Self-reported Changes Research Articles

Covid-19 pandemic-related changes in teleworking, emotional exhaustion, and occupational burnout: a cross-sectional analysis of a cohort study

BackgroundThe COVID-19 pandemic prompted significant shifts to teleworking, raising questions about potential impacts on employee wellbeing. This study examined the association between self-reported changes to teleworking frequency (relative to before the pandemic) and two indicators of occupational burnout: emotional exhaustion and professionally diagnosed burnout.MethodsData were derived from two samples from a digital cohort study based in Geneva, Switzerland: one population-based, and one from a sample of workers who were likely mobilized in the early stages of the COVID-19 pandemic. Emotional exhaustion was measured using the Maslach Burnout Inventory (EE-MBI), while self-reported diagnosed burnout was assessed by asking participants if they had received a professional diagnosis of occupational burnout within the previous 12 months. Participants were categorized based on self-reported telework frequency changes: “no change,” “increase,” “decrease,” “never telework,” and “not possible to telework.” Adjusted regression models for each of the study samples were used to estimate associations between telework changes and burnout outcomes, accounting for sociodemographic, household, and work-related factors.ResultsIn the population-based sample of salaried employees (n = 1,332), the median EE-MBI score was 14 (interquartile range: 6–24), and 7.3% reported diagnosed burnout. Compared to those reporting no change in telework frequency (19% of the sample), those reporting a decrease (4%) and those reporting that teleworking was not possible (28.7%) had significantly higher emotional exhaustion scores (adjusted beta (aβ) 5.26 [95% confidence interval: 1.47, 9.04] and aβ 3.51 [0.44, 6.59], respectively) and additionally reported higher odds of diagnosed burnout (adjusted odds ratio (aOR) 10.59 [3.24, 34.57] and aOR 3.42 [1.22, 9.65], respectively). “Increased” (28.9%) and “never” (19.4%) telework statuses were not significantly associated with burnout outcomes. These trends were mirrored in the “mobilized-workers” sample, with the exception that those reporting that teleworking was not possible did not report significantly higher odds of diagnosed burnout compared to those reporting no change in telework frequency.ConclusionsDecreased teleworking frequency and not having the possibility of telework were associated with higher emotional exhaustion and diagnosed burnout. As organizations reconsider their telework policies in a post-pandemic era, they should consider the impact of such organizational changes on employee wellbeing.

Trauma exposure and posttraumatic stress symptoms: Associations with self-reported dietary and exercise changes.

Exposure to trauma and subsequent posttraumatic stress symptoms (PTSS) increase the risk of poor physical health outcomes. Yet, the nuances of the paths from trauma to poor health are largely theoretical, and research regarding how trauma types relate to specific trauma-related changes to diet and exercise is needed. The present study examined the associations between noninterpersonal and interpersonal trauma and PTSS with several novel dietary and exercise changes (i.e., perceived trauma-related diet changes in intake of calories, comfort food, refined carbohydrates, and sugar as well as changes in exercise amount and intensity). Participants were 430 Midwestern University trauma-exposed students (Mage = 23.87, SD = 6.90, range = 18-63; 81.1% female; 56.9% White). Higher PTSS corresponded to increased perceived trauma-related changes in consumption of calories, comfort foods, carbohydrates, and sugar (Bs = 0.1-.02). Interpersonal trauma was not tied to dietary changes, and noninterpersonal traumas were linked to decreased sugar intake. For trauma-related exercise changes, higher PTSS was associated with both increased likelihood of lower intensity exercise (B = .02) and higher intensity exercise (B = .03), yet neither trauma types were related. Further, neither trauma exposure nor PTSS was associated with perceptions in trauma-related increases in exercise amount. PTSS, as opposed to types of trauma exposure, may be the primary driver of perceived trauma-related diet and exercise changes. The identification of trauma-related health modifications may help improve health outcomes of trauma survivors, and ongoing work should examine whether trauma-focused treatment reduces maladaptive changes to diet and exercise. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Cancer-related health behaviors during the COVID 19 pandemic in geographically diverse samples across the US

