The Federal Trade Commission's mandated Four Loko labeling fails to facilitate accurate estimation of alcohol content by college students.

BACKGROUND: Four Loko, the leading supersized alcopop brand, is a pre-mixed alcoholic beverage containing up to 5.5 standard alcoholic drinks in a can. In 2013, the Federal Trade Commission (FTC) mandated the addition to Four Loko cans of a label indicating its alcohol content in standard drinks, presented as "alcohol per serving" and "servings per container." OBJECTIVE: The current study investigated whether college students accurately estimate the alcohol content in cans of Four Loko bearing the FTC mandated labels. METHOD: Undergraduate student drinkers (n = 833; 51.6% women) in three states (Florida, Montana, and Virginia) were provided an empty Watermelon Four Loko can and asked to determine the number of standard drinks it contained, using 12-ounce regular beer (Budweiser) equivalents. In Florida and Virginia, Watermelon Four Loko contains 4.70 standard alcoholic drinks; in Montana, it contains 3.13. RESULTS: More than 60% of Florida students and more than 70% of Virginia students underestimated Four Loko's alcohol content by one or more standard drinks, compared to 45% of Montana students. Multivariable logistic regression analysis found the following variables were associated with greater odds of underestimating Four Loko's alcohol content by one or more standard alcoholic drinks: being female (AOR = 2.2), having never seen nor heard of Four Loko (AOR = 1.9), and residing in Florida (AOR = 1.7) or Virginia (AOR = 2.8) versus Montana. CONCLUSIONS: Students were far less likely to underestimate alcohol content for 8% alcohol-by-volume (abv) cans compared to those with higher alcohol concentrations. Thus, policies restricting supersized alcopops' abv may help consumers better estimate their alcohol content.

Underage drinkers' first experience consuming a popular brand of supersized alcopop.

BACKGROUND: Supersized alcopops are sugar sweetened beverages with high alcohol concentration; Four Loko is the most commonly consumed brand among underage drinkers. OBJECTIVES: The current study examined the prevalence and correlates of Four Loko consumption, as well as drinking location, beverage source, quantity consumed, and alcohol-related consequences among students who consumed the product before age 21. METHODS: Undergraduate drinkers (n = 1,019; 53.5% female) attending public universities in Florida, Montana, and Virginia completed a classroom survey. Multivariable logistic regression models examined first-time Four Loko experiences among students under age 21 at the time of the drinking episode (n = 336). RESULTS: Among drinkers, 46% had consumed Four Loko. The vast majority (93%) drank the product before age 21. During their first Four Loko drinking episode, 57% consumed at least one can and 10% drank two or more cans. Among underage drinkers, being male (AOR = 6.8), paying for the Four Loko (AOR = 3.1), and earlier age of alcohol initiation (AOR = 0.8) were associated with greater odds of drinking at least one can. Among underage drinkers who finished at least one can, 36% blacked out and 21% vomited. The odds of blacking out and vomiting were greater if the participant drank at least one can (AOR = 6.0, AOR = 4.0). Students in states that sold Four Loko with higher alcohol-by-volume were more likely to blackout (AOR = 2.0) and vomit (AOR = 2.5). CONCLUSIONS: Delaying the age of first alcohol use may have protective effects on supersized alcopop consumption. Increased enforcement of existing laws is needed to prevent underage access to Four Loko. Further, laws that reduce the alcohol content of Four Loko may reduce negative consequences associated with its consumption.

Racial/Ethnic Differences in the Effectiveness of a Multisector Childhood Obesity Prevention Intervention.

