Search

The article focuses on evaluating the quality of reporting in palliative and end-of-life care intervention studies regarding social characteristics like socioeconomic position, race, religion, and main language of participants. Topics include the findings that a significant proportion of studies do not report these characteristics adequately, with a tendency to use broad categories that may not capture the diversity of participants, hindering efforts to address inequalities in palliative care.

Background: People with intellectual disability have a high risk of falls and falls‐related injuries. Although people with intellectual disability are at increased risk of falls, there is a need to better understand the efficacy of interventions that can help reduce falls and address risk factors in this population. This systematic review aimed to evaluate the type, nature and effectiveness of interventions undertaken to reduce falls with community‐dwelling adults with intellectual disability and the quality of this evidence. Method: Four electronic databases were searched: Ovid MEDLINE, PsycINFO, CINAHL Plus and the Cochrane Library. Studies were included if they involved people aged 18 years or over, at least 50% of study participants had intellectual disability, participants were community‐dwelling, and the study evaluated any interventions aiming to reduce falls. Study quality was assessed using the National Institutes of Health study quality assessment tools. Reporting of the review followed Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines. Results: Seven studies were eligible for review, with a total of 286 participants and mean age of 50.4 years. As only one randomised trial was identified, a narrative synthesis of results was undertaken. Five studies evaluated exercise interventions, one evaluated a falls clinic programme, and one evaluated stretch fabric splinting garments. Methodological quality varied (two studies rated as good, four as fair, and one as poor). Exercise interventions varied in terms of exercise type and dosage, frequency and intensity, and most did not align with recommendations for successful falls prevention exercise interventions reported for older people. While the majority of studies reported reduced falls, they differed in methods of reporting falls, and most did not utilise statistical analyses to evaluate outcomes. Conclusion: This review identified a small number of falls prevention intervention studies for people with intellectual disability. Although several studies reported improvements in fall outcomes, ability to draw conclusions about intervention effectiveness is limited by small sample sizes and few studies. Further large‐scale research is required to implement and evaluate falls prevention interventions specifically for adults with intellectual disability. [ABSTRACT FROM AUTHOR]

Traditional epidemiologic approaches allow us to compare counterfactual outcomes under 2 exposure distributions, usually 100% exposed and 100% unexposed. However, to estimate the population health effect of a proposed intervention, one may wish to compare factual outcomes under the observed exposure distribution to counterfactual outcomes under the exposure distribution produced by an intervention. Here, we used inverse probability weights to compare the 5-year mortality risk under observed antiretroviral therapy treatment plans to the 5-year mortality risk that would had been observed under an intervention in which all patients initiated therapy immediately upon entry into care among patients positive for human immunodeficiency virus in the US Centers for AIDS Research Network of Integrated Clinical Systems multisite cohort study between 1998 and 2013. Therapy-naïve patients (n = 14,700) were followed from entry into care until death, loss to follow-up, or censoring at 5 years or on December 31, 2013. The 5-year cumulative incidence of mortality was 11.65% under observed treatment plans and 10.10% under the intervention, yielding a risk difference of -1.57% (95% confidence interval: -3.08, -0.06). Comparing outcomes under the intervention with outcomes under observed treatment plans provides meaningful information about the potential consequences of new US guidelines to treat all patients with human immunodeficiency virus regardless of CD4 cell count under actual clinical conditions. [ABSTRACT FROM AUTHOR]

In this randomized, controlled trial among 957 English- or Spanish-speaking drug misusing adult emergency department (ED) patients, we determined if a tailored brief intervention (BI) increased uptake of rapid HIV/HCV screening, and identified factors associated with greater screening uptake. Rapid HIV/HCV screening uptake was greater in the control than the BI arm (45 vs. 38 %; p < 0.04). Screening uptake depended on elapsed study time and which research staff member offered testing. In the control arm, uptake was lowest for those spending <30 or ≥90 min in the study. In the BI arm, screening uptake generally increased over time. Tailored BI content specifically addressing participant HIV/HCV knowledge, HIV/HCV risk behaviors, or need for HIV/HCV screening was not associated with greater screening uptake. These study findings suggested factors that should be considered when designing future ED-based screening initiatives, such as elapsed study time, who offers testing, and the content of interventions. [ABSTRACT FROM AUTHOR]