BackgroundThe COVID-19 pandemic involved business closures (e.g., gyms), social distancing policies, and prolonged stressful situations that may have impacted engagement in health behaviors. Our study assessed changes in cancer-related health behaviors during the pandemic, specifically physical activity, fruit/vegetable intake, smoking/tobacco use, and alcohol consumption.MethodsEight cancer centers administered mailed/web-based/telephone surveys between June 2020 and March 2021. Surveys assessed demographics, perceptions on social distancing, and self-reported changes of behaviors (less/same/more) associated with cancer prevention or risk, e.g., physical activity, fruit/vegetable intake, tobacco/smoking use, and alcohol consumption. Descriptive analyses and logistic regression models assessed association of variables with behavior change.ResultsMost of the 21,911 respondents reported adhering to at least 4(of 5) social distancing measures (72%) and indicated social distancing was very/somewhat important to prevent the spread of COVID-19 (91%). 35% of respondents reported less physical activity, 11% reported less fruit/vegetable intake, 27% reported more smoking/tobacco use (among those who used tobacco/smoking products in past 30 days), and 23% reported more alcohol consumption (among those who reported at least 1 drink in past 30 days) than before the pandemic. Urban residence, younger age, female gender, and worse general health were associated with less physical activity, less fruit/vegetable intake, more smoking/tobacco use, and more alcohol intake. Higher educational attainment was associated with less physical activity and fruit/vegetable intake and more alcohol consumption. Reporting social distancing as important and adhering to more COVID-19 safety practices were associated with less physical activity and more alcohol consumption.ConclusionOur findings suggest that certain demographics and those who adhered to social distancing measures were more likely to self-report unfavorable changes in health behaviors during the pandemic. Future studies should examine if the behaviors returned to baseline following relief from pandemic restrictions, and if these behavior changes are associated with increased cancer incidence and mortality.

Impact of atrial fibrillation on productivity in working-age patients: an analysis of Swiss-AF prospective cohort study data.

We aimed to explore atrial fibrillation (AF)-induced productivity losses in working-age atrial fibrillation patients and to estimate atrial fibrillation-related indirect costs. Between 2014 and 2017, the Swiss Atrial Fibrillation prospective cohort study (Swiss-AF) enrolled 217 working-age patients with documented atrial fibrillation. Self-reported changes in professional activity and the reasons thereof were descriptively analysed over 8 years of follow-up or until patients reached the retirement age. Results were put into perspective, and indirect costs were planned to be estimated, through comparison with a general population-based, age-, sex- and year-matched comparison sample from the Swiss labour force survey (SLFS). Of 217 analysed Swiss-AF patients, 14.7% reported a professional activity change (9.2% stop, 5.5% reduction) due to atrial fibrillation before the end of observation. Of those working at enrolment (n = 157), 3.8% had a subsequent professional activity change due to atrial fibrillation, 11.6% due to other reasons. Patients were more likely to report an impact of atrial fibrillation on professional activity if they had had atrial fibrillation longer and were closer to the retirement age. Slightly fewer Swiss-AF patients were employed (75%) than in the comparison sample (77%). For those working however, the degree of employment was higher (88% vs 83%). Lack of differences between the Swiss-AF patients and the comparison sample indicated no relevant indirect costs of atrial fibrillation due to lost productivity. Only a minority of atrial fibrillation patients reported a negative impact of atrial fibrillation on their professional activity. Professional activity changes due to other reasons were reported more frequently. Compared with the general population, atrial fibrillation did not cause distinct differences.

The Impact of Lifestyle Intervention Programs on Long-Term Cardiac Event-Free Survival in Patients With Established Coronary Artery Disease.

