Parent-Child communication about concussion: what role can the Centers for Disease Control and Prevention's HEADS UP concussion in youth sports handouts play?

BACKGROUND: Concussion education for parents/guardians (hereafter referred to as parents) has the potential to play an important role in youth athlete concussion safety. The goal of this study was to evaluate the impact of the Centers for Disease Control and Prevention's (CDC) HEADS UP handout on parent-child communication about concussion. METHODS: YMCA branches from 15 associations from across the United States were randomized to CDC HEADS UP intervention condition or education as usual control condition using a cluster randomization strategy. In the intervention condition, coaches shared parent- and athlete-specific handouts with parents and asked parents to share and discuss the athlete-specific handouts with their child. Generalized estimating equations, with repeated measures to account for the correlation among matched participants and YMCA associations, were employed. RESULTS: Multivariable analyses exploring the relationship between time (pre- and post-intervention) and communication showed that the percent of parents who talked to their child about concussion increased in the intervention group (aRR=1.33, 95% CI=1.22, 1.44), but not in the control group. CONCLUSION: CDC HEADS UP handouts help families talk about concussion safety. Sports organizations seeking to educate parents of athletes about concussion should consider using CDC HEADS UP handouts and following a similar dissemination strategy.

Raising Public Awareness of Clinical Trials: Development of Messages for a National Health Communication Campaign.

Clinical trials are essential for developing new and effective treatments and improving patient quality of life; however, many trials cannot answer their primary research questions because they fall short of their recruitment goals. This article reports the results of formative research conducted in two populations, the public and primary care physicians, to identify messages that may raise awareness and increase interest in clinical trials and be used in a national communication campaign. Results suggested that participants were primarily motivated to participate in clinical trials out of a self-interest to help themselves first. Messages illustrated that current treatments were tested via clinical trials, helped normalize trials as routine practices, and reduced concerns over trying something new first. Participants wanted messages that portray trials as state-of-the-art choices that offer some hope, show people like themselves, and are described in a clear, concise manner with actionable steps for them to take. The study revealed some differences in message salience, with healthy audiences exhibiting lower levels of interest. Our results suggest that targeted messages are needed, and that communication with primary health-care providers is an important and necessary component in raising patient awareness of the importance of clinical trials.

Overweight and Obesity in Local Media: An Analysis of Media Coverage in CDC-Funded Communities.

We conducted a content analysis of newspaper and television news coverage in Centers for Disease Control and Prevention (CDC) grantee locations from June 2011 through May 2013. After searching 2 databases for news stories related to overweight or obesity, we coded and analyzed stories for valence (how the author/reporter framed overweight and obesity control strategies), descriptors, causes and solutions, and populations mentioned. Of almost 3,000 stories analyzed, most had a neutral or positive valence, depicted overweight and obesity as epidemic, discussed individual causes and environmental solutions most frequently, and mentioned children most often. Earned media can be part of addressing overweight and obesity by emphasizing prevention and by emphasizing both environmental and individual causes and solutions.

Randomized Evaluation of Centers for Disease Control and Prevention HEADS UP Concussion Education Materials for Youth Sport Coaches.

The Centers for Disease Control and Prevention (CDC) HEADS UP youth sports coach materials are the most widely adopted form of concussion education for coaches across the United States-reaching millions of youth sports coaches over the last decade. These materials focus on concussion symptom identification, response, and management (e.g., return to school and sports), while also addressing the importance of communicating to athletes and their families about concussion safety. The purpose of this study was to assess the effectiveness of CDC HEADS UP materials on coach knowledge and communication with youth athletes about concussion safety. This is the first randomized control study of the CDC HEADS UP materials in real world youth sport conditions. Participants were 764 coaches at 15 YMCA associations. Cluster randomization was used to assign branches within associations to intervention (CDC HEADS UP) and control (treatment as usual) conditions. Coaches completed surveys prior to and at the end of the competitive season. Communication with athletes about concussion increased among coaches in the intervention group (adjusted risk ratio [aRR] = 1.24, 95% confidence interval [CI] = 1.14, 1.36) but not the control group (aRR = 1.09, 95% CI = 0.90, 1.31), in multi-variate analyses controlling for coach demographic characteristics and baseline communication practices. Concussion symptom knowledge and communication intentions also significantly increased in the intervention group but not in the control group. This study provides evidence that CDC HEADS UP materials increase the likelihood that youth sport coaches communicate with their athletes about concussion safety. As youth sports organizations increasingly mandate concussion education for coaches, CDC HEADS UP materials may be considered a leading resource for adoption and setting-relevant implementation.

