Nutritional Risk among Congregate Meal Site Participants: Benefits of a SNAP-Ed Program.

This study examined the impact of the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) program Fresh Conversations (FC) on the nutritional risk (NR) of older adults (OAs). A convenience sample of OAs (207 Treatment, 148 Control) completed questionnaires comprised of validated measures to assess NR, barriers to healthy eating self-efficacy (SE), food safety behaviors (FSB), and food security (FS) at three-time points over 9 months. Participants were mostly white (92.4%), older (age 81+ years, 40.1%), widowed (52.4%), and females (75.2%). Independent t-tests identified baseline differences among groups. Analysis of covariance assessed group changes at each time point for each measure. Block regression determined which variables influence baseline NR. Baseline NR risk was significantly predicted by SE (ß = 0.21), education (ß = 0.19) and age (ß = 0.14) (p < 0.05). NR improvement was significantly higher for treatment group participants who attended four or more FC sessions than for the control group (p = .04) when controlling for the effects of gender (p = .061) and SE (p = .098).

Evaluating Iowa Severe Maternal Morbidity Trends and Maternal Risk Factors: 2009-2014.

Objectives To describe statewide SMM trends in Iowa from 2009 to 2014 and identify maternal characteristics associated with SMM, overall and by age group. Methods We used 2009-2014 linked Iowa birth certificate and hospital discharge data to calculate SMM based on a 25-condition definition and 24-condition definition. The 24-condition definition parallels the 25-condition definition, but excludes blood transfusions. We calculated SMM rates for all delivery hospitalizations (N = 196,788) using ICD-9-CM diagnosis and procedure codes. We used log-binomial regression to assess the association of SMM with maternal characteristics, overall and stratified by age groupings. Results In contrast to national rates, Iowa's 25-condition SMM rate decreased from 2009 to 2014. Based on the 25-condition definition, SMM rates were significantly higher among women <20 years and >34 years compared to women 25-34 years. Blood transfusion was the most prevalent indicator, with hysterectomy and disseminated intravascular coagulation (DIC) among the top five conditions. Based on the 24-condition definition, younger women had the lowest SMM rates and older women had the highest SMM rates. SMM rates were also significantly higher among racial/ethnic minorities compared to non-Hispanic white women. Payer was the only risk factor differentially associated with SMM across age groups. First trimester prenatal care initiation was protective for SMM in all models. Conclusions High rates of blood transfusion, hysterectomy, and DIC indicate a need to focus on reducing hemorrhage in Iowa. Both younger and older women and racial/ethnic minorities are identified as high risk groups for SMM that may benefit from special consideration and focus.

Prevalence of Physical Activity Policies and Environmental Strategies in Communities and Worksites: The Iowa Community Transformation Grant.

OBJECTIVE: This study describes results of community and worksite assessments of physical activity policies and environmental strategies in 26 Iowa counties. METHODS: Community coalition members completed the Community Health Assessment and Group Evaluation tool. The study explored findings using descriptive statistics and examined rural-urban differences in two of the five assessed sectors: community and worksites. RESULTS: Lower community scores (ie, needing improvement) were found for complete streets, bicycle use, and street calming. Higher scores (ie, identified strengths) were found for land use plans, maintain parks, and sidewalks Americans with Disabilities Act compliant. Worksites scored lower on promote stairwells, encourage non-motorized commuting, and implement activity breaks but higher on subsidize gym membership and provide area for physical activity. No rural-urban differences were found. CONCLUSIONS: Results identify opportunities to enhance community and worksite policies and environmental strategies to increase physical activity.

Vending Assessment and Program Implementation in Four Iowa Worksites.

The worksite food environment, including vending options, has been explored as an important contributor to dietary decisions made every day. The current study describes the vending environment, and efforts to change it, in four Iowa worksites using a series of case studies. Data were gathered by local coordinators as part of the Iowa Community Transformation Grant project. Data were collected from three sources. First, the Nutrition Environment Measures Survey-Vending was used to assess healthy vending options in worksite machines before and after the intervention. Second, employee vending behavior was evaluated with a pre-, post-intervention survey. Items assessed attitudes and behaviors regarding vending, plus awareness and reaction to intervention activities. Third, program coordinators documented vending machine intervention strategies used, such as social marketing materials and product labels. The Nutrition Environment Measures Survey-Vending documented that the majority of vending options did not meet criteria for healthfulness. The vending survey found that employees were generally satisfied with the healthier items offered. Some differences were noted over time at the four worksites related to employee behavior and attitudes concerning healthy options. There were also differences in intervention implementation and the extent of changes made by vending companies. Overall, findings demonstrate that a large percentage of employees are constrained in their ability to access healthy foods due to limited worksite vending options. There also remain challenges to making changes in this environment. Findings have implications for public health practitioners to consider when designing healthy vending interventions in worksites.

Implementation of the baby-friendly hospital initiative steps in Iowa hospitals.