Coronary artery disease (CAD) is a leading global cause of morbidity and mortality, necessitating comprehensive approaches for its management. This systematic review evaluates the long-term impact of structured lifestyle intervention programs on cardiac event-free survival in patients with established CAD. A total of eight studies, including randomized controlled trials (RCTs) and prospective cohort studies, were analyzed, encompassing diverse interventions such as cardiac rehabilitation, dietary modifications, exercise programs, and psychosocial support. The findings indicate that lifestyle interventions significantly improve event-free survival, reduce recurrent cardiac events, and enhance overall health markers as compared to usual care. Intensive interventions, such as comprehensive cardiac rehabilitation, showed the most pronounced benefits, including regression of coronary artery stenosis measured through angiographic imaging and a reduced need for revascularization (relative risk reduction up to 45%; p < 0.05). Flexible and accessible approaches, like home-based or telephonic rehabilitation, demonstrated potential in improving adherence, measured by program completion rates and self-reported lifestyle changes, and outcomes in specific populationssuch as elderly or high-risk patients. Limitations include variability in intervention intensity, small sample sizes in some studies, and differences in adherence definitions and measurement methods. This review highlights the critical role of lifestyle modifications as a cornerstone of secondary prevention strategies in CAD management and suggests that technology-based and demographic-specific interventions may hold promise for improving long-term outcomes. Future research should focus on long-term sustainability and optimizing tailored intervention designs.

Medication adherence feedback with older adults with cognitive impairment: a mixed Methods study

Objective: Older adults with cognitive impairment are at risk of medication-taking errors. This study assessed the impact of providing medication adherence feedback to cognitively impaired older adults. Methods: Forty participants with mild cognitive impairment or mild dementia had their medication adherence electronically monitored for 8 weeks. They were provided with verbal and visual feedback about their adherence results. Initial participant reactions were elicited using a Motivational Interviewing approach, and self-reported behavior changes were assessed during a follow-up interview. Quantitative analyses assessed relationships among electronically monitored and self-rated adherence, initial reactions to adherence feedback, and subsequently reported medication self-management changes. Thematic analysis determined facilitators and barriers to making self-management changes. Results: Although self-rated adherence was high, electronic monitoring revealed that 20% of the sample had suboptimal adherence (took the recommended dose on <80% of monitored days). Fifty-three percent of the sample reported feeling surprised by their adherence results, and 45% endorsed initial motivation to change self-management behaviors. Motivated participants demonstrated worse electronically monitored adherence than unmotivated peers, and those who were surprised by their medication-taking errors expressed greater initial motivation to change. At follow-up, 50% reported having made changes, and 82.4% of them indicated that this study played a role. Facilitators of making changes included awareness of medication-taking errors and cognitive impairment, whereas barriers included lack of perceived difficulty/need. Conclusions: Adherence monitoring with feedback is feasible and impactful in cognitively impaired older adults. Increasing awareness of medication-taking errors fosters motivation to improve medication self-management and results in participant-reported behavior change.

A co-designed intervention to support people living with achalasia to eat in a social setting: a feasibility study

BackgroundAchalasia is a rare oesophageal condition that can affect eating behaviours. This study aimed to evaluate the feasibility of recruitment and assess the acceptability of a co-designed, workbook-based intervention targeting one of the most challenging eating behaviours, which was eating in a social setting.MethodsA mixed-method approach was employed, which involved pre- and post-intervention questionnaires and semi-structured interviews. The Achalasia Action group, a UK-based support group, facilitated participant recruitment. The intervention was a workbook designed collaboratively by the researchers and people living with achalasia, with strategies built on the COM-B model (Capability, Opportunity, Motivation-Behaviour). Outcome measures were based on recruitment and retention rates, the APEASE criteria for usability and acceptability, self-reported changes in eating behaviours, and qualitative feedback from participant interviews.ResultsThe study aimed to recruit 20 participants, and this target was achieved, resulting in a 100% recruitment rate. However, the post-intervention questionnaires were completed by only 10 participants, indicating a 50% retention rate from baseline. No issues were raised with completing the pre- and post-questionnaires, from completers. The quantitative feedback from participants indicated that they found the workbook activities clear, easy to understand, and complete, with the majority reporting positive experiences. Qualitative feedback on the intervention described enhanced social support and improved symptom management of achalasia in a social setting. Furthermore, the intervention met the APEASE criteria, indicating its usability and acceptability.ConclusionsThis study explored the feasibility of recruiting and retaining people living with achalasia in intervention research, highlighting the acceptability of the co-designed intervention to improve social eating experiences. However, with a retention rate of only 50% at follow-up, it is evident that future studies should explore the reason behind this and also consider recruiting a larger baseline sample to ensure the target is achieved. The positive outcomes of the co-designed intervention underscore the importance of user involvement in developing interventions. The intervention demonstrated the potential to support people living with achalasia in eating in a social setting. The co-designed intervention has significant practical implications by providing healthcare professionals and support groups with a feasible, potentially effective method to enhance the social eating experience of people living with achalasia, potentially improving their overall quality of life.

