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The role of community colleges in training public health professionals is of growing importance to the continuum of public health education. Some 5 years have passed since the Framing the Future initiative outlined curricular models at community colleges, and colleges deploying these models are serving as learning sites for public health education at community colleges. While past research has focused on capturing insights from community college executives and program administrators, this study captures perspectives from teaching faculty. Drawing on a national sample of teaching faculty at community colleges and universities accepting transfer students throughout the United States, an online survey of teaching faculty affiliated with public health programs was coupled with follow-up interviews. This study characterizes the nature and scope of public health programming in community colleges and transfer settings, and highlights associated challenges and opportunities as public health becomes further integrated into health professions pathways in 2-year settings and beyond.

Behavioral and mental health risk factors are prevalent among primary care patients and contribute substantially to premature morbidity and mortality and increased health care utilization and costs. Although prior studies have found most adults screen positive for multiple risk factors, limited research has attempted to identify factors that most commonly co-occur, which may guide future interventions. The purpose of this study was to identify subgroups of primary care patients with co-occurring risk factors and to examine sociodemographic characteristics associated with these subgroups. We assessed 12 behavioral health risk factors in a sample of adults (n = 1628) receiving care from nine primary care practices across six U.S. states in 2013. Using latent class analysis, we identified four distinct patient subgroups: a ‘Mental Health Risk’ class (prevalence = 14%; low physical activity, high stress, depressive symptoms, anxiety, and sleepiness), a ‘Substance Use Risk’ class (29%; highest tobacco, drug, alcohol use), a ‘Dietary Risk’ class (29%; high BMI, poor diet), and a ‘Lower Risk’ class (27%). Compared to the Lower Risk class, patients in the Mental Health Risk class were younger and less likely to be Latino/Hispanic, married, college educated, or employed. Patients in the Substance Use class tended to be younger, male, African American, unmarried, and less educated. African Americans were over 7 times more likely to be in the Dietary Risk versus Lower Risk class (OR 7.7, 95% CI 4.0–14.8). Given the heavy burden of behavioral health issues in primary care, efficiently addressing co-occurring risk factors in this setting is critical.

The implementation of evidence-based physical activity interventions is improved when integrated research-practice partnerships are used. These partnerships consider both research- and practice-based evidence that moves beyond only assessing program efficacy. Our novel hypothesis is that integrated research-practice partnerships may lead to interventions that are practical and effective, reach more participants, and are more likely to be sustained in practice.

In July 2018, the United States Department of Housing and Urban Development (HUD) implemented a mandatory smoke-free rule in public housing. This study assessed administrator and resident perceptions of rule implementation during its initial year in the District of Columbia Housing Authority (DCHA). Assessment included nine focus groups (n = 69) with residents and in-depth interviews with administrators (n = 7) and residents (n = 26) from 14 DCHA communities (family = 7 and senior/disabled = 7). Semi-structured discussion guides based on the multi-level socio-ecological framework captured dialogue that was recorded, transcribed verbatim, and coded inductively. Emerging major themes for each socio-ecological framework level included: (1) Individual: the rule was supported due to perceived health benefits, with stronger support among non-smokers, (2) Interpersonal: limiting secondhand smoke exposure was perceived as a positive for vulnerable residents, (3) Organizational: communication, signage, and cessation support was perceived as a need, (4) Community: residents perceived mobility, disability, weather, and safety-related issues as barriers, and (5) Public Policy: lease amendments were perceived as enablers of rule implementation but expressed confusion about violations and enforcement. A majority of administrators and residents reported favorable implications of the mandated HUD rule. The novel application of a socio-ecological framework, however, detected implementation nuances that required improvements on multiple levels, including more signage, cessation support, clarification of enforcement roles, and addressing safety concerns.

Translating evidence-based physical activity interventions into practice have been problematic. Limited research exists on the adoption decision-making process. This study explored health educator perceptions of two evidence-based, physical activity programs-one was developed through an integrated research-practice partnership approach (FitEx) and the other was research-developed, Active Living Every Day (ALED). Semi-structured interviews were conducted with 12 health educators who were trained on either ALED (n = 6) or FitEx (n = 6) and had either delivered (n = 6) or did not deliver (n = 6) the intervention. Program adopters identified with program characteristics, materials, processes, implementation, fit within system, and collaborations as more positive factors in decision-making when compared to those that did not deliver. FitEx health educators were more likely to deliver the program and found it to be a better fit and easier to use. An integrated research-practice partnership may improve adoption of physical activity programs in typical practice settings.

