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Background: Individuals are exposed to a variety of indoor residential toxins including volatile organic compounds and particulates. In adults with asthma, such exposures are associated with asthma symptoms, asthma exacerbations, and decreased lung function. However, data on these exposures and asthma-related outcomes are generally collected at different times and not in real time. The integration of multiple platforms to collect real-time data on environmental exposure, asthma symptoms, and lung function has rarely been explored., Objective: This paper describes how adults with asthma perceive the acceptability and usability of three integrated devices: (1) residential indoor air quality monitor, (2) ecological momentary assessment (EMA) surveys delivered via a smartphone app, and (3) home spirometry, over 14 days., Methods: Participants (N=40) with uncontrolled asthma were mailed the Awair Omni indoor air quality monitor, ZEPHYRx home spirometer, and detailed instructions required for the in-home monitoring. The air quality monitor, spirometer, and EMA app were set up and tested during a videoconference or phone orientation with a research team member. Midway through the 14-day data collection period, participants completed an interview about the acceptability of the study devices or apps, instructional materials provided, and the setup process. At the end of the 14-day data collection period, participants completed a modified System Usability Scale. A random sample of 20 participants also completed a phone interview regarding the acceptability of the study and the impact of the study on their asthma., Results: Participants ranged in age from 26 to 77 (mean 45, SD 13.5) years and were primarily female (n=36, 90%), White (n=26, 67%), college graduates (n=25, 66%), and residing in a single-family home (n=30, 75%). Most indicated that the air quality monitor (n=23, 58%), the EMA (n=20, 50%), and the spirometer (n=17, 43%) were easy to set up and use. Challenges with the EMA included repetitive surveys, surveys arriving during the night, and technical issues. While the home spirometer was identified as a plausible means to evaluate lung function in real time, the interpretation of the readings was unclear, and several participants reported side effects from home spirometer use. Overall, the acceptability of the study and the System Usability Scale scores were high., Conclusions: The study devices were highly acceptable and usable. Participant feedback was instrumental in identifying technical challenges that should be addressed in future studies., (©Barbara Polivka, Kathryn Krueger, Olivia Bimbi, Luz Huntington-Moskos, Sharmilee Nyenhuis, Emily Cramer, Kamal Eldeirawi. Originally published in JMIR Formative Research (https://formative.jmir.org), 10.10.2024.)

Purpose: To explore specific medication literacy (SML) of older adults and associations of SML strength., Methods: This was an observational study. Participants were at least 60 years old, with an asthma diagnosis and in good health. Data were collected by a registered nurse researcher. The SML data collection instrument gathered information about each medication a participant used: name, purpose, how taken, special instructions, adverse effects, and drug-drug or drug-disease interactions. An SML scoring rubric was developed., Results: All could provide name, and most provided purpose, how taken. The lowest SML domains were side effects and interactions. Age at time of asthma diagnosis correlated with stronger SML scores and living in a disadvantaged neighborhood correlated with lower SML scores., Discussion: Gaps in medication literacy may create less ability to self-monitor. Patients want medication literacy but struggle with appropriate, individualized, information., Conclusion: The study provides insights on gaps and opportunities for SML.

Introduction: Science communication plays a crucial role in tackling pressing regional, national, and global health issues. Effective communication with various audiences is integral to dissemination of science findings., Purpose: This study evaluates changes in self-efficacy and attitudes toward science communication skills over time and also assesses program outcomes and satisfaction with a Faculty Fellows in Science Communication (FFSC) program among faculty (N = 30) with interest in environmental health science and/or education in Appalachia Kentucky., Methods: A mixed methods program evaluation was employed using longitudinal data on behaviors, attitudes, and program outcomes from three cohorts of Faculty Fellows who participated in the year-long UK-CARES Faculty Fellows in Science Communication (FFSC) program from 2018 to 2021. Repeated Measures Analysis of Variance was used to evaluate changes over time in self-efficacy and attitude scores., Results: A total of 30 Fellows enrolled in the program. Participation in the FFSC program significantly increased self-efficacy in communicating with peers in one's own department ( F = 7.6, p = 0.002), outside department ( F = 7.3, p = 0.002 ), and lay audiences ( F = 5.8, p = 0.006) and evaluations of the program were positive. Qualitative feedback from participants offered insights into how program participation helped them communicate with different audiences, incorporate narratives or stories to engage audiences, and develop innovative methods of communicating with lay audiences., Implications: The FFSC program provides a useful framework for other institutions and supports faculty as they build the communication skills necessary to effectively translate science with various audiences., Competing Interests: Cover Page Footnote No competing financial or editorial interests were reported by the authors of this paper. This publication was supported by UK-CARES through Grant P30 ES026529. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIEHS., (Copyright © 2023 Stacy Stanifer, Beverly Delidow, Kathy Rademacher, Luz Huntington-Moskos, Kelly Kennoy, Amanda Thaxton-Wiggins, Craig Wilmhoff, and Ellen J. Hahn.)