Online learning modules improve confidence in providing gender affirming care for youth

PurposeHealthcare providers often lack training and education in caring for gender diverse youth. We aimed to explore changes in provider confidence and behaviors following the implementation of an online learning course focused on gender affirming care for youth.MethodsAn asynchronous, online training consisting of 2 modules was made available in October 2021. Participants were asked to complete 3 surveys for each module they completed: a pre-survey, a post-survey, and a 3-month follow-up survey. Surveys included demographic data and an assessment of provider confidence and self-reported behaviors related to the provision of gender affirming care for adolescents that were in line with the objectives outlined in each module. Paired sample t-tests were used to compare participant confidence at all timepoints.ResultsParticipants (n = 487) completed at least one survey from one module. There was notable diversity in provider types, including mental health providers (n = 86, 17.7%), community health workers (n = 71, 14.6%), and medical students or health professionals (n = 61, 12.5%). Participants were significantly more confident in all aspects of care provision when comparing pre-surveys and post-surveys (p < 0.001 for all survey items focused on change in provider confidence ). At 3-month follow-up after module completion, improvements in confidence were sustained in providing information and resources to adolescents and their families, and having conversations with them about gender identity along with the importance of using affirming language. However, these modules did not result in self-reported behavior change regarding provision of gender affirming hormones or puberty blockers.ConclusionsOnline learning modules may be an effective means of educating a large number of healthcare providers about caring for gender diverse youth in a variety of settings and across disciplines.

Assessing the Feasibility and Acceptability of the Daybreak Drink Tracker: Prospective Observational Study.

Excessive alcohol use is associated with significant harms, with wide-ranging social and economic impacts. Efforts to prevent and reduce the harmful use of alcohol are a public health priority. Smartphone apps have the potential to provide accessible and cost-effective support to those seeking to reduce alcohol consumption; however, the evidence base regarding which components are effective is lacking. Self-monitoring is considered as one of the most effective components for behavior change across multiple health domains, yet there is mixed evidence for its role in the alcohol use space. An improved understanding of the use, acceptability, and outcomes of smartphone apps and their inherent components is required to determine their potential role in alcohol behavior change. We investigated the feasibility and acceptability of the Drink Tracker, a novel feature of the commercially available Daybreak (Hello Sunday Morning) app. The Daybreak app is accessible worldwide via major app stores and is offered free of charge to Australian residents. Individuals (aged over 18 years) registering for Daybreak were invited to access the Drink Tracker to monitor their alcohol consumption as part of an uncontrolled observational prospective study. Feasibility was assessed via uptake and frequency of use of the Drink Tracker. Acceptability was measured via participant feedback to determine overall satisfaction, perceived helpfulness, and likelihood of recommending the Drink Tracker to others. Self-reported changes in alcohol consumption (Alcohol Use Disorders Identification Test score) and psychological distress (Kessler Psychological Distress Scale score) at 3-month follow-up were also measured. Preliminary data collected for the first 4 months (October 2023 to February 2024) of the study were reported, including 3-month follow-up outcomes. Feasibility was demonstrated, with almost 70% (2847/4119) of those registering for Daybreak going on to access the Drink Tracker. Of those accessing the Drink Tracker, 71.1% (n=2024) consented to research, comprising the final participant sample. Frequency of use was high, with over half of participants (1112/2024, 54.9%) using the Drink Tracker more than once, and more than one-third (757/2024, 37.4%) using the Drink Tracker more than 5 times. Of the 30 participants completing a 3-month follow-up, acceptability was high, with 73% (n=22) reporting high satisfaction levels with the Drink Tracker overall, 87% (n=26) indicating it was easy to use and rating a mean score of 7.7 (SD 2.8) out of 10 in terms of likelihood of recommending to others. Significant reductions in alcohol consumption (P<.001) and psychological distress scores (P<.001) were observed at the 3-month follow-up. Our results suggest that the Daybreak Drink Tracker is highly feasible and acceptable in supporting individuals accessing commercially available smartphone apps to change their relationship with alcohol. While positive clinical outcomes were observed, the absence of a control group disallows any conclusions with regard to the efficacy of the Drink Tracker. Further testing via a randomized controlled trial is required.