Background Nearly 1 in 5 people living with HIV in the United States are unaware they are infected. Therefore, it is important to develop and evaluate health communication messages that clinicians can use to encourage HIV testing. Methods The objective was to evaluate health communication messages designed to increase HIV testing rates among women and evaluate possible moderators of message effect. We used a randomized four-arm clinical trial conducted at urban community outpatient health clinics involving 1,919 female patients, 18 to 64 years old. The four health message intervention groups were: i) information-only control; ii) one-sided message describing the advantages of HIV testing; iii) two-sided message acknowledging a superficial objection to testing (i.e., a 20 minute wait for results) followed by a description of the advantages of testing; and iv) two-sided message acknowledging a serious objection (i.e., fear of testing positive for HIV) followed by a description of the advantages of testing. The main outcome was acceptance of an oral rapid HIV test. Results Participants were randomized to receive the control message (n =483), one-sided message (n =480), two-sided message with a superficial objection (n =481), or two-sided message with a serious objection (n =475). The overall rate of HIV test acceptance was 83%. The two-sided message groups were not significantly different from the controls. The one-sided message group, however, had a lower rate of testing (80%) than the controls (86%) (OR, 0.66; 95% CI, 0.47-0.93; P =0.018). "Perceived obstacles to HIV testing" moderated this effect, indicating that the decrease in HIV test acceptance for the one-sided message group was only statistically significant for those who had reported high levels of obstacles to HIV testing (OR, 0.36; 95% CI, 0.19-0.67; P =0.001). Conclusions None of the messages increased test acceptance. The one-sided message decreased acceptance and this effect was particularly true for women with greater perceived obstacles to testing, the very group one would most want to persuade. This finding suggests that efforts to persuade those who are reluctant to get tested, in some circumstances, may have unanticipated negative effects. Other approaches to messaging around HIV testing should be investigated, particularly with diverse, behaviorally high-risk populations. [ABSTRACT FROM AUTHOR]

Background: Sepsis affects 1.7 million patients in the US annually, is one of the leading causes of mortality, and is a major driver of US healthcare costs. African American/Black and LatinX populations experience higher rates of sepsis complications, deviations from standard care, and readmissions compared with Non-Hispanic White populations. Despite clear evidence of structural racism in sepsis care and outcomes, there are no prospective interventions to mitigate structural racism in sepsis care, nor are we aware of studies that report reductions in racial inequities in sepsis care as an outcome. Therefore, we will deliver and evaluate a coalition-based intervention to equip health systems and their surrounding communities to mitigate structural racism, driving measurable reductions in inequities in sepsis outcomes. This paper presents the theoretical foundation for the study, summarizes key elements of the intervention, and describes the methodology to evaluate the intervention., Methods: Our aims are to: (1) deliver a coalition-based leadership intervention in eight U.S. health systems and their surrounding communities; (2) evaluate the impact of the intervention on organizational culture using a longitudinal, convergent mixed methods approach, and (3) evaluate the impact of the intervention on reduction of racial inequities in three clinical outcomes: a) early identification (time to antibiotic), b) clinical management (in-hospital sepsis mortality) and c) standards-based follow up (same-hospital, all-cause sepsis readmissions) using interrupted time series analysis., Discussion: This study is aligned with calls to action by the NIH and the Sepsis Alliance to address inequities in sepsis care and outcomes. It is the first to intervene to mitigate effects of structural racism by developing the domains of organizational culture that are required for anti-racist action, with implications for inequities in complex health outcomes beyond sepsis., (© 2022. The Author(s).)

The article discusses a qualitative study, which assessed the impact of the problem-solving intervention in the informal hospice caregivers. A thematic analysis of open-ended exit interviews was conducted. The study findings reinforced the understanding of problem-solving interventions and highlighted the importance of using a structured approach, which aided the patient in resolving problems and gaining confidence as well as control. Thus, such studies can enhance existing support services.

Minority and low socioeconomic status groups have the highest rates of overweight and obesity. Children from these families face a greater risk for weight-related health problems such as diabetes, heart disease and cancer as compared to their nonminority and more affluent peers. Factors from the larger physical, social, and cultural environments, and within families, influence weight status among children. Many of these factors are yet to be identified and relationships among known factors are complex and not well understood. The National Institutes of Health and U.S. Department of Agriculture have proposed a research agenda for social and behavioral scientists to "examine how social contexts influence health and elucidate the mechanisms through with those mechanisms operate", and to "develop ways to intervene on those factors for preventing obesity." This editorial presents a social ecological view of child obesity and proposes several steps necessary to identify how community and family domain factors affect the weight-regulating behaviors of children. An empiricallybased, theoretically-driven approach will lead to efficacious interventions which can be translated and widely disseminated into community-based programs, thus increasing the probability of success of population-based obesity prevention and control interventions. [ABSTRACT FROM AUTHOR]