Occasions, Locations, and Reasons for Consuming Sugar-Sweetened Beverages among U.S. Adults.

Frequent intake of sugar-sweetened beverages (SSBs) is associated with adverse health outcomes such as obesity, type 2 diabetes, and cardiovascular disease. Little is known about when, where, and why U.S. adults consume SSBs. This study, using data from an online survey distributed in 2021, examined the occasions, locations, and reasons for consuming SSBs and the characteristics of the adults who consume them. Nearly 7 of 10 adults reported consuming a SSB (1-6 times) in the past 7 days, and more than a third (38%) reported doing so once or more per day (on average). For comparative purposes, the sample was limited to adults who reported consuming SSBs within the last 7 days. Mealtimes were reported as the most frequent occasion for the intake of SSBs (43%) and SSBs were most often consumed at home (70%). Over half of respondents (56%) reported they consume SSBs because they enjoy the taste. Younger adults (18-34 years old) were more likely to consume SSBs in social settings than older adults (≥50 years old). Hispanic adults were less likely to consume SSBs at the beginning of the day compared to non-Hispanic White adults. Younger (18-34 years old) and middle-aged (35-49 years old) adults were more likely to consume SSBs in restaurants, at work, and in cars than older adults (≥50 years old). Women were less likely to consume SSBs at work than men. Hispanic adults were less likely to consume SSBs in cars than non-Hispanic White adults, while those earning USD 50,000-

Marketing Self-management Education: Lessons on Messaging and Framing.

Objective Self-management education (SME) refers to educational interventions that help individuals with chronic diseases maintain or improve their quality of life. To help increase SME participation, the US Centers for Disease Control and Prevention conducted audience research to assess feasibility of a campaign to market SME as a chronic disease management strategy and increase future receptivity to specific SME programs. Methods Twenty focus groups were conducted in 3 rounds across 8 cities with men and women ages 45-75 with a variety of, or multiple, chronic conditions. Data were analyzed to identify cross-cutting themes and assess differences by sex, race/ethnicity, and location. Results Findings revealed that although people with chronic disease are not aware of SME, it is feasible to deliver motivating messages about SME, and content need not be condition- or intervention-specific. Concepts viewed most positively by focus groups incorporated positive tone, empowering language, specific references to health, relatable images, and a website for more information. Conclusion This qualitative work suggests SME marketing strategies will be most effective by providing background information, framing messages positively, using clear relatable language, and making it easy for potential participants to find a program.

Attitudinal and contextual factors associated with discussion of sexual issues during adolescent health visits.

PURPOSE: To examine attitudinal and contextual factors associated with the occurrence of sexual health assessments during adolescent primary care visits. METHODS: A total of 313 primarily African-American youth aged 11-21 years from 16 community-based organizations in suburban Maryland and in New York City completed questionnaires focusing on sexually transmitted diseases (STD) and health care. The analysis examined the relationship of sexual activity, attitudes, and presence of the parent at the health care visit with discussion of three sexual health topics and testing for STD at the most recent health care visit. Data were analyzed using Chi-square tests and logistic regression. RESULTS: Overall, 74% of respondents reported that they had talked about at least one sexual health topic at their last health care visit but only 32% had discussed all three topics of sexual behavior, birth control, and STD. Females were more likely than males to discuss birth control although there were no gender differences in the overall likelihood of talking about a sexual health topic. Few adolescents initiated discussion of sexual issues. Positive attitudes toward discussing sexual issues with a provider and absence of a parent at the visit were independently associated with higher odds of discussing at least one sexuality topic and STD testing. CONCLUSIONS: Although relatively large numbers of adolescents in the sample received sexual health assessments, the proportion was below recommended guidelines. The opportunity to speak privately with a clinician and having positive attitudes about discussing sex with a doctor appear to be important influences on the receipt of sexual health assessments. Improving the quality of adolescent preventive care will require creating a health care environment that facilitates discussion of sexual health issues.