Background: Food insecurity has been associated with poorer asthma control in children, but research lacks in adults., Objective: To assess the frequency of food insecurity and its association with asthma control in adults during the coronavirus disease 2019 pandemic., Methods: An online cross-sectional survey study was conducted in US adults with asthma. Survey questions included how worried or concerned participants were about food security since the pandemic. Asthma control was assessed using the Asthma Control Test, with uncontrolled asthma defined as Asthma Control Test score less than or equal to 19. Self-report of food insecurity since the pandemic was assessed. Food insecurity variables were dichotomized into high insecurity (≥3) or low insecurity (<3). Descriptive statistics and bivariate analyses were performed., Results: Of the total participants (N = 866), 82.79% were female; mean age of participants was 44 ± 15.05 years, their mean Asthma Control Test score was 19.25 ± 4.54, and 18.48% had high food insecurity. Participants with high food insecurity were more likely to have uncontrolled asthma (74.38%) compared with those with lower food insecurity (34.99%; P < .01). The relationship between asthma control and food insecurity remained significant after adjusting for age, education, sex, race, anxiety, and living stability concerns due to the pandemic., Conclusions: Food insecurity exists in adults with asthma and is associated with uncontrolled asthma. Providers should consider screening their patients for food insecurity when treating individuals with uncontrolled asthma., (Copyright © 2023 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Background: Recent technological advances allow for the repeated sampling of real-time data in natural settings using electronic ecological momentary assessment (eEMA). These advances are particularly meaningful for investigating physical activity, sedentary behavior, and sleep in young adults who are in a critical life stage for the development of healthy lifestyle behaviors., Objective: This study aims to describe the use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults., Methods: The PubMed, CINAHL, PsycINFO, Embase, and Web of Science electronic databases were searched through August 2022. Inclusion criteria were use of eEMA; sample of young adults aged 18 to 25 years; at least 1 measurement of physical activity, sedentary behavior, or sleep; English language; and a peer-reviewed report of original research. Study reports were excluded if they were abstracts, protocols, or reviews. The risk of bias assessment was conducted using the National Heart, Lung, and Blood Institute's Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Screening, data extraction, and risk of bias assessments were conducted by independent authors, with discrepancies resolved by consensus. Descriptive statistics and narrative synthesis were used to identify overarching patterns within the following categories guided by the Checklist for Reporting Ecological Momentary Assessments Studies: study characteristics, outcomes and measures, eEMA procedures, and compliance., Results: The search resulted in 1221 citations with a final sample of 37 reports describing 35 unique studies. Most reports (28/37, 76%) were published in the last 5 years (2017-2022), used observational designs (35/37, 95%), consisted of samples of college students or apprentices (28/35, 80%), and were conducted in the United States (22/37, 60%). The sample sizes ranged from 14 to 1584 young adults. Physical activity was measured more frequently (28/37, 76%) than sleep (16/37, 43%) or sedentary behavior (4/37, 11%). Of the 37 studies, 11 (30%) reports included 2 movement behaviors and no reports included 3 movement behaviors. eEMA was frequently used to measure potential correlates of movement behaviors, such as emotional states or feelings (25/37, 68%), cognitive processes (7/37, 19%), and contextual factors (9/37, 24%). There was wide variability in the implementation and reporting of eEMA procedures, measures, missing data, analysis, and compliance., Conclusions: The use of eEMA methodologies in physical activity, sedentary behavior, and sleep research in young adults has greatly increased in recent years; however, reports continue to lack standardized reporting of features unique to the eEMA methodology. Additional areas in need of future research include the use of eEMA with more diverse populations and the incorporation of all 3 movement behaviors within a 24-hour period. The findings are intended to assist investigators in the design, implementation, and reporting of physical activity, sedentary behavior, and sleep research using eEMA in young adults., Trial Registration: PROSPERO CRD42021279156; https://www.crd.york.ac.uk/prospero/display&#95;record.php?ID=CRD42021279156., (©Kimberly R Hartson, Luz Huntington-Moskos, Clara G Sears, Gina Genova, Cara Mathis, Wessly Ford, Ryan E Rhodes. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 29.06.2023.)

