Design and Approach of the Healthy Weight Clinic Pediatric Weight Management Intervention Package and Implementation: Massachusetts-CORD 3.0.

Background: Although proven effective interventions for childhood obesity exist, there remains a substantial gap in the adoption of recommended practices by clinicians. Objective: The aims are to: (1) package implementation and training supports to facilitate the adoption of the evidence-based Healthy Weight Clinic Pediatric Weight Management Intervention (PWMI) (based on three previous effectiveness trials); (2) pilot and evaluate the packaged Healthy Weight Clinic PWMI; and (3) develop a sustainability and dissemination plan. Design/Methods: We used the Consolidated Framework of Implementation Research constructs to create an Implementation Research Logic Model that defined the facilitators and barriers of the Healthy Weight Clinic PWMI. We linked these constructs to implementation strategies and mechanisms. Packaging and design will be informed by the core essential components and functions of the PWMI along with stakeholder engagement. Once the package is complete, we will pilot the PWMI by using a Type III effectiveness-implementation hybrid design. Implementation outcomes will be evaluated by using the RE-AIM framework. Results: We will create an integrated, multisystems level package for national dissemination. The package will include training and a suite of resources for primary care physicians and healthy weight clinic staff, including: patient and caregiver facing videos, patient and caregiver handouts, group curriculum guide, online provider trainings, and access to a virtual learning collaborative. Conclusion: The results will highlight the extent to which the package of the Healthy Weight Clinic PWMI facilitates the adoption of effective strategies for treating childhood obesity. Lessons learned will inform modifications to the Healthy Weight Clinic PWMI and strategies for future scaling.

Planned Evaluation of the Healthy Weight Clinic Pediatric Weight Management and Implementation: Massachusetts-CORD 3.0.

Background: Despite evidence that offering multidisciplinary treatment for children with obesity is effective, access to evidence-based pediatric weight management interventions (PWMIs) is limited. The Healthy Weight Clinic PWMI is a multidisciplinary approach in primary care that improves BMI among children with a BMI ≥ 85th percentile. Objective: To describe the method by which we will evaluate the adoption, acceptability, and feasibility of integrating and implementing a multidisciplinary Healthy Weight Clinic (HWC) into primary care. Design/Methods: We used the Consolidated Framework for Implementation Research (CFIR) domains and constructs to inform our implementation strategies. We will use a Type III hybrid effectiveness-implementation design to test our implementation strategies and improvement in BMI. Sources of data collection will include qualitative interviews with patient caregivers, HWC staff and surveys with HWC staff, patient caregivers, and electronic health record data. Our outcomes are guided by the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Results: We identified all five CFIR domains as integral for successful implementation. Some strategies to address barriers within these domains include online self-paced training modules for the HWC staff, a virtual learning collaborative, and engagement of site leadership. Outcomes will be measured at the patient and pilot site levels, and they will include patients reached, patient health outcomes such as BMI and quality of life, level of adoption, acceptability, feasibility, and sustainability of the PWMI. Conclusion: Our use of implementation science frameworks in the planning of Healthy Weight Clinic PWMI could create a sustainable and effective program for dissemination.

Food Insecurity and Cardiovascular Disease Risk Factors among Mississippi Adults.

Background: Food insecurity is a public health problem. There is limited data on food insecurity in Mississippi. Methods: We analyzed data from the 2015 Mississippi Behavioral Risk Factor Surveillance System, which included the Social Context Module for 5870 respondents. Respondents who indicated that in the past 12 months they were "always", "usually", or "sometimes" "worried or stressed about having enough money to buy nutritious meals" were considered food insecure. Food insecurity was compared across sociodemographic and health characteristics using chi-square tests, and the association between food insecurity and select cardiovascular disease risk factors was assessed using logistic regression. Results: The prevalence of food insecurity was 42.9%. Compared to the referent group, Mississippi adults with high blood pressure had 51% higher odds, those with diabetes had 30% higher odds, those who were not physically active had 36% higher odds, and those who consumed fewer than five fruits and vegetables daily had 50% higher odds of being food insecure. Conclusion: Among Mississippi adults, food insecurity is associated with high blood pressure, diabetes, obesity, fruit and vegetable consumption, physical inactivity, and smoking.

Association Between Consumption of Sugar-Sweetened Beverages and Sociodemographic Characteristics Among Mississippi Adults.