Preventing Adolescent Suicide: Feasibility and Preliminary Outcome Evaluation of a Theatre-Based Gatekeeper Training for Teachers.

Improving teachers' knowledge and skills in dealing with adolescent suicidality may be important for prevention. We evaluated the feasibility and acceptability of a theatre-based gatekeeper teacher training for adolescent suicide prevention (SPES project). Self-reported changes in knowledge and self-efficacy were also investigated. Based on a quasi-experimental repeated measures design, secondary schools were invited to participate in one of two intervention groups (theatre workshop or attending a theatre performance) or a control group (no intervention). Assessments were conducted prior to the intervention, shortly following it and 3 months later. Attendance and retention were indicators of feasibility. Knowledge and self-efficacy were assessed longitudinally using anonymous questionnaires. Data were analyzed using linear mixed models. 191 teachers (84.3% women; Mage = 46.8, SD = 9.8) participated in the study (63 workshop, 66 performance and 62 control group). Attendance was 92% in the workshop group and 94% in the performance group. The retention rate after three months was 51% in the workshop group and 53% in the performance group. Teachers in both groups reported greater knowledge of adolescent suicide (p < 0.001) and higher gatekeeper self-efficacy (p < 0.05) than the control group. The SPES project was found to be feasible and acceptable. Both the workshop and the performance viewing may improve teachers' knowledge and self-efficacy in recognizing signs of suicide risk in adolescents.

Changes in sick leave one year before and after starting treatment: a naturalistic study of employed outpatients with common mental health disorders

Background This study explores sick leave changes 1-year pre- and post-treatment start for common mental health issues and their associations with self-reported symptoms, functioning, and health changes. Methods Ninety-five employed patients, without previous disability benefits, underwent treatment at a public mental health outpatient clinic. Sick leave data was obtained from the Norwegian Labour and Welfare Administration. Symptoms, work/social functioning, and health quality were self-reported at treatment onset and completion. Results Twelve months before starting treatment, only 6.3% were on sick leave, contrasting with 69.5% at treatment start. At post-treatment, 25% received work assessment allowance (WAA), 63% were off sick leave, and 12% were on sick leave. Sick leave days exhibited an inverted U-shape for non-WAA recipients. Those on sick leave post-treatment reported less improvement in symptoms and health, while the WAA group showed diminished work functioning enhancement. Discussion Evaluating the effect mental health treatment has on sick leave is clearly affected by the timing of assessments. Treatment seems associated with improved sick leave outcomes compared with status at treatment start, but less so when compared with status one year before starting treatment. Also, a large group of patients went on to receive WAA, constituting a group in need of further longitudinal evaluations and interventions.

A Longitudinal Pediatric Residency Climate Justice Curriculum.

Background Graduate medical education programs must prepare physicians to adapt their care for patients whose health equity and outcomes are being threatened by climate change. This article presents the implementation of a longitudinal climate justice curriculum within a pediatrics residency program. Objective To measure the self-reported changes in attitudes and intentions for change in behavior after implementation of a climate justice curriculum. Methods A longitudinal, 4-part, climate justice and health equity (CJHE) curriculum was implemented from 2023 to 2024 into the broader advocacy training of a pediatrics residency program. Resident participants completed pre- and post-session surveys that assessed their attitudes toward climate change and health, as well as their intentions to engage in climate advocacy. Paired deidentified responses were analyzed via Wilcoxon signed-rank test. Results Thus far, facilitators have conducted 4 introduction sessions, 4 narrative medicine sessions, and 3 health system sustainability sessions. Sixty-eight of 100 residents (68%) completed both pre- and post-session surveys. The curriculum was associated with increased self-reported understanding of how climate change impacts human health (CJHE 1: median of pairwise averages of pair-differences [MPA]=1.00, P<.001; CJHE 3-4: MPA=1.00, P<.001), increased agreement that health care providers can be effective climate advocates (CJHE 1: MPA=2.00, P<.001; CJHE 3-4: MPA=1.50, P<.001), and increased intention to discuss the health impacts of climate change in future patient encounters (CJHE 1: MPA=1.00, P<.001; CJHE 3-4: MPA=1.00, P<.001). Conclusions This longitudinal CJHE curriculum demonstrated acceptability and increased participants' self-reported understanding of how climate change impacts human health and the ways in which physicians can act as advocates.

