Performance enhancing substances (PES) constitute a multi-billion dollar industry, fueling public health concerns regarding use in adolescents hoping to enhance athletic performance and body appearance, or fight obesity. Adverse effects may include violent behavior, suicide attempts, and premature deaths. Prevalence of use is difficult to ascertain due to secrecy issues and misinterpretation of survey questions. Healthcare providers are less familiar with PES than other types of substance use. A correlational secondary analysis of 2007 National Youth Risk Behavior Survey (YRBS) data was conducted (n =14,041) to better understand predictors of PES use (methamphetamines, steroid pills/injections, and diet pill/powder/liquids). Bandura's Social Cognitive Theory served as the organizing framework guiding the analysis. SPSS version 17.0 Complex Samples was used to examine relationships among variables; bi-variate and logistic regression analyses were performed. Feeling sad/ hopeless, considering suicide, perceiving being overweight, being offered drugs at school, geographic location, being sexually active, cigarette smoking, and alcohol use were significantly associated (p <.05) with PES use. Rates of being offered/sold/given illegal drugs at school ranged from 17-39%; PES use ranged from 5-17% across the US. Multiple factors predicted PES use; those contributing to morbidity and mortality may be preventable. Though policies are designed to ensure safe school settings, high rates of obtaining drugs at school were reported. The South US region reported the highest rates of PES use. Regional differences have implications for health professionals and policy makers who must address physical, psychological, and social issues related to adolescent PES use.

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Family presence during resuscitation or invasive procedures is controversial, but research suggests multiple benefits. Professional organizations recommend developing family presence protocols; however, few hospitals have them. This integrative review examined research evidence regarding implemented family presence protocols for adults in the hospital setting-specifically, the use of protocols and providers' feedback. Four key findings include a positive trend in family presence practice, varying provider attitudes, problems with family facilitators, and factors inhibiting or facilitating protocol implementation.

Energy drink sales are expected to reach $52 billion by 2016. These products, often sold as dietary supplements, typically contain stimulants. The Dietary Supplement Protection Act claims an exemplary public health safety record. However, in 2011 the number of emergency department visits related to consumption of energy drinks exceeded 20,000. Nearly half of these visits involved adverse effects occurring from product misuse. Political, social, economic, practical, and legal factors shape the landscape surrounding this issue. In this policy analysis, we examine 3 options: capping energy drink caffeine levels, creating a public education campaign, and increasing regulatory scrutiny regarding the manufacture and labeling of energy drinks. Increased regulatory scrutiny may be in order, especially in light of wrongful death lawsuits related to caffeine toxicity resulting from energy drink consumption.

According to the American Cancer Society, 1 in 23 Americans will be diagnosed with colorectal cancer (CRC) in their lifetime. Screening for CRC is an effective, yet underused preventive approach. This is especially true in rural areas, where only 35% of patients were found to be up to date on their screenings in 2014. Increasing CRC screening can produce positive patient outcomes by early recognition and removal of precancerous polyps. The purpose of this project was to use quality improvement (QI) interventions to increase CRC screening rates at a nurse-managed clinic in rural Indiana. Using Deming's Plan-Do-Study-Act QI model, multiple interventions were implemented which resulted in a 37% increase in the number of screenings ordered on eligible patients and an overall increase of 28% in the completion of the screenings. This project contributes to healthcare quality knowledge by also suggesting that the fundamental principles of encouraging staff feedback to gain buy-in, improving processes informed by patient data, and valuing frequent performance feedback to staff, strengthened this QI project and ensured adoption and sustainability of these results.