Abstract: The Evaluation of the US Department of Housing and Urban Development Lead-Based Paint Hazard Control Grant Program studied the effectiveness of the housing intervention performed in reducing the blood lead of children at four post-intervention times (6-months, 1-year, 2-years, and 3-years). A repeat measures analysis showed that blood lead levels declined up to three-years post-intervention. The results at each successive collection time were significantly lower than at the previous post-intervention time except for the difference between the levels at two and three years. At two-years post-intervention, geometric mean blood lead levels were approximately 37% lower than at pre-intervention. Children with pre-intervention blood lead levels as low as 10μg/dL experienced substantial declines in blood lead levels. Previous studies have found substantial improvements only if a child''s pre-intervention blood lead level was above 20μg/dL. Individual interior lead hazard control treatments as grouped by Interior Strategy were not a significant predictor of post-intervention blood lead levels. However, children living in dwellings where exterior lead hazard control interventions were done had lower blood lead levels at one-year post-intervention than those living in dwellings without the exterior interventions (all other factors being equal), but those differences were only significant when the mean exterior paint lead loading at pre-intervention was about the 90th percentile (7.0mg/cm2). This observation suggests that exterior lead hazard control can be an important component of a lead hazard control plan. Children who were six to eleven months of age at pre-intervention had a significant increase in blood lead at one-year post-intervention, probably due to other exposures. [Copyright &y& Elsevier]

A pilot was conducted to test the feasibility and compare the effectiveness of a group approach (facilitated group discussions) to that of a self-guided approach (newsletters) to weight management in postpartum women enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (base-line n = 151; final n = 64). Mean group attendance was 3.6/10 sessions. Being older and meeting with the dietitian were related to greater attendance (P < .01). At 1 year, there were no significant differences in weight between groups. There is a critical need for weight-management interventions in the postpartum period. Lessons learned are presented. [ABSTRACT FROM AUTHOR]

A meta-analytic review of 16 studies of the Youth Fit For Life obesity prevention intervention found an overall significant body mass index (BMI) reduction effect (r=.07) in the intended 5- to 12-year-old age range. Possible moderation of effects on BMI by participants' age, ethnicity, gender, intervention administration format, and publication status was tested. Only ethnicity was found to be a significant moderator, with minority participants having significantly larger effects than White participants. The overall effect size was larger than overall effects on BMI in a recent comprehensive meta-analysis of 64 child and adolescent obesity prevention intervention studies (r=.04) (Stice, Shaw, & Marti, 2006), and overall effects in a subset of 45 of those studies with ages consistent with the Youth Fit For Life studies. In that case, the effect size (r=.01) was not significantly different from zero. When moderators were contrasted between meta-analyses, Youth Fit For Life studies had larger effects for participants who were ages 8 through 12 years, and when physical activity participation was mandated. Implications for child obesity prevention research and interventions were discussed. [ABSTRACT FROM AUTHOR]

Objective: To assess whether incentives for practicing regular physical activities in fact help raising the frequency of exercising. Methods: Male and female subjects undergoing two to three assessments in the Check-Up Unit of Hospital Israelita Albert Einstein (HIAE) were evaluated by noting any increase in levels of physical activity, improvements in mean metabolic unit numbers, and the sensitization index. The International Physical Activity Questionnaire was applied to assess the sample. Results: There were 1,879 subjects - 1,559 (83%) males and 320 (17%) females - aged 20 to 76 years (mean age = 45.8 years, standard deviation ± 8.8) who underwent a Continued Health Review at the Center for Preventive Medicine of the HIAE, Check-Up Unit, Jardins. Initially, over half of the sample was insufficiently active (sedentary or poorly active); there were more women than men in this group. After the health review, most subjects increased their level of physical activity; this increase was higher among women. Males encouraged three times to exercising showed better results (increased level of physical activity) as compared to males encouraged twice for exercising. The best results in females were found in the group that went through two evaluations. This result is due to the fact that the sample of females comprising the group that received incentives on three occasions was small. This was also the only group that showed no increase in mean metabolic units. The sensitization index assessment in the overall sample was very satisfactory, as the expected results were achieved. Conclusions: These results show that motivational interventions are effective for raising the level of physical activity. We concluded that to encourage the practice of regular physical activity through information programs about its health benefits is very important. [ABSTRACT FROM AUTHOR]

Experiments test ‘new’ ideas about interventions that might produce better outcomes. Re-entry requires that the intervention should be offered at the transition point (from prison to community) and in the community. In general, the experiment requires the researchers to differentiate the ‘new’ approach from usual practice. The answer lies in the design and measures of the experiment. It is important to make sure that the intervention will be designed and implemented in such a manner that makes it operationally different from traditional services. Each experiment must include measures to determine the content and dosage of the new intervention as well as the traditional practice. This special edition is devoted to examining how these issues are handled in four different experiments, as well as comments from members of a Data Safety Monitoring Board (DSMB) on the efforts to monitor studies. Together, the articles point to the need to measure the fidelity and adherence of new innovations. [ABSTRACT FROM AUTHOR]

