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Study Objectives: Prior research suggests that insomnia may increase the risk of death. However, the potential influence of age and sex is unclear. This study aimed to investigate the association of insomnia symptoms with all-cause mortality by age and sex. Methods: This prospective cohort was drawn from the Health and Retirement Study, a survey of Americans older than 50 years and their spouses of any age from 2002–2018. Insomnia symptom scores were based on difficulties initiating sleep, difficulty maintaining sleep, waking up too early, and nonrestorative sleep. Cox proportional-hazards regression models were employed to investigate the association between insomnia symptoms and all-cause mortality stratified by age and sex. Results: A total of 33,004 participants were included with a mean age of 61.7 years and 56.8% females. Over a mean follow-up of 8.4 years, 8,935 (27.1%) deaths were recorded. After adjusting for confounding, males with insomnia symptom scores ranging from 5–8 had a 71% increased risk of death (hazard ratio = 1.71; 95% confidence interval: 1.27, 2.30) compared with their counterparts without insomnia symptoms. Similarly, males aged ≥ 60 years and females aged < 60 years with insomnia symptoms ranging from 5–8 had an increased risk of death compared with their counterparts without insomnia symptoms (hazard ratio = 1.15; 95% confidence interval: 1.02, 1.31 and hazard ratio = 1.38; 95% confidence interval: 1.00, 1.90, respectively). However, there was no increased risk of death for females aged ≥ 60 years (hazard ratio = 0.94; 95% confidence interval: 0.84, 1.06). Conclusions: These findings suggest that insomnia symptoms may serve as predictors of low life expectancy. © 2024 American Academy of Sleep Medicine. All rights reserved.

Food insecurity is a detriment to the health and academic success of college students nationwide, increasing the need for innovative interventions. This cross-sectional study administered an online survey to 140 students attending a Northeastern public university to understand student interest in a student-sustained grocery program. The majority of students (53.6%) were food insecure (FI), measured with the USDA 6-item survey, as well as upperclassmen. Results identified that FI students may be most interested in a food pickup program that provides them with cooking classes, snack foods, and ingredients for 2–6 meals at a cost between $24.50 and $26.90 per week. © 2024 Taylor & Francis Group, LLC.

The aim of this qualitative research paper was to identify how social isolation policies implemented during the COVID-19 pandemic impacted the lives of pregnant women and mothers with opioid use disorder. Between 2020 and 2022, in-depth interviews were conducted with 37 mothers and pregnant women living in the suburbs of Newark, NJ, and New Haven, CT. Participants had to be at least 18 years old, misused or abused opioids in the last 12 months while residing in a suburban location, and pregnant or caring for children aged 12 and younger. We used syndemics theory to guide our grounded theory analysis to identify relationships between social situations, health conditions, and opioid use disorder. Five major themes emerged that were either directly or indirectly impacted by social isolation caused by policies implemented during the COVID-19 pandemic: Relationships, Environment, Services, Drug Use, and Health. Findings from this study reveal new insights into how mothers and their health were impacted by prolonged social isolation policies and offer suggestions for policymakers and service providers to better address future crisis.

BackgroundCancer is the second-leading cause of death in the United States. Most studies have reported rural versus urban and Black versus White cancer disparities. However, few studies have investigated racial disparities in rural areas.ObjectiveWe conducted a literature review to explore the current state of knowledge on racial and ethnic disparities in cancer attitudes, knowledge, occurrence, and outcomes in rural United States.MethodsA systematic search of PubMed and Embase was performed. Peer-reviewed articles published in English from 2004-2023 were included. Three authors independently reviewed the articles and reached a consensus.ResultsAfter reviewing 993 articles, a total of 30 articles met the inclusion criteria and were included in the present review. Studies revealed that underrepresented racial and ethnic groups in rural areas were more likely to have low cancer-related knowledge, low screening, high incidence, less access to treatment, and high mortality compared to their White counterparts.ConclusionUnderrepresented racial and ethnic groups in rural areas experienced a high burden of cancer. Improving social determinants of health may help reduce cancer disparities and promote health.