OBJECTIVES: To investigate racial/ethnic and language differences in the effectiveness of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study among children aged 2 to 4 years enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). METHODS: We performed a multisector quasiexperimental study in 2 MA-CORD intervention communities and 1 comparison community. Using WIC data from 2010 to 2015, we examined intervention effect on child weight and behavior outcomes by child race/ethnicity and parental primary language using multilevel linear regression models with an interaction term. RESULTS: Non-Hispanic Black children exposed to the intervention demonstrated a greater decrease in body mass index (BMI) than did other children (P < .05). Racial/ethnic minority children in the comparison site had greater increases in BMI than did their White counterparts (P < .05). There were no differences in intervention effectiveness by race/ethnicity or language for health behaviors. CONCLUSIONS: White children demonstrated decreased BMI in both the intervention and control groups. However, intervention minority children demonstrated greater improvements in BMI than did control minority children. Public Health Implications. To reduce racial/ethnic disparities, we need to disseminate effective obesity prevention interventions during early childhood in low-income settings.

Public health 101 nanocourse: a condensed educational tool for non-public health professionals.

Graduate students and postdoctoral fellows-including those at the Harvard School of Public Health (HSPH)-have somewhat limited opportunities outside of traditional coursework to learn holistically about public health. Because this lack of familiarity could be a barrier to fruitful collaboration across disciplines, HSPH postdocs sought to address this challenge. In response, the Public Health 101 Nanocourse was developed to provide an overview of five core areas of public health (biostatistics, environmental health sciences, epidemiology, health policy and management, and social and behavioral sciences) in a two half-day course format. We present our experiences with developing and launching this novel approach to acquainting wider multidisciplinary audiences with the field of public health.

Occupational injury among hospital patient-care workers: what is the association with workplace verbal abuse?

OBJECTIVE: To test the association between workplace abuse exposure and injury risk among hospital workers. We hypothesized that exposed workers would have higher injury rates than unexposed workers. METHODS: Survey of direct-care workers (n = 1,497) in two hospitals. Exposure to workplace abuse was assessed through self-report; occupational injury reports were extracted from employee records. We tested associations between non-physical workplace violence and injury using log-binomial regression and multilevel modeling. RESULTS: Adjusted prevalence ratio (PR) for injury associated with being yelled at was 1.52 (95% CI 1.19, 1.95); for experiencing hostile/offensive gestures 1.43 (1.11, 1.82); and for being sworn at 1.41 (1.09, 1.81). In analyses by injury subtypes, musculoskeletal injuries were more strongly associated with abuse than were acute traumatic injuries. Associations operated on group and individual levels and were most consistently associated with abuse perpetrated by patients. CONCLUSION: Exposure to workplace abuse may be a risk factor for injuries among hospital workers.

Adverse outcomes and an immunosuppressed endotype in septic patients with reduced IFN-γ ELISpot.

BACKGROUNDSepsis remains a major clinical challenge for which successful treatment requires greater precision in identifying patients at increased risk of adverse outcomes requiring different therapeutic approaches. Predicting clinical outcomes and immunological endotyping of septic patients generally relies on using blood protein or mRNA biomarkers, or static cell phenotyping. Here, we sought to determine whether functional immune responsiveness would yield improved precision.METHODSAn ex vivo whole-blood enzyme-linked immunosorbent spot (ELISpot) assay for cellular production of interferon γ (IFN-γ) was evaluated in 107 septic and 68 nonseptic patients from 5 academic health centers using blood samples collected on days 1, 4, and 7 following ICU admission.RESULTSCompared with 46 healthy participants, unstimulated and stimulated whole-blood IFN-γ expression was either increased or unchanged, respectively, in septic and nonseptic ICU patients. However, in septic patients who did not survive 180 days, stimulated whole-blood IFN-γ expression was significantly reduced on ICU days 1, 4, and 7 (all P < 0.05), due to both significant reductions in total number of IFN-γ-producing cells and amount of IFN-γ produced per cell (all P < 0.05). Importantly, IFN-γ total expression on days 1 and 4 after admission could discriminate 180-day mortality better than absolute lymphocyte count (ALC), IL-6, and procalcitonin. Septic patients with low IFN-γ expression were older and had lower ALCs and higher soluble PD-L1 and IL-10 concentrations, consistent with an immunosuppressed endotype.CONCLUSIONSA whole-blood IFN-γ ELISpot assay can both identify septic patients at increased risk of late mortality and identify immunosuppressed septic patients.TRIAL REGISTRYN/A.FUNDINGThis prospective, observational, multicenter clinical study was directly supported by National Institute of General Medical Sciences grant R01 GM-139046, including a supplement (R01 GM-139046-03S1) from 2022 to 2024.