We examined the extent to which studies aimed at testing interventions to improve antiretroviral adherence have targeted the facilitators of and barriers known to affect adherence. Of the 88 reports reviewed, 41 were reports of descriptive studies conducted with US HIV-positive women and 47 were reports of intervention studies conducted with US HIV-positive persons. We extracted from the descriptive studies all findings addressing any factor linked to antiretroviral adherence and from the intervention studies, information on the nature of the intervention, the adherence problem targeted, the persons targeted for the intervention, and the intervention outcomes desired. We discerned congruence between the prominence of substance abuse as a factor identified in the descriptive studies as a barrier to adherence and its prominence as the problem most addressed in those reports of intervention studies that specified the problems targeted for intervention. We also discerned congruence between the prominence of family and provider support as factors identified in the descriptive studies as facilitators of adherence and the presence of social support as an intervention component and outcome variable. Less discernible in the reports of intervention studies was specific attention to other factors prominent in the descriptive studies, which may be due to the complex nature of the problem, individualistic and rationalist slant of interventions, or simply the ways interventions were presented. Our review raises issues about niche standardization and intervention tailoring, targeting, and fidelity. [ABSTRACT FROM AUTHOR]

This paper presents the results of a study that aimed to describe the prevalence and evolution of metabolic syndrome (MetS) in the Mediterranean population of Catalonia, Spain, between 1992–1993 and 2002–2003 by applying the National Cholesterol Education Program's Adult Treatment Panel III (ATPIII) and International Diabetes Federation (IDF) definitions. Data from two cross-sectional population-based surveys were used (ENCAT 1992–1993 [ n = 820] and 2002–2003 [ n = 1,384]). Applying IDF definitions, MetS tended to increase ( P = 0.08), from 25% in 1992–1993 to 28.5% in 2002–2003. Applying ATPIII definitions, MetS prevalence was lower, and it increased significantly ( P < 0.001) from 18.4% in 1992–1993 to 24.8% in 2002–2003. MetS prevalence is high and has increased significantly in the last decade in Catalonia. [ABSTRACT FROM AUTHOR]

Aim Reductions in substance use were examined in response to an intensive intervention with people living with human immunodeficiency virus (HIV) (PLH). Design, setting and participants A randomized controlled trial was conducted with 936 PLH who had recently engaged in unprotected sexual risk acts recruited from four US cities: Milwaukee, San Francisco, New York and Los Angeles. Substance use was assessed as the number of days of use of 19 substances recently (over the last 90 days), evaluated at 5-month intervals over 25 months. Intervention A 15-session case management intervention was delivered to PLH in the intervention condition; the control condition received usual care. Measurements An intention-to-treat analysis was conducted examining reductions on multiple indices of recent substance use calculated as the number of days of use. Findings Reductions in recent substance use were significantly greater for intervention PLH compared to control PLH: alcohol and/or marijuana use, any substance use, hard drug use and a weighted index adjusting for seriousness of the drug. While the intervention-related reductions in substance use were larger among women than men, men also reduced their use. Compared to controls, gay and heterosexual men in the intervention reduced significantly their use of alcohol and marijuana, any substance, stimulants and the drug severity-weighted frequency of use index. Gay men also reduced their hard drug use significantly in the intervention compared to the control condition. Conclusions A case management intervention model, delivered individually, is likely to result in significant and sustained reductions in substance use among PLH. [ABSTRACT FROM AUTHOR]

Some health indicators for Latinos tend to be more positive than socioeconomic status would predict. Yet, Latina women and their young children use fewer preventive health services and have a higher incidence of preventable diseases than non-Hispanic whites. The Institute of Medicine recently called for intervention research among minority subgroups to end racial and ethnic disparities in health care. To help guide future intervention research, this article presents a critique and synthesis of the peer-reviewed literature on interventions that enroll Latina women into preventive reproductive health services (prenatal care, cervical cancer screening, and child immunizations). Results are presented according to three categories of interventions: improvements within formal health care settings, outreach through lay health advisors (promotoras) and media, and interventions combining these approaches. An agenda for intervention research is proposed for preventive-care use by this population. [ABSTRACT FROM AUTHOR]

