Parental influence on urban adolescents' physical activity experience.

As important socializing agents of adolescents, parents may substantially influence adolescents' physical activity but their roles in adolescents' physical activity experience have not been sufficiently studied. Furthermore, there is a dearth of research on potential mechanisms through which parents may promote adolescents' positive physical activity experience. Using a longitudinal sample of 464 urban and primarily Hispanic and African American adolescents, this study examined the impact of parental support on adolescents' physical activity experience. Results of structural equation modeling showed that after controlling for adolescents' gender, body mass index, and perceived overall health, parental support positively affected adolescents' restructuring ability (i.e., ability to construct meaningful and satisfying activities during unpleasant experiences) and intrinsic motivation (i.e., activity participation driven by inherent interest and enjoyment) in physical activity, which in turn positively affected adolescents' physical activity experience. No significant gender differences were found in these relationships. Theoretical and practical implications are discussed.

Identifying appropriate comparison groups for health system interventions in the COVID-19 era.

Introduction: COVID-19 has created additional challenges for the analysis of non-randomized interventions in health system settings. Our objective is to evaluate these challenges and identify lessons learned from the analysis of a medically tailored meals (MTM) intervention at Kaiser Permanente Northwest (KPNW) that began in April 2020. Methods: We identified both a historical and concurrent comparison group. The historical comparison group included patients living in the same area as the MTM recipients prior to COVID-19. The concurrent comparison group included patients admitted to contracted non-KPNW hospitals or admitted to a KPNW facility and living outside the service area for the intervention but otherwise eligible. We used two alternative propensity score methods in response to the loss of sample size with exact matching to evaluate the intervention. Results: We identified 452 patients who received the intervention, 3873 patients in the historical comparison group, and 5333 in the concurrent comparison group. We were able to mostly achieve balance on observable characteristics for the intervention and the two comparison groups. Conclusions: Lessons learned included: (a) The use of two different comparison groups helped to triangulate results; (b) the meaning of utilization measures changed pre- and post-COVID-19; and (c) that balance on observable characteristics can be achieved, especially when the comparison groups are meaningfully larger than the intervention group. These findings may inform the design for future evaluations of interventions during COVID-19.

Examining the association of medical-dental integration with closure of medical care gaps among the elderly population.

BACKGROUND: The integration of medical and dental care in the dental setting offers a unique opportunity to close medical care gaps, such as providing immunizations and laboratory-based tests, compared with traditional nonintegrated settings. METHODS: We used a matched cohort study design among patients 65 years or older (n = 2,578) with an index dental visit to the Kaiser Permanente Northwest medical-dental integration (MDI) program from June 1, 2018, through December 31, 2019. MDI patients were matched 1:1 to non-MDI controls (n = 2,578) on 14 characteristics. The Kaiser Permanente Northwest MDI program focuses on closing 23 preventive (for example, flu vaccines) and disease management care gaps (for example, glycated hemoglobin testing) within the dental setting. The closure of all care gaps (yes versus no) was the outcome for the analysis. Multivariable logistic regression was used to evaluate the association between exposure to the MDI program and level of office integration (least, moderate, and most integration) with closure of care gaps. All data were obtained through Kaiser Permanente Northwest's electronic health record. RESULTS: MDI patients had significantly higher odds (odds ratio [OR], 1.46, 95% confidence interval [CI], 1.29 to 1.65) of closing all medical care gaps than non-MDI patients. Greater MDI integration was associated with significantly higher odds of gap closure compared with non-MDI (least integration: OR, 1.18, 95% CI, 1.02 to 1.37; moderate integration: OR, 1.70, 95% CI, 1.36 to 2.12; most integration: OR, 2.08, 95% CI, 1.73 to 2.50). CONCLUSIONS: Patients receiving dental care in an MDI program had higher odds of closing medical care gaps compared with similar patients receiving dental care in a non-MDI program. PRACTICAL IMPLICATIONS: MDI is effective at facilitating delivery of preventive and disease management medical services.

Evaluating the Effectiveness of Medical-Dental Integration to Close Preventive and Disease Management Care Gaps.

Background: The integration of medical care into the dental setting has been shown to facilitate the closure of care gaps among patients with unmet needs. However, little is known about whether program effectiveness varies depending on whether the care gap is related to preventive care or disease management. Materials and Methods: We used a matched cohort study design to compare closure of care gaps between patients aged 65+ who received care at a Kaiser Permanente Northwest (KPNW) Medical-Dental Integration (MDI) clinic or a non-MDI dental clinic between June 1, 2018, and December 31, 2019. The KPNW MDI program focuses on closing 12 preventive (e.g., flu vaccines) and 11 disease management care gaps (e.g., HbA1c testing) within the dental setting. Using the multivariable logistic regression, we separately analyzed care gap closure rates (yes vs. no) for patients who were overdue for: (1) preventive services only (n = 1,611), (2) disease management services only (n = 538), or (3) both types of services (n = 429), analyzing closure of each care gap type separately. All data were obtained through the electronic health record of KPNW. Results: The MDI patients had significantly higher odds of closing preventive care gaps (OR = 1.51, 95% CI = 1.30-1.75) and disease management care gaps (OR = 1.65, 95% CI = 1.27-2.15) than the non-MDI patients when they only had care gaps of one type or the other. However, no significant association was found between MDI and care gap closure when patients were overdue for both care gap types. Conclusions: Patients with care gaps related to either preventive care or disease management who received dental care in an MDI clinic had higher odds of closing these care gaps, but we found no evidence that MDI was helpful for those with both types of care gaps. Practical Implications: MDI may be an effective model for facilitating the delivery of preventive and disease management services, mainly when patients are overdue for one type of these services. Future research should examine the impact of MDI on long-term health outcomes.

Urban Adolescents' Physical Activity Experience, Physical Activity Levels, and Use of Screen-Based Media during Leisure Time: A Structural Model.

There is limited understanding of the relationship between physical activity and use of screen-based media, two important behaviors associated with adolescents' health outcomes. To understand this relationship, researchers may need to consider not only physical activity level but also physical activity experience (i.e., affective experience obtained from doing physical activity). Using a sample predominantly consisting of African and Latino American urban adolescents, this study examined the interrelationships between physical activity experience, physical activity level, and use of screen-based media during leisure time. Data collected using self-report, paper and pencil surveys was analyzed using structural equation modeling. Results showed that physical activity experience was positively associated with physical activity level and had a direct negative relationship with use of non-active video games for males and a direct negative relationship with use of computer/Internet for both genders, after controlling for physical activity level. Physical activity level did not have a direct relationship with use of non-active video games or computer/Internet. However, physical activity level had a direct negative association with use of TV/movies. This study suggests that physical activity experience may play an important role in promoting physical activity and thwarting use of screen-based media among adolescents.