What circumstances prompt a workplace discussion in medical evaluations for back pain?

PURPOSE: To determine how frequently workplace topics emerge in the interactions between patients and providers in an evaluation for low back pain (LBP) and to determine its association with patient and provider characteristics. METHODS: Adults with work-related LBP (N = 97; 64 % male; median age = 38) completed a demographic questionnaire and a survey of disability risk factors, then agreed to audio-taping of their visits with a participating occupational healthcare provider (n = 14). Utterance-level verbal exchanges were categorized by trained coders using the Roter interaction analysis system. In addition, coders flagged any instance of workplace discussion between patients and providers. RESULTS: Workplace discussions occurred in 51 % of visits, and the most frequent topic was physical job demands. Workplace discussions were more frequent among the oldest and youngest patients and when patients were seen by providers who were more patient-centered and made more efforts to establish patient rapport and engagement. However, patients reporting numerous disability risk factors and workplace concerns in the pre-visit questionnaire were no more likely to discuss workplace topics with their providers (p > 0.05). Only the patient-centered orientations of providers and patients remained statistically significant predictors in multivariate modeling (p < 0.05). CONCLUSIONS: Workplace discussions are facilitated by a patient-centered orientation and by efforts to establish patient engagement and rapport, but workplace discussions are no more frequent among patients with the most significant workplace concerns. Screening questionnaires and other assessment tools may be helpful to foster workplace discussions to overcome possible barriers for returning to work.

Adverse Long-Term Outcomes and an Immune Suppressed Endotype in Sepsis Patients with Reduced Interferon-γELISpot: A Multicenter, Prospective Observational Study.

BACKGROUND: Sepsis remains a major clinical challenge for which successful treatment requires greater precision in identifying patients at increased risk of adverse outcomes requiring different therapeutic approaches. Predicting clinical outcomes and immunological endotyping of septic patients has generally relied on using blood protein or mRNA biomarkers, or static cell phenotyping. Here, we sought to determine whether functional immune responsiveness would yield improved precision. METHODS: An ex vivo whole blood enzyme-linked immunosorbent (ELISpot) assay for cellular production of interferon-γ (IFN-γ) was evaluated in 107 septic and 68 non-septic patients from five academic health centers using blood samples collected on days 1, 4 and 7 following ICU admission. RESULTS: Compared with 46 healthy subjects, unstimulated and stimulated whole blood IFNγ expression were either increased or unchanged, respectively, in septic and nonseptic ICU patients. However, in septic patients who did not survive 180 days, stimulated whole blood IFNγ expression was significantly reduced on ICU days 1, 4 and 7 (all p<0.05), due to both significant reductions in total number of IFNγ producing cells and amount of IFNγ produced per cell (all p<0.05). Importantly, IFNγ total expression on day 1 and 4 after admission could discriminate 180-day mortality better than absolute lymphocyte count (ALC), IL-6 and procalcitonin. Septic patients with low IFNγ expression were older and had lower ALC and higher sPD-L1 and IL-10 concentrations, consistent with an immune suppressed endotype. CONCLUSIONS: A whole blood IFNγ ELISpot assay can both identify septic patients at increased risk of late mortality, and identify immune-suppressed, sepsis patients.

Assessing the relationship between work-family conflict and smoking.

