Intra and Inter-Device Reliabilities of the Instrumented Timed-Up and Go Test Using Smartphones in Young Adult Population.

The Timed-Up and Go (TUG) test is widely utilized by healthcare professionals for assessing fall risk and mobility due to its practicality. Currently, test results are based solely on execution time, but integrating technological devices into the test can provide additional information to enhance result accuracy. This study aimed to assess the reliability of smartphone-based instrumented TUG (iTUG) parameters. We conducted evaluations of intra- and inter-device reliabilities, hypothesizing that iTUG parameters would be replicable across all experiments. A total of 30 individuals participated in Experiment A to assess intra-device reliability, while Experiment B involved 15 individuals to evaluate inter-device reliability. The smartphone was securely attached to participants' bodies at the lumbar spine level between the L3 and L5 vertebrae. In Experiment A, subjects performed the TUG test three times using the same device, with a 5 min interval between each trial. Experiment B required participants to perform three trials using different devices, with the same time interval between trials. Comparing stopwatch and smartphone measurements in Experiment A, no significant differences in test duration were found between the two devices. A perfect correlation and Bland-Altman analysis indicated good agreement between devices. Intra-device reliability analysis in Experiment A revealed significant reliability in nine out of eleven variables, with four variables showing excellent reliability and five showing moderate to high reliability. In Experiment B, inter-device reliability was observed among different smartphone devices, with nine out of eleven variables demonstrating significant reliability. Notable differences were found in angular velocity peak at the first and second turns between specific devices, emphasizing the importance of considering device variations in inertial measurements. Hence, smartphone inertial sensors present a valid, applicable, and feasible alternative for TUG assessment.

Designing an evaluation tool for evaluating training programs of medical students in clinical skill training center from consumers' perspective.

INTRODUCTION: The Clinical Skill Training Center (CSTC) is the first environment where third year medical students learn clinical skills after passing basic science. Consumer- based evaluation is one of the ways to improve this center with the consumer. This study was conducted with the aim of preparing a consumer-oriented evaluation tool for CSTC among medical students. METHOD: The study was mixed method. The first phase was qualitative and for providing an evaluation tool. The second phase was for evaluating the tool. At the first phase, after literature review in the Divergent phase, a complete list of problems in the field of CSTC in medicine schools was prepared. In the convergent step, the prepared list was compared with the standards of clinical education and values of scriven. In the second phase it was evaluated by the scientific and authority committee. Validity has been measured by determining CVR and CVI: Index. The face and content validity of the tool was obtained through the approval of a group of specialists. RESULTS: The findings of the research were in the form of 4 questionnaires: clinical instructors, pre-clinical medical students, and interns. All items were designed as a 5-point Likert. The main areas of evaluation included the objectives and content of training courses, implementation of operations, facilities and equipment, and the environment and indoor space. In order to examine the long-term effects, a special evaluation form was designed for intern. CONCLUSION: The tool for consumer evaluation was designed with good reliability and trustworthiness and suitable for use in the CSTC, and its use can improve the effectiveness of clinical education activities.

Standardizing Fidelity to Evidence-Based Practice in the Early Psychosis Intervention Network.

OBJECTIVE: This study investigated variations in the measurement of fidelity to coordinated specialty care (CSC) within the Early Psychosis Intervention Network (EPINET), a learning health system that consists of 101 CSC programs within eight hubs. The study investigated the degree to which five fidelity scales could be mapped onto a standard scale. METHODS: The investigators identified six fidelity scales in use by EPINET participants; examined their item content, scoring, and data sources; and mapped five scales onto the First Episode Psychosis Services Fidelity Scale (FEPS-FS), which is the most widely used scale. RESULTS: Mapping five fidelity scales onto the FEPS-FS showed that the percentage of FEPS-FS components successfully mapped ranged from 42% to 81%. CONCLUSIONS: Mapping five scales onto one that uses dichotomous scoring identified the degree of variation in measures and reduced the amount and quality of usable fidelity data. Identifying variations in fidelity measurement is a core function of a learning health system.