The objective of this study was to determine the feasibility (i.e., limited efficacy testing, practicality, and acceptability) of a 6-week smartphone game-based applications program for promoting physical activity (PA) in adolescents in an afterschool program.This mixed-method, quasi-experimental design study included 27 adolescents who evaluated four smartphone PA game-based applications in two BoysGirls Clubs of America. After an initial baseline week (i.e., usual activity during their visit to the Club), adolescents played each game for 1 week. During a final week, the participants could choose to play any combination of the four games. An established conceptual framework was used to assess feasibility. Efficacy was assessed by changes in PA via wrist-worn accelerometers (model GT3x+; ActiGraph LLC, Pensacola, FL). Practicality was measured through field notes, the number of players attending each session, and the proportion of attendees who played the games. Acceptability was measured using poststudy focus groups.Compared with baseline (3.22 metabolic equivalents [METs]), mean accelerometer values were significantly (P0.05) higher during "Space Rayders" (4.33 METs) and "Color Hunt" (3.67 METs). Attendance did not differ among games, and weekly number of players averaged 12 of 27 participants. Qualitative findings indicated that participants perceived "Space Rayders" as the most acceptable game. Overall, participants found the games to be enjoyable and easy to use, although they had suggestions to improve graphics and sounds.Smartphone games can be feasible for adolescents to use for PA. Lessons learned will be used to provide improvements for future game development and evaluation.

Integrated research-practice partnerships (IRPPs) may improve adoption of evidence-based programs. The aim of this study is to compare adoption of an IRPP-developed physical activity (PA) program (Fit Extension, FitEx) to a typical efficacy-effectiveness-dissemination pipeline model program (Active Living Every Day, ALED). Guided by the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework, a randomized controlled trial assigned health educators (HEs) to FitEx (n = 18) or ALED (n = 18). Fourteen HEs adopted FitEx, while two HEs adopted ALED (χ 2 = 21.8; p 0.05). IRPP-developed programs may improve PA program adoption, implementation, and maintenance and may also result in programs that have higher reach—without reducing effectiveness.

PURPOSE To describe the frequency and patient-reported readiness to change, desire to discuss, and perceived importance of 13 health risk factors in a diverse range of primary care practices. METHODS Patients (n = 1,707) in 9 primary care practices in the My Own Health Report (MOHR) trial reported general, behavioral, and psychosocial risk factors (body mass index [BMI], health status, diet, physical activity, sleep, drug use, stress, anxiety or worry, and depression). We classified responses as “at risk” or “healthy” for each factor, and patients indicated their readiness to change and/or desire to discuss identified risk factors with providers. Patients also selected 1 of the factors they were ready to change as most important. We then calculated frequencies within and across these factors and examined variation by patient characteristics and across practices. RESULTS On average, patients had 5.8 (SD = 2.12; range, 0–13) unhealthy behaviors and mental health risk factors. About 55% of patients had more than 6 risk factors. On average, patients wanted to change 1.2 and discuss 0.7 risks. The most common risks were inadequate fruit/vegetable consumption (84.5%) and overweight/obesity (79.6%). Patients were most ready to change BMI (33.3%) and depression (30.7%), and most wanted to discuss depression (41.9%) and anxiety or worry (35.2%). Overall, patients rated health status as most important. CONCLUSIONS Implementing routine comprehensive health risk assessments in primary care will likely identify a high number of behavioral and psychosocial health risks. By soliciting patient priorities, providers and patients can better manage counseling and behavior change.

PURPOSE Guidelines recommend screening patients for unhealthy behaviors and mental health concerns. Health risk assessments can systematically identify patient needs and trigger care. This study seeks to evaluate whether primary care practices can routinely implement such assessments into routine care. METHODS As part of a cluster-randomized pragmatic trial, 9 diverse primary care practices implemented My Own Health Report (MOHR)—an electronic or paper- based health behavior and mental health assessment and feedback system paired with counseling and goal setting. We observed how practices integrated MOHR into their workflows, what additional practice staff time it required, and what percentage of patients completed a MOHR assessment (Reach). RESULTS Most practices approached (60%) agreed to adopt MOHR. How they implemented MOHR depended on practice resources, informatics capacity, and patient characteristics. Three practices mailed patients invitations to complete MOHR on the Web, 1 called patients and completed MOHR over the telephone, 1 had patients complete MOHR on paper in the office, and 4 had staff help patients complete MOHR on the Web in the office. Overall, 3,591 patients were approached and 1,782 completed MOHR (Reach = 49.6%). Reach varied by implementation strategy with higher reach when MOHR was completed by staff than by patients (71.2% vs 30.2%, P