INTRODUCTION: The consumption of sugar-sweetened beverages (SSBs) is linked to excessive weight gain, diabetes, and risk of cardiovascular disease. We examined the association between SSB consumption and sociodemographic characteristics among Mississippi adults. METHODS: We used data from the 2012 Mississippi Behavioral Risk Factor Surveillance System, which collected information on SSB consumption from 7,485 respondents. We used logistic regression models to calculate adjusted prevalence ratios (APRs) and 95% confidence intervals (CIs) for characteristics associated with SSB consumption. RESULTS: In 2012, 40.8% of Mississippi adults reported consuming at least one SSB daily. The likelihood of consuming SSBs at least once daily among respondents aged 18 to 34 years was 2.81 times higher (APR, 2.81; 95% CI, 2.49-3.18) than among those aged 65 years or older. The prevalence among men was 20% higher (APR, 1.20; 95% CI, 1.11-1.30) than among women and 23% higher (APR, 1.23; 95% CI, 1.13-1.35) among black respondents than among white respondents. The prevalence among respondents with less than a high school education was 25% higher (APR, 1.25; 95% CI, 1.11-1.41) than among those who with more than a high school education and 33% higher (APR, 1.33; 95% CI, 1.16-1.52) among those with an annual household income of less than $20,000 than among those with an income of $50,000 or more. CONCLUSION: Among Mississippi adults, age, sex, race, education level, and income are associated with an increased likelihood of SSB consumption. Findings highlight the need for policies and interventions to address SSB consumption and promote alternatives to SSBs among Mississippians.

Electronic Cigarette Use among Mississippi Adults, 2015.

Electronic cigarettes (e-cigarettes) are battery-powered devices that deliver nicotine in the form of aerosol. We identify differences and associations in e-cigarette use by sociodemographic characteristics and describe the reported reasons for initiating use among Mississippi adults. We used the 2015 Mississippi Behavioral Risk Factor Surveillance System, which collected information on e-cigarette use from 6,035 respondents. The prevalence of current e-cigarette use and having ever tried an e-cigarette was determined overall and by sociodemographic characteristics. Weighted prevalences and 95% confidence intervals were calculated, and prevalences for subgroups were compared using the X2 tests and associations were assessed using logistic regression. In 2015, 4.7% of Mississippi adults currently used e-cigarettes, while 20.5% had ever tried an e-cigarette. The prevalence of current e-cigarette use was significantly higher for young adults, whites, men, individuals unable to work, those with income $35,000-$49,999, and current smokers compared to their counterparts. Similar results were observed for having ever tried an e-cigarette. E-cigarette use was associated with age, race, income, and smoking status. Most (71.2%) of current e-cigarette users and over half (52.1%) of those who have ever tried e-cigarettes reported that a main reason for trying or using e-cigarettes was "to cut down or quit smoking."

Overweight, Obesity, and Extreme Obesity Among Mississippi Adults, 2001-2010 and 2011-2015.

INTRODUCTION: In 2015, about 1.5 million adults in Mississippi were overweight or obese. Obesity is associated with increased risk for diabetes and cardiovascular problems. We examined trends in the prevalence of overweight, obesity, and extreme obesity from 2001 through 2010 and 2011 through 2015. METHODS: We used data from the Mississippi Behavioral Risk Factor Surveillance System to analyze trends in the prevalence of overweight, obesity, and extreme obesity among adults from 2001 through 2010 and 2011 through 2015. Joinpoint software was used to examine annual percentage change (APC) in the prevalence of each condition overall and by sex and race. RESULTS: We observed a significant decrease in overweight prevalence from 2001 to 2010, both overall (APC, -1.3%) and among men (APC, -2.0%), blacks (APC, -1.0%), and whites (APC, -1.5%), but not among women. The overall prevalence of both obesity (APC, 2.9%) and extreme obesity (APC, 3.6%) increased significantly, and these increases occurred across all subgroups for both obesity (men APC, 3.5%; women APC, 2.5%; blacks APC, 1.9%; and whites APC, 3.8%) and extreme obesity (men APC, 6.7%; women APC, 2.5%; blacks APC, 2.2%; and whites APC, 5.0%). From 2011 to 2015, the only significant change was an increase in the prevalence of extreme obesity among whites (APC, 2.6%). CONCLUSION: The increasing proportion of adult Mississippians in the 2 highest-risk BMI categories warrants urgent community and clinical obesity interventions. Community-tailored and sustained obesity prevention, treatment, and control programs that include diet and physical activity are needed to address the obesity epidemic.