Implementation of a 2-for-1 Price Incentive for Fruits and Vegetables in a Grocery Retail Setting.

BACKGROUND AND PURPOSE: There is growing interest in expanding healthy eating interventions in the retail setting. The purpose of this study was to evaluate the implementation of a successful 2-for-1 price incentive for fruits and vegetables (F&V), including frozen and canned, that took place in partnership with a large chain grocery retailer in Maine. Intervention Approach. A randomized controlled trial (RCT) pilot study was conducted in 2015-2016, followed by a larger RCT in 2016-2017, to assess whether a supermarket double-dollar F&V incentive increased purchases of these items. EVALUATION METHODS: A convergent, parallel mixed-methods design was used to examine barriers and facilitators to implementing the interventions, using six implementation outcomes: acceptability, adoption, appropriateness, feasibility, implementation fidelity, and perceived cost. RESULTS: The intervention was deemed highly acceptable, appropriate, and feasible by shoppers, retailers, and researchers. The F&V discount had a high rate of initial adoption. There was a moderate degree of fidelity, which improved over time based on lessons learned from the pilot and applied to the subsequent RCT. Specific costs associated with implementation from the research perspective are reported. Implications for Practice, Policy, and Research. Partnerships between academic researchers and retailers can be an effective model for improving healthful purchases among shoppers. These findings are relevant for investigators, public health advocates, and retailers interested in implementing similar grocery retail-based interventions.

Improving care planning and coordination for service users with medical co-morbidity transitioning between tertiary medical and primary care services.

WHAT IS KNOWN ON THE SUBJECT?: Mental health service users with medical co-morbidity frequently experience difficulties accessing and receiving appropriate treatment in emergency departments. Service users frequently experience fragmented care planning and coordinating between tertiary medical and primary care services. Little is known about mental health nurses' perspectives about how to address these problems. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Emergency department clinicians' poor communication and negative attitudes have adverse effects on service users and the quality of care they receive. The findings contribute to the international evidence about mental health nurses' perspectives of service users feeling confused and frustrated in this situation, and improving coordination and continuity of care, facilitating transitions and increasing family and caregiver participation. Intervention studies are needed to evaluate if adoption of these measures leads to sustainable improvements in care planning and coordination, and how service users with medical co-morbidity are treated in emergency departments in particular. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Effective planning and coordination of care are essential to enable smooth transitions between tertiary medical (emergency departments in particular) and primary care services for service users with medical co-morbidity. Ongoing professional development education and support is needed for emergency department clinicians. There is also a need to develop an organized and systemic approach to improving service users' experience in emergency departments. ABSTRACT: Introduction Mental health service users with medical co-morbidity frequently experience difficulties accessing appropriate treatment in medical hospitals, and often there is poor collaboration within and between services. Little is known about mental health nurses' perspectives on how to address these problems. Aim To explore mental health nurses' perspectives of the experience of service users with medical co-morbidity in tertiary medical services, and to identify how to improve care planning and coordination for service users transitioning between tertiary medical and primary care services. Method Embedded within an experience-based co-design study, focus group discussions were conducted with 17 emergency department nurses and other clinicians, in Melbourne, Australia. Results Three main themes were abstracted from the data: feeling confused and frustrated, enhancing service users' transition and experience and involving families and caregivers. Participants perceived the service user experience to be characterized by fear, confusion and a sense of not being listened to. They highlighted that service users' transition and experience could be enhanced by facilitating transitions and improving coordination and continuity of care. They also emphasized the need to increase family and caregiver participation. Conclusion Our findings contribute to knowledge about improving the way service users are treated in emergency departments and improving care planning and coordination; in particular, facilitating transitions, improving coordination and continuity of care and increasing family and caregiver participation.

MADD victim impact panels and stages-of-change in drunk-driving prevention.

