Internally-Developed Teen Smoking Cessation Programs: Characterizing the Unique Features of Programs Developed by Community-Based Organizations

We have compared the unique features of teen tobacco cessation programs developed internally by community-based organizations (N=75) to prepackaged programs disseminated nationally (N=234) to expand our knowledge of treatment options for teen smokers. Internally-developed programs were more likely offered in response to the sponsoring organization’s initiative (OR=2.16, p<0.05); had fewer trained cessation counselors (OR=0.31, p<0.01); and were more likely found in urban areas (OR=2.89, p=0.01). Internally-developed programs more often provided other substance-abuse treatment services than prepackaged programs and addressed other youth-specific problem behaviors (p≤0.05). Studies that examine the effectiveness of internally-developed programs in reducing smoking and maintaining cessation for teen smokers are warranted

Comparative Effectiveness Trial of an Obesity Prevention Intervention in EFNEP and SNAP-ED: Primary Outcomes

There is a need to disseminate evidence-based childhood obesity prevention interventions on a broader scale to reduce obesity-related disparities among underserved children. The purpose of this study was to test the comparative effectiveness of an evidence-based obesity prevention intervention, Hip-Hop to Health (HH), delivered through Expanded Food and Nutrition Education Program (EFNEP) and the Supplemental Nutrition Assistance Program-Education (SNAP-Ed) versus the standard curriculum delivered by the programs (Standard Nutrition Education (NE)). A nonequivalent control group design was delivered to compare the effectiveness of HH to NE on weight gain prevention and health behavior outcomes at EFNEP and SNAP-Ed sites. One hundred and fifty-three caregiver–child dyads (n = 103 in the HH group; n = 50 in the NE group) participated in the study. HH is an evidence-based dietary and physical activity intervention for low-income preschool children. The NE curriculum provided lessons for children that are consistent with the Dietary Guidelines for Americans 2010. Data were collected on demographics, anthropometrics, and behavioral variables for parent–child dyads at baseline and postintervention. Mixed model methods with random effects for site and participant were utilized. No differences in child or caregiver diet, physical activity, or screen time by group were found. No between-group differences in child BMI z-score were found; however, caregivers in the HH group lost significantly more weight than those in the NE group. Results from this trial can inform future dissemination efforts of evidenced-based programs for underserved families

A National Evaluation of Community-Based Youth Cessation Programs: End of Program and Twelve-month Outcomes

Most youth cessation treatment research consists of efficacy studies in which treatments are evaluated under optimal conditions of delivery. Less is known about the effectiveness of youth cessation treatments delivered in real-world, community based settings. A national sample of 41 community-based youth cessation programs participated in a longitudinal evaluation to identify site, program, and participant characteristics associated with successful cessation. Validated quit rates were comparable to those in randomized controlled trials; 7-day abstinence at the end of program averaged 14% and 30-day abstinence at 12 months averaged 12%. Multivariate GEE models explored predictors of smoking cessation at the end of the programs and at 12 months. Results showed correlates of both short- and long-term cessation. Findings point to the importance of both individual and community-level variables, including motivation, opportunities for and encouragement to engage in activities outside of academics, having youth participate in treatment before they become highly dependent smokers, and community norms and ordinances that discourage youth purchase, use and possession of tobacco. Providing evidence-based treatment to youth in community-based settings results in successful cessation.Keywords: Youth smoking cessation, Program evaluation, Community health promotion program

Spatial Effects Models for Group Interaction.

Appropriate statistical models for social interaction must (a) separate the effects of between-group factors from those that operate within-groups, and (b) provide a within-group individual-level analysis that allows interdependent (autocorrelated) observations. The analysis of variance and linear regression approaches fail the latter criterion. Following Erbring and Young (1979), several contextual analysis models are examined from a structural equations viewpoint and found inadequate because they do not reflect the social process to be modeled. However, one model based on the idea that the nonindependence takes the form of endogenous feedback among observational units with respect to one variable meets both substantive and statistical criteria. This model is formally similar to spatial effects regression models developed in biology and economic geography to study the interactions of neighboring plants and industries. In the present case the notion of social distance replaces that of physical distance. The spatial effects technique was compared to ordinary least squares (OLS) regression using a sample of 90 members of 23 public advisory committees from the Department of Health and Human Services. The eleven equations estimated were derived from an open systems model of group behavior (Stogdill, 1959; Mabry and Barnes, 1980) that classifies variables as member inputs, aspects of emergent group process, or outcomes of group activity. In eight of the nine equations for which spatial effects coefficients could be obtained, no improvement in prediction over OLS regression was observed. However, a significant endogenous feedback coefficient was found in the equation predicting a member's level of involvement in the committee. In other words, a member's involvement was reliably greater when he served on a committee whose other members were also highly involved. This finding demonstrates the potentially useful application of spatial effects regression to estimate endogenous feedback models of mutual social influence.Ph.D.Social researchUniversity of Michiganhttp://deepblue.lib.umich.edu/bitstream/2027.42/159341/1/8314240.pd

Examining patients' trust in physicians and the VA healthcare system in a prospective cohort followed for six-months after an exacerbation of heart failure.

OBJECTIVE: To examine the associations of several characteristics with patients’ trust in physician and the healthcare system. METHODS: A prospective cohort of patients were followed after an exacerbation of heart failure at one of two Veterans Affairs (VA) hospitals. Patients rated pre-visit and post-visit trust in physician and in the VA healthcare system at follow-up outpatient visits. The associations of trust in physician and VA with covariates were analyzed using multivariate mixed-effects regression. RESULTS: After adjusting for covariates, post-visit trust in physician was significantly higher than pre-visit trust (P<.001), but was not significantly different by race. Trust in VA did not change significantly over time (P>.20), but was significantly lower for Black patients (P<.001). High self-efficacy to communicate was independently associated with both trust in physician and VA (P<0.001). CONCLUSIONS: Trust in physician improved over the course of each visit. Trust in VA was not associated with time, but was lower among black patients. Trust was higher when ratings of communication were higher. PRACTICE IMPLICATIONS: Trust in physician improved at each visit and was independently associated with communication. Interventions designed to improve communication should be tested for their ability to improve trust in physician and trust in the healthcare system