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Purpose: Guideline implementation in primary care has proven difficult. Although external assistance through performance feedback, academic detailing, practice facilitation (PF), and learning collaboratives seems to help, the best combination of interventions has not been determined., Methods: In a cluster randomized trial, we compared the independent and combined effectiveness of PF and local learning collaboratives (LLCs), combined with performance feedback and academic detailing, with performance feedback and academic detailing alone on implementation of the National Heart, Lung and Blood Institute's Asthma Guidelines. The study was conducted in 3 primary care practice-based research networks. Medical records of patients with asthma seen during pre- and postintervention periods were abstracted to determine adherence to 6 guideline recommendations. McNemar's test and multivariate modeling were used to evaluate the impact of the interventions., Results: Across 43 practices, 1,016 patients met inclusion criteria. Overall, adherence to all 6 recommendations increased (P ≤.002). Examination of improvement by study arm in unadjusted analyses showed that practices in the control arm significantly improved adherence to 2 of 6 recommendations, whereas practices in the PF arm improved in 3, practices in the LLCs improved in 4, and practices in the PF + LLC arm improved in 5 of 6 recommendations. In multivariate modeling, PF practices significantly improved assessment of asthma severity (odds ratio [OR] = 2.5, 95% CI, 1.7-3.8) and assessment of asthma level of control (OR = 2.3, 95% CI, 1.5-3.5) compared with control practices. Practices assigned to LLCs did not improve significantly more than control practices for any recommendation., Conclusions: Addition of PF to performance feedback and academic detailing was helpful to practices attempting to improve adherence to asthma guidelines.

Purpose: Evaluate youth assets or potential strengths and sexual intercourse associations by household income., Design: Data consisted of youth and parent responses from randomly selected households from a cross-sectional study and wave one of a longitudinal extension of that study. Youth assets and sexual intercourse were compared for four income categories., Setting: Midwestern racially diverse, inner-city neighborhoods., Subjects: One adolescent (12-19 years) and one parent (2335 pairs)., Measures: Adjusted odds ratios (ORs) were calculated using logistic regression. Variables assessed included parent and youth demographics, youth sexual intercourse, and youth assets (adult and peer role models, family communication, use of time [religion or sports], community involvement, future aspirations, responsible choices, and health practices)., Results: Youths' mean age was 14.9 (± 1.8) years, and 52% were female; 44% of respondents were white. Use of time (religion) was significantly associated with never having sex for all but the lowest income youth (OR range=1.79-2.64). The variable peer role models was significant for the lowest income (O =2.01) and two upper income groups (ORs=2.52 and 4.27, respectively). The variable future aspirations was significant for the lowest income youth (OR=1.77)., Conclusion: The youth asset variable future aspirations was critical for the lowest income households. Other asset variables, such as peer role models and use of time (religion) were critical regardless of income., (Copyright © 2011 by American Journal of Health Promotion, Inc.)

Youth internal assets and external resources are protective factors that can help youth avoid potentially harmful behaviors. This study investigates how the relationship between youth assets or resources and two sexual risk behaviors (ever had sex and birth control use) varied by gender. Data were collected through in-home interviews from parent-adolescent dyads, including 1,219 females and 1,116 males. Important differences exist between male and female adolescents. Females with the nonparental role models or the family communication resource were more likely to report never having had sexual intercourse than were females without the resources. Among males, the aspirations for the future and responsible choices assets were associated with never having had sexual intercourse. Males and females had two assets or resources in common that were protective of never having had sex: peer role models and use of time (religion). Considering which youth assets and resources are more likely to positively influence sexual behaviors of males and females may be important when planning prevention programs with youth.

In private community-based primary care practices in Oklahoma, approximately two thirds of patients now have access to a computer and e-mail either at home or work. A substantial majority would like to use e-mail to communicate with their primary care clinicians. Since 1997, rural patients have caught up with urbanites in their access to computers.