Developing an international consensus Reporting guideline for intervention Fidelity in Non-Drug, non-surgical trials: The ReFiND protocol.

BACKGROUND: Inadequate reporting of fidelity to interventions in trials limits the transparency and interpretation of trial findings. Despite this, most trials of non-drug, non-surgical interventions lack comprehensive reporting of fidelity. If fidelity is poorly reported, it is unclear which intervention components were tested or implemented within the trial, which also hinders research reproducibility. This protocol describes the development process of a reporting guideline for fidelity of non-drug, non-surgical interventions (ReFiND) in the context of trials. METHODS: The ReFiND guideline will be developed in six stages. Stage one: a guideline development group has been formed to oversee the guideline methodology. Stage two: a scoping review will be conducted to identify and summarize existing guidance documents on the fidelity of non-drug, non-surgical interventions. Stage three: a Delphi study will be conducted to reach consensus on reporting items. Stage four: a consensus meeting will be held to consolidate the reporting items and discuss the wording and structure of the guideline. Stage five: a guidance statement, an elaboration and explanation document, and a reporting checklist will be developed. Stage six: different strategies will be used to disseminate and implement the ReFiND guideline. DISCUSSION: The ReFiND guideline will provide a set of items developed through international consensus to improve the reporting of intervention fidelity in trials of non-drug, non-surgical interventions. This reporting guideline will enhance transparency and reproducibility in future non-drug, non-surgical intervention research.

Social Needs Screening and Intervention in Pediatric Primary Care: Impact on Families' Experience of Care.

INTRODUCTION/OBJECTIVES: Social determinants of health (SDoH) screening and intervention in pediatric primary care depends upon caregiver disclosure of adverse household or social conditions and thus may be influenced by perceived bias or stigma. This paper examines to what extent parents' experience of their child's medical home is associated with their perceptions of a practice-based social needs intervention. METHODS: We conducted a cohort study of data reported by 73 parents of children obtaining care in a medical home with an embedded SDoH navigation program. Using survey data collected in October 2021 and October 2022, we calculated descriptive statistics and non-parametric bivariate analyses of the association between engagement with the SDoH navigation program and parent-reported social needs, stress, and perception of care quality as measured by the Person-Centered Primary Care Measure (PCPCM). RESULTS: Initial ratings of care quality were high (mean baseline PCPCM score = 3.63) and remained high on second interview (mean change in PCPCM score = -0.04, 95%CI -0.16, 0.09, P = .58) despite significant reductions in parents' ratings of access to care over time. Parents reported substantial stress, unmet social needs, and unmet healthcare needs, with 41 families (56%) ever using the practice-based SDoH program, including 16 (22%) who were new users in 2022. There was no association observed between PCPCM score and parent stress, unmet social needs, or use of SDoH services. CONCLUSIONS: Parents' perceptions of care delivered in their child's medical home appears to be stable on repeat measurement, and independent of family context or interactions with social needs navigation services offered in the practice.

Picking Apart a Program Evaluation Committee: A Multiple Case Study Characterizing Primary Care Residency Program Evaluation Committee Structure, Program Improvement, and Outcomes.

BACKGROUND: As of 2014, the Accreditation Council for Graduate Medical Education (ACGME) mandates initiating a Program Evaluation Committee (PEC) to guide ongoing program improvement. However, little guidance nor published reports exist about how individual PECs have undertaken this mandate. OBJECTIVE: To explore how four primary care residency PECs configure their committees, review program goals and undertake program evaluation and improvement. METHODS: We conducted a multiple case study between December 2022 and April 2023 of four purposively selected primary care residencies (e.g., family medicine, pediatrics, internal medicine). Data sources included semi-structured interviews with four PEC members per program and diverse program artifacts. Using a constructivist approach, we utilized qualitative coding to analyze participant interviews and content analysis for program artifacts. We then used coded transcripts and artifacts to construct logic models for each program guided by a systems theory lens.  Results: Programs adapt their PEC structure, execution, and outcomes to meet short- and long-term needs based on organizational and program-unique factors such as size and local practices. They relied on multiple data sources and sought diverse stakeholder participation to complete program evaluation and improvement. Identified deficiencies were often categorized as internal versus external to delineate PEC responsibility, boundaries, and feasibility of interventions. CONCLUSION: The broad guidance provided by the ACGME for PEC configuration allows programs to adapt the committee based on individual needs. However, further instruction on program evaluation and organizational change principles would augment existing PEC efforts.