A Comprehensive Evaluation of Goslings-II: A Sustainable Early Language and Literacy Program for NICU Parents.

This program evaluation aimed to assess the impact of a streamlined and less expensive version of Goslings-I (a NICU parent education program) on parents' early language and literacy practices and their confidence in interacting with their infants. This evaluation used a single-group, pre- and posttest, mixed-methods design. Sixty-three parents completed pre- and postprogram questionnaires on the frequency of language and literacy activities, confidence in understanding infant signals, and program satisfaction. Seven parents participated in follow-up interviews. Interview participants reported on interaction with their infants 1-2 weeks after attending the program. Goslings-II resulted in self-reported positive behavioral changes in parent-infant interactions, increased early language and literacy activities, and enhanced confidence. Parents also reported they could apply Goslings-II skills to other parent-infant interactions, like diapering. Positive results from this evaluation are similar to the original program, Goslings-I, demonstrating program effectiveness at a more affordable price.

Patient-reported outcome following an acetabular fracture: an observational study of 385 patients from the Swedish Fracture Register.

The primary aim of this study was to assess the patient's self-reported change in health 1 year after sustaining an acetabular fracture. The secondary objective was to examine differences in patient-reported outcomes (PROMs) based on sex, age groups, injury mechanisms, type of fracture, and treatment. Data was collected from the Swedish Fracture Register (SFR) for patients with acetabular fractures sustained between 2014 and 2021. Patients with additional fractures at the time of injury or during the following 18 months, periprosthetic fractures, or pediatric fractures were excluded. The PROM used was the Short Musculoskeletal Function Assessment (SMFA) wherein the subindices of bother, dysfunction, and mobility were analyzed with a higher score indicating worse outcome. The differences in SMFA and in subindices between the score 1 year after fracture and preinjury (recall) were analyzed. Of the 385 included patients with complete PROMs, there was no significant difference in changes in SMFA score between the sexes. Surgically treated patients had significantly higher scores 1 year post-injury compared with non-surgically treated patients with bother index 18.3 (95% confidence [CI] 14.0-22.6) vs 7.2 (CI 4.7-9.8), dysfunction index 15.8 (CI 12.7-18.9) vs 7.0 (CI 5.0-9.0), and mobility index 21.6 (CI 17.9-25.2) vs 9.2 (CI 6.9-11.5). Most patients sustaining an acetabular fracture experience a decline in their functional abilities 1 year after the injury compared with before the injury. Younger patients with high-energy injuries and complex fracture types, which typically require surgical intervention, experience the most unfavorable outcomes. The large group of non-surgically treated patients reported minimal functional changes, likely attributable to selection bias.

Diet Quality and Past Changes in Food Consumption as Determinants of Intentions to Eat Less Meat and More Plant-Based Foods.

This study aimed to examine the relationship between self-reported changes in food consumption over the past 2 years, quality of actual diet, and declared intentions to eat more plant-based foods while reducing meat consumption in the next year. A cross-sectional study using Computer-Assisted Web Interview (CAWI) was conducted on 1003 Polish adults in 2023. The Beliefs and Eating Habits Questionnaire (KomPAN) was used to assess the frequency of consuming various food groups and to calculate diet quality indices. Four distinct segments ("No change", "All products limited", "Changes in meat", and "Less red meat, more other products") were identified using cluster analysis. Logistic regression analysis verified the associations between these clusters, diet quality indices, and intended changes in plant-based food and meat consumption. The study results showed that most pre-existing changes involved reduced red meat intake (52%). The "No change" cluster (47.9%) was represented by more men, people with lower education, and those with a lower overall dietary quality index (DQI). A higher quality diet (as indicated by the DQI) was associated with a greater tendency to increase plant food consumption and reduce meat consumption across the entire group and within each cluster. A better understanding of how changes in food consumption relate to diet quality and intended changes in plant-based food and meat consumption can inform interventions promoting sustainable consumption, considering both nutritional recommendations and environmental requirements.

