Come together, play, be active: Physical activity engagement of school-age children at Play Streets in four diverse rural communities in the U.S.

Across the U.S., Play Streets - temporary street closures creating safe places for play for a few hours- are being implemented in urban areas during summer. Play Streets have never been implemented or evaluated in rural communities but have the potential to address challenges residents face accessing safe physical activity opportunities in these areas. Community organizations in four diverse low-income rural communities (selected to represent African American, American Indian, Latino, or White, non-Hispanic populations) received mini-grants in 2017 to implement four, three-hour Play Streets during the summer focusing on school-aged children in elementary-to-middle school. Physical activity was measured using Digi-walker (Yamax-SW200) pedometers and the System for Observing Play and Recreation in Communities (SOPARC/iSOPARC). Sixteen Play Streets were implemented in rural Maryland, North Carolina, Oklahoma, and Texas communities during June-September 2017. A total of 370 children (mean age = 8.81 years [SD = 2.75]; 55.0% female) wore pedometers across all 16 Play Streets (µâ€¯= 23.13 [SD = 8.59] children/Play Street). School-aged children with complete data (n = 353) wore pedometers for an average of 92.97 min (SD = 60.12) and accrued a mean of 42.08 steps/min (SD = 17.27), with no significant differences between boys (µâ€¯= 43.82, SD = 15.76) and girls (µâ€¯= 40.66, SD = 18.34). iSOPARC observations revealed no significant differences in child activity by sex; however, male teens were more active than female teens. Most adults were sedentary during Play Streets according to pedometer and iSOPARC data. Children in diverse rural communities are physically active at Play Streets. Play Streets are a promising intervention for promoting active play among children that lack safe opportunities to be active.

Prospective trial of customized adherence enhancement plus long-acting injectable antipsychotic medication in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder.

BACKGROUND: Treatment nonadherence in people with schizophrenia is associated with relapse and homelessness. Building on the usefulness of long-acting medication and our work in psychosocial interventions to enhance adherence, we conducted a prospective uncontrolled trial of customized adherence enhancement (CAE) plus long-acting injectable antipsychotic (LAI) using haloperidol decanoate in 30 homeless or recently homeless individuals with DSM-IV-defined schizophrenia or schizoaffective disorder. METHOD: Participants received monthly CAE and LAI (CAE-L) for 6 months. Primary outcomes were adherence, as measured by the Tablets Routine Questionnaire, and housing status. Secondary outcomes included psychiatric symptoms, functioning, side effects, and hospitalizations. The study was conducted from July 2010 to December 2012. RESULTS: The mean age of participants was 41.8 years (SD = 8.6); they were mainly minorities (90%, n = 27 African-American) and mainly single/never married (70%, n = 21). Most (97%, n = 29) had past or current substance abuse and had been incarcerated (97%, n = 29). Ten individuals (33%) terminated the study prematurely. CAE-L was associated with good adherence to LAI (at 6 months, 76%) and dramatic improvement in oral medication adherence, which changed from missing 46% of medication at study enrollment to missing only 10% at study end (P = .03). There were significant improvements in psychiatric symptoms (P < .001) and functioning (P < .001). Akathisia was a major side effect with LAI. CONCLUSIONS: While interpretation of findings must be tempered by the methodological limitations, CAE-L appears to be associated with improved adherence, symptoms, and functioning in homeless or recently homeless individuals with schizophrenia or schizoaffective disorder. Additional research is needed on effective and practical approaches to improving health outcomes for homeless people with serious mental illness. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT01152697.

Customized adherence enhancement for individuals with bipolar disorder receiving antipsychotic therapy.

OBJECTIVE: A three-month prospective trial of a psychosocial intervention--customized adherence enhancement (CAE)--was conducted with 43 medication-nonadherent individuals with bipolar disorder. METHODS: CAE modules were administered as indicated by a screen that identifies reasons for nonadherence. The primary outcome was change in adherence to mood-stabilizing medications as measured by the Tablet Routines Questionnaire and pill counts. Secondary outcomes included change in symptoms, measured by the Hamilton Rating Scale for Depression (HAM-D), Young Mania Rating Scale (YMRS), and Brief Psychiatric Rating Scale (BPRS). RESULTS: Participants completed 76% of sessions. Dropout at three months was 13 (30%). Adherence improved from a baseline mean±SD of 34%±27% of tablets missed in the past month to only 10%±15% (p<.001). BPRS, HAM-D, andYMRS scores all indicated significant improvement at three-month follow-up (p<.05). CONCLUSIONS: Although conclusions must be tempered by the uncontrolled design, CAE appeared to be well accepted and was associated with improvements in adherence, symptoms, and functioning.

Why do persons with bipolar disorder stop their medication?

OBJECTIVE: Non-adherence to maintenance medication regimens is a major problem, limiting outcomes for many persons with bipolar disorder. The aim of this paper is to determine the most relevant aspects of adherence attitudes in a sample of bipolar patients selected for problems with adherence behavior. METHODS: Among a larger sample of bipolar disorder patients participating in a prospective follow-up study (N = 140), a subsample of patients were selected for non-adherent behavior defined as missing ≥ 30% of medication during the past month (n = 27; 19.3%). Adherence attitudes were assessed with the Rating of Medication Influences scale (ROMI), a self-reported attitudinal measure assessing reasons for and against adherence. Multiple logistic regression models for non-adherence vs. adherence were estimated with each of the 19 ROMI items in the model, while controlling for sex, age, ethnicity, education, duration of illness, and substance abuse. RESULTS: Mean score of ROMI items corresponding to reasons for treatment adherence was greater among adherent participants, whereas the mean score of ROMI items corresponding to reasons for treatment non-adherence was greater among nonadherent participants. The ROMI item identifying that the individual believes that medications are unnecessary had the strongest influence for non-adherence (p < 0.0001). This was followed by ROMI items corresponding to no perceived daily benefit (p = 0.0008), perceived change in appearance (p = 0.0057), and perceived interference with life goals (p = 0.0033). The ROMI item identifying fear of relapse was the strongest predictor for adherence (p = 0.0017). CONCLUSIONS: Non-adherent patients with bipolar disorder differ from adherent patients with bipolar disorder on reasons for adherence and non-adherence. Utilization of tools that evaluate medication treatment attitudes, such as the ROMI or similar measures, may assist clinicians in the selection of interventions that are most likely to modify future treatment adherence.