Background: It is estimated that over 60% of adults with asthma have uncontrolled symptoms, representing a substantial health and economic impact. The effects of the home environment and exposure to volatile organic compounds (VOCs) and fine particulate matter (PM 2.5 ) on adults with asthma remain unknown. In addition, methods currently used to assess the home environment do not capture real-time data on potentially modifiable environmental exposures or their effect on asthma symptoms., Objective: The aims of this study are to (1) determine the feasibility and usability of ecological momentary assessment (EMA) to assess self-report residential environmental exposures and asthma symptoms, home monitoring of objective environmental exposures (total VOCs and PM 2.5 ), and lung function in terms of forced expiratory volume in 1 second (FEV 1 %); (2) assess the frequency and level of residential environmental exposures (eg, disinfectants/cleaners, secondhand smoke) via self-reported data and home monitoring objective measures; (3) assess the level of asthma control as indicated by self-reported asthma symptoms and lung function; and (4) explore associations of self-reported and objective measures of residential environmental exposures with self-reported and objective measures of asthma control., Methods: We will recruit 50 adults with asthma who have completed our online Global COVID-19 Asthma Study, indicated willingness to be contacted for future studies, reported high use of disinfectant/cleaning products, and have asthma that is not well controlled. Participants will receive an indoor air quality monitor and a home spirometer to measure VOCs, PM 2.5 , and FEV 1 %, respectively. EMA data will be collected using a personal smartphone and EMA software platform. Participants will be sent scheduled and random EMA notifications to assess asthma symptoms, environmental exposures, lung function, and mitigation strategies. After the 14-day data collection period, participants will respond to survey items related to acceptability, appropriateness, and feasibility., Results: This study was funded in March 2021. We pilot tested our procedures and began recruitment in April 2022. The anticipated completion of the study is 2023., Conclusions: Findings from this feasibility study will support a powered study to address the impact of home environmental exposures on asthma symptoms and develop tailored, home-based asthma interventions that are responsive to the changing home environment and home routines., Trial Registration: ClinicalTrials.gov NCT05224076; https://clinicaltrials.gov/ct2/show/NCT05224076., International Registered Report Identifier (irrid): DERR1-10.2196/39887., (©Sharmilee Nyenhuis, Emily Cramer, Matthew Grande, Luz Huntington-Moskos, Kathryn Krueger, Olivia Bimbi, Barbara Polivka, Kamal Eldeirawi. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 02.08.2022.)

Abstract: Although chemical exposures from cleaning and disinfectant products often go unnoticed or unrecognized, such exposures have been associated with asthma-related symptoms and exacerbations. The Environmental Working Group (EWG) website provides consumer information on a wide range of issues and products related to human health and the environment, including the use of cleaning and disinfectant products, 2,500 of which it has rated in terms of their effects on respiratory function and asthma. In discussing how the use of cleaning and disinfectant products and the frequency of their use may affect asthma control, the authors use the EWG ratings as well as data collected for a study they conducted on older adults with asthma., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Purpose: Determine associations of strength of local smoke-free laws and urban/rural location with cigarette and smokeless tobacco use among high school students in grades 10 and 12., Design: Secondary data analysis from the 2004-2018 biennial Kentucky Incentives for Prevention Survey., Setting: Public high schools in Kentucky., Sample: N = 353502 10 th /12 th graders., Measures: County-level smoke-free law status from the Kentucky Center for Smoke-free Policy; Rural Urban Continuum Codes; self-reported last 30-day alcohol, marijuana, cigarette, and smokeless tobacco use., Analysis: Generalized estimating equations modeling assessed the association of law status and urban/rural location with tobacco use across cohorts, controlling for demographics and other substance use., Results: Students in counties with a comprehensive smoke-free law were 23% less likely to smoke cigarettes and 16% less likely to use smokeless, compared to those in counties without a law. Students in counties with moderate/weak laws did not differ in likelihood of use for either product, compared to those in counties without a law. Students in urban counties were 14% less likely to smoke, but there was no difference in likelihood of smokeless use by urban/rural location., Conclusion: Comprehensive smoke-free laws are associated with a lower likelihood of youth cigarette and smokeless use. Rural youth may be at increased risk of cigarette smoking relative to youth in urban areas.