Abstract: Background : Given the low rates of physical activity participation, innovative intervention approaches are needed to make a public health impact. Methods : The study was conducted at the Miriam Hospital/Brown Medical School in Providence, RI, and in communities of Southeastern Massachusetts from 2002 to 2005. Previously sedentary women (n =280; mean age=47.1; 94.6% Caucasian) were randomly assigned to one of three conditions: (1) Choose to Move, a self-help printed booklet (n =93), (2) Jumpstart, a motivationally tailored, print based intervention (n =95); or (3) Wellness, women''s health materials (n =92). Face-to-face contact at months 3 (M3) and 12 (M12) occurred within participants'' communities in local libraries. Results : At M3, participants in the Jumpstart condition reported significantly more minutes of physical activity per week (M=140.4, SE=14.82) than participants in the Wellness condition (M=98.1, SE=15.09), (t(275)=2.00, p <0.05). The Jumpstart arm showed a trend towards significance (t(275)=1.93, p =0.054) when compared with the CTM arm (M=99.5, SE=15.11); there was no significant difference between the CTM and Wellness arms (t(275)=0.07, p =NS). At M12, there were no significant differences (F(2,275)=0.147, p =NS) between any of the treatment arms. Conclusions : Results suggest that print-based programs for physical activity may be efficacious short-term, but more research is needed to find approaches that are effective long-term. It is possible to deliver print-based programs through existing community infrastructures, however these approaches need further evaluation to examine maintenance effects apart from the demand characteristics of a research study. [Copyright &y& Elsevier]

The incidence of acute gastrointestinal illness (AGI) attributable to public drinking water systems in the United States cannot be directly measured but must be estimated based on epidemiologic studies and other information. The randomized trial is one study design used to evaluate risks attributable to drinking water. In this paper, we review all published randomized trials of drinking water interventions in industrialized countries conducted among general immunocompetent populations. We then present an approach to estimating the incidence (number of cases) of AGI attributable annually to drinking water. To develop a national estimate, we integrate trial results with the estimated incidence of AGI using necessary assumptions about the estimated number of residents consuming different sources of drinking water and the relative quality of the water sources under different scenarios. Using this approach we estimate there to be 4.26–11.69 million cases of AGI annually attributable to public drinking water systems in the United States. We believe this preliminary estimate should be updated as new data become available. [ABSTRACT FROM AUTHOR]

Abstract: Background : Effective clinical weight management approaches are needed to reach African-Americans. Methods : African-Americans recruited through outpatient practices for a culturally-adapted Healthy Eating and Lifestyle Program were offered 10 weekly weight loss classes (Phase 1) with the option of continuing for another 8–18 months (Phase 2) in a randomized comparison of further group counseling or staff-facilitated self-help vs. follow-up clinic visits only. Results. : Of 237 enrollees (91% women; mean age 43.5 years; mean body mass index 38.0 kg/m2), 167 attended no classes or only the first Phase 1 class, 134 provided Phase 1 follow-up data, 128 were randomized in Phase 2, and 87 provided final follow-up data (“completers”). Mean weight changes for completers were: −1.5 (P &#60; 0.001), +0.3 (P = 0.47), and −1.2 (P = 0.04) kg, respectively, for Phase 1, Phase 2, and overall (baseline to final visit; average 18 months total duration), with no Phase 2 treatment effect (P = 0.55). Final study weight was ≥5% below baseline for 25% of completers and was strongly predicted by Phase 1 weight loss. Conclusions : Weight loss achieved in Phase 1 was maintained even with relatively minimal follow-up contact. Increasing the percent who achieve clinically significant weight loss initially would improve long-term results. [Copyright &y& Elsevier]

Abstract: Background: Upon discovering an NTD incidence rate of 27/10,000 in a Texas border county, the Texas Department of Health initiated folic acid intervention for prevention of recurrent NTDs in this predominantly Mexican-American population. This paper describes compliance of this population with USPHS folic acid recommendations and the impact of supplementation on pregnancy outcomes. Methods: Based upon information from active surveillance, field teams personally contacted women having NTD-affected pregnancies to enroll them in FA intervention. Enrollees were provided FA at home visits at 3-month intervals throughout the project. Results: Of 405 women identified with NTD-affected pregnancies, 299 (73.8%) enrolled in the intervention. One hundred ninety-three pregnancies occurred among 138 women. FA supplementation of 0.4 mg/day or more occurred during the last month preconception in 161 (83.4%) of the 193 pregnancies. No NTDs were detected in the 130 livebirths to women who received supplementation nor were NTDs detected in the 23 supplemented women who experienced pregnancy loss. Conclusions: Supplementation was successful in preventing recurrent NTDs in Mexican-American women. [Copyright &y& Elsevier]

