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AbstractBackgroundMethodsResultsConclusionsVaping prevention media campaigns have promising effects on harm perceptions but have yet to demonstrate impacts on vaping behaviors in young people. The goal of this study was to evaluate the effect of Vermont’s vaping prevention campaign (Unhyped) on vaping-related beliefs and behaviors.Data come from Waves 5 (Winter 2020) and 9 (Winter 2021) (n = 433) of the Policy and Communication Evaluation Vermont study, a longitudinal online cohort study of adolescents and young adults ages 12-25. Analyses examined associations between awareness of Unhyped in 2020 and outcomes in 2020 and 2021. Primary analyses compared participants aged 12-17 (campaign target) who reported awareness of Unhyped to propensity score-matched controls.In 2020, more adolescents aware of the Unhyped campaign perceived great risk from weekly vaping compared with matched controls (49.3% vs. 24.3%; p = 0.019). Adolescents aware of Unhyped in 2020 were also less likely than matched controls to report willingness to try a vapor product in the next year (15.8% vs. 40.1%; p = 0.048) or use one if offered by a friend (21.4% vs. 49.1%; p = 0.031) in 2021. There was no relationship between brand awareness and vaping behaviors in 2020 or 2021.Although there were no effects of awareness of Vermont’s Unhyped campaign on vaping behaviors, the campaign was effective in altering short-term risk perceptions and reducing susceptibility to vape in adolescents one year later. [ABSTRACT FROM AUTHOR]

As the COVID-19 pandemic highlighted gaps in meeting adolescent behavioral health needs, primary care providers (PCPs) were a locus for interventions to address adolescent mental health and substance use concerns. Strength-based approaches may support PCP promotion of positive behavioral health in adolescents, but competing priorities or other factors may inhibit their use. We analyzed health record review data from 31 primary care practices to assess utilization of strength-based approaches during the health supervision visit (HSV) for adolescents with and without behavioral health concerns. We found that most had strengths identified (78%) or well-being topics addressed (83%). However, adolescents screening positive for depression were 40% less likely to have strengths identified, whereas those screening positive for anxiety or substance use were 89% and 163%, respectively, more likely to have well-being topics addressed. Primary care providers may need support for integrating strength-based approaches when managing adolescents screening positive for depression. [ABSTRACT FROM AUTHOR]

Purpose: Few studies have addressed beliefs about treatment for opioid use disorder (OUD) among family members of people with OUD, particularly in rural communities. This study examined the beliefs of rural family members of people with OUD regarding treatment, including medication for OUD (MOUD), and recovery. Methods: Semi‐structured qualitative interviews were conducted with rural Vermont family members of people with OUD. Twenty family members completed interviews, and data were analyzed using thematic analysis. Results: Four primary themes related to beliefs about OUD treatment emerged: (1) MOUD is another form of addiction or dependency and should be used short‐term; (2) essential OUD treatment components include residential and mental health services and a strong support network involving family; (3) readiness as a precursor to OUD treatment initiation; and (4) stigma as an impediment to OUD treatment and other health care services. Conclusions: Rural family members valued mental health services and residential OUD treatment programs while raising concerns about MOUD and stigma in health care and the community. Several themes (e.g., MOUD as another form of addiction, residential treatment, and treatment readiness) were consistent with prior research. The belief that MOUD use should be short‐term was inconsistent with the belief that OUD is a disease. Findings suggest a need for improved education on the effectiveness of MOUD for family members and on stigma for health care providers and community members. [ABSTRACT FROM AUTHOR]

