Healthy Amistad: improving the health of people with severe mental illness.

Here, we report evaluation results of implementing a health promotion program for individuals with serious mental illnesses. Healthy Amistad aimed to address four behaviors: physical inactivity, nutrition choices, smoking, and seeking access to health care. The evaluation employed a mixed-method study design to assess changes in the health of individuals in the program. Process measures assessed the implementation of the program. A pre-post examination was used to compare data associated with behaviors. Data sources included the 2008 and 2009 annual surveys, clinical data, interviews for staff, interviews with members, and an on-site observation. Participants were staff and members of Amistad. Those involved with the Peer Patient Navigator lost weight; new physically active activities were being offered. A new salad bar and healthier menu was offered in the Amistad cafeteria. Interviews revealed that 11 members lost a total of 150 pounds. The percentage reporting visits to an emergency room more than once in the last 6 months decreased from 58% to 37%, the percentage calling the crisis line less often increased from 75% to 86%, and the percentage reporting that they had become more satisfied with their life since joining Amistad improved from 76% to 88%. Individuals with serious mental illnesses are benefiting from programs that focus on the mitigation of disease states manifested from issues with physical inactivity, nutrition, smoking, and health access. Evaluation of the Healthy Amistad program has shown a positive influence.

Trek across Maine 25th anniversary: a public health strategy to increase physical activity.

Could an annual event be an effective strategy to improve physical activity? Based on 25 years of data, we argue that it could be. Although there are eight recommended strategies to promote physical activity in the Community Guide, there is insufficient evidence for six others. Qualitative data collected from Trek Across Maine participants and other cause-specific events suggests that goal setting (i.e., individually adapted health behavior change) and family-based social support may be key factors in helping individuals become more physically active.

Healthy Maine Partnerships: policy and environmental changes.

BACKGROUND: Tobacco settlement funds were used to establish the Healthy Maine Partnerships (HMPs) to reduce tobacco use, increase physical activity, and improve nutrition through local policy and environmental change. CONTEXT: The HMP model is a progressive approach to public health. It provides for coordinated efforts between state and local partners for health promotion and disease prevention. Community coalitions, supported with funding and guidance by the state, are the basis for policy and environmental change. METHODS: The state awarded contracts and provided program guidance to foster policy and environmental change at the local level. The partnerships' efforts were assessed with a retrospective evaluation that consisted of 2 data collection periods conducted using the same tool. A survey booklet containing lists of possible environmental and policy changes was developed and mailed - once in 2005 and once in 2006 - to all 31 local partnership directors and school health coordinators who completed it. Additional data were collected from the local partnerships in the form of narrative reports required by their funder (Maine Center for Disease Control and Prevention). CONSEQUENCES: All local partnerships implemented policy or environmental interventions to address tobacco use, physical activity, and nutrition during the period covered by the surveys (July 2002-June 2005 [fiscal years 2003-2005]). Cumulatively, more than 4,600 policy or environmental changes were reported; tobacco use policies represent most changes implemented. A second round of HMP funding has since been secured. INTERPRETATION: Although the survey methodology had limitations, results suggest that much work has been accomplished by the local partnerships. Plans are to share success stories among partnerships, provide training, and continue to improve the public health infrastructure in Maine.

State diabetes prevention and control program participation in the Health Disparities Collaborative: evaluating the first 5 years.

BACKGROUND: Approximately 20.8 million people in the United States, or 7% of the population, have diabetes mellitus. Treatment for this disease costs Americans more than 130 billion dollars yearly, and it is the sixth leading cause of death. The prevalence of diabetes has grown substantially in recent decades and is expected to continue to rise. CONTEXT: The medically underserved and poor are at greater risk of developing diabetes and its complications than are other members of the U.S. population. The Health Resources and Services Administration makes health care resources and services available to economically disadvantaged populations through the Health Disparities Collaborative (HDC), a consortium formed to pool resources and services from state- and community-level donors. Since 1999, many of the Centers for Disease Control and Prevention's Division of Diabetes Translation State Diabetes Prevention and Control Programs (DPCPs) have joined the HDC to leverage resources and services. METHODS: The purpose of a 2004 evaluation was to examine the impact that DPCP involvement with the Collaborative had on aspects of diabetes care at Federally Qualified Health Centers (FQHCs). An electronic survey was administered to DPCP coordinators. They were asked about 1) their roles and experience as participants in the Collaborative; 2) the skills and expertise most useful in developing and maintaining an effective collaboration for improved health care for diabetes; 3) which DPCP contributions were viewed as being routine and which were perceived to be essential; 4) the effects of DPCP contributions on the use of the chronic care model under which FQHCs operate; and 5) which health systems improvements played the greatest role in enhancing components of the chronic care model. CONSEQUENCES: Most respondents identified themselves as DPCP coordinators with 3 years of experience in that position. Organizational skills, such as communication, leadership, conflict resolution, negotiation, and meeting management, were cited as necessary to develop and maintain collaborative partnerships. DPCP contributions to FQHCs were perceived to be training, technical assistance with clinical care and patient education, financial resources, linkages to other diabetes partners, educational materials, and improved linkages with community resources. INTERPRETATION: DPCPs contribute resources, skills, knowledge, and varied perspectives to the Collaborative that FQHCs may not have otherwise.