Background: Although masks are recommended for those with asthma in the era of COVID-19, there is limited research exploring the extent of and problems related to mask use in adults with asthma., Objective: We sought to describe in adults with asthma: (1) the extent masks are worn and attitudes and beliefs about wearing masks; (2) participant characteristics associated with problems experienced while wearing a mask, and (3) participant experiences and recommendations regarding masks., Methods: The Mask Use in Adults with Asthma online survey was conducted with 501 adults with asthma (96.6%) primarily from the United States. A Mask Effects Scale (MES) was compiled from items addressing problems experienced wearing a mask with higher total scores indicating more problems. Open-ended questions explored factors considered when choosing a mask, problems experienced while wearing a mask, and recommendations to others with asthma. Survey data were analyzed descriptively and via multiple regression. Themes were generated from open-ended items., Results: Almost all participants (98.4%) indicated wearing a mask in public, and most (67.4%) wore a mask ≤3 hours per day. Poorer asthma control and wearing a mask longer were significantly associated with higher MES scores (P ≤ .001 and .005, respectively). Participant recommendations included "Just wear it," use a comfortable, well-fitting mask, take mask breaks, and carry your inhaler., Conclusions: Wearing a mask in public was almost uniformly adhered to by participants, despite reporting problematic effects. Implementing recommendations, such as planned mask breaks, can support and enhance the experience of wearing a mask for adults with asthma., (Copyright © 2021 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

A civic engagement and data science design was used to develop a report-back intervention to address stakeholder concerns related to air emissions surrounding a coke oven factory near Buffalo, NY. This factory had historically emitted high levels of benzene pollution and ceased operation in October 2018 because of violations of the US Clean Air Act and US Resource Conservation and Recovery Act. Using publicly available air pollution and weather data, descriptive time series and wind-rose data visualizations were developed using open-source software as part of a two-page report-back brief. Data from two air toxics monitoring sites in this direction suggest that industrial sources were likely the major contributor to the benzene in the air at these locations prior to May 2018, after which traffic emissions became the likely major contributor. Wind-rose visualizations demonstrated that the wind typically blew toward the northeast, which was qualitatively consistent with locations of stakeholder concerns. With the factory closed, collective efforts subsequently shifted to address traffic emission air pollution sources, factory site cleanup, and ground and water pollution mitigation. Because this intervention utilized open-source software and publicly available data, it can serve as a blueprint for future data-driven nursing interventions and community-led environmental justice efforts., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Report back is active sharing of research findings with participants to prompt behavior change. Research on theory-driven report back for environmental risk reduction is limited. The study aim is to evaluate the impact of a stage-tailored report back process with participants who had high home radon and/or air nicotine levels. An observational one-group pre-post design was used, with data collection at 3, 9, and 15 months post intervention. Participants from the parent study ( N = 515) were randomized to the treatment or control group and this sample included all 87 treatment participants who: (1) had elevated radon and/or air nicotine at baseline; and (2) received stage-tailored report back of their values. Short-term test kits measured radon; passive airborne nicotine samplers assessed secondhand smoke (SHS) exposure. Stage of action was categorized as: (1) ' Unaware ', (2) ' Unengaged ', (3) ' Deciding ', (4) ' Action ', and (5) ' Maintenance '. Interventions were provided for free, such as in-person radon and SHS test kits and a brief telephonic problem-solving consultation. Stage of action for radon mitigation and smoke-free policy increased from baseline to 3 months and remained stable between 3 and 9 months. Stage of action for radon was higher at 15 months than baseline. Among those with high baseline radon, observed radon decreased by 15 months ( p < 0.001). Tailored report back of contaminant values reduced radon exposure and changed the health behavior necessary to remediate radon and SHS exposure.

Training in environmental health (EH) engages and inspires youth to tackle health promotion and policy change. Yet, there is little guidance on how to successfully nurture and sustain youth engagement. This paper compares four case studies of youth engagement to promote EH in rural and urban communities using the Youth Empowerment Solutions (YES!) framework. Of the case studies in rural (Central Appalachia) and urban (Cincinnati, Ohio) communities, two employ citizen science approaches using PhotoVoice and environmental sampling; one engages youth in a science communication camp; and one focuses on policy advocacy. We compare and contrast these case studies using the YES! Critical Components and Empowerment levels. The case studies were discussed at the 2020 Partnerships in Environmental Public Health Meeting, where participants identified challenges and possible solutions for promoting and maintaining authentic youth engagement in EH research and advocacy. Analysis of the case studies indicated that youth engagement activities focusing on the individual were more common than those targeting the organizational setting or the community. Youth demonstrate agency to impact EH issues in their communities by engaging in hands-on opportunities to practice citizen science and advocacy. Overcoming challenges to authentic young engagement is important to sustain this work.