OBJECTIVES: We examined the relationship between smoking and work-family conflict among a sample of New England long-term-care facility workers. METHODS: To collect data, we conducted in-person, structured interviews with workers in 4 extended-care facilities. RESULTS: There was a strong association between smoking likelihood and work-family conflict. Workers who experienced both stress at home from work issues (i.e., work-to-home conflict) and stress at work from personal issues (i.e., home-to-work conflict) had 3.1 times higher odds of smoking than those who did not experience these types of conflict. Workers who experienced home-to-work conflict had an odds of 2.3 compared with those who did not experience this type of conflict, and workers who experienced work-to-home conflict had an odds of 1.6 compared with workers who did not experience this type of conflict. CONCLUSIONS: The results of this study indicate that there is a robust relationship between work-family conflict and smoking, but that this relationship is dependent upon the total amount of conflict experienced and the direction of the conflict.

Using a Social Determinants of Health Summary Measure to Predict General Health Status in the BRFSS.

PURPOSE: This study aims to assess the relationship between social determinants of health (SDoH) burden and overall health. DESIGN: Three years of Behavioral Risk Factor Surveillance System (BRFSS) data (2017-2019) were combined for this cross-sectional study. SETTING: Massachusetts. SUBJECTS: Out of a possible 21,312 respondents, 16,929 (79%) were eligible for inclusion. MEASURES: To create the SDoH summary measure, items assessing social risk experiences including financial instability (1 item), housing instability (2 items), perceptions of neighborhood crime (1 item), and food insecurity (2 items) were summed to create a count of risk experiences. Outcome measures included self-rated general health, days of poor physical health, and days of poor mental health. ANALYSIS: Multivariable logistic regression was used to evaluate the association between each outcome and the SDoH summary measure, adjusting for demographic confounders. RESULTS: In adjusted analyses, respondents who reported experiencing 1, 2, 3, or 4+ SDoH had a 1.6 (95% CI: 1.3-2.0), 2.9 (95% CI: 2.3-3.7), 3.2 (95% CI: 2.4-4.3), or 5.3 (95% CI: 4.0-7.0) increased odds (respectively) of self-rated fair/poor health, compared to those who reported zero SDoH. The adjusted relationship between the SDoH summary measure and physical health and mental health was similar in magnitude and statistically significant. CONCLUSIONS: These results demonstrate that the overall burden of risk due to SDoH is an important predictor of health.

Effect of pulsed-xenon ultraviolet light on environmental contamination and risk of health care worker hand contamination.

In this study, we conducted a prospective survey of a convenience sample of high touch objects using adenosine triphosphate bioluminescence surface sample readings, aerobic cultures, and gloved hand methicillin-resistant Staphylococcus aureus imprint cultures to assess inpatient room cleanliness. We demonstrated that thoroughness of cleaning is improved with housekeeping education and feedback and that the addition of automated decontamination with pulsed UV irradiation provides further benefit in decontamination and subsequent risk for health care worker hand contamination.

Nutrition provider confidence in the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study.

OBJECTIVE: The multi-sector, multi-level Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study resulted in improvements in obesity risk factors among children age 2-4 years enrolled in the Special Supplemental Nutrition program for Women, Infants, and Children (WIC). The goal of this study was to examine whether the MA-CORD intervention increased WIC provider confidence in their ability to identify childhood obesity and obesity-related behaviors. METHODS: As part of the MA-CORD intervention conducted from 2012 to 2015, we implemented WIC practice changes focused on childhood obesity prevention within two Massachusetts communities. We examined changes in provider confidence to assess childhood obesity risk factors and practice frequency among WIC practices located in MA-CORD intervention communities over a 3-year period, compared to non-intervention sites. We measured provider confidence on a continuous scale using questions previously developed to assess provider and parent confidence to make weight-related behavior change (range 0 to 24). RESULTS: There were 205 providers at baseline and 165 at follow-up. WIC providers at intervention sites reported greater confidence in their ability to identify childhood obesity and obesity-related behaviors compared to the usual care sites (ß = 1.01, standard error = 0.13). These findings persisted after adjusting for provider gender, years in practice, highest education level, and WIC position. CONCLUSIONS: The MA-CORD intervention was associated with increased WIC provider confidence to assess children's obesity risk. Interventions that increase confidence in assessing obesity-related behaviors may have salutary effects within WIC programs that serve low-income families.

