A Menu to Evaluate Factors Influencing Implementation of Obesity Prevention Early Care and Education Regulations.

CONTEXT: In recent years, several states have adopted new regulations concerning nutrition, physical activity, and screen time in early care and education (ECE) settings to help prevent childhood obesity. OBJECTIVE: To disseminate a menu of factors that facilitate and/or impede implementation of obesity prevention regulations in ECE settings. DESIGN: To create the menu, we condensed and categorized factors identified in the literature and through field work by placing them within domains. We applied the menu by conducting semistructured interviews during a pilot test assessing implementation of ECE regulations in Colorado. SETTING AND PARTICIPANTS: We first interviewed state and local government agency leaders responsible for policy oversight, and state employees and contractors who acted as intermediaries to direct implementers. We then interviewed directors at ECE centers in the Denver, Colorado, area. We selected 21 ECE centers for a site visit on the basis of feasibility, percentage of low-income families, and diversity in race and ethnicity at each center. Seven centers participated. MAIN OUTCOME MEASURES: Minor and major facilitators and impediments to implementation of childhood obesity prevention regulations in ECE settings. RESULTS: The resulting menu includes 7 domains and 39 factors influential for implementation of ECE regulations. Of these 39 factors, interviewees identified 7 facilitating factors (4 major and 3 minor) and 2 impeding factors (both major). Major facilitating factors were buy-in from parents/caregivers, training and communication provided by governing authority and their contractors, and low level of change required by the regulations themselves. Major impeding factors were timing of implementation and balancing the demands of the regulations against other priorities. CONCLUSIONS: The menu developed by our research team, combined with existing frameworks in dissemination and implementation research, can be used by researchers, practitioners, and policy makers to anticipate factors that facilitate and/or impede implementation of ECE policies to prevent childhood obesity.

Evaluation of active living research: ten years of progress in building a new field.

BACKGROUND: The Robert Wood Johnson Foundation Active Living Research (ALR) program commissioned an evaluation of its initiative to assess 10 years (2001-2011) of progress in establishing a new interdisciplinary field to develop and translate research focused on policy and environmental factors affecting physical activity in children and families. PURPOSE: The second-phase evaluation (ALR-2) was conducted from March to July 2011 to measure progression from evidence- and field-building (Goals 1 and 2) to policy and practice contributions (Goal 3) to inform childhood obesity strategies, and to develop recommendations for a third phase (ALR-3). METHODS: The evaluation was a retrospective, in-depth descriptive study utilizing qualitative and quantitative methods. Key informant interviews (N=100) across seven stakeholder groups were conducted and analyzed in 2011. Data from web-based surveys of grantee investigators conducted from 2007 to 2011 and analyzed in 2011 served as the primary quantitative source. RESULTS: Key indicators of ALR's overall progress confirmed ALR's success across its three goals: (1) establishing a strong research base: 309 publications filling major knowledge gaps; (2) building an interdisciplinary and diverse field: grantees represented 31 disciplines, with more than one quarter (28%) of investigators having ≤5 years of experience, of which 39% were people of color; and (3) using research to inform policy and practice: 62 examples, of which slightly more than one half (n=32) resulted in actual policy or practice change. CONCLUSIONS: Overall, ALR met its three goals during ALR-2 and was well positioned to implement a third phase of the program to further accelerate the translation of its research into policy and practice.

An initial assessment of the consumer demand roundtable: Results and promise.

BACKGROUND: An initial assessment of the National Tobacco Cessation Collaborative's (NTCC) 2005-2007 Consumer Demand Roundtable (CDR) was conducted in 2008 to assess the results and products of CDR, and to offer recommendations to guide ongoing NTCC efforts to expand the demand, reach, and use of effective tobacco-cessation treatments. METHODS: The evaluation was a small, retrospective, descriptive study, primarily using in-depth telephone interviews, supplemented by a review of CDR agendas, products, and web-based participant surveys. A sample of 30 tobacco-cessation leaders who had participated in at least one CDR meeting or conference was interviewed in May and June of 2008. RESULTS: Specific products implemented or influenced by CDR were identified, and organized by its six core strategies. Almost all respondents reported that the CDR was successful in its first goal to generate new ways of thinking about increasing demand for chronically underused evidence-based quit-smoking treatment, providing concrete examples of ways they had infused CDR concepts into the work of their organizations. The development of new products and communication messages suggested some progress in meeting the goal of identifying and catalyzing feasible innovations in treatment design, promotion, research, practice, and policy. CONCLUSIONS: Results suggest that the CDR, conceived as a "think tank" for the tobacco-cessation field, made sizable progress, especially in shifting the field to a new way of thinking. Continued leadership, funding, and proactive, sustained communication are needed to ensure these new innovations are further tested, implemented, and sustained. A longer-term follow-up evaluation to measure this impact is recommended.