Electronic waste (e-waste) or discarded electronic devices that are unwanted, not working, or have reached their end of life pose significant threats to human and environmental health. This is a major concern in Africa, where the majority of e-waste is discarded. In the year 2021, an estimated 57.4 million metric tons of e-waste were generated worldwide. Globally, COVID-19 lockdowns have contributed to increased e-waste generation. Although Africa generates the least of this waste, the continent has been the dumping ground for e-waste from the developed world. The flow of hazardous waste from the prosperous ‘Global North’ to the impoverished ‘Global South’ is termed “toxic colonialism”. Agbogbloshie, Ghana, an e-waste hub where about 39% of e-waste was treated, was listed among the top 10 most polluted places in the world. The discard of e-waste in Ghana presents an issue of environmental injustice, defined as the disproportionate exposure of communities of color and low-income communities to pollution, its associated health and environmental effects, and the unequal environmental protection provided through policies. Despite the economic benefits of e-waste, many civilians (low-income earners, settlers, children, and people with minimal education) are exposed to negative health effects due to poverty, lack of education, and weak regulations. We critically examine the existing literature to gather empirical information on e-waste and environmental injustice. Comprehensive policies and regulations are needed to manage e-waste locally and globally.

In 2019, there was no entity specifically dedicated to health promotion and education practitioners in Connecticut or New England. This made it difficult for health promotion practitioners and students to network, collaborate, and engage in professional development. The purpose of this article is to share our experiences developing the new Connecticut Chapter of the Society for Public Health Education (CT SOPHE), including how we leveraged student interns during the first two years to promote organizational growth. To build our membership, it was important to determine who would be interested in joining CT SOPHE and so we focused on three groups: the current workforce/professionals, future workforce/students, and future leaders/interns. Over the course of these two years, three interns were recruited to help with creating a needs assessment (MPH student) and program development (two BS students); the organization was established by an MPH student as her internship project. Three former interns share how their experience working with the CT SOPHE board has helped them develop crucial leadership skills early in their careers. Embedding student interns into the framework and operations of CT SOPHE demonstrates an intentional and strategic commitment to the sustainability of both the organization and the workforce.

Context: Authors of previous research at a public university in New England, where the current study takes place, showed that approximately one-third of undergraduate students have experienced some aspect of food insecurity. More recent investigators at this university revealed that students who were members of a sport team were 4 times more likely to be food insecure than their peers who were not on a sport team. The estimated prevalence of student-athlete food insecurity from other previous research studies ranged from 14% to 32%. Objective: To understand the contributing factors to food insecurity among collegiate athletes. Design: Qualitative study. Setting: A public university in New England. Patients or Other Participants: Data are presented for 10 collegiate athletes who experienced some level of food insecurity according to the United States Department of Agriculture Six-Item Short Form. Data Collection and Analysis: Data were collected using a brief demographic questionnaire and semistructured interviews. Results: Contributing factors were a lack of time, special dietary needs, limited campus dining options, and limited access to transportation or kitchens. Coping strategies were managing time and resources, buying cheaper foods, and skipping meals. Food insecurity negatively affected students' athletic performance. The athletes struggled to balance their athletic and academic schedules and obtain a diet that allowed them to meet their performance goals. Conclusions: Additional and innovative programming is needed to support food-insecure student-athletes. © by the National Athletic Trainers' Association, Inc.

Background: Perceptions of the US healthcare system can impact individuals' healthcare utilization, including vaccination intentions. This study examined the association between perceived racial-ethnic inequities in COVID-19 healthcare and willingness to receive the COVID-19 vaccine. Methods: This study used data from REACH-US, a nationally representative online survey of a large, diverse sample of U.S. adults (N=5145 January 26, 2021-March 3, 2021). Confirmatory factor and regression analyses examined a latent factor of perceived racial-ethnic inequities in COVID-19 healthcare, whether the factor was associated with willingness to receive the COVID-19 vaccine, and whether associations varied across racial-ethnic groups reported as probit estimates (B) and 95% confidence intervals (CIs). Results: Perceived racial-ethnic inequities in COVID-19 healthcare were highest among Black/African American adults (mean latent factor score: 0.65 ± 0.43) and lowest among White adults (mean latent factor score: 0.04 ± 0.67). Black/African American (B = -0.08; 95% CI = -0.19, 0.03) and Native Hawaiian/Pacific Islander (B = -0.08; 95% CI = -0.23, 0.07) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were less willing than participants who perceived lower inequities. In contrast, American Indian/Alaska Native (B = 0.15; 95% CI = -0.01, 0.30), Asian (B = 0.20; 95% CI = 0.08, 0.31), Hispanic/Latino (English language preference) (B = 0.22; 95% CI = 0.01, 0.43), Multiracial (B = 0.23; 95% CI = 0.09, 0.36), and White (B = 0.31; 95% CI = 0.19, 0.43) adults who perceived greater racial-ethnic inequities in COVID-19 healthcare were more willing to receive the COVID-19 vaccine than participants perceiving higher inequities. Conclusions: Greater perceived racial-ethnic inequities in COVID-19 healthcare were associated with less willingness to receive the COVID-19 vaccine among Black/African American and Native Hawaiian/Pacific Islander adults. © 2024 Lippincott Williams and Wilkins. All rights reserved.