Purpose: Rural adolescents engage in higher smoking and smokeless tobacco use rates than those from urban communities; urban adolescents are more likely to use e-cigarettes. The study investigated whether place of residence (rural vs urban) is associated with tobacco use prevalence and change in prevalence among middle and high school students over time., Methods: We analyzed data from the National Youth Tobacco Survey (2011-2016). Multiple logistic regression methods for weighted survey data assessed the relationship of place of residence with current tobacco product use over time, adjusting for demographics., Findings: There was no difference in rate of change in use of any tobacco product between rural and urban middle or high school students. Adjusting for age, sex, race/ethnicity, and survey year, both middle and high school rural students were more likely to use cigarettes and smokeless tobacco, whereas urban high school students were more likely to use hookah. Significant polynomial trends were observed for e-cigarette and hookah use patterns, whereas linear changes in use patterns were detected for cigarette and smokeless tobacco use over time., Conclusions: Rural high school students are more likely to smoke cigarettes and use smokeless tobacco than their urban counterparts, although prevalence rates have decreased over time. However, use of hookah and e-cigarettes among middle and high school students has increased over time regardless of place of residence. To stem the rapid increase in use of hookah and e-cigarettes, comprehensive tobacco control policies are needed regardless of rural or urban location., (© 2019 National Rural Health Association.)

Introduction: Tobacco smoke and radon are the leading causes of lung cancer. The FRESH intervention was a randomized controlled trial of 515 homeowners to promote stage of action to reduce radon and air nicotine levels., Methods: We studied 515 participants, 257 in a treatment group and 258 in a control group. Treatment participants received free radon and air nicotine test kits, report back, and telephone support, and those participants whose homes had high radon levels received a voucher for $600 toward mitigation. Both groups were asked to retest 15 months post intervention. We examined differences in stage of action to test for and mitigate radon and adopt a smoke-free-home policy and in observed radon and air nicotine values by study group over time., Results: Homeowners in the treatment group scored higher on stage of action to test for radon and air nicotine and to mitigate for radon during follow-up than those in the control group at 3 months and 9 months, but the effect of the intervention diminished after 9 months. We saw no difference between groups or over time in observed radon or air nicotine values. Of homeowners in the treatment group with high radon levels at baseline, 17% mitigated, and 80% of them used the voucher we provided., Conclusion: The null finding of no significant change in observed radon or air nicotine values from baseline to 15 months may reflect the low proportion of radon mitigation systems installed and the decline in stage of action to adopt a smoke-free home policy. Including a booster session at 9 months post intervention may improve the remediation rate.

Objective: Globally, indoor and outdoor pollutants are leading risk factors for death and reduced quality of life. Few theories explicitly address environmental health within the nursing discipline with a focus on harmful environmental exposures. The objective here is to expand the National Institutes of Health Symptom Science Model to include the environmental health concepts of environmental endotype (causative pathway) and environmental exposure., Design: Meleis' research to theory strategy for theory refinement was used. Research workshop proceedings, environmental health nursing research expert consensus, panelist research trajectories, and review of the literature were utilized as data sources., Results: Ongoing emphasis on the physical environment as a key determinant of health and theoretical perspectives for including environmental exposures and endotypes in symptom science are presented. Definitions of these concepts, further developed, are provided. Recommendations to strengthen environmental health nursing research and practice through capacity building/infrastructure, methods/outcomes, translational/clinical research, and basic/mechanistic research are included., Conclusion: The revised model deepens theoretical support for clinical actions that include environmental modification, environmental health education, and exposure reduction. This modification will enable a middle-range theory and shared mental model to inspire the prioritization of environmental health in nursing leadership, research, practice, and education., (© 2019 Wiley Periodicals, Inc.)