Context: Athletes in the United States are at high risk for using spit (smokeless) tobacco (ST) and incurring its associated adverse health effects. Objective: To examine whether an athletic trainer-directed ST intervention could decrease initiation and promote cessation of ST use among male collegiate baseball athletes. Design: Stratified, cluster-randomized controlled trial. Setting: Fifty-two California colleges. Patients or Other Participant(s): A total of 883 subjects in 27 intervention colleges and 702 subjects in 25 control colleges participated, as did 48 certified athletic trainers. Intervention(s): For college athletic trainers and associated dental professionals, a 3-hour video conference, and for collegiate athletes, an oral cancer screening with feedback and brief counseling during the preseason health screenings, athletic trainer support for cessation, and a peer-led educational baseball team meeting. Main Outcome Measure(s): The subjects' ST use over 1 year was assessed by self-report. At the end of the study, the certified athletic trainers were mailed a survey assessing their tobacco use and perceptions and behavior related to tobacco control in the athletic environment. We used multivariable logistic regression models for clustered responses (generalized estimating equations) to test the difference between groups in ST-use initiation and cessation and to identify significant overall predictors of noninitiation and cessation of ST use. Results: Of the 1585 athletes recruited, 1248 (78.7%) were followed up at 12 months. In addition, 48 of the 52 athletic trainers (92%) responded to the 1-year follow-up survey. The ST-use initiation (incidence) was 5.1% in intervention colleges and 8.4% in control colleges (generalized estimating equation odds ratio = 0.58, 95% confidence interval = 0.35-0.99). Predictors of ST noninitiation were low lifetime tobacco and monthly alcohol use (odds ratio = 1.98, 95% confidence interval = 1.40-2.82) and athletic trainers' report that the baseball coach supported ST-use prevention activities (odds ratio = 1.43, 95% confidence interval = 1.11-1.83). Although at 1 year, cessation of ST use was relatively high in both groups (36%), we noted no significant difference between the groups (odd ratio = 0.94, 95% confidence interval = 0.70-1.27). Conclusions: The intervention was significantly effective in preventing incident ST use but did not significantly increase cessation beyond that seen in the control group. The latter finding is inconsistent with previous studies and may be explained by spillover of the intervention to control colleges, other anti-tobacco activity in control colleges, and/or the small sample of dependent ST users enrolled in the study. [ABSTRACT FROM AUTHOR]

Data collected as part of Pathways, a school-based trial for the primary prevention of obesity in American Indian children conducted between 1997 and 2000, were analyzed to examine possible intervention-related bias in food reporting. The authors hypothesized that children in the intervention schools may have systematically underreported their dietary intake relative to children in the control schools. Nutrient intake estimates for lunch derived from record-assisted 24-hour dietary recalls were compared with intake estimates from observed lunch intakes. Reported nutrient intakes were included in regression analyses as the dependent variables; observed intake, intervention condition, and age were included as independent variables. Results indicated that, among females, intervention condition was a significant predictor of reported energy, fat, and saturated fatty acid intakes. Independently of observed intake, reported lunch energy intake among females in the intervention schools was 66.8 calories lower than reported intake among females in the control schools (p = 0.03). These findings suggest that investigators should consider bias in reporting of dietary intake by intervention condition when conducting diet-focused intervention studies. Specifically, enhancing measures that rely on self-reports with objective measures of dietary intake would help investigators to evaluate whether differential reporting by treatment group has occurred. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate the acceptability and feasibility of a lifestyle physical activity program for people with spinal cord injury (SCI). Methods. Sixteen nonexercising adult volunteers with SCI participated in a single group pre-post-test of the "Be Active in Life Program" comprising stage-matched educational materials, home visit by a nurse, construction of a personal plan to increase activity, and four follow-up phone calls. Program acceptability, stage of change, barriers to health promoting activities, abilities for health practices, health, depression, and muscle strength were rated. Physical activity was monitored using actigraphy and a self-report record. Results. Participants rated the program positively, although some preferred a structured exercise approach. Eighty-one percent of participants progressed in stage of change and 60% increased physical activity. There were significant changes in motivational barriers, exercise self-efficacy, self-rated health, and muscle strength. Discussion. Lifestyle physical activity is feasible and acceptable and could be effective in promoting greater physical activity among people with SCI. [ABSTRACT FROM AUTHOR]

Objective: To determine the efficacy of a spit tobacco (ST) intervention designed to promote ST cessation and discourage ST initiation among male high school baseball athletes. Methods: This study was a cluster-randomized controlled trial. Forty-four randomly selected high schools in rural California were randomized within strata (prevalence of ST use and number and size of baseball teams) to either the intervention or the control group. Ninety-three percent of eligible baseball athletes participated, yielding 516 subjects in 22 intervention schools and 568 subjects in 22 control schools. Prevalences of sustained ST cessation and ST use initiation over 1 year were assessed by self-report. Multivariate logistic regression models for clustered responses were used to test the null hypotheses of no association between group and the two outcomes, adjusted for the stratified design and baseline imbalances between groups in significant predictors of ST use. Results: Prevalence of cessation was 27% in intervention high schools and 14% in control high schools (odds ratio (OR)=2.29; 95% confidence interval (CI), 1.36–3.87). The intervention was especially effective in promoting cessation among those who, at baseline, lacked confidence that they could quit (OR=6.4; 95% CI, 1.0–4.3), among freshmen (OR=15; 95% CI, 0.9–260), and among nonsmokers (OR=3.2; 95% CI, 0.9–11). There was no significant difference between groups in the prevalence of ST initiation. Conclusions: This intervention was effective in promoting ST cessation, but was ineffective in preventing initiation of ST use by nonusers. [Copyright &y& Elsevier]