Interprofessional Curriculum Delivery: Experience of a Primary Care Education Program.

Few post-graduate training programs offer a comprehensive curriculum that includes structured clinical experiences to teach interprofessional care. To address this need, the United States Department of Veterans Affairs, Office of Academic Affiliations funded the Centers of Excellence in Primary Care Education (CoEPCE) from 2011-2019 to provide interprofessional curricula for health profession trainees (HPTs), including physician residents, nurse practitioner residents, pharmacy residents, and psychology residents. We examined changes over time in curricular domains, system impacts, and program practices based on HPT survey data and the qualitative evaluation of narrative feedback. An annual survey was administered to participants. Indirect standardized ratios were calculated for interprofessional professional education (IPE) program domains, system impacts, and program practices. Qualitative responses were coded based on curricular domains and key program components. The study cohort included 369 HPTs. Site and profession standardized indirect ratios across all professions indicated improvements in curricular domains, system impacts, and program practices, with significant differences observed for associated health HPTs as compared to other HPTs for performance improvement. Qualitative data indicated that profession was associated with differences in perceptions of the curriculum. Although improvements occurred over time, our findings support the need for the thoughtful consideration of profession-specific identity characteristics when designing interprofessional curricula.

Matching Mobile Crisis Models to Communities: An Example from Northwestern Ontario.

Police are often the first to encounter individuals when they are experiencing a mental health crisis. Other professionals with different skill sets, however, may be needed to optimize crisis response. Increasingly, police and mental health agencies are creating co-responder teams (CRTs) in which police and mental health professionals co-respond to crisis calls. While past evaluations of CRTs have shown promising results (e.g. hospital diversions; cost-effectiveness), most studies occurred in larger urban contexts. How CRTs function in smaller jurisdictions, with fewer complementary resources and other unique contextual features, is unknown. This paper describes the evaluation of a CRT operating in a geographically isolated and northern mid-sized city in Ontario, Canada. Data from program documents, interviews with frontline and leadership staff, and ride-along site visits were analyzed according to an extended Donabedian framework. Through thematic analysis, 12 themes and 11 subthemes emerged. Overall, data showed that the program was generally operating and supporting the community as intended through crisis de-escalation and improved quality of care, but it illuminated potential areas for improvement, including complementary community-based services. Data suggested specific structures and processes of the embedded CRT model for optimal function in a northern context, and it demonstrated the transferability of the CRT model beyond large urban centres. This research has implications for how communities can make informed choices about what crisis models are best for them based on their resources and context, thus potentially improving crisis response and alleviating strain on emergency departments and systems.

Family-based education and follow-up program for patients with burns: A mixed assessment study.