Purpose: To examine the short-term impact of a personalized environmental report-back intervention to reduce home exposure to tobacco smoke and radon on perception of synergistic risk for lung cancer. Radon-induced lung cancer is more common among those exposed to tobacco smoke., Design: Randomized controlled trial., Setting: Primary care clinics and a pharmacy waiting area at a University Medical Center in the Southeastern United States and community events., Participants: Five hundred sixty adult homeowners and renters (3-month follow-up, n = 334)., Intervention: Personalized environmental report back., Measures: Single-item synergistic risk perception measure using 5-point Likert-type scale., Analysis: Change in synergistic risk from baseline to 3 months was evaluated using a generalized estimating equation model containing main effects of treatment group and time. Covariates in the model included age, gender, education, and home smoking status., Results: For treatment and control groups combined, there was a significant increase in perception of synergistic risk from baseline to 3 months, but the study groups did not differ. There was no association between perceived synergistic risk and whether or not there were smokers at home., Conclusion: Learning about combined risks for lung cancer, with or without dual home screening for secondhand smoke and radon and environmental report-back, may enhance perceived risk for combined environmental exposures. Evaluation of perceived synergistic risk with a single item is a study limitation.

Background: More radon-related lung cancers occur among those exposed to tobacco smoke., Objectives: To test the effects of a personalized environmental report back intervention on change in stage of action for air nicotine testing and adopting a smoke-free home and radon testing and mitigation from baseline to 3 months postintervention., Methods: The study design used a two-arm parallel groups randomized controlled trial with stratified quota sampling. The treatment group received free air nicotine and radon home test kits and a brief problem-solving phone intervention; the control group received a coupon for free test kits. A sample of 515 homeowners were enrolled; 319 completed the 3-month follow-up. Stage of action to test and remediate the home was measured consistent with the precaution adoption process model. Linear mixed modeling assessed whether the main and interaction effects of treatment and time were associated with the testing and remediation outcomes; multiple covariates were included in the models., Results: The models for the four stages of action outcomes (testing and remediating for radon and secondhand smoke) each had a significant treatment-by-time effect. The general pattern was an increase in stage of action from baseline to 3 months. The degree of change was generally larger among the treatment group participants relative to the controls, indicating that those in the treatment group were more ready to take action. For all the models, participants with higher self-efficacy for radon/air nicotine testing and radon/secondhand smoke remediation were more ready to take action to test and remediate. Synergistic risk perception was associated with stage of action for radon mitigation., Conclusions: Homeowners who were provided free radon and air nicotine test kits, given their results, and engaged in a brief telephonic problem-solving consultation tended to show a greater increase in readiness to take action to test and remediate by 3 months compared with those who received standard public health practice. Both groups showed an increase in stage of action for all four outcomes over time.

Purpose: Adolescent tobacco use is higher in rural than in urban areas. While e-cigarette use is increasing rapidly among this age group, differences in prevalence between rural versus urban populations for this relatively novel product have not been explored. The purpose is to investigate whether location of school (rural-urban) is associated with e-cigarette use and dual use (defined as the use of both e-cigarettes and conventional cigarettes) among high school students., Design: Cross-sectional survey obtained using a stratified, 3-stage cluster sample design., Setting: United States., Participants: A nationally representative sample of US high school students (N = 11 053) who completed the 2014 National Youth Tobacco Survey (NYTS); slightly more than half were urban (54%)., Measures: The NYTS measures tobacco-related knowledge, attitudes, and use behavior and demographics of students in the United States., Analysis: Weighted logistic regression assessed the relationships of urban-rural location with current e-cigarette use and dual use, adjusting for demographic factors, perceived risk, and social norms., Results: There were clear differences in patterns of adolescent e-cigarette and cigarette use in rural versus urban areas. Social norms and perceptions may play a role in understanding these differences., Conclusion: Urban youth current cigarette smokers were nearly twice as likely as rural cigarette smokers to also use e-cigarettes. Reasons for urban-rural differences need to be taken into account when designing prevention programs and policy changes.

Objective: This study determined whether having minor children in the home was associated with the teachable moment (TM) constructs of lung cancer worry, perceived risk, health-related self-concept, and the novel construct of synergistic risk., Design and Sample: Secondary data analysis of baseline data from a randomized controlled trial of an intervention to reduce home exposure to radon and secondhand smoke (SHS). Quota sample of adults recruited at a Central Kentucky academic medical center (N = 556)., Measures: Survey items assessed lung cancer worry, perceived risk, synergistic risk perception, and health-related self-concept., Results: The presence of children in the home was not a significant predictor of any construct needed to create a TM for lung cancer prevention. Individuals with children living in the home were more likely to be younger, a racial/ethnic minority, a current smoker, and live with a smoker compared to those without children in the home., Conclusions: There is a critical need to raise parental awareness on child health inequities related to the home exposure to radon and SHS. Public health nurses can create TMs for lung cancer prevention through greater awareness of the risks posed by radon and SHS along with promoting home testing and low-cost resources to reduce risk., (© 2016 Wiley Periodicals, Inc.)

