Objective: Tennessee’s tobacco use prevalence rate is 20.7%, compared to 16.1% nationally. This is associated with over 11,000 premature deaths and $5 billion annual costs. Over a third of young adults attend colleges/universities, and the use of electronic nicotine products is highest among this age group. This study created a Tennessee-specific best practices policy rating instrument to assist Higher Education Institutions (HEIs) in crafting comprehensive nicotine product policies. Methods: Between August 2017 and October 2018, a Tobacco-Free Generation Campus Initiative-funded team developed the Nicotine Product Policy Index (NPPI) rating instrument, with 50 items within four sections: 1) environment, 2) enforcement, 3) prevention and treatment services, and 4) policy organization. The policies of 84 Tennessee HEIs were scored using the NPPI, and total scores were transformed to ratings from 0-5 for a comprehensive policy. Results: Of Tennessee’s 34 independent colleges/universities, 11.76% were rated at 0 for lack of policy accessible to investigators. Ratings of 1 were given to 44%, 2 to 8.82%, 3 to 14.71%, and 4 to 17.64%. A rating of 4 was given to 17.64% of independent colleges/universities,15.38% of Tennessee’s 13 Community Colleges and 33.33% of Tennessee’s six Locally Governed Institutions. All four University of Tennessee-affiliated institutions earned a 4 rating. Only one institutional tobacco/smoking policy rated a 5: Tusculum College, an independent college/university. Conclusion: The NPPI could guide development of comprehensive nicotine product policies designed to address the high prevalence of tobacco use.

Background: Electronic nicotine products (ENPs) such as e-cigarettes have emerged as the most commonly used tobacco products among middle and high school students in the United States (U.S.). In 2019, almost 1 in 10 and 1 in 4 middle and high school students used e-cigarettes, respectively. Although familial relations and access to ENPs continue to play a major role in the uptake of e-cigarettes among adolescents, little is known about the role of social media in this phenomenon. Therefore, this study aimed to assess the role of social media in the uptake of e-cigarettes among students in Appalachian Tennessee. Methods: In March 2019, data involving high school students in an Appalachian Regional Commission (ARC)-designated distressed county in Appalachian Tennessee were collected (N=399). We ascertained the study’s outcomes (current e-cigarette use), the exposure (use of social media and the type of social media used to discuss e-cigarette) and covariates using validated questions. Descriptive statistics, bi-variate and multi-variable analyses were performed. The Odds Ratios (ORs), confidence intervals (CI), and the significance level (p ≤ 0.05) have been reported. Results: About 15.5% of the population were current e-cigarette users, with 9.8% of them ever discussed electronic cigarettes/JUUL on social media, more commonly with snap-chat (8.33%) and Instagram (4.31%). Use of social media (OR = 0.56, CI = 0.37 - 0.83, p = 0.0042) and type of social media used (OR = 0.80, CI = 0.65 - 0.99, p =0.0375) were significantly associated with decreased number of days of e-cigarette use in the last 30 days, after controlling for the covariates. Conclusion: The use of social media was associated with current e-cigarettes users. As such, there is need for more in-depth examination of social media contents as it relates to ENPs, to understand the mechanism of reduced ENP use among school-going youths in rural Appalachia.

This study assesses cost savings associated with specific contraceptive methods provided to beneficiaries enrolled in South Carolina Medicaid between 2012 and 2018. Incremental cost-effectiveness ratios, defined as the additional cost of contraception provision per live birth averted, were estimated for 4 contraceptive methods (intrauterine devices [IUDs], implants, injectable contraceptives, and pills), relative to no prescription method provision, and savings per dollar spent on method provision were calculated. Costs associated with publicly funded live births were derived from published sources. The analysis was conducted for the entire Medicaid sample and separately for individuals enrolled under low-income families (LIFs), family planning, and partners for healthy children (PHC) eligibility programs. Sensitivity analysis was performed on contraceptive method costs. IUDs and implants were the most cost-effective with cost savings of up to $14.4 and $7.2 for every dollar spent in method provision, respectively. Injectable contraceptives and pills each yielded up to $4.8 per dollar spent. However, IUDs and implants were less cost-effective than injectable contraceptives and pills if the average length of use was less than 2 years. Medicaid's savings varied across Medicaid eligibility programs, with the highest and lowest savings from contraceptive provision to women in the LIFs and PHC eligibility programs, respectively. The results suggest the need to account for unique needs and preferences of beneficiaries in different Medicaid eligibility categories during contraception provision. The findings also inform program administration and provide evidence to justify legislative appropriations for Medicaid reproductive health care services.