Drug waste poses a real threat to human health and the environment. Therefore, recycling and sustainability scholars have recently sought practical solutions to the drug waste problem. Furthermore, several governments have made significant efforts to reduce the negative effects of waste, such as establishing programs to take back unwanted drugs (expired and unused) for recycling (i.e., drug reuse or drug redispersing). However, many of these programs have failed to achieve their goals. In this context, it is expected that creating green start-ups to collect unwanted drugs will contribute to solving this problem. Accordingly, this study aims to investigate the antecedents of intentions to create green start-ups for collecting unwanted drugs. To this end, the authors integrate start-up self-efficacy and drug waste collection-related knowledge constructs into the theory of planned behavior (TPB). Using a self-administered paper questionnaire and relying on a convenience sample, data were collected from 328 students in six Algerian universities. A hierarchical multiple regression was conducted to test the proposed study model. Theresults revealed that perceived behavioral control (PBC) (β = 0.187, p < 0.001), attitudes (β = 0.182, p = 0.002), start-up self-efficacy (β = 0.169, p = 0.001), drug waste collection-related knowledge (β = 0.161, p < 0.001), and subjective norms (β = 0.088, p < 0.05) have a positive significant effect on the intention to create a start-up to collect unwanted drugs. In conclusion, this paper contributes to reducing drug waste by investigating the drivers of intention to create green start-ups for collecting unwanted drugs. Therefore, our study is expected to provide valuable insights for hospitals, pharmacies, pharmaceutical manufacturers, environmental protection associations, and stakeholders interested in reverse logistics. © 2024 by the authors.

Background: Limited research has been done on nursing students’ awareness of racial disparities and their readiness to address bias and racism in clinical practice. Purpose: This study investigated nursing students' perceptions of how racial disparities affect health outcomes, including maternal outcomes, in the United States. Methods: Interpretive description was used and supported by the critical race theory as a framework to guide the data collection, analysis, and interpretation to understand participants’ perceptions surrounding racism and health disparities. Discussion: Nurse educators should guide students to look beyond individual behavioral and risk factors and consider systemic issues as a leading contributors to health disparities. Conclusion: The most critical finding was the lack of participants’ understanding of systemic racism and its impact on health disparities. While they often attributed racial disparities to low socioeconomic status and lack of education, they did not understand the relationships between social determinants of health and systemic racism. © 2024

As the population of Aotearoa/New Zealand heads towards one-in-four being aged over 65-years-and-over by 2040, it is anticipated that family members will play an increasingly important role in caring for older relatives with chronic and age-related health issues. Multi-generational, and in particular three-generational living arrangements, combined with family care of older relatives are a growing trend; a trend already even evident among Māori communities. This paper reports on a study that explored the care experiences and expectations of 14 past and current Māori carers (aged 23 to 72-years) of older relatives. Interviews were audio-recorded, transcribed verbatim, and coded independently. The initial thematic analysis revealed nine themes and participants were invited to feedback on the summary in person or in writing. The feedback resulted in the original themes being collapsed into four (with subthemes): “Care is Normal”; “Collective Coordination of Care”; “Insider-Carer—Outsider Perspectives on Caring”; and “Societal Influences on Family Care/Carers”. Firstly, these themes highlight how Māori cultural norms infuse direct care, support, and coordination roles within family care of the older family member. Secondly, they reveal the challenges for family carers in talking about their work with others, especially (thirdly) in the face of negative attitudes towards care and carers of an older family member within wider society. These findings have implications for cultural and wider socio-political influences in socialising different groups to carer role expectations. If society is to better prepare future caregivers for their role, ongoing research is needed with the various cultural groups in Aotearoa/New Zealand.