Anger and associated risk and protective factors among rural American adolescents: Implications for violence prevention

BackgroundAdolescent violence in the United States is a prevalent public health problem and is understudied in rural settings. Anger is a significant risk factor for adolescent violence. To better craft adolescent violence interventions, it is important to examine anger and identify its most significant associated factors. AimsThis study examined (1) self-reported anger changes over time for rural American adolescents; and (2) structural, community, interpersonal, and individual level factors that may contribute to anger. MethodsWe analyzed self-reported survey data from West Virginian middle schoolers (N = 2861) with anger as the outcome. Data was collected twice yearly from October 2020 through April 2023. Independent variables included perceptions of inequality, individual socioeconomic status (SES), neighborhood characteristics, family structure, support from adults at home and school, and harsh parenting. AnalysisGeneralized estimating equation Poisson regression models for main effects and gender interaction were used. Parameter estimates were exponentiated and interpreted as Rate Ratios (RR). Self-reported gender was an effect modifier. ResultsSignificant main effects included perceived inequality (RR = 0.98, 95 % CI = 0.97–0.99), SES (RR = 0.99, 95 % CI = 0.98–0.99), supportive adults at school (RR = 0.99, 95 % CI = 0.98–0.99), primary caregiver support (RR = 0.99, 95 % CI = 0.98–0.99), and harsh parenting (RR = 1.10, 95 % CI = 1.05–1.05). Significant gender interaction terms included perceived harsh parenting (RR = 0.98, 95 % CI = 0.97–0.99) and supportive adults at school (RR = 1.01, 95 % CI = 1.00–1.02) for ‘other’ genders (i.e., participants identifying as neither boy nor girl) compared to boys. ConclusionsFindings underline the importance of examining rural adolescent anger development and associated risk factors for designing prevention approaches to curb downstream violent behavior.

Improving Residency Training in Refugee and ImmigrantHealth Care at an Urban Academic Family Medicine Residency.

As a safety net hospital, Boston Medical Center (BMC) serves a global community of patients and is welcoming new refugeeand immigrant patients at an unprecedented rate. Many of these patients are cared for by Family Medicine residents and faculty in both inpatient and outpatient settings. Currently, the care delivered by Family Medicine residents lacks uniformity due to lack of familiarity with the U.S. Centers for Disease Prevention and Control (CDC) guidelines for refugee health, differing levels of faculty preceptor experience, and variable in-house resources for primary care across five residency clinic sites. To address these disparities, a team of Family Medicine residents and faculty designed a multidisciplinary global health educational series with a focus on strengthening resident competencies in refugee and immigranthealth care. Refugeeand immigrant health is discussed in didactic workshops and residents apply a refugee and immigrant health care map that has been developed for use in their clinics. The primary outcome is self-reported changes in clinical practices while caring for refugee and immigrantpatients who are establishing or re-establishing care in the United States. Our goal is to continue improving resident education in order to provide the most equitable care for populations at an increased risk of disparate access to care.

Project SCOPE: a National Training Initiative to improve capacity of providers to support children impacted by prenatal opioid exposure using the ECHO model™.

