PURPOSE: The purpose of this feasibility study was to explore the use of an online video intervention to prepare surgical patients to properly dispose of unused opioids. SPECIFIC AIMS: Describe the feasibility of recruiting, enrolling, randomizing and retaining participants who recently had a general surgery into the study. Describe the differences in opioid disposal by age, sex, education, and type of surgery for the entire sample and by treatment assignment. Describe the preliminary change in knowledge, behavioral beliefs, normative beliefs and disposal of opioids from baseline to post-intervention by group. Describe the relationship between social desirability and behavioral beliefs, normative beliefs and disposal of opioids. FRAMEWORK: The Theory of Reasoned Action was used to guide both the intervention and the measures. DESIGN: This study used a randomized controlled feasibility study to explore a novel video intervention to teach safe storage and disposal of unused opioids after general surgery. RESULTS: A total of 40 participants were enrolled in the study, average age was 44.7 (range 21-75 years), most were White, educated and employed. Recruitment took 11 weeks and the retention rate was excellent at 85%. Differences in opioid disposal was not significantly different by age, sex, education or type of surgery. The video intervention was positively received, but the majority (80%) still stored their pills unsecured. CONCLUSION: The results demonstrate that a video intervention addressing safe storage and disposal practices of unused opioids is feasible and more research is needed to determine efficacy in increasing rates of secure storage and disposal of unused opioid pills KEYWORDS: Opioids, opioid disposal, general surgery, video education

The obesity epidemic in youth is increasing, due to the decreasing levels of physical activity within the youth population. One variable that has never been examined as a correlate of physical activity is mental toughness. Mental toughness is a psychological trait characterized by determination, resiliency, and perform optimally regardless of the circumstances. In order to evaluate this trait the MeBActive-Youth was developed. The purpose of this study was to first, evaluate the psychometric properties of the newly developed measure and secondly, to assess the relationship of mental toughness, social support and self-efficacy to physical activity. Participants (N = 106) completed a demographic survey, the MeBActive-Youth, Social Support and Exercise Survey (SSES), Physical Activity Self-Efficacy Scale (PASES), and Physical Activity Questionnaire for Adolescents (PAQ-A). The Rasch Rating Scale Model showed that the MeBActive-Youth had appropriate items (range of 0.53 – -0.64 logits) for the sample and measured mental toughness appropriately. All but four of the items had a fit statistic within the acceptable range, but only one item had a much higher statistic (infit = 1.68 logits). Although the four response options were all utilized appropriately, it may be beneficial to reduce them to three. There was a significant positive correlation between MeBActive-Youth and physical activity (ρ = .52, p ≤ .01) and PASES (ρ = .30, p ≤ .01). The correlation between social support from friends and family and MeBActive-Youth was not significant (ρ = .12, p ≥ .05; ρ = .17, p ≥ .05). There was a positive significant correlation between, physical activity and familial and friend social support (ρ = .47, p ≤ .01; ρ = .27 p ≤ .05), PASES (ρ = .34, p ≤ .01) and mental toughness. The MeBActive-Youth is a valid and reliable instrument yet can be improved with slight changes. This study showed that there is a strong positive correlation between mental toughness, self-efficacy and physical activity. Positive correlations were also found between physical activity and all the measured variables.

Adolescent obesity in Southern Appalachian is among the highest in the nation. Even though adolescent obesity is a major public health concern, effective interventions are limited. Team Up for Healthy Living is a cluster-randomized control trial developed to test the effectiveness of a cross-peer intervention with high school students focusing on healthy eating and physical activity. This instructional article describes the 8-week curriculum developed and utilized by Team Up for Healthy Living with an emphasis on the relationship to National Health Education Standards. This is important given the standards were created to promote and support health-enhancing behaviors for students all across America. Findings showed that this intervention adhered highly to the National Health Education Standards. It may be important for future school based obesity prevention efforts to consider using these standards as a framework to help meet national health education goals.

Purpose- This article examined the post-game debriefing of a student-created board game on the topic of malaria, taken from UNICEF and other international agencies’ Facts for Life. Design/Methodology/Approach- A group of university health students participated in the play of the game and the debriefing. Initial debriefing of seven steps(key themes) occurred through written format, followed by an oral debriefing. Findings – Major categories from the written debriefing by steps, key category response, and number of categories were as follows: For experience recall – how to prevent malaria, nine response categories; for feelings – felt informed, felt happy, nine response categories; for enjoyment – learned new information, game was fun, 11 response categories; for importance – malaria prevention, 12 response categories; for new information learned – malaria affects pregnancy, 10 response categories; for new information to learn – multiple topics such as strategies to prevent malaria, 13 response categories; for improvements as suggestions – add more questions, nine response categories. Follow up oral debriefing supported the written debriefing categories, as well as yielding some additional categories. The students suggested at least 70 response categories after the play of the game. Conclusion- This study demonstrates the applicability of a student created and played board game based on the Facts for Life topic of malaria, as a vehicle for health topic discussion. A combined written and oral debriefing approach complimented each other in an educational gaming strategy. Recommendations – Game debriefing is a valuable and essential tool to be included in a health educational gaming strategy. The use of this malaria game should be extended for play in other non-formal settings. Key words: Malaria, board-game, written debriefing, oral debriefing, student created games, public health education, health education

