An educational campaign to increase chiropractic intern advising roles on patient smoking cessation

BACKGROUND: Tobacco use, particularly smoking, is the most preventable cause of death in the United States. More than 400,000 premature deaths are associated with its use and the health care costs are in the billions. All health care provider groups should be concerned with patients who continue to smoke and use tobacco. The US Preventive Services Taskforce and Health People 2010 guidelines encourage providers to counsel smokers on cessation. Current studies, though limited regarding chiropractic advising practices indicate a low engagement rate when it comes to providing cessation information. OBJECTIVE: To test a campaign regarding initial impact aimed at increasing chiropractic interns advising on cessation and delivery of information to smokers on cessation. DISCUSSION: Chiropractic interns do engage patients on smoking status and can be encouraged to provide more cessation messages and information to patients. The initial impact assessment of this campaign increased the provision of information to patients by about 25%. The prevalence of smoking among chiropractic patients, particularly at teaching clinics may be lower than the national averages. CONCLUSION: Chiropractic interns can and should be encouraged to advise smokers about cessation. A systematic method of intake information on smoking status is needed and a standardized education protocol for chiropractic colleges is needed. Chiropractic colleges should assess the adequacy of their advising roles and implement changes to increase cessation messages to their patients as soon as possible

The Impact of Built Environment on Pedestrian Crashes and the Identification of Crash Clusters on an Urban University Campus

Objectives: Motor vehicle-pedestrian crash is a significant public health concern. The urban campus of Georgia State University poses unique challenges due to a large number of students and university employees. The objectives of this study are twofold: (1) to examine the correlation between specific features of the built environment on and around the University campus and pedestrian crashes; and (2) to identify crash clusters in the study area using network-based geospatial techniques.Methods: We obtained pedestrian crash data (n=119) from 2003 to 2007 from Georgia Department of Transportation and evaluated environmental features pertaining to the road infrastructure, pedestrian infrastructure and streetscape for each road segment and intersection. Prevalence rate of each feature with pedestrian crashes present was calculated. We used network-based Kernel Density Estimation to identify the high density road segments and intersections, then used network-based K-function to examine the clustering of pedestrian crashes.Results: Over 50% of the crosswalk signs, pedestrian signals, public transit, and location branding signs (more than three) at intersections involved pedestrian crashes. More than half of wider streets (greater than 29 feet), two-way streets, and streets in good condition had pedestrian crashes present. Crashes occurred more frequently in road segments with strong street compactness and mixed land use present and were significantly (p<0.05) clustered in these high-density zones.Conclusions: Findings can be used to understand the correlation between built environment and pedestrian safety, to prioritize the high-density zones for intervention efforts, and to formulate research hypotheses for investigating pedestrian crashes. [West J Emerg Med. 2010; 11(3): 295-302.

The Effect of Heavy Alcohol Consumption On Coronary Heart Disease Among U.S. Adults: Using The 2020 BRFSS Annual Survey Data

Background: Evidence supports a significant non-linear relationship between alcohol consumption and cardiovascular disease-specific mortality among US adults. Epidemiologic investigations presume that the J/U-shaped distribution is the sum of the detrimental effect of high consumption on other causes of death and the protective effect on coronary heart disease (CHD) morbidity and mortality. Studies demonstrated that heavy alcohol consumption reduces the risk of CHD. However, results have been inconsistent among heavy drinkers. In this study, we investigated the association of heavy alcohol consumption with CHD among different subgroups in the US. Methods: Data from the 2020 Behavioral Risk Factor Surveillance System (BRFSS) were used. BRFSS is an annual survey of Americans’ health-related risk behaviors, chronic health conditions, and the use of preventive services among the general adult population via self-report. Logistic regression analysis was conducted to determine the association between history of CHD and heavy alcohol consumption. Heavy alcohol use was defined as consuming greater than 14 drinks per week for men and greater than 7 drinks per week for women. The model was adjusted for other risk factors. Results: A total of 398,656 cases were included. Approximately, 5.67% of the study population reported history of CHD and 6.47% reported heavy alcohol consumption. Overall, the odds of having CHD among heavy alcohol drinkers was 42% less than those who were not heavy alcohol drinkers (adjusted odds ratio): 0.58, 95% confidence interval (CI): (0.50-0.68). Stratified by age, we found that heavy alcohol consumption could be either risk factor or protective factor of CHD or no effect on CHD across different age groups: for 18-24 age group, the odds of having CHD among heavy alcohol drinkers was 25% higher than those who were not heavy alcohol drinkers, OR 1.25 (CI 0.54-2.90); for 25-34 age group, 1.42 (0.94-2.14); for 35-44 age group, 1.04 (0.75-1.43); for 45-54 age group, 0.78 (0.63-0.96); for 55-64 age group, 0.71 (0.62-0.82); for \u3e64 age group, 0.61 (0.55-0.67). Stratified by race, for the male group, the odds of having CHD among heavy alcohol drinkers was 45% lower than those who were not heavy alcohol drinkers, 0.55 (0.46-0.67); for the female group, 0.52 (0.41-0.66). Stratified by race, for the White group, the odds of having CHD among heavy alcohol drinkers was 47% lower than those who were not heavy alcohol drinkers 0.53 (0.49-0.57); for the Black group, 0.44 (0.30-0.66); for the Hispanic group, 0.84 (0.62-1.13); for Other groups, 0.56 (0.41-0.77). Conclusion: The study findings demonstrate that heavy alcohol consumption is a protective factor for CHD among people aged \u3e44, the older the more protective, but the younger the more risk of having CHD among people age