Neonatal abstinence syndrome (NAS) is a complex condition resulting from prenatal substance exposure that has become increasingly prevalent as a result of the opioid epidemic. NAS can lead to long-term developmental challenges. Interdisciplinary teams with experience working with children with disabilities that focus on social determinants of health can be effective at supporting families affected by NAS. Unfortunately, interdisciplinary teams often lack sufficient training, ongoing practice support, and public health policies to support these families. The objective of this project was to determine the feasibility and impact of a National Training Initiative, called Project SCOPE, to improve the capacity of providers to address the needs of children with NAS and their families. Fourteen (14) sites were trained to fidelity in the ECHO model and SCOPE curriculum, and then each team implemented this model for at least one, eight to 12 session series between 2019-2022. The reach, impact, satisfaction, and intention to implement the model were assessed from administrative records, pre/post surveys, and post-session evaluations. SCOPE state teams delivered the curriculum to 9,392 individuals across 33 US states. Surveys from 2,197 individuals were used for analysis. Most participants (84%) had previous training in trauma informed care, but only 53% had any training on the NAS or the opioid crisis' impact on children. Satisfaction with SCOPE sessions was high (96.4%), and there was a statistically significant increase of self-reported knowledge change from pre- to post-SCOPE. Over 94% reported their skills increased because of participation. Over 97% of participants indicated their motivation to work with this population increased from SCOPE participation and that they could successfully apply what they learned. Almost 70% reported they were "very" or "extremely" likely to use their new skills. Project SCOPE is a highly effective and impactful model that can radically improve capacity to support children affected by the opioid epidemic, thereby increasing the capacity of our healthcare system to respond to this epidemic. Moreover, this model can be rapidly deployed and reach a wide geographic region, especially areas that are affected by the opioid crisis and underserved rural communities.

Decoding derogation: The impact of environmental values and political ideology on the effect of persuasive message about recycle and reuse behaviors.

Although persuasive messages are designed to motivate individuals to engage in intended behaviors, they do not always work. Often, people follow previously established values and ideologies and dismiss persuasive messages. We examine how participants react to a persuasive message related to plastic pollution and how these reactions shape their willingness to recycle and reuse. Results indicate that environmental values and political ideology are associated with message derogation in distinct ways, which, in turn, affect risk perception, self-efficacy, and intention to recycle and reuse. Further, past behavior moderates the relationship between message derogation and perceived risk, but not the relationship between message derogation and self-efficacy. These results suggest that pre-existing values and ideologies play an important role in message derogation, a hitherto under-researched phenomenon that has key implications for self-reported behavioral change. Moreover, past behavior could serve as a powerful lever in steering risk perception and behavioral intent.

COVID-19 Pandemic Coping, Social Support, and Emotional Health in American Indian and Alaska Native Peoples

The COVID-19 pandemic has placed a burden on the health of many people, including significant disparities in American Indian and Alaska Native communities. This study examines the associations between coping behaviors, social support, and emotional health among American Indian and Alaska Native peoples during the COVID-19 pandemic. This cross-sectional study included survey data collected from November 2021 to May 2022 from American Indian and Alaska Native adults aged 18 years or older without dementia or other serious cognitive impairments who were seen at 6 urban health organizations primarily in urban settings (in New Mexico, Alaska, Colorado, Minnesota, Utah, and Kansas) in the year prior to the survey. Exposures of interest included avoidant and direct problem-solving coping behaviors and functional and emotional social support. The study outcome was self-reported change in emotional health since COVID-19 pandemic onset. Poisson regression was used to model adjusted multivariate associations. Data were weighted to account for age, nonresponse, and disproportionate representation by clinic population. A total of 1164 participants were included in the analysis, with a mean (SD) age of 42.5 (13.4) years; 830 (61%, weighted sample percentage) were female. Since COVID-19 pandemic onset, 465 patients (39% weighted) reported worsened emotional health. Problem-solving coping mean (SD) utilization score was 2.5 (0.5), avoidant coping mean (SD) utilization score was 2.3 (0.5), mean (SD) functional social support score was 11.4 (2.9), and 219 participants (18% weighted) reported that emotional support was always available. Using problem-solving coping skills was associated with better emotional health (adjusted prevalence ratio [APR], 0.66 [95% CI, 0.54-0.81] for highest vs lowest tertile), as was always (vs never or rarely) getting emotional support (APR, 0.40; 95% CI, 0.30-0.55) and having more functional support (APR, 0.90 [95% CI, 0.87-0.92] per 1-unit increase in functional social support). In examination of psychological resilience potentially modifying primary exposure associations, no interactions were statistically significant. In this cross-sectional study of urban American Indian and Alaska Native peoples, problem-solving coping skills and more social support were associated with better emotional health during the COVID-19 pandemic. These findings can be used to identify strengths-based approaches to support community emotional health during social upheavals.