INTRODUCTION The overwhelming majority of US children are seen for primary care by family physicians (FPs) and pediatricians (PEDs). (1) Studies suggest, however, that the proportion of children seeing FPs [...], PURPOSE Evidence that fewer children are being seen at family physician (FP) practices has not been confirmed using population-level data. This study examines the proportion of children seen at FP and pediatrician practices over time and the influence of patient demographics and rurality on this trend. METHODS We conducted a retrospective longitudinal analysis of Vermont all-payer claims (2009-2016) for children aged 0 to 21 years. The sample included 184,794 children with 2 or more claims over 8 years. Generalized estimating equations modeled the outcome of child attribution to a FP practice annually, with covariates for calendar year, child age, sex, insurance, and child Rural Urban Commuting Area (RUCA) category. RESULTS Over time, controlling for other covariates, children were 5% less likely to be attributed to a FP practice (P CONCLUSIONS The declining proportion of children attending FP practices, confirmed in this population-based analysis and more pronounced in rural areas, represents a continuing challenge. Key words: child health; pediatricians; physicians, family; primary health care; workforce

To examine the association between supportive environments and adolescent suicidal behavior, especially among marginalized minority groups. Participants included 12,196 middle and 16,981 high school students who completed the 2019 Vermont Youth Risk Behavior Survey. Multiple logistic regression models were used to assess the association between three protective factors that were part of a supportive environment (feeling like they matter to people in their community, usually eating dinner at home, having a trusted adult) and suicidality (plan or attempt), controlling for key demographics (sex, sexual orientation, gender identity, and race/ethnicity). Moderating effects of demographics were also explored. All supportive environment variables were protective of making a suicide plan and making a suicide attempt (ORs < 0.75, p-values < 0.005). Students of minority identities were significantly more likely to make a suicide plan (middle school ORs: 1.34–3.51, p-values < 0.0005; high school ORs: 1.19–3.38, p-values < 0.02) and attempt suicide (middle school ORs: 1.42–3.72, p-values < 0.006; high school ORs: 1.38–3.25, p-values < 0.0005) compared to students with majority demographic characteristics. Generally, the associations between having a supportive environment and suicidality did not vary within sexual orientation, gender identify, or race/ethnicity subgroups, suggesting that these supportive environment factors were more universally protective. However, a few associations were stronger among students in the majority demographic groups. These data suggest that having a supportive environment is protective of suicidality for adolescents from both majority and minority demographic groups. A supportive environment is protective of adolescent suicide plan and attempt. Minority sexual, gender, and racial identities are risk factors for suicidality. Minority and majority students are protected by supportive environments. [ABSTRACT FROM AUTHOR]

Students in Vermont with incomplete or undocumented immunization status are provisionally admitted to schools and historically had a calendar year to resolve their immunization status. The process of resolving these students' immunization status was challenging for school nurses. We conducted a school-based quality improvement effort to increase student compliance with Vermont immunization regulations using a collaborative learning approach with public health school liaisons and school nurses from public schools to reduce provisional admittance in 2011-2012. Strategies included using a tracking system, accessing the immunization registry, promoting immunization importance, tracking immunization plans, and working with medical homes to update records. Participating school nurses observed decreases in the number of provisionally admitted students, although this reduction was not significantly different than matched comparison schools. We also found the number of provisionally admitted students fluctuated throughout the year and resolving the immunization status of New Americans and exchange students required special attention. Our approach supports the coordinated school health model and demonstrates the critical role school nurses play in improving population health outcomes.

International comparisons were conducted of preschool children's behavioral and emotional problems as reported on the Child Behavior Checklist for Ages 1 1/2-5 by parents in 24 societies (N = 19,850). Item ratings were aggregated into scores on syndromes; "Diagnostic and Statistical Manual of Mental Disorders"-oriented scales; a Stress Problems scale; and Internalizing, Externalizing, and Total Problems scales. Effect sizes for scale score differences among the 24 societies ranged from small to medium (3-12%). Although societies differed greatly in language, culture, and other characteristics, Total Problems scores for 18 of the 24 societies were within 7.1 points of the omnicultural mean of 33.3 (on a scale of 0-198). Gender and age differences, as well as gender and age interactions with society, were all very small (effect sizes less than 1%). Across all pairs of societies, correlations between mean item ratings averaged 0.78, and correlations between internal consistency alphas for the scales averaged 0.92, indicating that the rank orders of mean item ratings and internal consistencies of scales were very similar across diverse societies. (Contains 4 tables and 1 figure.)