: BackgroundSmoking prevalence rates in some ethnic minority groups are elevated relative to the majority population. Thus, identifying cessation interventions that are effective for these groups is important. This article reviews published studies that examine effects of smoking cessation interventions relevant to racial ethnic minority populations.: MethodsA literature search of tobacco interventions, reporting smoking cessation outcomes (including quit rates) in U.S. minority populations, was conducted for the period 1985 to 2001.: ResultsThirty-six studies met preset criteria for inclusion. Twenty-three reported quit rates for African Americans, 4 for Asian/Pacific Islanders, 3 for Native Americans, and 10 for Hispanics.: ConclusionsThe disproportionate number of studies that focused on African American smokers compared with the other major racial/ethnic groups suggests the need for continued efforts to develop and evaluate the effectiveness of smoking cessation interventions for all ethnic minority populations. Abstinence rates varied considerably depending on study design and intervention strategy. Moreover, a relatively small percentage of studies that were randomized trials reported statistically significant findings, and most used intervention strategies that do not reflect the current state-of-the-art. These results strongly suggest that more research is needed to identify successful smoking cessation interventions in these populations. [Copyright &y& Elsevier]

The effectiveness of commercially available interventions for reducing workers' perchloroethylene exposures in three small dry-cleaning shops was evaluated. Depending upon machine configuration, the intervention consisted of the addition of either a refrigerated condenser or a closed-loop carbon adsorber to the existing dry-cleaning machine. These relatively inexpensive (less than $5000) engineering controls were designed to reduce perchloroethylene emissions when dry-cleaning machine doors were opened for loading or unloading. Effectiveness of the interventions was judged by comparing pre- and postintervention perchloroethylene exposures using three types of measurements in each shop: (1) full-shift, personal breathing zone, air monitoring, (2) next-morning, end-exhaled worker breath concentrations of perchloroethylene, and (3) differences in the end - exhaled breath perchloroethylene concentrations before and after opening the dry-cleaning machine door. In general, measurements supported the hypothesis that machine operators' exposures to perchloroethylene can be reduced. However, work practices, especially maintenance practices, influenced exposures more than was originally anticipated. Only owners of dry-cleaning machines in good repair, with few leaks, should consider retrofitting them, and only after consultation with their machine's manufacturer.If machines are in poor condition, a new machine or alternative technology should be considered. Shop owners and employees should never circumvent safety features on dry-cleaning machines. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Older adults in the U.S. have high rates of obesity. Despite the demonstrated efficacy of lifestyle interventions among older adults, lifestyle interventions are not widely implemented in community settings. Program delivery by lay health educators (LHEs) might support greater dissemination because of lower delivery cost and greater accessibility. We examined the costs of a LHE-delivered translation of the Diabetes Prevention Program (DPP) evidence-based lifestyle intervention for older adults in Arkansas senior centers. Methods: This examination of costs used data from a cluster randomized control trial (conducted 2008–2010) in which 7 senior centers (116 participants) were randomized to implement a LHE-delivered 12-session translation of the DPP lifestyle intervention. We compiled direct lifestyle intervention implementation costs, including training, recruitment, materials, and ongoing intervention implementation support. Weight loss data (at 4-month follow-up) were collected from participants. Results: Participant weight loss averaged 3.7kg at 4-months. The total estimated cost to implement the lifestyle intervention is $2731 per senior center, or $165 per participant. The implementation cost per kilogram lost is $45. Conclusions: A LHE-delivered DPP translation in senior centers is effective in achieving weight loss at low cost and offers promise for the dissemination of this evidence-based intervention. [Copyright &y& Elsevier]

Purpose: The aim of the study was to evaluate the efficacy of faith-based and nonfaith-based parent-child abstinence-only interventions in reducing sexual risk behavior among young African American adolescents., Methods: Randomized controlled trial recruiting 613 African American parent-adolescent dyads from urban African American Baptist churches and randomizing them to one of three parent-child interventions: faith-based abstinence-only intervention emphasizing delaying or reducing sexual intercourse drawing on Biblical scriptures; nonfaith-based abstinence-only emphasizing intervention delaying or reducing sexual intercourse without referencing scriptures; or attention-matched control intervention targeting health issues unrelated to sexual behavior. Primary outcome was the self-reported frequency of condomless sexual intercourse in the past 3 months assessed periodically through 18 months postintervention. Secondary outcomes were frequency of sexual intercourse, number of sexual partners, consistent condom use and, among sexually inexperienced adolescents, sexual debut., Results: Generalized estimating equations analyses revealed that nonfaith-based abstinence-only intervention reduced the frequency of condomless sexual intercourse, frequency of sexual intercourse, and number of sexual partners compared with the attention-matched control intervention, whereas faith-based abstinence-only intervention did not. Neither intervention affected consistent condom use or sexual debut., Conclusions: Parent-child abstinence-only interventions can reduce condomless sexual intercourse among young African American adolescents in church settings. Linking the abstinence message to Biblical scriptures may not be efficacious., (Copyright © 2019. Published by Elsevier Inc.)