Early Return to Work Has Benefits for Relief of Back Pain and Functional Recovery After Controlling for Multiple Confounds.

OBJECTIVE: The aim of the study was to evaluate the effect on health outcomes of an early or immediate return-to-work (RTW) after acute low back pain (LBP). METHODS: A longitudinal cohort of workers (N = 557) consulting for uncomplicated LBP were assessed on demographic, pain, occupational, and psychosocial variables. Pain and function were assessed at 3-month postpain onset. We tested the longitudinal effects of an early RTW on 3-month outcomes. RESULTS: Pain and function improved more rapidly for workers with an immediate (30.7%) or early (1 to 7 days) RTW (36.8%). Eleven demographic, health, or workplace variables were identified as potential confounds, but controlling for these factors only partially attenuated the benefits of an early RTW. CONCLUSIONS: An early RTW improves acute LBP and functional recovery, and alternate confounding explanations only partially eclipse this therapeutic effect.

Rationale and design of the Clinic and Community Approaches to Healthy Weight Randomized Trial.

BACKGROUND: Recent studies have demonstrated the effectiveness of family-centered, pediatric weight management programs in reducing childhood obesity. Yet, programs to optimize the care of low-income children with obesity are needed. We sought to examine the comparative effectiveness of two, potentially scalable pediatric weight management programs delivered to low-income children in a clinical or community setting. MATERIALS AND METHODS: The Clinic and Community Approaches to Healthy Weight Trial is a randomized trial in two communities in Massachusetts that serve a large population of low-income children and families. The two-arm trial compares the effects of a pediatric weight management program delivered in the Healthy Weight Clinics of two federally qualified health centers (FQHC) to the Healthy Weight and Your Child programs delivered in two YMCAs. Eligible children are 6 to 12 years old with a body mass index (BMI) ≥ 85th percentile seen in primary care at the two FQHCs. Both programs are one-year in duration and have at least 30 contact hours throughout the year. Measures are collected at baseline, 6 months, and 1 year. The main outcome is 1-year change in BMI (kg/m2) and percent change of the 95th percentile (%BMIp95). CONCLUSION: The Clinic and Community Approaches to Healthy Weight Trial seeks to 1) examine the comparative effects of a clinical and community based intervention in improving childhood obesity, and 2) inform the care of >7 million children with obesity covered by the Children's Health Insurance Program or Medicaid.

Use of chronic care model elements is associated with higher-quality care for diabetes.

PURPOSE: In 30 small, independent primary care practices, we examined the association between clinician-reported use of elements of the Chronic Care Model (CCM) and diabetic patients' hemoglobin A(1c) (HbA(1c)) and lipid levels and self-reported receipt of care. METHODS: Ninety clinicians (60 physicians, 17 nurse-practitioners, and 13 physician's assistants) completed a questionnaire assessing their use of elements of the CCM on a 5-point scale (never, rarely, occasionally, usually, and always). A total of 886 diabetic patients reported their receipt of various diabetes care services. We computed a clinical care composite score that included patient-reported assessments of blood pressure, lipids, microalbumin, and HbA(1c); foot examinations; and dilated retinal examinations. We computed a behavioral care composite score from patient-reported support from their clinician in setting self-management goals, obtaining nutrition education or therapy, and receiving encouragement to self-monitor their glucose. HbA(1c) values and lipid profiles were obtained by independent laboratory assay. We used multilevel regression models for analyses to account for the hierarchical nature of the data. RESULTS: Clinician-reported use of elements of CCM was significantly associated with lower HbA(1c) values (P = .002) and ratios of total cholesterol to high-density lipoprotein cholesterol (P = .02). For every unit increase in clinician-reported CCM use (eg, from "rarely" to "occasionally"), there was an associated 0.30% reduction in HbA(1c) value and 0.17 reduction in the lipid ratio. Clinician use of the CCM elements was also significantly associated with the behavioral composite score (P = .001) and was marginally associated with the clinical care composite score (P = .07). CONCLUSIONS: Clinicians in small independent primary care practices are able to incorporate elements of the CCM into their practice style, often without major structural change in the practice, and this incorporation is associated with higher levels of recommended processes and better intermediate outcomes of diabetes care.