The Diabetes Detection Initiative: a pilot program of selective screening.

OBJECTIVE: To identify adults who might have undiagnosed type 2 diabetes. METHODS: Using social marketing methods, we identified the characteristics and preferences of the pilot communities. Risk assessment tests were developed to reflect these preferences. Clinics with registries provided quantitative evaluation data and all clinics shared qualitative data. RESULTS: Baseline and intervention period data showed that the number of newly detected cases of diabetes increased by 11.5 per month for the 8 registry clinics. CONCLUSION: Findings have advanced our understanding of screening by identifying ways of improving the identification of undiagnosed diabetes.

Chronic pain patients' perspectives of medical cannabis.

Medical cannabis (MC) is used for a variety of conditions including chronic pain. The goal of this report was to provide an in-depth qualitative exploration of patient perspectives on the strengths and limitations of MC. Members of MC dispensaries (N = 984) in New England including two-thirds with a history of chronic pain completed an online survey. In response to "How effective is medical cannabis in treating your symptoms or conditions?," with options of 0% "no relief" to 100% "complete relief," the average was 74.6% ± 0.6. The average amount spent on MC each year was $3064.47 ± 117.60, median = $2320.23, range = $52.14 to $52,140.00. Open-ended responses were coded into themes and subthemes. Analysis of answers to "What is it that you like most about MC?" (N = 2592 responses) identified 10 themes, including health benefits (36.0% of responses, eg, "Changes perception and experience of my chronic pain."), the product (14.2%, eg, "Knowing exactly what strain you are getting"), nonhealth benefits (14.1%), general considerations (10.3%), and medications (7.1%). Responses (N = 1678) to "What is it that you like least about MC?" identified 12 themes, including money (28.4%, eg, "The cost is expensive for someone on a fixed income"), effects (21.7%, eg, "The effects on my lungs"), the view of others (11.4%), access (8.2%), and method of administration (7.1%). These findings provide a patient-centered view on the advantages (eg, efficacy in pain treatment, reduced use of other medications) and disadvantages (eg, economic and stigma) of MC.

Evaluating progress toward Healthy People 2010 national diabetes objectives.

INTRODUCTION: In 1999, the National Diabetes Prevention and Control Program at the Centers for Disease Control and Prevention and its 59 Diabetes Prevention and Control Programs adopted five Healthy People 2010 objectives. These objectives aim to improve the rates of preventive care services among people with diabetes and include annual foot examinations, hemoglobin A1c tests, and annual dilated eye examinations. This paper examines progress toward meeting these three objectives. METHODS: Questions from the diabetes module of the Behavioral Risk Factor Surveillance System (BRFSS) were used to evaluate changes in age-adjusted rates for annual foot examinations, hemoglobin A1c tests, and annual dilated eye examinations of 44 jurisdictions between 2000 and 2003. Questions from the diabetes module were also used to compare percentage rates of 47 jurisdictions in 2003 with Healthy People 2010 percentage targets. RESULTS: From 2000 to 2003, for the 44 jurisdictions, the aggregate, age-adjusted rate of annual foot examinations increased from 63.7% to 69.3% (P < .001); the rate of self-reported hemoglobin A1c tests increased from 68.3% to 69.5% (P = .35); and the rate of annual dilated eye examinations decreased from 67.7% to 65.2% (P = .05). In 2003, 20 of 47 jurisdictions met the Healthy People 2010 target for foot or eye examinations, and all 47 jurisdictions met the target for hemoglobin A1c tests. An inverse association was found between baseline rates in 2000 and the magnitude of change from 2000 to 2003 for all three national diabetes objectives. CONCLUSION: The National Diabetes Prevention and Control Program should consider adopting additional Healthy People 2010 objectives. Baseline rates should be considered in 1) selecting objectives, 2) setting percentage targets, and 3) evaluating current or future objectives. Program-related information should be linked with traditional data sources such as BRFSS so that we can understand the role of environmental factors and evaluate progress of jurisdictions toward national diabetes objectives.