Purpose: Hypertension is a risk factor for cardiovascular disease (CVD) in adults and children and has its origins in childhood. While the prevalence of hypertension in children is estimated to be 2 to 5%, instance elevations in blood pressure readings (BPRs) in school-age children and adolescents are more common, track to adulthood, and are an independent risk factor for CVD. Less information is available about BPR in the preschool period and what child factors could influence those BPR. The primary aims of this exploratory study were to determine child blood pressure (BP) levels and determine effect sizes of the relationships between child and maternal factors that can influence child BP., Methods: A convenience sample of 15 rural and 15 urban children enrolled in Head Start programs (13 males; 14 females; all black) with ability to understand and speak English and with mothers who gave consent and could understand, read and speak English were enrolled. Mothers completed demographic information about their child including, gender, birth history and age. Height, weight, waist circumference and BP were measured in the mothers and the children. Children gave saliva specimens for cortisol and C-reactive protein., Results: Over 37% of the children had elevated BPR with over 20% at or above the 95th percentile. Effect sizes of relationships ranged from very small to large., Conclusion: Elevations in BPR may be seen as early as preschool. It is important to examine factors, both child and maternal that influence BP., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Purpose: Nearly half of all adolescents in the United States are exposed to secondhand smoke (SHS) daily, primarily at home, resulting in respiratory infections, asthma exacerbations, and reduced lung function. A concise self-report measure is needed to identity adolescents exposed to SHS. The purpose of this study was to test whether nonsmoking adolescents who reported exposure to peer and/or family smoking on the Peer and Family Smoking Index had higher salivary cotinine levels than those reporting no exposure to either peer or family smoking., Methods: A convenience sample of 135 English-speaking adolescents ages 15-18 years was recruited from two high schools. Those who reported use of nicotine replacement therapy, cigarette smoking (past 30 days), smokeless tobacco use (past 30 days), or who self-reported pregnancy were excluded. Salivary cotinine and self-report data from the Peer and Family Smoking Index were collected after obtaining parental consent and assent from the adolescent., Results: Mean salivary cotinine levels differed by exposure group (none, family, peer, or family and peer), F (3, 130) = 5.44, p = .001. The post hoc analysis identified a significantly higher mean cotinine level among those exposed to SHS from both family and peers than among those with no exposure (p = .001)., Conclusions: Known groups validity of the index was supported. Adolescents who reported family smoking or a combination of family and peer smoking had significantly higher salivary cotinine levels than unexposed adolescents. The Peer and Family Smoking Index is a concise and valid self-report measure for SHS exposure in adolescents., (Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The pathogenesis of hypertension begins in youth. An estimated 4% of US adolescents have diagnosed hypertension and 17% have elevated blood pressures, predisposing them to hypertension and cardiovascular disease (CVD) later in life. There is limited research on the clustering of CVD risk factors such as tobacco exposure and weight status that may be associated with high blood pressure in adolescents. The aim of this exploratory study was to determine the relationships between total smoke exposure (TSE; cigarette smoking and secondhand smoke), waist circumference, and blood pressure in a sample of rural adolescents, ages 15-18. A convenience sample of 148 adolescents ages 15-18 was recruited from two rural high schools (88 female and 60 male, all Caucasian). Adolescents were assessed for tobacco exposure (self-report, salivary cotinine), weight status (body mass index, waist circumference), and blood pressure. Self-report measures of tobacco exposure included the Uptake Continuum and Peer and Family Smoking measure. Age, gender, waist circumference and salivary cotinine contributed to 35% of the variance in systolic blood pressure and 18% in diastolic blood pressure. One-fourth (25%) of adolescent males and 11% of adolescent females had elevated systolic blood pressures. Approximately one-fifth of the sample (22%) had elevated salivary cotinine levels indicative of tobacco use and secondhand smoke exposure. TSE and waist circumference were predictors of elevated blood pressure in adolescents. Public health measures need to address clusters of risk factors including blood pressure, tobacco exposure, and weight status among adolescents in order to reduce CVD.