Little Milligan Elementary School in rural Carter County, Tennessee was provided with health literacy resources in the form of health education Go-Packs––easily implementable lessons contained in a small storage tote––as part of the community project requirement of the James H. Quillen College of Medicine Rural Primary Care Track Curriculum. These Go-Packs included detailed lesson plans and accompanying materials that were designed to facilitate health education in the classrooms by providing easily deployable lessons for the teachers to utilize. Four Go-Packs were provided for hygiene, oral health, tobacco use, and nutrition that teachers used to augment instruction during teachable moments that arose in their classrooms. Our objective was to determine whether the development and implementation of these Go-Packs increased the amount of health education delivered to the students and determine what barriers persist to provide health education in the classroom. Participants were randomly assigned a number which they placed on their pre and post surveys. A focus group was also conducted to better understand the faculty’s experience utilizing the Go-Packs and where improvements could be made. A paired sample t-test showed no significant differences in pre and post attitudes of teachers at the school. The focus group and survey questions identified the need to improve the usability of specific Go-Packs, map the Go-Packs to state mandated curriculums and target Go-Pack usage towards non-core instructors.

Social media has several advantages over more traditional forms of mass communication, but many non-profit organizations (NPOs) are underutilizing social media as a communication platform. There is limited research on social media use among NPOs in rural Appalachia. The current study fills this gap in the literature by examining social media use among NPOs in rural Appalachian Tennessee. We conducted 20 semi-structured phone interviews with NPO representatives (President, CEO, Executive Directors) in an 8-county region of Appalachian Tennessee. The interviews were transcribed and analyzed using Braun and Clarke’s thematic analysis. Thematic analysis indicated that rurality, organizational capacity, messaging, and social media as a secondary communication strategy were important themes. Fiscal, personnel, and time constraints were limiting factors in terms of NPOs ability to use social media. NPOs used social media primarily to share information with their target audience. While acknowledged as an important feature of social media, NPOs were less likely to use social media to advocate, engage, or mobilize community support. Further data collection is ongoing to confirm these findings and to identify best practices. NPOs in rural Appalachia can use these findings to enhance their communication strategies.

Obesity and type 2 diabetes (T2DM) has increased greatly in incidence in the United States over the past decade. Diagnosis of T2DM is typically preceded by insulin resistance, which is typically indicated by increases in fasting blood sugar and called pre-diabetes. The Diabetes Prevention Program (DPP) is a group-based program focused on improving diet and maintaining consistent exercise towards a lower body weight. It has been found that minimum weight loss and 150 minutes of moderate exercise is more effective at preventing T2DM than medication-based treatment. Therefore, the DPP has potential in preventing T2DM however currently faces obstacles concerning recruitment and retention. Unfortunately, only 1-5% of individuals who would benefit from the program actually sign up. In order to address this, researchers obtained RDC funding and partnered with YMCA to determine barriers and motivators to the DPP. Individuals were invited to an on-campus, pilot DPP aimed towards employees in a single building. All employees received an invitation to give feedback in 1 of 3 focus groups: 1 with those who joined the program and 2 with employees who did not join. There were 4 individuals in the focus group for DPP participants and 18 total who attended the other focus groups (one group of 5, and one group of 13). The focus group for current participants was scheduled during the time of a normal weekly meeting, while the group for non-DPP participants was during lunchtime. Questions centered around individuals' perceptions on wellness programs, barriers to participation, and recommendations. Thematic analysis was done on notes taken at each focus group. Motivators found in the focus group with DPP participants included family history of diabetes, weight loss, desire to take control of lifestyle, hearing success stories, and support from others. A challenge faced by individuals going through the program included unsupportive family members or home environment. Themes found among the non-DPP participant focus groups gave greater insight in the negatives and barriers to wellness programs. Themes emphasized included importance of convenience, variability, coworker support, and appealing to individual interests. Overlapping themes included convenience, coworker support, and the importance of steering away from the 'diabetes' or 'prediabetic' labels. This study has significant impact especially in Tennessee where the DPP has become a covered benefit under insurance. In order to ensure strong recruitment and retention of these programs across the state and nation, researching further and addressing the motivators and barriers identified is key. With the DPP having such great potential in reducing risk of diabetes and obesity, a strong, intentional recruitment plan is necessary.