Reaching Youth With Sexually Transmitted Disease Testing: Building on Successes, Challenges, and Lessons Learned From Local Get Yourself Tested Campaigns.

Nine programs were funded across eight states in the United States to customize, implement, and evaluate local campaigns in support of the national Get Yourself Tested (GYT) campaign. Each program promoted chlamydia screening and treatment/referral to sexually active young women (aged 15-25 years) and their partners through accessible, free, or low-cost services. This article documents the strategies and outcomes of these local GYT campaigns, highlighting the diversity in which a national sexual health campaign is implemented at the local level and identifying challenges and successes. Nearly all (n = 7) programs involved target audience members in campaign development/implementation. Youth were linked to free or low-cost sexually transmitted disease testing through community centers, high schools and colleges, community and clinic events; online or text-based ordering of test kits; and community pickup locations. Sites used a combination of traditional and new media, on-the-ground activities, promotional products, and educational and social events to promote testing. With the exception of one site, all sites reported increases in the number of persons tested for chlamydia during campaign implementation, compared to baseline. Increases ranged from 0.5% to 128%. Successes included development of local partnerships, infrastructure, and capacity; use of peer leaders and involvement; and opportunities to explore new innovations. Challenges included use of social media/new technologies, timing constraints, limited organizational and evaluation capacity, and unforeseen delays/setbacks. Each of these issues is explored, along with lessons learned, with intent to inform future sexual health promotion efforts.

Health status and health service access and use among children in U.S. immigrant families.

OBJECTIVES: We examined the health status and patterns of health care use of children in US immigrant families. METHODS: Data from the 1999 National Survey of America's Families were used to create 3 subgroups of immigrant children: US-born children with noncitizen parents, foreign-born children who were naturalized US citizens, and foreign-born children with noncitizen parents. Chi-square and logistic regression analyses were used to examine relationships between immigrant status and health access variables. Subgroup analyses were conducted with low-income families. RESULTS: Foreign-born noncitizen children were 4 times more likely than children from native families to lack health insurance coverage and to have not visited a mental health specialist in the preceding year. They were 40% and 80% more likely to have not visited a doctor or dentist in the previous year and twice as likely to lack a usual source of care. US-born children with noncitizen parents were also at a disadvantage in many of these aspects of care. CONCLUSIONS: We found that, overall, children from immigrant families were in worse physical health than children from non-immigrant families and used health care services at a significantly lower frequency.

High caffeine intake in adolescents: associations with difficulty sleeping and feeling tired in the morning.

The objective of this study was to examine the association between caffeine usage in U.S. adolescents and the frequency that feeling tired in the morning and having difficulty sleeping is reported. In this study we found that feeling tired in the morning and having difficulty sleeping was experienced more commonly in those adolescents that have a high intake of caffeine.

A cost-effectiveness analysis of interventions to increase repeat testing in patients treated for gonorrhea or chlamydia at public sexually transmitted disease clinics.

BACKGROUND: Persons who have been infected with chlamydia or gonorrhea (CT/GC) are at elevated risk for reinfection. The cost-effectiveness of interventions designed to encourage public sexually transmitted disease (STD) clinic patients to return for rescreening has not been well-evaluated. GOAL: The goal of this study was to conduct a program- and societal-perspective cost-effectiveness analysis of five interventions designed to encourage public STD clinic patients infected with CT/GC to return for rescreening 3 months after initial treatment. STUDY: Researchers at two STD clinics collected cost data for the five interventions. These were combined with study data on return rates and CT/GC positivity rates among returning patients to compare the cost-effectiveness of the interventions. RESULTS: The cost per patient counseled with a brief recommendation to return, followed by a telephone reminder after 3 months, was higher than two interventions: a brief recommendation to return with no reminder and a $20 incentive, received on return. However, the brief recommendation with a telephone reminder yielded the highest return rate (33%) and was the least costly in terms of cost per infection treated ($622 program, $813 societal). In-depth motivational counseling that helped clients identify risk factors and provided reasons for returning was more costly than a phone reminder alone and was not more effective. CONCLUSIONS: Phone reminders are more cost-effective than motivational counseling and improve return rates over a brief recommendation given at the time of initial treatment.

Local school district adoption of state-recommended policies on HIV prevention education.