Objective: To test the fit of a seven-syndrome model to ratings of preschoolers' problems by parents in very diverse societies. Method: Parents of 19,106 children 18 to 71 months of age from 23 societies in Asia, Australasia, Europe, the Middle East, and South America completed the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5). Confirmatory factor analyses were used to test the seven-syndrome model separately for each society. Results: The primary model fit index, the root mean square error of approximation (RMSEA), indicated acceptable to good fit for each society. Although a six-syndrome model combining the Emotionally Reactive and Anxious/Depressed syndromes also fit the data for nine societies, it fit less well than the seven-syndrome model for seven of the nine societies. Other fit indices yielded less consistent results than the RMSEA. Conclusions: The seven-syndrome model provides one way to capture patterns of children's problems that are manifested in ratings by parents from many societies. Clinicians working with preschoolers from these societies can thus assess and describe parents' ratings of behavioral, emotional, and social problems in terms of the seven syndromes. The results illustrate possibilities for culture-general taxonomic constructs of preschool psychopathology. Problems not captured by the CBCL/1.5-5 may form additional syndromes, and other syndrome models may also fit the data. (Contains 2 tables and 1 figure.)

There is considerable interest in using propensity score (PS) statistical techniques to address questions of causal inference in psychological research. Many PS techniques exist, yet few guidelines are available to aid applied researchers in their understanding, use, and evaluation. In this study, the authors give an overview of available techniques for PS estimation and PS application. They also provide a way to help compare PS techniques, using the resulting measured covariate balance as the criterion for selecting between techniques. The empirical example for this study involves the potential causal relationship linking early-onset cannabis problems and subsequent negative mental health outcomes and uses data from a prospective cohort study. PS techniques are described and evaluated on the basis of their ability to balance the distributions of measured potentially confounding covariates for individuals with and without early-onset cannabis problems. This article identifies the PS techniques that yield good statistical balance of the chosen measured covariates within the context of this particular research question and cohort. (Contains 2 figures and 2 tables.)

Objective: To test the association between the catechol-O-methyltransferase (COMT) Val158Met polymorphism and both aggressive behavior and attention problems in youth. We hypothesized that youth carrying a Met allele would have greater average aggressive behavior scores, and that youth exhibiting Val-homozygosity would have greater average attention problems scores. Method: Complete data on maternally rated Child Behavior Checklist (CBCL) measures of aggressive behavior (AGG) and attention problems (AP), COMT polymorphism data, demographics, and maternal parenting quality were available for 149 youth (6 to 18 years old). Multivariable linear regression models were used to test the degree to which youth COMT Val158Met genotype was associated with AGG and AP while statistically controlling for age, gender, parental socioeconomic status (SES), and maternal parenting quality from the Alabama Parenting Questionnaire. Results: Mothers of Met-carriers rated their children higher on average AGG scores when compared with mothers of Val-homozygotes (p = 0.016). Further analyses revealed that this association was even more robust for maternal ratings of direct aggression (p = 0.007). The hypothesized association between Val-homozygosity and higher average AP scores relative to average AP scores of Met-carriers did not quite reach statistical significance (p = 0.062). Conclusions: After controlling for demographics, SES, and maternal parenting quality as confounders, there remains a strong association between youth carrying a Met allele and higher average AGG scores relative to Val-homozygotes. (Contains 2 tables.)