The Annual African American Conference on Diabetes: evolving program evaluation with evolving program implementation.

BACKGROUND: According to 2003 Behavioral Risk Factor Surveillance System data, South Carolina has the fourth highest rate of overall diabetes among the 50 states (9.3%) but the second highest rate among African Americans (15.5%). Nationwide, African Americans are disproportionately affected by diabetes. In addition, 40% of the African American population in South Carolina lives in a rural area, and approximately 26% live at or below the poverty level. Lack of access to health care and diabetes education are additional barriers for people with diabetes and their families. CONTEXT: Since 1997, the South Carolina Diabetes Prevention and Control Program and the Diabetes Today Advisory Council have sponsored the African American Conference on Diabetes, which targets African Americans with diabetes, their families, and their caregivers. This article describes the evolution of the conference and its evaluation. METHODS: In 2002, we conducted focus groups with 20 African American conference attendees with diabetes to 1) assess the program's effects, 2) determine how to reach more individuals, and 3) improve programming. In 2004, we incorporated the preconference and postconference Diabetes Understanding Scale survey to assess the cognitive impact of the conference on participants. CONSEQUENCES: Focus group results revealed that participants wanted to attend the conference because of the opportunity to increase their knowledge and change their behaviors through 1) education, 2) social support, 3) resources, and 4) logistics. Self-rated understanding increased significantly after the conference for each cognitive understanding item on the Diabetes Understanding Scale. INTERPRETATION: Focus group results suggested that participants who continue to attend the conference year after year may improve diabetes self-management skills. A quantitative evaluation showed that this 1-day diabetes education conference significantly increased short-term, self-rated cognitive understanding of diabetes behaviors.

Working toward the elimination of residential fire deaths: the Centers for Disease Control and Prevention's Smoke Alarm Installation and Fire Safety Education (SAIFE) program.

To address residential fires and related injuries, the Centers for Disease Control and Prevention funds state health departments to deliver a Smoke Alarm Installation and Fire Safety Education (SAIFE) program in high-risk homes in 16 states. This program involves recruiting local communities and community partners, hiring a local coordinator, canvassing neighborhood homes, installing long-lasting lithium-powered smoke alarms, and providing general fire safety education and 6-month follow-up to determine alarm functionality. Local fire departments are vital community partners in delivering this program. Since the program's inception, more than 212,000 smoke alarms have been installed in more than 126,000 high-risk homes. Additionally, approximately 610 lives have potentially been saved as a result of a program alarm that provided early warning to a dangerous fire incident.

Notes from the field: the evaluation of Maine Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC) experience.

More than half of all children in the United States aged 3 to 6 years are enrolled in child care centers. Maine received funds from the U.S. Department of Health and Human Services' Communities Putting Prevention to Work to promote the adoption of Nutrition and Physical Activity Self-Assessment for Child Care (NAPSACC), an evidence-based program for the child care setting. We evaluated the rollout and adoption of NAP SACC in Maine using multiple methods. Our findings suggest that the NAP SACC program has been successfully adopted in Maine. Nutrition and physical activity policies and offerings have improved, especially with regard to purchasing healthier options in the child care setting.

Shared decision making: views of first-year residents and clinic patients.

PURPOSE: Patients' and physicians' views of their roles in decision making have implications for patient care and medical education. This study was designed to determine perspectives of residents and patients on the amount of control each should have in health care decisions. METHOD: Data were collected from a self-administered questionnaire of 45 first-year residents and a parallel structured interview with 92 patients from three resident clinics. Information Seeking (IS) and Decision Making (DM) scales from the Autonomy Preference Index were supplemented by five clinical scenarios focused on decisions concerning hypertension, depression, cholecystectomy, hysterectomy, and prostate cancer. Analysis of variance (ANOVA) and repeated-measures ANOVA were used to test for significant differences in scores. RESULTS: Patients' and residents' mean scores on IS were practically equivalent, indicating strong desire for information sharing. For DM, patients indicated a desire for slightly less than equal control in decisions, while residents thought patients should have a more than equal role. Given the specific clinical scenarios, the picture varied. Patients wanted equal roles in the hypertension, depression, and prostate cancer scenarios, while residents wanted to have more control in these decisions. Conversely, patients wanted greater control in the hysterectomy and cholecystectomy scenarios, and residents wanted a less than equal role in these decisions. Patients thought consultants such as surgeons desired the same role as their physicians, but residents assumed consultants wanted more control. CONCLUSIONS: Patients from a disadvantaged population indicated a strong desire for information and participation in making decisions about their care. Understanding the similarities and discrepancies in patients' and first-year residents' perspectives on shared decision making can have consequences for the patient-physician relationship and medical education.

