Evaluation of a Vaccine-Communication Tool for Physicians.

OBJECTIVES: To evaluate a Kaiser Permanente Northern California physician training tool entitled "Effective Communication without Confrontation" aimed at improving communication with vaccine-hesitant parents, building trust, and alleviating physician stress surrounding vaccination visits. STUDY DESIGN: Trainings were held May to July 2015. Pre- and post-training surveys assessed physician comfort and perceived effectiveness in communicating with vaccine-hesitant parents. We measured vaccination coverage at the 2-, 4-, and 6-month well-child visits, and days undervaccinated at 9 months of age. We compared vaccination rates before and after the training. RESULTS: Of 415 physicians who received training, 249 completed post-training surveys. Physicians reported that the training helped them feel "much more or more" comfortable talking with parents who are unsure (72.3%), want to delay (73.9%), or refuse (63.5%) vaccinations and "much more or more" effective at persuading parents who are unsure (67.5%) or want to delay vaccinations (61.4%). They reported feeling "the same or less" effective persuading parents who refuse vaccinations (66.3%). Vaccine coverage remained unchanged and high from before to after the training (95%-96%), as did parent satisfaction with his or her child's provider (4.73/5.00). CONCLUSIONS: The Effective Communication without Confrontation training did not increase vaccine coverage, but did improve physicians' comfort and perceived effectiveness communicating with most vaccine-hesitant parents and may help to ease potentially stressful vaccination visits.

Comparative Effectiveness of 2 Diabetes Prevention Lifestyle Programs in the Workplace: The City and County of San Francisco Diabetes Prevention Trial.

INTRODUCTION: Data on the comparative effectiveness of Diabetes Prevention Programs (DPPs) in the workplace are limited. METHODS: Between September 2015 and July 2016, employees of the City and County of San Francisco who were at risk for type 2 diabetes (N = 158) were randomly assigned to one of 2 DPP-derived programs recognized by the Centers for Disease Control and Prevention: an in-person YMCA-DPP (n = 78) or an online virtual lifestyle management DPP (VLM-DPP) offered through Canary Health (n = 80). The primary outcome was change in body weight assessed at 6 and 12 months. Follow-up ended in August 2017. RESULTS: Both the YMCA-DPP and VLM-DPP yielded a significant reduction in percentage body weight at 6 months. For the YMCA-DPP, mean percentage change at 6 months was -2.70% (95% confidence interval [CI], -3.91% to -1.48%) and at 12 months was -2.46% (95% CI, -4.24% to -0.68%). For the VLM-DPP, mean percentage change at 6 months was -2.41% (95% CI, -4.07% to -0.77%) and at 12 months was -1.59% (95% CI, -3.51% to 0.33%). The mean between-condition difference at 6 months was -0.25% (95% CI, -2.04% to 1.55%) and at 12 months was -0.84% (95% CI, -3.03% to 1.34%). No significant differences were observed between conditions. The YMCA-DPP had a slightly higher reduction in waist circumference than VLM-DDP at 6 months (mean between-condition difference -2.00 cm [95% CI, -4.24 to 0.25 cm]). Participant engagement, expressed as mean number of completed core program sessions, was significantly higher for the YMCA-DPP than the VLM-DPP. Participants of the YMCA-DPP completed an average of 10.2 sessions (95% CI, 9.0 to 11.4), and participants of the VLM-DPP completed an average of 5.9 sessions (95% CI, 4.7 to 7.1). The adjusted mean between-condition difference was 4.2 sessions (95% CI, 2.54 to 5.99). CONCLUSION: Both the YMCA-DPP and VLM-DPP yielded weight loss at 6 months, which was maintained at 12 months in the YMCA-DPP. The workplace may be an effective setting to offer DPPs.

Health Behavior Changes during the COVID-19 Pandemic: A Longitudinal Analysis among Children.

This longitudinal study compared children's health behaviors before the COVID-19 pandemic versus during the pandemic. This analysis examined the association between individual-level characteristics and health behavior change. Four prospective cohort studies in the Environmental influences on Child Health Outcomes (ECHO) Program contributed data. Children aged 4−12 years and their caregivers were recruited in California, Colorado, North Dakota, and New Hampshire. Dietary intake, physical activity, screen time, and sleep duration were assessed with questionnaires pre-pandemic and during the pandemic. The final sample included 347 children: 47% female and 62% non-Hispanic White. Compared with pre-pandemic, weekday screen time duration was higher during the pandemic (3.0 vs. 4.5 h, p < 0.001). Unadjusted increases in screen time duration differed by race and ethnicity: 1.3 h/day for non-Hispanic White children, 2.3 h/day for Hispanic children, and 5.3 h/day for non-Hispanic Black children. Overall, no changes occurred in sugar-sweetened beverage (SSB) intake (p = 0.26), discretionary food intake (p = 0.93), and physical activity (p = 0.15). Sleep duration increased by 30 min among children who did not meet sleep recommendations pre-pandemic. Child sex and maternal education level were not associated with health behavior change. The pandemic may have exacerbated disparities in some health behaviors. Families may need support to re-establish healthy routines.

Evaluation results from an active living intervention in Somerville, Massachusetts.

BACKGROUND: Community policies and programs can encourage active living and promote physical activity among residents. Somerville MA implemented an Active Living by Design project in 2003-2008 that promoted partnerships and advocacy to encourage physical activity. PURPOSE: To evaluate the Active Living by Design project implemented in Somerville. METHODS: A retrospective design assessed relative differences in the rates of meeting moderate or vigorous physical activity recommendations among middle- and high-school students and adults at baseline and follow-up within Somerville and at follow-up only in Everett MA, a comparison community. The middle- and high-school Youth Risk Behavior Surveys and the adult Behavioral Risk Factor Surveillance Survey were supplemented with Active Living by Design evaluation-specific questions at follow-up. Analyses included chi-square and logistic regression modeling to assess relationships. RESULTS: Approximately 1000 youth completed surveys at baseline and follow-up in Somerville and at follow-up in Everett. Similarly, adult residents completed surveys at baseline (n=1081) and follow-up in Somerville (n=644) and follow-up in Everett (n=608). Within Somerville, high school-aged students and adults were more likely to meet physical activity recommendations at follow-up after adjusting for demographic, health, and behavioral variables (OR=1.6 [95% CI=1.34, 1.92] and 2.36 [95% CI=2.29, 2.43], respectively). Between cities, Somerville adults were 1.47 (95% CI=1.37, 1.56) times more likely than Everett adults to meet physical activity recommendations. CONCLUSIONS: Community-based active living interventions may help residents meet physical activity recommendations. To improve community health, public health surveillance data can identify predictors of meeting physical activity recommendations that can be used to inform city policy and planning.