Lessons learned from statewide contingency management rollouts addressing stimulant use in the Northwestern United States.

Increases in stimulant drug use (such as methamphetamine) and related deaths creates an imperative for community settings to adopt evidence-based practices to help people who use stimulants. Contingency management (CM) is a behavioral intervention with decades of research demonstrating efficacy for the treatment of stimulant use disorder, but real-world adoption has been slow, due to well-known implementation barriers, including difficulty funding reinforcers, and stigma. This paper describes the training and technical assistance (TTA) efforts and lessons learned for two state-wide stimulant-focused CM implementation projects in the Northwestern United States (Montana and Washington). A total of 154 providers from 35 community-based service sites received didactic training in CM beginning in 2021. Seventeen of these sites, ten of eleven in Montana (90.9%) and seven of 24 in Washington (29.2%), went on to implement contingency management programs adherent to their state's established CM protocol and received ongoing TTA in the form of implementation coaching calls. These findings illustrate that site-specific barriers such as logistical fit precluded implementation in more than 50% of the trained sites; however, strategies for site-specific tailoring within the required protocol aided implementation, resulting in successful CM program launch in a diverse cross-section of service sites across the states. The lessons learned add to the body of literature describing CM implementation barriers and solutions.

Pono Choices: Lessons for School Leaders From the Evaluation of a Teen Pregnancy Prevention Program.

BACKGROUND: The US Office of Adolescent Health (OAH) funded studies of teen pregnancy and sexually transmitted infection (STI) prevention programs in 2010. The results of a 5-year OAH study conducted in the state of Hawai'i with middle school youth has implications for school leaders in the selection and implementation of comprehensive sex education curricula yielding positive outcomes for youth. METHODS: A cluster randomized controlled trial was conducted across 34 middle school in the state of Hawai'i with 1783 student participants in pre-, post-, and 1-year follow-up surveys to determine effectiveness of a culturally responsive teen pregnancy prevention curriculum, called Pono Choices, specifically developed for youth in Hawai'i. RESULTS: Students receiving the Pono Choices curriculum had significantly higher rates of knowledge gains than students in control schools, although there were no statistically significant differences in initiation of sexual activity between the groups at the 1-year follow-up. Teachers implemented the curriculum at high rates of adherence to fidelity making this a model for implementation. CONCLUSIONS: Knowledge and retention of medically accurate teen pregnancy and STI prevention information can be attributed to implementation of a comprehensive program with attention to factors such as fidelity, program quality, engagement, and dosage.

Comparing women with and without disabilities in five-site "Healthy Weight" interventions for lesbian/bisexual women over 40.

BACKGROUND: Lesbian/bisexual women with physical disabilities (LBPD) are an under-studied population. OBJECTIVES: This study compared LBPD to LB women without physical disabilities as defined by the Americans with Disabilities Act on socio-demographic variables, health characteristics, and quality of life, physical activity, weight, and nutrition outcomes following a health intervention. METHODS: Data came from the Healthy Weight in Lesbian and Bisexual Women Study (HWLB) where 376 LB women were recruited into five geographically dispersed interventions. Baseline data were examined to compare women with and without physical disabilities as defined by the ADA, and pre/post intervention data were analyzed for differences in treatment outcomes including quality of life, physical activity, nutrition, and body size. RESULTS: Compared to women without disability, LBPD were more likely to be bisexual or another sexual identity than lesbian, single, report poor or fair health status, postmenopausal, and had a higher body mass index and waist circumference to height ratio. LBPD women were less likely to work and to drink heavily, and reported reduced physical and mental health quality of life. In spite of these differences, after the intervention, LBPD had similar outcomes to women without disabilities on most measures, and were more likely to show improvements in physical quality of life and consumption of fruits/vegetables. CONCLUSIONS: Although different from women without disabilities on many socio-demographic and health variables at baseline, the study suggests that LBPD have similar outcomes to women without disabilities, or may even do better, in group health interventions.

Culturally Responsive Adolescent Pregnancy and Sexually Transmitted Infection Prevention Program for Middle School Students in Hawai'i.