BACKGROUND: Burn injuries are a major cause of morbidity and mortality worldwide, affecting not only the patients but also their families. Family-based education and follow-up program are interventions that aim to improve the quality of life and psychosocial outcomes of patients with burns and their families. However, we find a lack of evidence on the effectiveness and feasibility of these programs in different settings and populations. This study aimed to evaluate the features of the family-based education and follow-up program (FBEFP), a pilot project that was developed and implemented at the Tabriz Sina Teaching Hospital in 2020 to improve its burn care system. DESIGN: A mixed-methods approach was used to collect and analyze both quantitative and qualitative data from various sources, such as, questionnaires, medical records, interviews and observation notes, to assess the content, process, and outcome of the program. The study followed the three steps of the CDC's framework for program evaluation: describing the program, measuring its effectiveness, and providing recommendations for improvement. RESULTS: The results of this study revealed the positive impacts of the FBEFP on the patients' physical, psychological, and social outcomes and quality of life. 4.8% of the people in the follow-up group were re-admitted, while this amount was 7.2% in the group without follow-up. Although the number of readmissions was less in the non-follow-up group, statistically no significant difference was observed between the two ratios before and after follow-up. In order to evaluate satisfaction rates, In the follow-up group, 72 patients and in the non-follow-up group, 38 patients were reached. After converting these data to normal distribution, using t-tests, it was determined that the difference between the two studied groups was highly significant. In other words, the follow-up process had favorable results on satisfaction of the studied people. However, the study also identified some challenges and barriers in implementing the program, such as lack of resources, staff training, and family involvement. CONCLUSION: FBEFP is a promising intervention that enhances the well-being of patients with burns and their families. However, more evidence is needed to support its effectiveness and feasibility in different contexts and populations. The study also provided valuable insights into the benefits and challenges of implementing a Family-Based Education and Follow-up Program for patients with burns in a low-resource setting. The study contributed to the development of guidelines and recommendations for future research and practice in this field.

eviQ Cancer Treatments Online: Providing evidence-based information to improve cancer patient outcomes.

AIM: To understand the current usage of eviQ Cancer Treatments Online (www.eviQ.org.au), an Australian, open-access website providing evidence-based and consensus-driven cancer treatment protocols and information, and the extent to which it is meeting its intended outcomes and providing value to its users. METHODS: A mixed-method evaluation was conducted in 2020-2022 which included a review of key program documentation and website usage data, and delivery of a focused online survey to its users. RESULTS: In 2022, 329 clinicians representing all Australian states and territories contributed to eviQ content development and review. eviQ content continues to grow with a 15.2% increase in total content from 2019 to 2022.  eviQ website users continue to grow with 90,000 total monthly users in 2022, representing a 166% increase from 2018. The proportion of international users compared to Australian users continues to grow with 57% of total users in Australia and 43% international in 2022. Of 466 survey responses, the most cited reason for eviQ use was for information on side effects/toxicity (67%). Ninety-three percent (93%) of respondents either agreed or strongly agreed that eviQ contributed to both health professionals providing the best evidence-based treatment and care and improving the standardization of treatment and care provided. CONCLUSION:  eviQ is embedded in Australian clinical practice, highly valued, and relied upon by users. Users agree that eviQ has a positive impact on patients by supporting the delivery of evidence-based treatment and that eviQ contributed to patients' improved health outcomes and quality of life. eviQ's increasing international usage should be explored.

What are the effects of smoke-free and tobacco-free university campus policies, and how can they be assessed? A systematic review.

OBJECTIVE: This article looks at the evaluation of smoke-free (SF) and tobacco-free (TF) university campus policies that ban smoking (and often vaping) both indoors and outdoors. To assess the effectiveness of these policies, we performed a systematic literature review to answer the following questions: what is the effect of SF/TF policies on campus users' behaviors/norms/perceptions around smoking? Are the SF/TF policies an effective measure for reducing smoking among young adults? What methods and indicators can we use to assess the impact of SF/TF campus policies? What is the theoretical model underpinning the influence of SF/TF policies on the behavior of campus users? METHODS: Three databases (PubMed, Scopus, and Web of Science) were searched over the period from January 2005 to December 2022. The article selection process included 54 articles published in scientific journals that analyzed the post-implementation impact of SF/TF campus policies. The quality of these articles was analyzed using six ad hoc indicators based on the Critical Appraisal Skills Program checklist and Joanna Briggs Institute scoping tools. RESULTS: Most of the research on SF/TF campus policies has been conducted in the United States using quantitative methodologies. Most of these studies show that SF/TF policies reduce positive beliefs about smoking and its acceptability, influence smoking behavior (reducing smoking initiation and increasing the number of quits and quit attempts), and reduce exposure to passive smoking and pollution from cigarette butts. User acceptability of SF/TF policies is generally high. Limitations of SF/TF campus policies include difficulty for smokers to comply with them, persistence of passive smoking around campuses, and limited uptake of on-campus cessation support services provided to smokers. DISCUSSION: The various mediating and moderating variables identified in the literature have made it possible to propose a model of the potential influence of SF/TF policy on campus users, based on the theory of planned behavior. Based on this review, we provide health professionals and higher education institutions wishing to implement a SF/TF campus policy with a set of indicators that can serve to assess the impact of a SF/TF campus policy (attitudes, acceptability, beliefs, norms, exposure to passive smoking and pollution, changes in smoking behavior). CONCLUSION: Based on scientific evidence, the implementation of SF/TF campus policies in France is an important measure to help combat smoking in young adults.