Reach, engagement, and retention in an Internet-based weight loss program in a multi-site randomized controlled trial.

BACKGROUND: Research increasingly supports the conclusion that well-designed programs delivered over the Internet can produce significant weight loss compared to randomized controlled conditions. Much less is known about four important issues addressed in this study: (1) which recruitment methods produce higher eHealth participation rates, (2) which patient characteristics are related to enrollment, (3) which characteristics are related to level of user engagement in the program, and (4) which characteristics are related to continued participation in project assessments. METHODS: We recruited overweight members of three health maintenance organizations (HMOs) to participate in an entirely Internet-mediated weight loss program developed by HealthMedia, Inc. Two different recruitment methods were used: personal letters from prevention directors in each HMO, and general notices in member newsletters. The personal letters were sent to members diagnosed with diabetes or heart disease and, in one HMO, to a general membership sample in a particular geographic location. Data were collected in the context of a 2x2 randomized controlled trial, with participants assigned to receive or not receive a goal setting intervention and a nutrition education intervention in addition to the basic program. RESULTS: A total of 2311 members enrolled. Bivariate analyses on aggregate data revealed that personalized mailings produced higher enrollment rates than member newsletters and that members with diabetes or heart disease were more likely to enroll than those without these diagnoses. In addition, males, those over age 60, smokers, and those estimated to have higher medical expenses were less likely to enroll (all P < .001). Males and those in the combined intervention were less likely to engage initially, or to continue to be engaged with their Web program, than other participants. In terms of retention, multiple logistic regressions revealed that enrollees under age 60 (P < .001) and those with higher baseline self-efficacy were less likely to participate in the 12-month follow-up (P = .03), but with these exceptions, those participating were very similar to those not participating in the follow-up. CONCLUSIONS: A single personalized mailing increases enrollment in Internet-based weight loss. eHealth programs offer great potential for recruiting large numbers of participants, but they may not reach those at highest risk. Patient characteristics related to each of these important factors may be different, and more comprehensive analyses of determinants of enrollment, engagement, and retention in eHealth programs are needed.

Key Organizational Characteristics for Integrated Approaches to Protect and Promote Worker Health in Smaller Enterprises.

OBJECTIVE: The aim of this study was to investigate relationships between worksite organizational characteristics (size, industrial sector, leadership commitment, and organizational supports) and integrated approaches to protecting and promoting worker health implemented in smaller enterprises. METHODS: We analyzed web-based survey data of Human Resource Managers at 114 smaller enterprises (<750 employees) to identify organizational factors associated with levels of integrated approaches among their worksites. RESULTS: The companies' mean integration score was 13.6 (SD = 9.6) of a possible 44. In multivariate analyses, having a safety committee (P = 0.035) and top leadership support for health promotion (HP) (P = 0.004) were positively associated with higher integration scores. CONCLUSIONS: Smaller enterprises in one U.S. region have relatively low levels of implementing integrated safety and promotion approaches. Having a safety committee and leadership support for HP may be important contributors to implementing integrated approaches in smaller enterprises.

Childhood obesity prevention in the women, infants, and children program: Outcomes of the MA-CORD study.

