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The U.S. Preventive Services Task Force recommends that clinicians adopt universal alcohol screening and brief intervention as a routine preventive service for adults, and efforts are underway to support its widespread dissemination. The likelihood that healthcare systems will sustain this change, once implemented, is under-reported in the literature. This article identifies factors that were important to postimplementation sustainability of an evidence-based practice change to address alcohol misuse that was piloted within three diverse primary care organizations. The Centers for Disease Control and Prevention funded three academic teams to pilot and evaluate implementation of alcohol screening and brief intervention within multiclinic healthcare systems in their respective regions. Following the completion of the pilots, teams used the Program Sustainability Assessment Tool to retrospectively describe and compare differences across eight sustainability domains, identify strengths and potential threats to sustainability, and make recommendations for improvement. Health systems varied across all domains, with greatest differences noted for Program Evaluation, Strategic Planning, and Funding Stability. Lack of funding to sustain practice change, or data monitoring to promote fit and fidelity, was an indication of diminished Organizational Capacity in systems that discontinued the service after the pilot. Early assessment of sustainability factors may identify potential threats that could be addressed prior to, or during implementation to enhance Organizational Capacity. Although this study provides a retrospective assessment conducted by external academic teams, it identifies factors that may be relevant for translating evidence-based behavioral interventions in a way that assures that they are sustained within healthcare systems.

Background: Among Hispanics, chronic liver disease and cirrhosis are among the leading causes of death despite generally lower alcohol consumption rates. Moreover, recent national studies have suggested temporal changes in Hispanic consumption and alcohol mortality, which raises the question of whether Hispanic white disparities in alcohol-related mortality are also changing over time. This study aimed to describe temporal trends of alcohol-related mortality between Hispanics and non-Hispanic (NH) whites in the United States from 1999 to 2014 and to assess county-level sociodemographic characteristics that are associated with racial/ethnic disparities in age-adjusted alcohol-related mortality., Methods: We conducted a population-based, cross-sectional, ecologic study using multiple cause-of-death mortality data linked, at the county level, to census data from the American Community Survey., Results: Overall, 77% of alcohol-related deaths were among men, and Hispanic men had the highest age-adjusted alcohol-related mortality rate (41.6 per 100,000), followed by NH white men (34.8), NH white women (10.8), and Hispanic women (6.7). Whereas the relative gap in alcohol-related mortality between NH white and Hispanic women increased from 1999 to 2014, the disparity between NH white and Hispanic men that was pronounced in earlier years was eliminated by 2012. From 2007 to 2014, when the race/ethnic disparity among men was decreasing, county-specific Hispanic:NH white age-adjusted mortality ratios (AAMRs) ranged from 0.29 to 2.64. Lower Hispanic rates were associated with large metropolitan counties, and those counties that tended to have Hispanic populations were less acculturated, as evidenced by their higher rates of being foreign-born, non-U.S. citizens or citizens through naturalization, and a higher proportion that do not speak English "very well.", Conclusions: Since 1999, whereas the increasing mortality rate among whites is leading to a widening gap among women, mortality differences between Hispanic and white men have been eliminated. The understanding of contextual factors that are associated with disparities in alcohol-related mortality may assist in tailoring prevention efforts that meet the needs of minority populations., (Copyright © 2016 by the Research Society on Alcoholism.)