Political science and tobacco policy--Theories of policy change--The global policy context--European countries and the EU--The UK: a case study--The United States--Other advanced industrial countries--Tobacco control policymaking in developing regions--The WHO Framework Convention on Tobacco Control (FCTC) / https://dc.etsu.edu/etsu_books/1104/thumbnail.jpg

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Objectives: Women with substance use disorders often experience unique challenges to obtaining contraception and adhering to user-dependent methods. As a result, this at-risk population of women tends to have higher than average rates of unintended pregnancy. The objective of this study was to describe contraceptive use, pregnancy intentions, and adequacy of access to reproductive healthcare among women receiving opioid agonist therapy in northeast Tennessee. Methods: A cross-sectional survey was piloted among female patients aged 18 to 55 years from two opioid agonist therapy clinics. Descriptive analyses were conducted using logistic regression to evaluate the statistical significance of bivariate associations. Results: Of 91 participants, 84% reported having health insurance, with 70% perceiving having adequate access to health care. More than half had a history of unwanted pregnancy (53%), among whom few (23.1%) reported the consistent use of contraception at time of conception. Although most desired to avoid pregnancy (90%), only 59% of women reported the current use of regular contraception. Most of those not using regular contraception believed that they were not at risk for pregnancy (54.3%). Conclusions: Although most participants reported adequate access to health care and a desire to avoid pregnancy, few reported the consistent use of regular contraception. Furthermore, misperceptions regarding pregnancy risk were common among participants. Research is needed to identify barriers to contraceptive acceptance and causes of pregnancy risk misperceptions in this population of women at increased risk of unintended pregnancy.

Introduction: Long–standing disparities in colorectal cancer (CRC) outcomes and survival between Whites and Blacks have been observed. A person–centered approach using latent class analysis (LCA) is a novel methodology to assess and address CRC health disparities. LCA can overcome statistical challenges from subgroup analyses that would normally impede variable–centered analyses like regression. Aim was to identify risk profiles and differences in malignant CRC survivorship outcomes. Methods: We conducted an LCA on the Surveillance, Epidemiology, and End Results data from 1975 to 2016 for adults ≥18 (N = 525,245). Sociodemographics used were age, sex/gender, marital status, race, and ethnicity (Hispanic/Latinos) and stage at diagnosis. To select the best fitting model, we employed a comparative approach comparing sample-size adjusted BIC and entropy; which indicates a good separation of classes. Results: A four–class solution with an entropy of 0.72 was identified as: lowest survivorship, medium-low, medium-high, and highest survivorship. The lowest survivorship class (26% of sample) with a mean survival rate of 53 months had the highest conditional probabilities of being 76–85 years–old at diagnosis, female, widowed, and non-Hispanic White, with a high likelihood with localized staging. The highest survivorship class (53% of sample) with a mean survival rate of 92 months had the highest likelihood of being married, male with localized staging, and a high likelihood of being non-Hispanic White. Conclusion: The use of a person–centered measure with population-based cancer registries data can help better detect cancer risk subgroups that may otherwise be overlooked.

Background: Social media (Facebook, WhatsApp, Instagram, Twitter) as communication channels have great potential to deliver Human papillomavirus self‐test (HPVST) intervention to medically underserved women (MUW) such as women of low income. However, little is known about MUW’s willingness to participate in HPVST intervention delivered through social media. We evaluated factors that contribute to MUW’s intention to participate in the social media‐related intervention for HPVST. Methods: A 21‐item survey was administered among women receiving food from a local food pantry in a U.S. southern state. Independent variables were social media usage facilitators (including confidentiality, social support, cost, and convenience), and barriers (including misinformation, time‐consuming, inefficient, and privacy concerns). Dependent variables included the likelihood of participating in social‐driven intervention for HPVST. Both variables were measured on a 5‐point scale. We used multinomial logistic regression to analyze the data. Results: A total of 254 women (mean age 48.9 ± 10.7 years) comprising Whites (40%), Hispanics (29%), Blacks (27%), and Other (4%) participated in the study. We found that over 44% of the women were overdue for their pap smears for the past three years, 12% had never had a pap smear, and 34% were not sure if they had had a pap smear. Over 82% reported frequent social media (e.g., Facebook) usage, and 52% reported willingness to participate in social media‐driven intervention for HPVST. Women who reported that social media provide privacy (Adjusted Odds Ratio (AOR) = 6.23, 95% CI: 3.56, 10.92), provide social support (AOR = 7.18, 95% CI: 4.03, 12.80), are less costly (AOR = 6.71, 95% CI: 3.80, 11.85), and are convenient (AOR = 6.17, 95% CI: 3.49, 10.92) had significantly increased odds of participating in social media intervention for HPVST. Conclusions: The findings underscore that the majority of the MUW are overdue for cervical cancer screening, regularly use social media, and are willing to participate in social media‐driven intervention. Social media could be used to promote HPV self‐testing among MUW.