This study tested the incremental validity of behavioral observations, over and above parent and teacher reports, for assessing symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) in children ages 6 to 12, using the Test Observation Form (TOF) and Direct Observation Form (DOF) from the Achenbach System of Empirically Based Assessment. The TOF Attention Problems and DOF Intrusive scales contributed significant unique variance, over and above parent and teacher ratings, to predicting parent and teacher ratings of hyperactivity and impulsivity and predicting categorical diagnoses of ADHD-Combined type versus Non-ADHD and ADHD-Combined type versus ADHD-Predominantly Inattentive type. The TOF Oppositional and Attention Deficit/Hyperactivity Problems scales contributed unique variance to predicting parent ratings of hyperactivity and impulsivity and the DOF Oppositional and Attention Deficit/Hyperactivity Problems scales contributed unique variance to predicting teacher ratings of hyperactivity and impulsivity. (Contains 7 tables and 1 footnote.)

Background: Supplementation in the newborn nursery has been associated with shorter breastfeeding duration. However, supplementation may at times be necessary. Research Aim: To determine the association between type of supplementation in the newborn nursery (mother's own milk, formula, donor human milk) and breastfeeding outcomes at 2 and 6 months of age. Methods: This was a prospective, longitudinal, observational multi-group cohort study. In total, 2,343 surveys were sent to parents who, prior to delivery, indicated intent to exclusively breastfeed. Participants were grouped by type of nursery supplementation. Surveys asked about breastfeeding outcomes when infants were 2 and 6 months old. Our final analytic sample included data from 1,111 healthy newborns ≥ 35 weeks. We used multiple logistic regression to compare future breastfeeding outcomes for infants who were exclusively directly breastfed or who received supplementation during their birth hospitalization. Results: Both the donor human milk and formula groups had decreased breastfeeding at 2 and 6 months compared to the exclusively directly breastfed group. Notably, for infants who received formula compared to donor human milk, the odds of breastfeeding at 2 and 6 months were 74% and 58% lower, respectively (OR = 0.26, 95% CI [0.12, 0.56] at 2 months; OR = 0.42, 95% CI [0.19, 0.94] at 6 months). The donor human milk group had lower odds of breastfeeding at both follow up times compared to the mother's own milk group. Conclusion: Among those who intend to breastfeed, supplementation with donor human milk instead of formula in the newborn nursery may support longer breastfeeding. [ABSTRACT FROM AUTHOR]

Trends in cocaine use over the past 2 decades were compared across levels of education in a population-based US sample of adults. Significant inverse associations between educational achievement and cocaine use after 1990 were driven by dramatic decreases in persistent cocaine use among more highly educated adults, whereas persistent cocaine use remained relatively unchanged among those who did not finish high school. This emerging health disparity highlights the need for improved interventions that target persistent cocaine users with low educational achievement. (Am J Public Health. 2007;97:1790-1793. doi: 10.2105/AJPH.2006.091108)

Pediatric asthma is a common, relapsing-remitting, chronic inflammatory airway disease that when uncontrolled often leads to substantial patient and health care system burden. Improving management of asthma in primary care can help patients stay well controlled. The Vermont Child Health Improvement Program (VCHIP) developed a quality improvement (QI) learning collaborative with a primary objective to improve clinical asthma management measures through improvement in primary care office systems to support asthma care. Seven months of medical record review data were evaluated for improvements on eight clinical asthma management measures. Pre and post office systems inventory (OSI) self-assessments detailing adherence to improvement strategies were analyzed for improvement. Logistic regressions were used to test for associations between OSI strategy post scores and the corresponding clinical asthma management measures by month seven. This study found significant improvement from baseline to month seven on seven of the eight clinical asthma management measures and between pre and post OSI for seven of the nine strategies assessed (N = 19 practices). Additionally, one point higher average OSI scores on the assessment and monitoring of asthma severity, asthma control, asthma action plans, and asthma education strategies were associated with significantly greater odds of improvement in their respective clinical asthma management measures. A QI learning collaborative approach in primary care can improve office systems and corresponding clinical management measures for pediatric patients with asthma. This suggests that linking specific office systems strategies to clinical measures may be a helpful tactic within the learning collaborative model. [ABSTRACT FROM AUTHOR]