studies, we reviewed 51 articles. These 51 articles identified factors from studies at each level of the social–ecological model: intrapersonal ( k = 20), interpersonal ( k = 2), organizational ( k = 7), community ( k = 11), and public policy ( k = 14). Conclusion: Findings provide insight into the applicability of NRT for adolescent smoking cessation, and factors by social–ecological model level highlight areas for additional research. Future adolescent NRT studies should assess factors at the interpersonal, organizational, and community levels, as well as the interactions between levels. </jats:sec

Pharmacist Recommendations for Adolescent Smoking Cessation: Results from a Delphi Study

While pharmacological and behavioral treatments exist for smoking cessation, there are currently no best practices for helping adolescents quit smoking. This study aimed to reach consensus regarding pharmacist recommendations for adolescent smoking cessation. Using a three-round Delphi technique, pharmacists across the USA with experience working with adolescent substance use provided quantitative and qualitative feedback on recommendations. Forty pharmacists completed Round 1, 37 completed Rounds 2 and 3. In Round 1, 36 (90%) responses included the nicotine patch, gum, or lozenge. Ten recommendations were identified in Round 1: nicotine patch, nicotine gum, nicotine lozenge, bupropion SR, varenicline, quitline, smoking cessation program, counseling, behavioral approaches, and cold turkey. In Round 2, pharmacists were most likely to recommend smoking cessation programs (median=7 of 7, Interquartile range [IQR]=1) and least likely to recommend varenicline (median=3, IQR=3). In Round 3, consensus to recommend was reached on smoking cessation program (83.3% likely or very likely to recommend). Despite initially recommending nicotine replacement therapy in Round 1, by Round 3 most pharmacists were more likely to recommend behavioral treatments than pharmacological interventions for this patient population. Such preferences by pharmacists could influence the accessibility of various treatments to adolescent smokers

Evaluation of a newly developed tobacco cessation program for people with disabilities

Background Tobacco use is the single most preventable cause of morbidity and mortality, accounting for at least 480,000 deaths in the United States annually. People with disabilities smoke at a rate 1.5 times greater than the able-bodied population. Higher incidence of tobacco use among people with disabilities has been directly related to both unique and universal cessation barriers. Despite increased prevalence of tobacco use and cessation obstacles, evidence is lacking on the development of successful interventions targeting people with disabilities. Objective We aimed to assess the feasibility, acceptability, and potential effectiveness of a cessation intervention tailored to people with disabilities. Methods Eighteen tobacco users with disabilities (56% African American, 64% male) participated in a 4-week, 8-session tobacco cessation program consisting of group sessions on managing addiction, relapse, and lifestyle changes specific to people with disabilities. Semi-structured interviews were conducted at the conclusion of the program. A follow-up measure of smoking status, triggers, and nicotine replacement therapy usage was completed at 4 weeks and 6 months. Results Sixteen participants completed the intervention (89%), with participants on average attending 86% of sessions. Most participants rated the program as excellent (83%) or good (8%). Qualitative interviews revealed participants value social support, accessibility, and a tailored program. Four participants (22%) reported abstinence at six months, which is greater than the standard quit rate. Conclusion This study suggests tailoring a cessation program to the characteristics unique to people with disabilities may be critical in delivering meaningful and effective cessation interventions among this population