OBJECTIVE: To assess the additional effects of Mothers Against Drunk Driving (MADD) Victim Impact Panels (VIPs) over the effects of a DWI (driving while intoxicated) school, on (1) moving individuals through the stages-of-change toward not drinking while driving and (2) drunk-driving recidivism. METHOD: A randomized experiment with 813 (75% male) DWI offenders in New Mexico measured progress through the stages-of-change at pretest, posttest, 1-year follow-up and 2-year follow-up. In addition, drunk-driving recidivism over 2 years was measured from state driving records. Individuals were randomly assigned to a DWI school or a DWI school plus a MADD VIP. RESULTS: No significant difference in movement through the stages-of-change, or in recidivism, occurred between respondents in the DWI-school-only treatment, and those in the DWI school plus VIP treatment. CONCLUSIONS: There was no additional effect of the MADD VIP, a relatively emotional intervention, over that of the DWI school, a relatively informational approach, on DWI behavior (whether measured by stages-of-change or by DWI rearrest data) over the 2-year period following the two interventions.

Correlates of condom use stage of change: implications for intervention.

A telephone survey was used to collect data on attitudes, beliefs, and practices concerning condom use among 812 African Americans with regular sex partners and of reproductive age in Baltimore. Condom use was "staged" according to Prochaska's model of stage of behavioral change. Characteristics of the respondents' sexual relationships, peer characteristics, and demographic and psychosocial characteristics were examined for their association with the stage of condom use. Multiple logistic regression analysis revealed that a partner's reaction to condom use, condom use self-efficacy with the partner, condom use outcome expectancy with the partner, perceived partner risk, length of relationship, sterility, cohabitation, perceived vulnerability to HIV infection and perceived peer norms about condom use were each independently related to staged condom use. Gender differences in the relationship of these independent variables with stages of change were found. Implications for intervention include differential treatment by gender and stage of change. Couples should also be considered for intervention.

PIP: According to 1996 US Centers for Disease Control data, HIV/AIDS has become the second and third leading cause of death for Black and Hispanic women, respectively, in the US aged 25-44 years. The main risks for infection among minority women are IV drug use and sexual contact with IV drug users. Findings are presented from a telephone survey conducted to collect data on the attitudes, beliefs, and practices concerning condom use among 812 reproductive-age African Americans with regular sex partners in Baltimore. Condom use was "staged" according to Prochaska's model of stage of behavioral change, while characteristics of the respondents' sexual relationships, peer characteristics, and demographic and psychosocial characteristics were examined for their association with the stage of condom use. Multiple logistic regression analysis found that a partner's reaction to condom use, condom use self-efficacy with the partner, condom use outcome expectancy with the partner, perceived partner risk, length of relationship, sterility, cohabitation, perceived vulnerability to HIV infection, and perceived peer norms about condom use were each independently related to staged condom use. Gender differences in the relationship of those independent variables with stages of change were found. Implications for intervention include differential treatment by gender and stage of change. Couples should also be considered for intervention.

Stage of behavior change for condom use: the influence of partner type, relationship and pregnancy factors.

A theoretical model was used to examine the influence of relationship factors, pregnancy intentions, contraceptive behavior and other psychosocial characteristics on stages of behavior change in condom use among heterosexual black women of reproductive age. Data from an inner-city street survey compared women who were not contemplating condom use, women who were attempting to use condoms or had used them consistently for short periods of time, and those who had achieved long-term consistent use. Women's relationship with their main partner appears to be an important factor in understanding their use of condoms both with main partners and with other partners. For condom use with the main partner, factors such as emotional closeness and partner support were significant predictors of the likelihood that women would be attempting to use condoms rather than not contemplating use. Cohabitation and the belief that condom use builds trust were significant predictors of long-term consistent condom use. Having a regular or main partner was strongly associated with intentions to use condoms with other partners. Women who wanted to become pregnant were much less likely to intend to use condoms with their main partner, and women using oral contraceptives were less likely to be long-term consistent condom users.