1 2 1 1 2 1/15 Purpose: Inclusive recreation practices are one of the most recognized means of providing recreational sport opportunities for youth with disabilities. Municipal recreation departments are responsible for ensuring opportunities to partake in youth sport programs. This study evaluates the extent to which recreation departments are providing inclusive recreational sport opportunities to individuals with disabilities. Methods: This study employed a cross-sectional design mail survey to gather data from recreation directors across New England. The two dependent variables for this study are provision of inclusive services and perceived challenges to providing those services. The independent variables include director recreation/sport education, years as a director, and community size. Analysis included univariate, bivariate, and ANOVA for the quantitative data. Qualitative data were reviewed for commonalities. Results: There were 136 respondents for a response rate of 34.8%. Most (85%) directors noted their agency provided some inclusive recreation. Areas of success included accessible facilities and accommodations/modifications. Areas of needed improvement included staff training and providing transportation for individuals with disabilities. The only significant factor was years as a Director (F=4.315; p=0.016). The multiple comparison test found statistical significance between those with the fewest years of experience (x=22.14) and highest experience (x=19.57). The top challenges in providing inclusive recreational sport was additional expense, and the lack of training for the provision of these services. Conclusions: Without director support, inclusive recreation can be difficult to achieve. Director support, including making inclusion an agency priority, reflecting inclusion in the agency's mission, and hiring practices was imperative to facilitating an inclusive recreation environment and program. Financial concerns and need for staff training are the biggest obstacles to providing inclusive recreational sport programming. Applications in Sport: Training of recreation and youth sport staff members, including those that aspire to be directors, can have a great impact on opening opportunities for inclusive recreational sports. University academic recreation and sport management programs need to embed the principles and practices of inclusion into their curriculum. In-service training can be an important tool to increase inclusion offerings to the community, increasing the amount of staff members who can facilitate increased opportunities for inclusive recreational sport.

Book Reviews 125 All of the above and more are detailed by Claerbaut. He also covers Michigan State’s program as it went into decline in the late 1960s. Daugherty began to miss on the recruiting trail. At the same time, African American students and athletes on campuses across the nation more vocally joined the civil rights protest movement. It was a difficult period for Daugherty, who never sought credit for his progressive attitudes of providing black athletes equal opportunities. One of his responses was to break more barriers with black assistant coaches. Sherman Lewis, Daugherty’s first Underground Railroad All-American as a halfback from Louisville, Kentucky, joined the MSU staff in 1969. Raye was hired part time in 1971 and full time in 1972. Raye and Lewis went on to the National Football League as assistant coaches and offensive coordinators. A consequence of Daugherty doing what was right without seeking credit allowed myths surrounding a 1970 game matching USC and the University of Alabama to usurp his far more significant role. That is reason to link Daugherty with the words of David Maraniss, the Pulitzer Prizewinning biographer, who wrote, “History writes people out of the story. It’s our job to write them back in.” Thus, until that national trip-wire is no longer stepped over and subsequently triggered, the more the merrier to rightly place Daugherty’s story back into history. Tom Shanahan Author, Raye of Light Anna Clark. The Poisoned City: Flint's Water and the American Urban Tragedy. New York: Metropolitan Books, 2018. Pp. 305. Index. Notes. Cloth: $30.00. Journalist Anna Clark provides a gripping, thought-provoking, and comprehensive account of the people who caused, suffered from, and exposed the Flint water crisis. Clark’s brilliant story reminds us of the farreaching , devastating effects of lead exposure and that safe, high-quality drinking water is essential to good health. Clark meticulously details how corruption, recklessness, and arrogance of public officials, prejudice, and greed characterized the crisis in Flint. The Poisoned City is divided into three parts, each subdivided into several chapters. Part one reviews how water that blessed the indigenous Ojibwa people would eventually curse Flint residents. We learn how industrialization coincided with mistreatment and development of waterways. Vast, ferocious Lake Huron served as Flint’s freshwater 126 The Michigan Historical Review source for nearly 50 years. Amid financial distress, Flint switched to the Flint River water system in April 2014. The new water treatment program lacked corrosion control, breaking federal law. Adding to Flint’s woes were exorbitant water and sewer bills, an aging water infrastructure, and decreased federal funding. Clark also describes the federal government’s alarming apartheid approach to city building. Vicious, systematic tactics prolonged residential segregation and created multigenerational housing inequalities. Desegregation triggered a large-scale departure of whites. In 2014, General Motors (GM) workers noticed water-corroded engine parts. People wondered what it did to the inside of humans. Part two discusses the damaging health effects of and countless sources of exposure to lead. We meet longtime GM research director and leaded gasoline creator Charles Kettering. We gain insight into leaded gasoline’s profitability, Flint’s re-engineering to favor automobiles, fierce rebuttals to decries of lead hazards, ethical burdens of proving lead toxicity, the lead industry’s massive lobbying, and victim-blaming in response to residents’ concerns. Clark discusses loopholes in lead restriction policies, manipulation of lead testing, and a trend of childhood lead poisoning in shrinking cities. We learn how biochemist Marc Edwards, veteran journalist Curt Guyette, regulations manager Miguel Del Toral, pediatrician Mona Hanna-Attisha, and local residents rallied to spur a movement to urge governmental action. We also see effects of a very expansive law signed in 2011 that gave emergency managers unyielding power. Part three details the switch back to Detroit water in October 2015 and the flawed, hasty decision-making of untrustworthy leaders. Governor Rick Snyder declares a state of emergency in January 2016 and announces a two-year Legionnaire’s disease outbreak. Declaration of a federal emergency in Flint follows. A myriad of lawsuits, rebuttals, indictments, and pushbacks ensues. Apologies are offered, promises are made, and secrecy and injustices proliferate. Sadly, accountability...