OBJECTIVE: To determine the status of each of the Baby-Friendly Hospital Initiative (BFHI) Ten Steps and associated policies in Iowa hospitals. DESIGN: Exploratory, descriptive study using the World Health Organization BFHI self-assessment survey. SETTING: Iowa hospitals with maternity services. PARTICIPANTS: Fifty-three Iowa hospital administrators. METHODS: Hospitals were classified by level of implementation of each of the Ten Steps and related criteria. RESULTS: The majority of the hospitals were implementing at least three of the Ten Steps. The most widely adopted policy, encouraging breastfeeding on demand, was implemented by 83% of the hospitals. None of the hospitals had implemented all six criteria included in Step One. Step One describes a written breastfeeding policy routinely communicated to all healthcare staff. CONCLUSION: Implementation of the steps varied by hospital locale; urban hospitals had higher implementation rates for Step 10 than rural hospitals. Areas identified as needing the greatest attention by hospitals were posting of breastfeeding policy, evaluation, and providing education to all mothers.

PROSPER STUDY OF EVIDENCE-BASED INTERVENTION IMPLEMENTATION QUALITY BY COMMUNITY-UNIVERSITY PARTNERSHIPS.

This study examined a community-university partnership model for sustained, high-quality implementation of evidence-based interventions. In the context of a randomized study, it assessed whether implementation quality for both family-focused and school-based universal interventions could be achieved and maintained through community-university partnerships. It also conducted exploratory analyses of factors influencing implementation quality. Results revealed uniformly high rates of both implementation adherence-averaging over 90%-and of other indicators of implementation quality for both family-focused and school-based interventions. Moreover, implementation quality was sustained across two cohorts. Exploratory analyses failed to reveal any significant correlates for family-intervention implementation quality, but did show that some team and instructor characteristics were associated with school-based implementation quality.

Extension Educators' Perceptions of Community Readiness, Knowledge of Prevention Science, and Experience with Collaboration.

This investigation compared Extension educators' perceptions of community readiness, knowledge of prevention science, and experience with community collaborations with the perceptions of community human service professionals. First, Cooperative Extension System (CES) educators and human service professionals were found to hold similar perceptions of community readiness for prevention programs. Second, CES educators demonstrated less awareness of prevention programs in the community, but a greater knowledge of research-based community risk and protective factors than the human service professionals. Third, CES educators and human service professionals were similar in terms of community collaborative involvement, success, and personal effectiveness.

Externalizing behaviors as predictors of substance initiation trajectories among rural adolescents.

PURPOSE: The purpose of the current study was to investigate the influence of externalizing behaviors on substance initiation trajectories among rural adolescents over a 42-month period. METHODS: Data were obtained from 198 rural adolescents (105 boys, 93 girls) who were participating in a longitudinal study. At the baseline assessment, subjects were on average 12.3 years of age. RESULTS: Controlling for gender, higher baseline levels of externalizing were associated with a greater number of substances initiated over time. The initiation trajectory was curvilinear. Girls, compared with boys, reported a lower number of substances initiated at baseline, a greater linear growth trajectory, and a deceleration of growth over time. CONCLUSIONS: The influence of adolescent externalizing behaviors on baseline levels and growth trajectories of substance initiation and the utility of latent growth curve modeling in the study of longitudinal change are discussed.

Internalizing, social competence, and substance initiation: influence of gender moderation and a preventive intervention.

Using latent growth curve modeling, the current study investigated gender moderation of the longitudinal pathways from internalizing to both social competency (i.e., social assertiveness) and the initiation of substance use (i.e., tobacco, alcohol, marijuana), as well as the effect of a preventive intervention on that process. Rural Midwestern adolescents who were participating in a school-based preventive intervention study were an average of 12.3 years old at the pretest assessment conducted in 1998. A latent growth curve comparison analysis found that internalizing was related inversely to initial levels of social assertiveness skill among girls; further, internalizing was related positively to substance use initiation growth trajectories among girls. Girls who participated in the preventive intervention demonstrated a slower increase over time in substance use initiation and a faster increase in social assertiveness. Gender moderation of the impact of internalizing and social assertiveness on substance use initiation and response to the intervention, as well as the utility of latent growth curve modeling in the study of longitudinal change, are discussed.

Program provider and observer ratings of school-based preventive intervention implementation: agreement and relation to youth outcomes.

Few prevention studies have examined the degree to which different measures of program implementation adherence predict youth outcomes. The current study was conducted with rural middle school youth participating in a longitudinal school-based preventive intervention program. Study participants' average age at the pretest assessment was 12.3 years. The association between program implementation ratings supplied by provider self-reports and trained independent observer reports were evaluated. In addition, the relationship between measures of implementation and youth outcomes were examined. Results indicated that although program providers tended to report higher implementation than independent observers, most ratings were correlated significantly across raters. Observer-reported implementation ratings significantly predicted several youth substance-related outcomes, while provider-reported self-ratings did not. Program provider characteristics predicted several youth outcomes. Findings suggest that there might be a social desirability bias in provider self-reported ratings of implementation and that caution must be used when interpreting self-reported ratings of implementation.