Risk Factors Associated with Pulmonary Disease Among Hospitalized Patients in The United States

Background: The etiology of pulmonary disease is complex and influenced by various factors, resulting in a significant public health issue, with 16 million Americans living with chronic obstructive pulmonary disease (COPD) and 24 million with asthma, and cases are on the rise. The purpose of this study was to explore demographic, health status, and lifestyle behaviors with pulmonary disease so patterns of risk can be understood and inform interventions. Methods: This cross-sectional study utilized the National Inpatient Sample Data from 2019 (NIS 2019). The predictor variables consisted of: demographics (age (18+), sex, race), health status (obesity, depression, diabetes), lifestyle behaviors (smoking, alcohol use, and aspirin use), and the outcome variable was pulmonary disease. To ensure accuracy, the data was weighted by the variable discharge weight (DISCWT), and chi-square analyses and ANOVA tests were conducted to determine the independence of categorical and numerical predictor variables. Descriptive statistics were conducted for all variables, simple and multiple logistic regression analyses were performed to identify factors that contribute to the likelihood of having pulmonary disease. Results: The sample of the NIS 2019 data included 6,043,654 cases of which, 22.65% of inpatients had pulmonary disease. The collective sample demographic characteristics were: mean age of 58.4 years, and more than half of inpatients were females (57.05% compared to 42.95% males). In terms of health, 17.75% of the sample were obese, 28.8% had diabetes, and 14.25% were depressed. Within the collective sample, 16.8% of inpatients reported smoking, 9.09% drank alcohol, and 14.51% consumed aspirin (long-term (current) use of aspirin). Results of the multivariate statistical analyses reveal that individuals who were obese were 68.3% more likely to have pulmonary disease compared to non-obese patients (aOR = 1.683, CI 1.679-1.686, pConclusion: Results of our study provide important insights between pulmonary disease and associated risk patterns. As pulmonary symptoms have risen in the wake of the COVID-19 pandemic, there is an urgent public health need to explore disruption of risk pathways to avoid overwhelming fragile global healthcare systems

Do Heavy Smoking and Early Onset of Smoking and Heavy Alcohol Intake Increase the Chance of Heart Condition?