The Central Appalachian region of the United States disproportionately experiences higher rates of cardiovascular diseases (CVD) and associated risk factors. Primary risk factors for CVD include hypertension, hypercholesterolemia, and tobacco use, all of which have the potential to be mitigated through lifestyle behavior changes. Dietary and physical activity practices are the two main driving forces for the development of hypertension and hypercholesterolemia, while tobacco use is a behavioral choice on its own. Subsequentially, shifting lifestyle choices to emphasize healthier living has the potential to reduce CVDs within the Central Appalachian region. Considering behavioral choices are not made in isolation and are the result of internal and external influences, it is necessary to contemplate the multitude of factors driving these rates. Additionally, healthcare systems within this region ability to provide patient-centered care (PCC) is another consideration, as effective point of care also can address these rates from a disease treatment and management level. The purpose of this study was to explore the knowledge, perceptions, and influences among patients with cardiovascular diseases and non-licensed caregivers within these communities, at the behavioral and community levels, in addition to the perceptions of essential components of PCC among professional stakeholders. Seven focus group discussions with CVD patients and non-licensed caregivers were conducted, with a total of 78 participants; additionally, 20 interviews were held with professional stakeholders within the healthcare field. At the behavioral level participants identified internal and external barriers to sustaining healthy diets, the impact of interpersonal relationships on diet and stress, and influential role of cardiac rehabilitation in physical activity following a major cardiac event. At the community level participants discussed the economic characteristics of communities, a need for community infrastructure expansion, and the role of community organizations. Professional stakeholders addressed PCC in the current healthcare system, constructs of effective patient-provider interactions and the role of community outreach. This research serves as a look into the challenges and opportunities within this region and provides insight to inform future research and interventions.

The purpose of this study was to examine teacher perception of student school meal preferences in an elementary school setting. This was a cross-sectional mixed-methods study that is part of a larger study to develop a nutrition education program for elementary school children. Focus groups and surveys were administered to faculty at a charter school in downtown Orlando to gain insight into the types of food offered at school and student response to these food items. All members of the faculty were invited to participate in the study, and seven teachers volunteered to take part in this study. Focus groups were recorded using tape recorders; they were then transcribed verbatim and coded independently by two research assistants. Results of this study showed that according to members of faculty, overall, the food served in school during breakfast and lunch is of poor quality. Portion sizes were acceptable according to participants, however, there is still too much food is being wasted. The students do not respond well to breakfast or lunch, which has adversely affected the academic performance of students as well as their classroom behavior due to hunger and low energy levels. It was also noted that older children expressed interest in learning about topics pertaining to nutrition. This study is the first stage of a larger initiative to develop nutrition education programs and to encourage conversation regarding school meal reform, especially as it pertains to those individuals of low socioeconomic status. The implications for this study could be beneficial for a wide-range of children who attend school on a daily basis.

Colorectal cancer is the third most common cancer among U.S. women; 63,610 new cases were estimated to have occurred in 2015. Prior studies found a reduced risk of colorectal cancer among antidepressant (AD) users, however, none adjusted for depression, which is itself linked to increased colorectal cancer risk and could confound this relationship. We assessed the relationship between ADs and AD drug classes with risk of colorectal cancer in a prospective cohort of 145,190 women between the ages of 50-79 without a previous history of cancer at enrollment. Current AD use was assessed at baseline. Over an average follow-up of 14 years, there were 5,280 incident cases of colorectal cancer cases. Cox proportional hazard ratios, adjusted for potential confounders including depressive symptoms, were used to estimate hazard ratios. Of all AD users, 51.1% used selective serotonin reuptake inhibitors (SSRIs), 40.7% used tricyclic antidepressants (TCAs), and 15.1% used other ADs. No association was observed between total AD use, SSRI use, and/or other ADs and risk of colorectal cancer. We observed a reduced risk of colorectal cancer among TCA users, which was significant for colon cancer specifically (HR 0.68, 95% CI: 0.48-0.96). Although a reduced risk of colon cancer was observed for TCAs use for less than two years (HR 0.39, 95%: CI 0.19-0.82), no association was observed for TCA use for two or more years (HR 0.85, 95%CI: 0.57-1.26). Our data suggests a protective association between TCA use and risk of colorectal cancer, however more research is needed to verify these findings.