Combustible tobacco users appear to be at greater risk for serious complications from COVID-19. This study examined cigar smokers’ perceived risk of COVID-19, quit intentions, and behaviors during the current pandemic. We conducted an online study between 23 April 2020 to 7 May 2020, as part of an ongoing study examining perceptions of different health effects of cigars. All participants used cigars in the past 30 days (n = 777). Three-quarters of the sample (76.0%) perceived they had a higher risk of complications from COVID-19 compared to non-smokers. The majority of participants (70.8%) intended to quit in the next six months due to COVID-19, and almost half of the sample (46.5%) reported making a quit attempt since the start of the COVID-19 pandemic. Far more participants reported increasing their tobacco use since COVID-19 started (40.9%) vs. decreasing their tobacco use (17.8%). Black or African American participants, participants who reported using a quitline, and participants with higher COVID-19 risk perceptions had higher intentions to quit using tobacco due to COVID-19, and higher odds of making a quit attempt since COVID-19 started. More research is needed to understand how tobacco users are perceiving COVID-19 risks and changing their tobacco use behaviors.

In many real-world settings, fewer than 60% of patients receive a colonoscopy within 1 year of a positive FOBT result.^1-4 A recent study found that many older patients without follow-up are in poor health or decline follow-up, which suggests that they should not have been screened in the first place.⁵ In addition, rates of follow-up have shown minimal improvement over the last decade.^3,4,6,7 Despite persistently low rates of follow-up colonoscopy in older adults with positive FOBT results, the long-term outcomes of these real-world screening and follow-up practices have not been described.^3,4,8

Objectives: Due to the high rates of inappropriate antibiotic prescribing for presumed urinary tract infections ( UTI s) in nursing home ( NH ) residents, we sought to examine the antibiotic prescribing pathway and the extent to which it agrees with the Loeb criteria; findings can suggest strategies for antibiotic stewardship. Methods: Chart review of 260 randomly‐selected cases from 247 NH residents treated with an antibiotic for a presumed UTI in 31 NH s in North Carolina. We examined the prescribing pathway from presenting illness, to the prescribing event, illness work‐up and subsequent clinical events including emergency department use, hospitalization, and death. Analyses described the decision‐making processes and outcomes and compared decisions made with Loeb criteria for initiation of antibiotics. Results: Of 260 cases, 60% had documented signs/symptoms of the presenting illness and 15% met the Loeb criteria. Acute mental status change was the most commonly documented sign/symptom (24%). NH providers (81%) were the most common prescribers and ciprofloxacin (32%) was the most commonly prescribed antibiotic. Fourteen percent of presumed UTI cases included a white blood cell count, 71% included a urinalysis, and 72% had a urine culture. Seventy‐five percent of cultures grew at least one organism with ≥100,000 colony‐forming units/milliliter and 12% grew multi‐drug resistant organisms; 28% of antibiotics were prescribed for more than 7 days, and 7% of cases had a subsequent death, emergency department visit, or hospitalization within 7 days. Discussion: Non‐specific signs/symptoms appeared to influence prescribing more often than urinary tract‐specific signs/symptoms. Prescribers rarely stopped antibiotics, and a minority prescribed for overly long periods. Providers may need additional support to guide the decision‐making process to reduce antibiotic overuse and antibiotic resistance.

Older adults with serious illness are particularly vulnerable to oral disease due to worsened overall health, progressive functional loss and polypharmacy. Meanwhile, inability to communicate oral health needs, increased functional disability and psychological distress also hamper timely oral health care and lead to prolonged suffering and compromised quality of life. While many seriously-ill older adults with poor oral health receive no oral health care prior to death, unnecessary treatment is also common. In response to these issues, a new oral health care model is proposed to better address the oral health needs of older adults with serious illness. This model aims to promote comfort, maintain oral function and improve quality of life. End-of-life oral health trajectories and stage-appropriate oral health care strategies are also introduced to guide the care of these vulnerable individuals.