Background: Cancer is a major public health problem due to its incidence, morbidity and mortality. A large proportion of cancer cases and deaths could be prevented through the implementation of cancer screening programmes. However, there are social inequalities in patient access to these programmes, especially in underserved communities and minority populations., Objective: To identify, characterise and analyse the effectiveness of patient-targeted healthcare interventions to promote cancer screening programmes in ethnic minorities., Methods: A comprehensive search of bibliographic databases was conducted. The results of our systematic review were reported in accordance with the PRISMA guidelines., Results: Seventeen articles were identified and included in the review. Sixteen of the seventeen studies were conducted in the United States and one was conducted in Israel. Fifteen of the seventeen interventions selected were effective in increasing cancer screening rates. Moreover, five of the seventeen studies found an improvement in cancer knowledge, awareness, self-efficacy, attitudes, intention and perceptions, and three studies found a positive change in health beliefs and barriers. The results show that culturally adapted interventions appear to increase the rate of participation in cancer screening. In addition, the effectiveness of the interventions seems to be related to the use of small media, one-on-one interactions, small group education sessions, reminder strategies, and strategies for reducing structural barriers and out-of-pocket costs., Conclusion: Culturally adapted patient-targeted healthcare interventions can help to reduce racial or ethnic inequalities in access to cancer screening programmes. Further research is needed to develop interventions to promote adherence to cancer screening programmes with repeat testing and vigorous economic evaluation methodologies., (Copyright © 2016. Published by Elsevier Ltd.)

Objective: This article investigated how a multicomponent memory intervention affected memory for prose. We compared verbatim and paraphrased recall for short stories immediately and 1, 2, 3, and 5 years post-intervention in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) sample. Method: We studied 1,912 ACTIVE participants aged 65 to 91. Participants were randomized into one of three training arms (Memory, Reasoning, Speed of Processing) or a no-contact Control group; about half of the trained participants received additional booster training 1 and 3 years post-intervention. Results: Memory-trained participants showed higher verbatim recall than non-memory-trained participants. Booster-memory training led to higher verbatim recall. Memory training effects were evident immediately following training and not after 1 year following training. Discussion: Results suggest that multifactorial memory training can improve verbatim recall for prose, but the effect does not last without continued intervention. [ABSTRACT FROM AUTHOR]

Exclusive breastfeeding (EBF), a perinatal core measure, is associated with a longer duration of breastfeeding. The purpose of this quality improvement project was to increase the percent of healthy term singleton newborns who were exclusively breastfed at an academic medical center in the Midwest. Implementation of skin-to-skin contact between mother and newborn immediately following birth resulted in an increase in the percent of healthy term singleton newborns who were EBF from 55% to 64%., (© 2014 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.)

Background: Colorectal cancer (CRC) screening is cost-effective but underused. The objective of this study was to determine the cost-effectiveness of a mailed standard intervention (SI) and tailored navigation interventions (TNIs) to increase CRC screening use in the context of a randomized trial among primary care patients., Methods: Participants (n = 945) were randomized either to a usual care control group (n = 317), to an SI group (n = 316), or to a TNI group (n = 312). The SI group was sent both colonoscopy instructions and stool blood tests irrespective of baseline preference. TNI group participants were sent instructions for scheduling a colonoscopy, a stool blood test, or both based on their test preference, as determined at baseline; then, they received a navigation telephone call. Activity cost estimation was used to determine the cost of each intervention and to compute incremental cost-effectiveness ratios. Statistical uncertainty within the base case was assessed with 95% confidence intervals derived from net benefit regression analysis. The effects of uncertain parameters, such as the cost of planning, training, and involvement of those receiving "investigator salaries," were assessed with sensitivity analyses., Results: Program costs of the SI were $167 per participant. The average cost of the TNI was $289 per participant., Conclusions: The TNI was more effective than the SI but substantially increased the cost per additional individual screened. Decision-makers need to consider cost structure, level of planning, and training required to implement these 2 intervention strategies and their willingness to pay for additional individuals screened to determine whether a tailored navigation would be justified and feasible., (© 2013 American Cancer Society.)