Pilot evaluation of a behavioral weight loss program for adults with physical disabilities: State of Slim Everybody usability and feasibility.

Background: People with physical disabilities (PWD) have a higher prevalence of obesity than populations without disability, but most evidence-based weight loss programs have not included this population. The State of Slim (SOS) program is an evidence-based weight loss program that has demonstrated success in producing weight loss in populations without disability, but it has not been adapted for or evaluated in PWD. Methods: The SOS program was systematically adapted using the evidence-informed Guidelines, Recommendations, and Adaptations Including Disability (GRAIDs) framework. A total of 35 participants enrolled in the State of Slim Everybody program. The program was offered entirely online. Body weight, attendance, and food log completion were also tracked weekly. The program length was 16.5 h and included weekly group instruction, with optional one-on-one sessions provided upon request. Following completion, participants completed post-evaluation surveys on overall satisfaction with the program. The primary outcomes were program effectiveness (i.e., body weight), usability, and feasibility. Results: Thirty-two out of 35 participants completed the program, representing a retention rate of 91.4%. Average weight loss was 10.9% (9.9 ± 0.7 kg (t (31) = -13.3, p =< 0.0001)). On a 1 (dissatisfied/completely useless) to 5 (very satisfied/completely helpful) Likert scale, the average score for overall program satisfaction was 4.8 ± 0.1 and program helpfulness 4.6 ± 0.1. Conclusion: The State of Slim Everybody program demonstrated significant weight loss and good usability and feasibility in PWD. Existing adaptation frameworks can be used to create inclusive health promotion programs for adults with physical disabilities.

Empowering Expecting Women to Obtain High-Quality Healthcare in Pakistan: An Evaluation of Khyber Pakhtunkhwa's Conditional Cash Transfer Program.

Maternal mortality, largely stemming from complications during pregnancy and childbirth, impacts poor expecting women with limited healthcare access in rural Pakistan. Conditional Cash Transfers (CCTs), commonly implemented in developing nations, are designed to improve the well-being of vulnerable populations by focusing on health and education. A CCT initiative named Chief Minister's Special Initiative for Mother and Child Health (CM-SIMCH) was launched in Khyber Pakhtunkhwa (KP), one of the less-developed provinces of Pakistan, to empower expecting women to access quality healthcare. This study investigates the factors influencing CM-SIMCH program participation and assesses its impact on the health of expecting women by analyzing health-seeking hospital visits in KP, Pakistan. The study utilizes the Propensity Score Matching (PSM) technique to analyze cross-sectional data obtained from 303 expecting women residing in the Nowshera district of KP. The PSM allows for a balanced comparison of participants who received the CM-SIMCH transfers with those who did not, assessing its impact on maternal healthcare access and outcomes. Empirical results show that factors such as education and family system positively influence the participation of expecting women in the CM-SIMCH program, whereas travel costs exert a negative effect. The intervention leads to a notable increase in hospital visits among these women, contributing to improved health outcomes in KP. This underscores the program's potential effectiveness in addressing maternal healthcare challenges and enhancing healthcare access for vulnerable women in less-developed areas. Therefore, empirical evidence supports the CM-SIMCH program's potential to promote maternal health and improve healthcare access in KP. The study recommends government intervention in health sector as a strategic imperative to empower women and enhance infant health.

Ageism webinars: a needs-based continuing education training for the national aging network.