Patient-centered health risk assessments (HRAs) that screen for unhealthy behaviors, prioritize concerns, and provide feedback may improve counseling, goal setting, and health. To evaluate the effectiveness of routinely administering a patient-centered HRA, My Own Health Report, for diet, exercise, smoking, alcohol, drug use, stress, depression, anxiety, and sleep, 18 primary care practices were randomized to ask patients to complete My Own Health Report (MOHR) before an office visit (intervention) or continue usual care (control). Intervention practice patients were more likely than control practice patients to be asked about each of eight risks (range of differences 5.3-15.8 %, p

Background The reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework was developed to determine potential public health impact of interventions (i.e., programs, policy, and practice). The purpose of this systematic review was to determine (1) comparative results across accurately reported RE-AIM indicators, (2) relevant information when there remains under-reporting or misclassification of data across each dimension, (3) the degree to which authors intervened to improve outcomes related to each dimension, and (4) the number of articles reporting RE-AIM dimensions for a given study. Methods In April 2013, a systematic search of the RE-AIM framework was completed in PubMed, PSYCHInfo, EbscoHost, Web of Science, and Scopus. Evidence was analyzed until January 2015. Results Eighty-two interventions that included empirical data related to at least one of the RE-AIM dimensions were included in the review. Across these interventions, they reached a median sample size of 320 participants (M = 4894 ± 28,256). Summarizing the effectiveness indicators, we found that: the average participation rate was 45 % (±28 %), 89 % of the interventions reported positive changes in the primary outcome and 11 interventions reported broader outcomes (e.g., quality of life). As for individual-level maintenance, 11 % of studies showed effects ≥6 months post-program. Average setting and staff adoption rates were 75 % (±32 %) and 79 % (±28 %), respectively. Interventions reported being delivered as intended (82 % (±16 %)) and 22 % intervention reported adaptations to delivery. There were insufficient data to determine average maintenance at the organizational level. Data on costs associated with each dimension were infrequent and disparate: four studies reported costs of recruitment, two reported intervention costs per participant, and two reported adoption costs. Conclusions The RE-AIM framework has been employed in a variety of populations and settings for the planning, delivery, and evaluation of behavioral interventions. This review highlights inconsistencies in the degree to which authors reported each dimension in its entirety as well as inaccuracies in reporting indicators within each dimension. Further, there are few interventions that aim to improve outcomes related to reach, adoption, implementation, and maintenance. Electronic supplementary material The online version of this article (doi:10.1186/s13643-015-0141-0) contains supplementary material, which is available to authorized users.

A recent article by Lee and Kahende1 identified predictors of successful smoking cessation to assist practitioners in tailoring programs for clients at high risk of relapse. These researchers found that cessation was significantly associated with the following factors: having rules against smoking in the home and a tobacco-free workplace; being at least 35 years of age, married or living with a partner, and of non-Hispanic White race or ethnicity; and having only 1 lifetime quit attempt and not having switched to low-tar or low-nicotine products. Research conducted by FirstHealth of the Carolinas, a not-for-profit health care system based in Pinehurst, NC,2–5 both supports these findings and identifies other factors to consider toward preventing smoking relapse. FirstQuit is our comprehensive, evidence-based cessation program that provides individual and group counseling to clients who smoke and are referred for treatment from provider offices in our rural, tobacco-growing service region. Program data corroborate the role of stress and addiction in hindering the cessation efforts of clients (Table 1). Stress played a large role in smoking relapse over time, as close to 50% of smokers identified stress as the reason for relapse up to 1 year after cessation (Table 1). This suggests the utility of incorporating on-going stress management components into tobacco cessation programs. Addiction, as indicated by physical urges or withdrawals, influenced relapse most particularly during the first 3 months after the initial quit date (Table 1). As expected, there was a decrease in reported symptoms of withdrawal over time. On the basis of these findings, FirstQuit has tailored its program to address stress and addiction by adding a component to educate clients about the symptoms of nicotine withdrawal, the reasons for their occurrence, and specific coping strategies. Clients are reminded that withdrawal symptoms are temporary and a sign that the body is healing itself. Ensuring access to nicotine replacement therapies and cessation medications to overcome physical addiction is now focused on the time period closest to the quit date and continued according to each client’s needs. In addition, stress is addressed continually throughout follow-up. Clients receive a stress management guide and relaxation CD, are invited to attend ongoing weekly support groups, obtain a trial membership to a fitness center, and are connected to additional local resources for mental health assistance (if necessary). Enhancing cessation interventions with timely, tailored resources that address stress and addiction may enhance efforts to prevent relapse in the Carolinas and elsewhere.