TV viewing habits and body mass index among South Carolina Head Start children.

The present study tested the hypothesis that TV viewing habits and overweight would be associated among 4-year-old children. A convenience sample of Head Start students was enrolled (N=148). Parents were asked to complete a questionnaire on their children's TV viewing habits for a typical weekday, and for Saturday and Sunday. Height and weight of the children were assessed by the authors. As BMI increased, average hours of TV viewing increased slightly. Nearly 97% of children whose BMI was greater than the 95th percentile for age and sex watched more than one hour of TV, compared with less than 80% of children below the 95th percentile (chi2=6.0, P=.01). The present study suggests that TV viewing habits relate to BMI among 4-year old children to approximately the same degree as in older cohorts.

PE2GO: program evaluation of a physical activity program in elementary schools.

BACKGROUND: PE2GO is a self-contained physical education (PE) program that provides classroom teachers with the tools they need to lead developmentally appropriate PE lessons. The purpose of this study was to evaluate the PE2GO pilot programs in 6 school districts across the United States. METHODS: We used paper and pencil surveys at pre intervention (n = 114) and mid intervention (n = 94) and an electronic survey at post intervention (n = 65). In addition an electronic survey was sent to administrators at preintervention (n = 18); focus groups were conducted with teachers at mid intervention for a broader perspective. The study took place September 2004 through May 2005. RESULTS: Results indicate that teachers were satisfied with the PE2GO program and the perceived effects it had on their students. Teachers reported that students increased their time engaged in physical activity (128.7-181.1 minutes per week pre-to-post intervention). Administrator support was important (ie, associated with improvement), but not always present. CONCLUSION: In conclusion, the PE2GO program holds promise for the concept of providing in-class physical activity opportunities for students.

Impact of a school health coordinator intervention on health-related school policies and student behavior.

BACKGROUND: Health-related, school-based interventions may serve to prevent disease and improve academic performance. The Healthy Maine Partnerships (HMP) initiative funded local school health coordinators (SHCs) as a part of Maine's Coordinated School Health Program (CSHP) beginning in January 2001. SHCs established school health leadership teams and implemented annual work plans to address health risk behaviors. This study evaluates the impact of the Healthy Maine Partnerships SHC (HMPSHC) intervention on school policies and student risk behaviors after its first 5 years. METHODS: Data sources include the Maine School Health Profiles Survey and the Maine Youth Drug and Alcohol Use Survey/Youth Tobacco Survey. Cross-sectional analyses were performed on 2006 data to assess physical activity, nutrition, and tobacco-related policy associations with the HMPSHC intervention. Finally, policy and student behavior analyses were conducted to assess associations. RESULTS: Intervention schools were more likely to be associated with physical activity intramural offerings, improved nutritional offerings, and tobacco cessation programs. In intervention schools, supportive school policies were associated with decreased soda consumption, decreased inactivity, and decreased tobacco use. Required school health education curricula were more predictive of decreased risk behavior in intervention schools than in nonintervention schools. CONCLUSIONS: In schools with SHCs, there exists a stronger association with improved school programs. Improved policies and programs were associated with decreases in risk behavior among students in intervention schools. The HMPSHC intervention may be a viable CSHP model to replicate and evaluate in other settings.

Assessment of a pilot video's effect on physical activity and heart health for young children.

This article assessed the effects of a video, "Dynamotion," on children's knowledge, self-efficacy, and attitude about physical activity and heart health. A quasi-experimental design was used; 12 classrooms (grades K-2) were assigned to intervention (N = 116) or comparison (N = 92) groups. Students completed a 9-item pre- and posttest; only the intervention group was exposed to the video, during which qualitative assessments were made. Repeated measures analyses were used to detect changes. Overall, the intervention group had greater gains in knowledge and self-efficacy than did the comparison group (p < 0.001), and they seemed to enjoy the video. The results suggest that exposure to a short, interactive, educational video may promote health among young children.