Introduction: There is no known safe level of secondhand smoke exposure; yet, less than 30% of the global population is covered by comprehensive smoke-free policies as of 2016 and there are few smoke-free policies in sub-Saharan Africa (SSA).This study examines the support for smoke-free public places in SSA and delineates their correlates. Methods: Data collected through the Global Adult Tobacco Survey (2012–2017) were analyzed using SAS for descriptive and multivariable analyses, with a significance level set at p < .05. Results: No SSA country had comprehensive smoke-free policies, defined as a prohibition of smoking in eight public places. In the four countries whose Global Adult Tobacco Survey data were analyzed (Nigeria, Cameroon, Kenya, and Uganda), support for the prohibition of smoking in public places was over 90% in all eight public places except bars. Support for smoking prohibition in bars was 65.8%, 81.1%, 81.4%, and 91.0% in Nigeria, Cameroon, Kenya, and Uganda, respectively. Factors associated with support for smoke-free bars differed across the four countries, but in all countries, current smokers had decreased odds of support for smoke-free bars. Knowledge of secondhand smoke harm and living in smoke-free homes were associated with increased odds of support for smoke-free bars in all countries except Kenya. Conclusion: The high support for smoke-free public places should inform the efforts of the public health community and policymakers in these four SSA countries toward meeting their obligations of Article 8 of theWorld Health Organization Framework Convention onTobacco Control (WHO FCTC). Implications: Much of the population in SSA is not protected by comprehensive smoke-free policies. It was found that the overwhelming majority of adults in four large countries in SSA support the prohibition of smoking in public places and that knowledge of the health dangers of smoking and exposure to secondhand smoke and home smoking rules increased support for the prohibition. High support for the prohibition of smoking in these four SSA countries suggests tobacco control proponents should advocate for comprehensive smoke-free policies.

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The amputation of a lower extremity is a significant and life altering event that has a major impact to a person's mobility and subsequent community involvement. Amputees electing to use a prosthesis benefit from improved mobility, community involvement, and improved fitness due to increased activity, but are reliant on an unyielding prosthetic socket that is often unable to adapt to residual limb volume change. This convergent mixed methods collective self-controlled case study evaluated the applicability of the Technology Acceptance Model (TAM) on a sample of community-ambulator amputees (n = 7) and determined if an experimental Smart Adaptive Socket System (SASS) can improve use of a prosthesis. A mixed methods approach was employed due to its alignment with clinical practice and its strength for research involving small samples. The TAM was adapted using an existing validated scale for amputees. The Prosthesis Evaluation Questionnaire (PEQ) has several subscales that align with variables in the TAM. Non-PEQ values were used to quantify variables that did not align with the PEQ subscales, namely intervention preference and activity data from a StepWatch Activity Monitor (SAM). Additionally, participants were asked for qualitative feedback to better understand their experience with the study and interventions. Participant-reported and performed measures were collected and analyzed. Ease of use and usefulness decreased for the SASS 21.9% and 9.8% respectively while activity increased 22.9%, though none were significant changes. Qualitative analysis found several themes that impacted participants' experience with SASS and identified design features that require improvement in future iterations of the technology. Analyses between the quantitative and qualitative data found weak relationships between qualitative themes present and quantitative findings (positive themes and usefulness r2 = 0.36, positive themes and ease of use r2 = 0.34, combined themes and usefulness r2 = 0.28, and combined themes and ease of use r2 = 0.19). Despite low statistical significance, this study gained useful data that supports use of TAM for amputation research and will positively impact the future development of the experimental system largely due to the selection of a mixed methods research design that facilitated collection, analysis, and triangulation of both quantitative and qualitative data.

Inequities in access to health services has negative consequences on individual well-being, and imposes financial and emotional burden on patients, families, health care systems, and the public. Inequities engendered from differences in socioeconomic status, health insurance coverage, race, and other characteristics can engender disparities. This study aimed to identify the potential predictors of unmet medical need among the civilian noninstitutionalized U.S. adults. Inability to receive needed medical care or receiving medical care after a delay, due to the associated costs, constructed unmet medical need. This study used a four-year (2014-2017) National Health Interview Survey (NHIS) data (sample size: 296,301 adults) and implemented a conceptual framework to study disparities in access to health services and estimate the relative importance of predisposing, enabling, and need factors as the predictors of unmet medical need. Findings from machine learning and logistics regression models highlight the importance of health insurance coverage as a key contributing factor of health disparities. About 60% of variation in unmet medical need was predictable, with over 90% accuracy, solely with health insurance coverage status. Self-rated health status, family structure, and family income to poverty ratio were other statistically significant predictors. Even after controlling for a wide variety of sociodemographic and health status variables such as age, gender, perceived health status, education, income, etc., health insurance remains significantly associated with unmet medical need (OR: 5.03 , 95%CI: 4.67-5.42). To ensure precise national estimates, proper survey data analysis methods were incorporated to account for the complex sampling method used by NHIS. Furthermore, the enabling factors (health insurance and income) exert much more weight on unmet medical need than predisposing factors and need factors. The findings raise the concerns about the existence and magnitude of disparities in health care access and provide a comprehensive framework to a target population for understanding the sources of health inequities with data-driven evidence. Results can be utilized to address potential areas for designing public policy and program interventions by identifying the relative vulnerability of different population groups for lacking access to affordable health services. Future studies using longitudinal panel data are necessary to establish a causal relationship between the predictors and unmet medical need.