OBJECTIVE: To examine the extent to which a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) intervention improved BMI z scores and obesity-related behaviors among children age 2 to 4 years. METHODS: In two Massachusetts communities, practice changes in WIC were implemented as part of the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) initiative to prevent obesity among low-income children. One WIC program was the comparison. Changes in BMI z scores pre and post intervention and prevalence of obesity-related behaviors of WIC participants were assessed. Linear mixed models were used to examine BMI z score change, and logistic regression models were used to examine changes in obesity-related behaviors in each intervention site versus comparison over 2 years. RESULTS: WIC-enrolled children in both intervention sites (vs. comparison) had improved sugar-sweetened beverage consumption and sleep duration. Compared to the comparison WIC program (n = 626), no differences were observed in BMI z score among children in Intervention Site #1 (n = 198) or #2 (n = 637). In sensitivity analyses excluding Asian children, a small decline was observed in BMI z score (-0.08 units/y [95% confidence interval: -0.14 to -0.02], P = 0.01) in Intervention Site #2 versus comparison. CONCLUSIONS: Among children enrolled in WIC, the MA-CORD intervention was associated with reduced prevalence of obesity risk factors in both intervention communities and a small improvement in BMI z scores in one of two intervention communities in non-Asian children.

Clinical effectiveness of the massachusetts childhood obesity research demonstration initiative among low-income children.

OBJECTIVE: To examine the extent to which a clinical intervention resulted in reduced BMI z scores among 2- to 12-year-old children compared to routine practice (treatment as usual [TAU]). METHODS: The Massachusetts Childhood Obesity Research Demonstration (MA-CORD) project is a multifaceted initiative to prevent childhood obesity among low-income children. At the federally qualified community health centers (FQHCs) of two communities (Intervention Site #1 and #2), the following were implemented: (1) pediatric weight management training, (2) electronic decision supports for clinicians, (3) on-site Healthy Weight Clinics, (4) community health worker integration, and (5) healthful clinical environment changes. One FQHC in a demographically matched community served as the TAU site. Using electronic health records, we assessed BMI z scores and used linear mixed models to examine BMI z score change over 2 years in each intervention site compared to a TAU site. RESULTS: Compared to children in the TAU site (n = 2,286), children in Intervention Site #2 (n = 1,368) had a significant decline in BMI z scores following the start of the intervention (-0.16 units/y; 95% confidence interval: -0.21 to -0.12). No evidence of an effect was found in Intervention Site #1 (n = 111). CONCLUSIONS: The MA-CORD clinical interventions were associated with modest improvement in BMI z scores in one of two intervention communities compared to a TAU community.

Using RE-AIM metrics to evaluate diabetes self-management support interventions.

BACKGROUND: Current healthcare evidence relies on relatively narrow efficacy data to make decisions about program impact. This paper illustrates the application of impact indices derived from the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework that takes a broader perspective and includes issues important to decision makers, such as reach, adoption, and cost. METHODS: Composite RE-AIM indices that summarize impact and cost efficiency at the individual participant and setting levels are used to compare two different diabetes self-management support approaches. One study, the Diabetes Priority (DP) program, involved 886 diabetes patients from 30 primary care offices, and relied on usual clinical staff for program implementation. The other study, Diabetes Health Connection (DHC), involved 335 diabetes patients in both HMO and fee-for-service settings, and used health education staff. RESULTS: The DP performed better on the setting-level impact index, but the programs produced similar results on individual-level impact. The DP had a greater reach (50% vs 38%); was more effective at the initial follow-up (median effect size [ES]=0.23 vs 0.17); and had greater impact consistency across various populations. The DHC performed better on several indices, including higher physician office adoption (20% vs 6%) and staff adoption (79% vs 70%), and there was less variability among intervention staff on protocol implementation (median ES=0.0 vs 0.50). CONCLUSIONS: Greater use of indices focused on public health and external validity criteria could help identify programs most likely to have a meaningful impact on population health and to fit local settings and priorities.