OBJECTIVES: To evaluate the effectiveness of Pono Choices, a culturally responsive adolescent pregnancy and sexually transmitted infection (STI) prevention program targeting middle school youths in Hawai'i. METHODS: We conducted a cluster randomized controlled trial with the school as the unit of random assignment over 3 semesters between 2012 and 2013. The sample consisted of 36 middle schools and 2203 students. We administered student surveys to collect baseline outcomes, student demographic data, and outcomes at 12 months after baseline. RESULTS: We found statistically significant effects for the knowledge assessment, which focused on basic understanding of adolescent pregnancy and STI prevention. The average percentage of correct responses was 73.6 for the treatment group and 60.4 for the control group (P < .001). We did not find statistically significant effects on behavioral outcomes (initiation of sexual activity or engagement in high-risk sexual behavior) or on other nonbehavioral outcomes (attitudes, skills, intentions). CONCLUSIONS: Pono Choices had a statistically significant impact on knowledge of adolescent pregnancy and STI prevention among middle school students at 12 months after baseline, though it did not lead to detectable changes in behavioral outcomes within the 1-year observation period. These results call for an exploration of longer-term outcomes to assess effects on knowledge retention and behavioral changes.

Healthy Weight in Lesbian and Bisexual Women Aged 40 and Older: An Effective Intervention in 10 Cities Using Tailored Approaches.

BACKGROUND: Lesbian and bisexual women are more likely to be overweight or obese than heterosexual women, leading to increased weight-related health risks. METHODS: Overweight women aged 40 or older who self-identified as lesbian, bisexual, or "something else" participated in five pilot interventions of 12 or 16 weeks' duration. These tailored interventions took place at lesbian and bisexual community partner locations and incorporated weekly group meetings, nutrition education, and physical activity. Three sites had non-intervention comparison groups. Standardized questionnaires assessed consumption of fruits and vegetables, sugar-sweetened beverages, alcohol, physical activity, and quality of life. Weight and waist-to-height ratio were obtained through direct measurement or self-report. ANALYTICAL PLAN: Within-person changes from pre-intervention to post-intervention were measured using paired comparisons. Participant characteristics that influenced the achievement of nine health objectives were analyzed. Achievement of health objectives across three program components (mindfulness approach, gym membership, and pedometer use) was compared with the comparison group using generalized linear models. RESULTS: Of the 266 intervention participants, 95% achieved at least one of the health objectives, with 58% achieving three or more. Participants in the pedometer (n = 43) and mindfulness (n = 160) programs were more likely to increase total physical activity minutes (relative risk [RR], 1.67; 95% confidence interval [CI], 1.18-2.36; p = .004; RR, 1.38; 95% CI, 1.01-1.89; p = .042, respectively) and those in the gym program (n = 63) were more likely to decrease their waist-to-height ratio (RR, 1.89; 95% CI, 0.97-3.68, p = .06) compared with the comparison group (n = 67). CONCLUSION: This effective multisite intervention improved several healthy behaviors in lesbian and bisexual women and showed that tailored approaches can work for this population.

Use of Maryland Biological Stream Survey data to determine effects of agricultural riparian buffers on measures of biological stream health.

This study was undertaken to determine the importance of riparian buffers to stream ecology in agricultural areas. The original Maryland Biological Stream Survey (MBSS) data set was partitioned to represent agricultural sites in Maryland's Coastal Plain and Piedmont regions. ANOVA, multiple linear regression (MLR), and CART regression tree models were developed using riparian and site catchment landscape characteristics. MBSS data were both stratified by physiographic region and analyzed as a combined data set. All models indicated that land management at the site was not the controlling factor for fish IBIs (FIBI) at that site and, hence, using FIBI to evaluate site-scale factors would not be a prudent procedure. Measures of instream habitat and location in the stream network were the dominant explanatory factors for FIBI models. Both CART and MLR models indicated that forest buffers were influential on benthic IBIs (BIBI). Explanatory variables reflected instream conditions, adjacent landscape influence, and chemistry in the Coastal Plains sites, all of which are relatively site specific. However, for Piedmont sites, hydrologic factors were important, in addition to adjacent landscape influence, and chemistry. Both Coastal Plain and Piedmont CART models identified several hydrologic factors, emphasizing the dominant control of hydrology on the physical habitat index (PHI). Riparian buffers were a secondary influence on PHI in the Coastal Plain, but not in the Piedmont. Between 40% and 70% of the variation in FIBI, BIBI, and PHI was explained by the "easily obtainable" variables available from the MBSS data set. While these are empirical results specific to Maryland, the general findings are of use to other locations where the establishment of forest buffers is considered as an aquatic ecosystem restoration measure.