Objective: To describe faculty efforts to deliver and evaluate health disparities–related education in US online undergraduate and graduate public health courses. Design: A pre- and post-survey was given to a cohort of 46 US college students in three public health courses taught asynchronously online over an 8-week period in 2017. This study took place at a mid-sized, public, rural, midwestern US university. Method: Faculty received professional development and online training and were assigned to develop courses for a new public health programme. Following the receipt of ethical approval, students completed anonymous, online pre- and post-surveys to assess effect of intentional instructional approaches on their knowledge and attitudes about health disparities. Curricula incorporated various assessment methods and teaching strategies. Descriptive statistics were used to compare pre- and post-survey scores and analyse demographic data. Paired t-tests and one-way analysis of variance were used to analyse pre- and post-survey test scores. Results: At post-survey, students demonstrated a positive change in mean scores for several items, including for ability to discuss the role of theory in understanding health behaviour and disparities in health status (3.20 vs 4.06; p < .001) and ability to discuss strategies health promotion programmes can use to reduce health disparities (3.47 vs 4.40; p < .001). Post-survey response rate was 87%. Conclusion: Results suggest an effective way to increase health disparities knowledge among online college students. Additional research is encouraged to expand upon these findings.

Preventable differences in health outcomes between U.S. population subgroups, related to factors such as race or ethnicity, income, and geographic location, are troubling. Geographically, rural American communities experience higher rates of adverse health conditions when compared with urban areas, further widening disparities in health outcomes. Such disparities necessitate the creation of effective curricula to enable students to address the health needs of underserved populations. By intentionally incorporating health disparities awareness content into the curricula, undergraduate and graduate public health programs can play an integral role in developing conscious health practitioners to help close gaps in health outcomes. Moreover, rural health courses may increase students’ interest in rural health careers. This article presents the process and results of faculty efforts to design and deliver health disparities–related education in undergraduate and graduate public health courses at a rural Midwestern U.S. university. Various teaching development programs inspired faculty to use intentional instructional approaches to teach students about health disparities. Consequently, faculty incorporated a variety of assessment methods and teaching styles to infuse health disparities awareness content into public health courses. Results from students’ course evaluations and reflections are discussed along with lessons learned and implications for future pedagogical directions.

There are emerging concerns about the preparedness of rural communities in the United States in the face of the 2019 novel coronavirus (called SARS-CoV-2, causing the disease COVID-19) considering the existing disparities across the social determinants of health between rural and urban Americans. Taking into account the current exponential rate of spread of the coronavirus, this article critically examines the risk facing the 60 million Americans living in rural areas, discusses possible solutions pertaining to rural COVID-19 prevention, and examines measures to consider to prepare for this epidemic before it reaches rural areas.

Breast cancer patients undergoing radiotherapy often experience severe levels of anxiety and depression within the African context. There is a gap in the research literature from Africa, particularly Ghana, with few studies focusing on depression among patients undergoing radiation treatment. The purpose of the study was to find various interventions for depression and anxiety among breast cancer patients in Ghana. A mixed method study examined breast cancer patients undergoing radiotherapy and their responses through a concurrent triangulation involving an interview with selected professional and a detailed patient survey. In all, 100 patients between the ages of 20-89 completed a questionnaire and individual interviews were held with 6 professionals with a minimum of 5 years of work experience. Themes were generated through open coding of the interview data, while multiple regression was performed to determine the relationship between depression and anxiety with the independent variables. In all, 89% had no family history of breast cancer, and the majority (55%) had the disease duration of one to three years. Almost 95% of patients with breast cancer had anxiety and depression in different categories. This included hair loss, discolored finger nails, cost of treatment, and fear of the unknown. Age and monthly income of patients were statistically significant in predicting the anxiety and depression among the patients. Coping mechanisms are essential for all patients undergoing treatment. This study’s implications will lead to positive change when all stakeholders assist in implementing measures to promote coping strategies for breast cancer patients in Ghana.

The commentary elucidates the importance of Protection Motivation Theory (PMT) as a theoretical framework to encourage the practice of social distancing in rural areas as the world grappled with the pandemic of COVID-19 outbreak.