Background: Cardiovascular disease (CVD) is the leading cause of death globally since the turn of the century. One major risk factor is tobacco smoking with a particular risk associated with early initiation/greater duration. Research also indicates that alcohol use can offer both risk or protective cardiovascular benefits depending on consumption characteristics (intensity, frequency, dose, type). The purpose of this study is to examine the early onset of smoking, heavy smoking, and alcohol behavior as they relate to CVD risk. Methods: Using the data from the 2019 National Survey on Drug Use and Health (N=56,136), logistic regression analysis were conducted to examine trends in heavy substance use predictive of CVD risk (Independent variables of heavy substance use: number of cigarettes smoked per day, ≤ 12 years of tobacco smoking, ≥ 5 drinks for males or ≥ 4 drinks for females on each of 5 or more days in the past 30 days; and the dependent variable - ever told by a doctor or other health care professional that you had heart condition) while controlling for sociodemographic factors. Results: Overall, 19.7% of the study population reported CVD conditions, 5.9% heavy alcohol consumption, and 4.9% early onset of smoking. Overall, the odds of having heart condition among heavy alcohol drinkers was 23.6% less than those who were not heavy alcohol drinkers (odds ratio (OR): 0.76, 95% confidence interval (CI): (0.63-0.92), 44% more among those smoked 26 or more cigarettes per day than 25 or less 1.44 (1.01-2.05), 49% more among those with early onset of smoking than none 1.49 (1.15-1.93). By age, we found that heavy alcohol consumption could be either risk factor or protective factor of heart condition or no effect on heart condition across different age groups: for aged 12-18, OR 1.69 (CI 0.69-4.16); 19-25, 0.75 (0.48-1.15), 26-29, 1.21 (0.57-2.53); 30-34, 0.80 (0.36-1.77); 35-49, 0.61 (0.40-0.93); 50-64, 1.12 (0.77-1.62); \u3e64, 0.93 (0.57-1.52). Based on gender, CVD risk was higher in males than females, 1.22 (1.13-1.32). In terms of race, the odds of CVD risk were lower for all groups when compared with non-Hispanic White. Based on income, the odds of CVD risk were higher in high-income earners with at least a college education when compared to low-income earners with high school education or less (≥$50k vs.Conclusion: Study findings demonstrate that the association of heavy alcohol consumption related to CVD risk varied by age. For heavy tobacco smoking, early onset of tobacco smoking, being male, white race, having above high school level education, high income, and advanced age were found to be significant predictors of CVD risk. Future observational studies should be performed to determine the combined effects of heavy alcohol consumption and heavy smoking as it relates to CVD risk by other behavioral risk factors such as types of alcohol consumed (i.e, spirits vs wine) and related behaviors

A Macrolevel Examination of County-Level Risk Factors for Underage Drinking Prevention: Intervention Opportunities to Protect Youth in the State of Georgia

Introduction: Underage drinking can have profoundly negative impacts on childhood development. This study compares 4 categories of known underage drinking risk factors with alcohol consumption. The social indicators in these categories will be compared in the 10 most-at-risk (MAR) counties and the 10 least-at-risk (LAR) counties identified in Georgia. Methods: Independent 2-tailed t-tests were conducted to compare group means among MAR and LAR counties for all identified risk factors. Results: Significant differences were observed in all factors included in the poverty and alcohol outlet density categories. Discussion. The findings underscore the importance of better understanding youth drinking, poverty, and alcohol outlet density. However, our findings, supported by previous individual and aggregated level research, support strategies for researchers and policy makers to more proactively respond to poverty-stricken and high-density alcohol outlet indicators. The current ecological evaluation of underage drinking risk assessed on a macrolevel offers insights into the demographic features, social structures, and cultural patterns of counties that potentially predispose youth to greater health risks specifically associated with underage drinking

Screening for Elder Mistreatment among Older Adults Seeking Legal Assistance Services

Introduction: The aging population is a rapidly growing demographic in the United States. Isolation, limited autonomy, and declining physical and mental health render many older adults vulnerable to elder mistreatment (EM). The purpose of this study was to assess the prevalence and correlates of EM among a sample of older adults using legal assistance services in Atlanta, Georgia. Methods: Researchers administered surveys to consenting older adults (aged 60þ) in 5 metro Atlanta community centers that hosted legal assistance information sessions as part of the Elderly Legal Assistance Program. The surveys screened for risk factors and prevalence of EM risk using valid and reliable measures and included additional questions regarding demographics characteristics and healthcare use behaviors. Results: Surveys were completed by 112 participants. Findings reveal that 32 (28.6%) respondents met the criteria for elder abuse / neglect risk; 17 (15.2%) respondents met criteria for depression; and 105 (93.7%) had visited a healthcare provider during the past 6 months. Conclusion: The rates of EM risk in this sample were higher than those previously reported in research. Findings support continued examination of unique risks that may be present among older adults who may be possibly facing legal issues. Additionally, the reported frequency of healthcare visits among participants reveals a promising opportunity to examine development of a more widespread EM screening approach to be conducted in non-emergency settings. Interdisciplinary collaboration is required to inform screening approaches that account for complexities that EM cases present. [West J Emerg Med. 2013;14(4):309–315.] INTRODUCTIO