OBJECTIVE: Mental health outcomes such as attention-deficit/hyperactivity disorder (ADHD), behavior disorders, anxiety, depression, and adverse childhood experiences (ACEs) are common disorders among children in the United States. Little is known on how potential resilient factors may moderate the relationship between exposure to ACEs and mental health outcomes. This study examines associations between ACEs and resilience on mental health outcomes using the 2018 National Survey of Children's Health (N = 26,572). METHOD: Logistic regression and interactions examined the association between ACEs, resilience, and mental health outcomes. ACE exposure and low resiliency were associated with an increased likelihood of mental health outcomes. RESULTS: There were significant interactions between exposure to ACEs and family resilience as well as significant interactions between ACE exposure and community resilience. On stratification, the presence of individual resilience and having all resilience measures decreased the odds of ADHD, behavioral disorders, anxiety, and depression and the presence of community resilience decreased the odds of depression among individuals who had experienced 4 or more ACEs. CONCLUSION: These results illustrate the need to promote resilience measures for tackling mental health problems and reducing the negative effect of trauma in children.

CONTEXT: The Foundational Public Health Services (FPHS) include a core set of activities that every health department should be able to provide in order to ensure that each resident has access to foundational services that protect and preserve health. Estimates of the public health workforce necessary to provide the FPHS are needed. OBJECTIVE: This study assessed the potential use of an FPHS calculator to assess health department workforce needs. DESIGN AND SETTING: Qualitative interviews were conducted via Zoom in December 2020-January 2021. PARTICIPANTS: Seventeen state and local public health leaders. MAIN OUTCOME MEASURES: Qualitative insights into the potential use of an FPHS calculator. RESULTS: Almost all participants expressed that a reliable estimate would help them justify requests for new staff and that a calculator based on the FPHS would help organizations to critically assess whether they are meeting the needs of their communities and the core expectations of public health. Although participants expected that a tool to calculate full-time equivalent needs by the FPHS would be helpful, some participants expressed concerns in regard to using the tool, given ongoing workforce issues such as recruitment challenges, hiring freezes, and funding restrictions. An anticipated positive consequence of using this tool was that it may lead to cross-training the workforce and result in more diverse expertise and skills among existing workers. The other unintended consequences were that an FPHS calculator would require a substantial amount of time assessing the current FPHS efforts of existing staff and the results of the FPHS gap estimate could become the bar rather than the minimum needed. CONCLUSIONS: The current public and political focus on public health infrastructure as a result of the COVID-19 pandemic has created a window of opportunity to create change. An FPHS-based staffing tool may help transform public health and initiate a new era.

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This research was completed in an attempt to enlighten the public about Long Term Care Insurance, and the issues that are related. Before this study began, there was very little research done to examine the world of Long-Term Care Insurance; and there was even a smaller amount of research done that looked at the employers and their role in purchasing this insurance for their employees. This study lasted a little over one year and within that time frame, a multitude of information was gathered and analyzed in an attempt to obtain a clear picture as to what the Central Florida market is doing with respect to Long-Term Care Insurance. Hopefully these findings will enlighten, and they may even be a little startling, but all of this information is factual and reliable. Enjoy!

A pre- and post-test survey design was used to help determine significant changes in students' HIV/AIDS-related knowledge, attitudes, and behaviors as a result of formal school education. Surveys were administered to students enrolled in a life sciences course at a minority-majority high school in Central Florida. Survey distribution took place once prior to these students' instruction in HIV/AIDS and once after the lesson. The results of these surveys were analyzed and used to provide insight on the effectiveness of this particular school-based HIV/AIDS education program. Survey results indicate that while the majority of students were knowledgeable in regards to the transmission of HIV, approximately half of those sexually active students reported not using condoms as a method of protection against transmission during sexual intercourse. Research analysis suggests the need for a more comprehensive HIV/AIDS unit that will increase the knowledge and retention rate among these students, as well as promote behaviors that will reduce the risk of spreading HIV/AIDS.

To increase patient safety and reduce aberrant accidents, the healthcare industry must address the emerging epidemic of medical errors, which demand investigation and resolvance. Through examination of error sources, several weaknesses emerge: lack of standardized training/education and performance techniques, lack of automation, and a 'blame and train' attitude. These factors interact and result in aberrant system errors with patient effects ranging from temporary ailments and extended hospital stays to death. Errors emerge as erroneous medication subscriptions, fillings, or dosage to amputation of incorrect limbs. Such situations are reducible if the medical profession incorporates proven systems from government and public peers. These systems are represented by standardized militaristic training methods, more specifically the United States Navy; technological innovations, such as Universal Product Codes in combination with automation; and attitudinal reform from administration to nurses, to accept that humans are fallible and physicians are humans.