BACKGROUND: This study evaluated the extent to which school districts in Massachusetts adopted HIV education policies consistent with state education agency recommendations, and whether adoption of state-recommended policy language was associated with other core components of school-based HIV prevention programs such as staff development, curriculum, and implementation characteristics. METHODS: A census of health coordinators (n = 251) and high school HIV teachers (n = 174) in randomly selected schools in Massachusetts were surveyed. Chi-squares and analysis of variance (ANOVAs) were used to analyze data. RESULTS: Most districts' policies fully incorporated state-recommended language for training HIV teachers (62%), providing HIV education within comprehensive sexuality education (62%), and providing skills-based instruction (57%). Districts adopting state-recommended policies were significantly more likely to have trained more HIV teachers (82% vs. 59% of teachers trained; P < 0.001), provided HIV education to a greater percentage of students (90% vs. 50% of students educated; P < 0.001), and adopted research-based curricula (44% vs. 27%; P < 0.01). High school teachers who received training and those using research-based curricula covered more HIV prevention topics and used more skills-based instructional methods than those who did not receive training or did not use research-based curricula (P < 0.01). CONCLUSIONS: Results suggest that strong, state-level HIV prevention education policy recommendations can help shape local school health policy and, when adopted locally, can positively influence the reach and quality of HIV education.

A community-based intervention designed to increase preventive health care seeking among adolescents: the Gonorrhea Community Action Project.

OBJECTIVES: We evaluated the effectiveness of an intervention designed to increase preventive health care seeking among adolescents. METHODS: Adolescents and young adults aged 12 to 21 years, recruited from community-based organizations in 2 different communities, were randomized into either a 3-session intervention or a control condition. We estimated outcomes from 3-month follow-up data using logistic and ordinary least squares regression. RESULTS: Female intervention participants were significantly more likely than female control participants to have scheduled a health care appointment (odds ratio [OR]=3.04), undergone a checkup (OR=2.87), and discussed with friends or family members the importance of undergoing a checkup (OR=4.5). There were no differences between male intervention and male control participants in terms of outcomes. CONCLUSIONS: This theory-driven, community-based group intervention significantly increased preventive health care seeking among female adolescents. Further research is needed, however, to identify interventions that will produce successful outcomes among male adolescents.

Condom availability programs in Massachusetts high schools: relationships with condom use and sexual behavior.

OBJECTIVES: This study assessed relationships between condom availability programs accompanied by community discussion and involvement and adolescent sexual practices. METHODS: Sexual practice and condom use differences were assessed in a representative sample of 4166 adolescents enrolled in high schools with and without condom availability programs. RESULTS: Adolescents in schools where condoms were available were more likely to receive condom use instruction and less likely to report lifetime or recent sexual intercourse. Sexually active adolescents in those schools were twice as likely to use condoms, but less likely to use other contraceptive methods, during their most recent sexual encounter. CONCLUSIONS: The strategy of making condoms available, an indication of socioenvironmental support for condom use, may improve HIV prevention practices.

Comparison of methods to increase repeat testing in persons treated for gonorrhea and/or chlamydia at public sexually transmitted disease clinics.

BACKGROUND: Retesting 3 to 4 months after treatment for those infected with chlamydia and/or gonorrhea has been recommended. GOAL: We compared various methods of encouraging return for retesting 3 months after treatment for chlamydia or gonorrhea. STUDY: In study 1, participants were randomly assigned to: 1) brief recommendation to return, 2) intervention 1 plus $20 incentive paid at return visit, or 3) intervention 1 plus motivational counseling at the first visit and a phone reminder at 3 months. In study 2, participants at 1 clinic were randomly assigned to 4) intervention 1, 5) intervention 1 plus phone reminder, or 6) intervention 1 plus motivational counseling but no telephone reminder. RESULTS: Using multiple logistic regression, the odds ratios for interventions 2 and 3, respectively, compared with intervention 1 were 1.2 (95% confidence interval [CI], 0.6-2.5) and 2.6 (95% CI, 1.3-5.0). The odds ratios for interventions 5 and 6 compared with intervention 4 were 18.1 (95% CI, 1.7-193.5) and 4.6 (95% CI, 0.4-58.0). CONCLUSIONS: A monetary incentive did not increase return rates compared with a brief recommendation. A reminder phone call seemed to be the most effective method to increase return.