PIP: This study examines the influence of five groups of factors on the stages of change in condom use among Black women in Baltimore, Maryland, in 1993. The stages of change included: precontemplation, contemplation, ready for action, action, and maintenance. Interviews were obtained from women aged 17-35 years in designated neighborhoods. The sample included 625 women equally divided among age groups 17-20 years, 20-24 years, and 25-35 years. 63% of the 625 women had a main sexual partner and 42% had other partners, of which 33% had a main partner and other partners. Most women with main partners were in the precontemplation stage (50%) and most women with other partners were in the maintenance stage (41%). Women with main and other partners were primarily in the maintenance stage (37%). Few were classified as being in the contemplation or action stages. Changes between the precontemplation stage and the middle stage are viewed as "developing intentions." Changes between the middle stage and maintenance stage are viewed as "using consistently." Condom use with a main partner was associated with all five groups of factors: demographic, social, pregnancy intentions, outcome expectations or HIV risk, and efficacy. Having a regular partner who supported condom use significantly increased the odds of developing intentions to use condoms and of using condoms consistently. Friends support of condom use and condom use among friends raised the odds of becoming a consistent condom user. Having two or more partners and having one or more HIV risk factors was positively associated with the likelihood of consistent condom use. The strongest effects on developing intentions to use condoms with a main partner were emotional closeness, partner support for condom use, and women's potential happiness if pregnancy was an outcome. Consistent condom use with a main partner was predicted best by cohabitation with the main partner, use of the pill at the last intercourse, and the belief in condoms as a means of building trust. Prediction among other partners was more difficult.

Interim outcomes for a community-based program to prevent perinatal HIV transmission.

The AIDS Prevention for Pediatric Life Enrichment (APPLE) project is a community-based program to prevent perinatal HIV infection by preventing infection in women. One project component tested a primary prevention model developed from principles of cognitive social learning theory which used street outreach and community-targeted small media materials to increase the use of condoms. Formative research was used to explore community perceptions about HIV/AIDS and to design media materials. Program evaluation employed a two-community, time series, quasi-experimental design. Annual street surveys samples individuals in areas where they were likely to encounter outreach workers. Baseline surveys found substantial pre-programmatic behavior change. After two years considerable APPLE name recognition (40%), contact with media materials (63%), and contact with outreach workers (36%) were found and norms reflecting social acceptability of condoms were more positive among women in the intervention community. Condom use at last sexual encounter rose in both communities but was significantly higher in the intervention community. Condom use also was higher among women who reported exposure to either small media or small media plus street outreach. Other self-reported HIV-prevention behaviors did not show change in the initial period.

AIDS and behavioural risk factors in women in inner city Baltimore: a comparison of telephone and face to face surveys.

STUDY OBJECTIVE: The study aimed to investigate the influence the mode of administration of a questionnaire (telephone or face to face) on reports of sexual behaviour and attitudes of HIV risk among woman of reproductive age. DESIGN: Two cross sectional surveys--one, a modified random digit dialing telephone survey, the second, a face to face street sample--were carried out by the same interviewers using similar questionnaires in the same neighbourhoods. SETTING AND PARTICIPANTS: Two socially deprived, inner city neighbourhoods of Baltimore City were assessed in early 1990 before a community health intervention was carried out in one of them. Women between 17 and 35 years were surveyed. MAIN RESULTS: Altogether 775 and 416 women in the target age group were interviewed by telephone and face to face methods: the response rates were 66.4% and 77% respectively. Telephone respondents tended to be older, had more education, were more often married, were less likely to live in subsidised housing, and were more likely to report HIV testing. The proportions of respondents who reported a previous abortion and had had a surgical sterilisation were higher among the telephone respondents (34.7% v 24.1% and 26.4% v 20.6%, respectively). With regard to sexual risk behaviour, the only statistically significant differences were found in the proportion who reported having used drugs (10.6% of the face to face v 2.4% of the telephone sample) or alcohol (30.5% v 16.3%) at last sexual intercourse. The observed method effect on these variables remained unchanged after adjusting for age, education, employment, and marital status. This effect was even stronger for a subgroup of face to face respondents who reported not having a telephone at home. The adjusted odds ratios for reporting alcohol consumption and use of drugs at the last sexual encounter in this group compared with the telephone respondents were 3.7 (2.1, 6.6) and 14.1 (5.7, 34.5) respectively. CONCLUSIONS: Despite the socioeconomic bias associated with the mode of data collection, there are only a few differences between the telephone and personal survey methods in reports of sexual behaviour. These differences are mostly concentrated in young women (under 20 years), and in a particularly socioeconomically deprived subgroup identified through telephone ownership.