To combat ageism, the National Resource Center on Nutrition and Aging (NRCNA) launched two Ageism Webinars (AWs). The study's aims were to 1) assess the effectiveness of the AWs for increasing participants' perceived familiarity (FAM) and knowledge (KNOW) and producing high behavioral intent to implement recommended action steps and quality among participants, and 2) practice equitable evaluation by ascertaining whether outcomes were fairly achieved by participants regardless of race, age, and education. A convenience sample of mostly educated non-Hispanic females with an average age of 52 years (n = 193) completed a retrospective online survey post-webinar. A retrospective Likert scale noted an overall increase in perceived FAM and KNOW (p < 0.001). However, these changes were significantly smaller (p < 0.05) among those from historically marginalized races and ethnicities. The theory of planned behavior (TPB) items predicted high intention to complete the recommended action step following the webinars. High satisfaction for webinars was reported, with 98.7% wanting to attend future NRCNA training. This study provides evidence of an effective training modality for addressing ageist perspectives, and the demonstrated differences provide insight into how to improve the AWs and the evaluation of future webinars.

Analyzing the impact of an MDG-Fund program on childhood malnutrition in Timor-Leste.

BACKGROUND: Timor-Leste's food insecurity, propelled by political conflicts, a fragile economy and biophysical limitations that characterize mountainous Small Island Developing States (SIDS), is expressed in a high incidence (50%) of stunted children. Hence, the Millennium Development Goals Achievement Fund's Joint Program's (MDG-F JP) in 2009 was a timely intervention to reduce prevalence of underweight among under-fives. Since the impact of the program remains largely unclear, the current study investigates the contributions of the MDG-F JP on improving children's nutritional status in Timor-Leste, in order to inform policymakers on how to make future programs more effective. METHODS: Using bivariate analyses and multiple linear regression models we analyzed Demographic and Health Survey (DHS) data from under-fives in 2009-2010 and 2016, combined with spatially explicit data from geographic information systems (GIS). The analyses generated trends and factors associated with undernutrition, which were used in a quasi-experimental setting to compare districts that received the MDG-F JP with similar districts that did not receive MDG-F JP interventions. RESULTS: A comprehensive set of factors dependent on seasons, locations, and individuals determine undernutrition in Timor-Leste. A positive impact of the MDG-F JP was found for the average severity of wasting, but not for stunting and underweight. CONCLUSIONS: The findings reinforce the pressing need for integrated and cross-sectoral programs, aimed especially at agricultural workers, mothers, and children. The agricultural challenge is to sustainably select, produce and conserve higher-yield and nutrient-rich crops, and educational enhancement should be aligned with local practices and research.

Practice-Oriented Research: An Introduction to New Developments and Future Directions.

Aimed at understanding and improving psychological therapies as they are conducted in clinical routine, practice-oriented research (POR) is now a well-established approach to the scientific foundations of mental health care services. Resting on the accumulation of a wide range of practice-based evidence related to treatment outcome and process, as well as factors associated with the participants of psychotherapy and its context, POR is ripe for new developments - regarding what to investigate and how to investigate it. This paper is the introduction of a series devoted to recent advances and future directions of POR as their pertained to routine outcome monitoring, technologies and artificial intelligence, the integration of constructs and methods from program evaluation and implementation science, and the investigation of populations with limited financial resources across various regions of the world. The series also includes commentaries from two leaders of POR.

The competency index for clinical research professionals: a potential tool for competency-based clinical research academic program evaluation.