Evaluation of Active Living Research progress and lessons in building a new field.

BACKGROUND: An evaluation was undertaken of the initial 6 years of the Active Living Research (ALR) program. Conducted in 2006 and analyzed in 2007, the evaluation was designed to assess productivity and progress on all three program goals and to inform consideration of program re-authorization. METHODS: The evaluation was a retrospective, in-depth, descriptive study utilizing multiple methods, both qualitative and quantitative. Qualitative data were derived mainly from 88 interviews with key informants. Quantitative data were derived primarily from a web-based survey of grantee investigators. RESULTS: Examples of key indicators of ALR's progress in addressing its goals were (1) in building a knowledge base: 40% of grantee investigators reported producing at least one scientific publication based on their ALR study, averaging two papers per principal investigator who had published; (2) in growing a transdisciplinary field: investigators funded in the first five rounds of grants reported representing more than 20 disciplines; and (3) in contributing to policy change: ten examples were reported of contribution to specific policy changes. In addition, more than one-third (37%) of principal investigators had leveraged additional funds, averaging $275,000 per ALR grant, suggesting that ALR also had made progress in growing financial resources for the field. CONCLUSIONS: Overall, ALR made strides during 6 years in addressing its mission to develop a transdisciplinary field of research on environmental and policy factors that promote physical activity. The evaluation provided insight into useful approaches and strategies for building a nascent research field and suggested how to enhance the contribution of research to policy.

Characteristics of substance-abusing women on welfare. Findings from the evaluation of CASAWORKS for Families pilot demonstration.

AIM: To describe and compare the characteristics and needs of substance-abusing women on Temporary Assistance to Needy Families (TANF) who enroll in a multi-service "welfare to work" program (n = 673) with two other relevant groups: (a) women from the general TANF population in the same locales (n = 157) and (b) a sample of substance-abusing women on TANF who entered standard outpatient substance-abuse treatment programs (n = 520). DESIGN: A field study with repeated measures and intent-to-treat sampling. INTERVENTION: The CASAWORKS for Families (CWF) program was delivered in 11 sites in 9 states across the country. The CWF intervention featured integration of substance-abuse treatment and employment-work readiness services, using case management to tailor needed services (parenting, victimization, mental health, physical health, legal, and basic needs). MEASUREMENT: The Addiction Severity Index, supplemented with subject-appropriate questions, was used at treatment admission. FINDINGS: The CWF sample exhibited multiple serious problems in the areas of substance abuse, victimization, medical and psychiatric health, and basic needs. The severity of their lifetime problems and their recent service needs were significantly higher in all these areas, except physical health, than were those of the general welfare sample of women in the same locales. Compared with women on TANF from standard addiction-treatment programs, CWF women exhibited similar substance-use problems but generally more severe co-occurring problems.

Potential barriers to work for substance-abusing women on welfare. Findings from the CASAWORKS for Families pilot demonstration.

AIM: To assess the prevalence and relationship to later employment of potential barriers to work for substance-abusing women on Temporary Assistance to Needy Families (TANF) enrolled in a multiservice welfare-to-work program. DESIGN: A field study with repeated measures and intent-to-treat sampling. INTERVENTION: The CASAWORKS for Families (CWF) was delivered in 11 sites in nine states across the nation and featured integration of substance-abuse treatment and employment and work readiness services. MEASUREMENT: The Addiction Severity Index, supplemented with subject-appropriate questions. SAMPLE: A total of 366 CWF women who completed interviews at program enrollment, and at 6 and 12 months later. FINDINGS: Substance-abusing women on TANF in the CWF program exhibited multiple potential barriers to work at enrollment, averaging 6 out of 14 potential barriers assessed. They reported significantly more obstacles than a general welfare sample of women from the same locales. Few single barriers were significantly related to employment at 12 months. However, the total number of potential barriers to work experienced, particularly at 6 months, was related to employment at 12 months.

Services integration and cost-effectiveness.

Alcohol treatment services are increasingly combined with other health and social services to address the needs of multiple-problem clients. Hence, it has been of growing policy interest to find the most effective and the most cost-effective ways of linking these services. This symposium presents some recent studies in this area. The small but growing body of studies in this area has great potential to inform public policy debates.