Background: Accreditation of graduate academic programs in clinical research requires demonstration of program achievement of Joint Task Force for Clinical Trial Competence-based standards. Evaluation of graduate programs include enrollment, student grades, skills-based outcomes, and completion rates, in addition to other measures. Standardized measures of competence would be useful. Methods: We used the Competency Index for Clinical Research Professionals (CICRP), in a separate-sample pretest-posttest study to measure self-confidence or self-efficacy in clinical research competency comparing cohorts of students entering and completing a master's degree program in clinical research across three semesters (summer 2021 - spring 2022). CICRP is a 20-item Likert scale questionnaire (0 = Not at all confident; 10 = extremely confident). Results: The study sample of 110 students (54 in the entry course, 56 in the exit course) showed overall 80.9% entered the program with only a baccalaureate degree and 55.5% had no prior experience in managing clinical trial research. Cronbach alpha for the instrument showed a high level of content validity (range 0.93-0.98). Median CICRP item rating range at entry was [1, 6] and at exit [7, 10]. Mean CICRP total score (sum of 20 items) at entry was 72.7 (SD 41.9) vs. 167.0 (SD 21.1) at exit (p < 0.001). Mean total score at program entry increased with increasing years of clinical trial management experience but attenuated at program exit. Conclusion: This is the first use of the CICRP for academic program evaluation. The CICRP may be a useful tool for competency-based academic program evaluation, in addition to other measures of program excellence.

Mixed methods evaluation of a jail diversion program: Impact on arrests and functioning.

This mixed methods study had two aims: (1) to examine the effectiveness of a jail diversion program in reducing recidivism and promoting educational and employment outcomes; and (2) to qualitatively explore mechanisms through which the program was effective. Participants were 17 individuals arrested for drug offenses who participated in an intensive, law enforcement-based jail diversion program, and 17 individuals in a comparison group. Arrests were extracted from police records, and education and employment were extracted from program data. Four intervention participants completed qualitative interviews. Arrest rates in the intervention group decreased significantly postintervention, and arrest rates in the intervention group were numerically lower than those in the comparison group. Participants experienced significant increases in employment and driver's license status. Participants also identified mechanisms through which the program was effective. This jail diversion program shows promise in reducing recidivism and promoting adaptive functioning. Jail diversion programs that include mentorship, peer support, and removal of barriers to success may be particularly effective.

Promoting healthful food purchases through in-store interventions: Empirical evidence from rural food deserts.

Effective ways to promote healthful food intake in rural areas are understudied. The paper evaluated whether a two-component, in-store intervention designed to encourage healthy food purchases was associated with improved healthfulness scores of food items purchased by shoppers in rural food deserts. One component introduced a point-of-sales label that assigned a single numerical score to each food item facilitating direct comparisons of the product's nutrition with those of other products shelved around it. The other component was a one-day nutrition education workshop promoted within the store. Interventions took place in 2015 at two stores in rural counties in the U.S. Midwest. Four stores in similar communities were selected as the control group. We applied a difference-in-difference model to estimate changes in the healthfulness of food items purchased attributable to the intervention among shoppers at the treatment stores (n = 486) and control stores (n = 10,759) using store transaction data. Healthfulness of food items was measured in terms of food scores published by the Environmental Working Group on a 1-10 scale. Both components had minimal impacts on the scores, although 0.2 and 0.1 points increases in the score per item and score per dollar were statistically significant at the 1% level respectively. A year after the intervention, these small effects of the intervention further diminished compared to the immediately after implementation. Results suggest the average effects of intervention across the study communities had limited practical significance but benefited some rural residents who were exposed to the intervention.

The Saturation- and Dose-Dependent Effects of a Teen Sexual Harassment Prevention Program: Findings from a Randomized Controlled Trial.

Using a randomized controlled trial, we investigated changes in both sexual harassment (SH) perpetration and victimization of 2104 middle school students in New York City who received divergent saturation and dosage levels of Shifting Boundaries, an SH prevention program, which was represented by the length of the program. We assessed the saturation effect of the program by comparing the outcomes across respondents from 26 schools in which there were varying percentages of students enrolled in the program. The data suggested that, overall, the program was effective in reducing sexual harassment victimization but achieved a null effect against respondents' SH perpetration and that neither the length nor the school-saturation level of the program exerted a significant effect on SH perpetration. Although the data indicated a significant difference in SH victimization between the treatment and control group, when comparing subgroups who received treatment with divergent saturation and dosage levels, no statistically significant difference was identified. Our results suggested that the program effect was not contingent on the portion of students in a school who enrolled in the program, nor was it contingent on the dosage.