Strategies for recruitment and retention of teen mothers in a program to prevent repeat pregnancy

Background: We describe challenges to recruitment and retention of teen mothers in a study to prevent repeat teen pregnancies, and strategies used to overcome them. Methods: We documented recruitment efforts, the teens who were retained at each stage of the intervention and changes to strategies. Results: Challenges to recruitment and retention were related to lifestyles, immaturity, and competing demands, among others. Successful strategies included bus advertisements, early pairing of teens with mentors, using electronic media, convenient meeting times with a meal, providing child care, transportation vouchers and immediate incentives. Conclusions: This study highlights impediments to teen mother research recruitment and retention, and the value of emerging technologies and strong bonding relationships early in the intervention to maximize recruitment and retention

Cost effectiveness of a practice-based intervention to improve vaccination rates in adults less than 65-years-old

The cost-effectiveness of the 4 Pillars™ Practice Transformation Program to improve vaccination rates in adults $2,099 per case (societal base case$846). Thus, the 4 Pillars Practice Transformation Program is an economically reasonable intervention to improve vaccination rates in adults <65-years-old, and could have a substantial public health impact

Factors Associated with Home Food Environment in Low-Income Overweight or Obese Pregnant Women

Limited research has examined factors associated with home food availability. This study investigated the associations among demographics, body mass index category, stress, and home food availability among low-income overweight or obese pregnant women. This cross-sectional study enrolled 332 participants who were non-Hispanic black or white. We performed logistic regression modeling for unprocessed food, processed food, overall ultra-processed food, and three subcategories of ultra-processed food (salty snacks, sweet snacks and candies, and soda). Black women were less likely than white women to have large amounts of processed foods (OR = 0.56), salty snacks (OR = 0.61), and soda (OR = 0.49) available at home. Women with at least some college education or at least a college education were more likely to have large amounts of unprocessed food (OR = 2.58, OR = 4.38 respectively) but less likely to have large amounts of soda (OR = 0.44; OR = 0.22 respectively) available at home than their counterparts. Women with higher stress were less likely to have large amounts of unprocessed food available at home (OR = 0.58) than those with lower stress. Home food availability varied by race, education, and levels of stress in low-income overweight or obese pregnant women

Factors Associated with Home Food Environment in Low-Income Overweight or Obese Pregnant Women

Limited research has examined factors associated with home food availability. This study investigated the associations among demographics, body mass index category, stress, and home food availability among low-income overweight or obese pregnant women. This cross-sectional study enrolled 332 participants who were non-Hispanic black or white. We performed logistic regression modeling for unprocessed food, processed food, overall ultra-processed food, and three subcategories of ultra-processed food (salty snacks, sweet snacks and candies, and soda). Black women were less likely than white women to have large amounts of processed foods (OR = 0.56), salty snacks (OR = 0.61), and soda (OR = 0.49) available at home. Women with at least some college education or at least a college education were more likely to have large amounts of unprocessed food (OR = 2.58, OR = 4.38 respectively) but less likely to have large amounts of soda (OR = 0.44; OR = 0.22 respectively) available at home than their counterparts. Women with higher stress were less likely to have large amounts of unprocessed food available at home (OR = 0.58) than those with lower stress. Home food availability varied by race, education, and levels of stress in low-income overweight or obese pregnant women.</jats:p

Factors associated with micronutrient intake of low-income overweight or obese young mothers

We examined the proportion of the low-income overweight or obese mothers meeting micronutrient recommendations, and whether race, education, and body mass index category (BMIc) were associated with micronutrient intake. This analysis included 198 women who completed a validated food frequency questionnaire (FFQ). Micronutrients were grouped: antioxidant (vitamins A, C, and E, as well as copper, selenium, and zinc), methylation (vitamins B2, B3, B6, B9, and B12, and choline), bone health (vitamins D and K, calcium, magnesium, and phosphorus), and others (vitamin B1, iron, potassium, and sodium). We performed descriptive analysis and generalized linear models. At least two-thirds of women met most antioxidant, methylation, and other micronutrient recommendations. Antioxidant: White reported lower intake of selenium than Black. There were negative associations between education and vitamin E intake and between BMIc and zinc intake. Methylation: White had lower intake of choline than Black, and BMIc was negatively associated with vitamin B12 intake. Bone health: White had lower vitamin K intake than Black. BMIc was negatively associated with magnesium intake. Others: White reported lower potassium and sodium intake than Black. Education was positively associated with iron intake. Nutrition education for the target population might consider tailoring intervention based on race, education, and BMIc

Cost-effectiveness of increasing vaccination in high-risk adults aged 18–64 Years: a model-based decision analysis

Abstract Background Adults aged 18–64 years with comorbid conditions are at high risk for complications of certain vaccine-preventable diseases, including influenza and pneumococcal disease. The 4 Pillars™ Practice Transformation Program (4 Pillars Program) increases uptake of pneumococcal polysaccharide vaccine, influenza vaccine and tetanus-diphtheria-acellular pertussis vaccine by 5–10% among adults with high-risk medical conditions, but its cost-effectiveness is unknown. Methods A decision tree model estimated the cost-effectiveness of implementing the 4 Pillars Program in primary care practices compared to no program for a population of adults 18–64 years of age at high risk of illness complications over a 10 year time horizon. Vaccination rates and intervention costs were derived from a randomized controlled cluster trial in diverse practices in 2 U.S. cities. One-way and probabilistic sensitivity analyses were conducted. Results From a third-party payer perspective, which considers direct medical costs, the 4 Pillars Program cost $28,301 per quality-adjusted life year gained; from a societal perspective, which adds direct nonmedical and indirect costs, the program was cost saving and more effective than no intervention. Cost effectiveness results favoring the program were robust in sensitivity analyses. From a public health standpoint, the model predicted that the intervention reduced influenza cases by 1.4%, with smaller decreases in pertussis and pneumococcal disease cases. Conclusion The 4 Pillars Practice Transformation Program is an economically reasonable, and perhaps cost saving, strategy for protecting the health of adults aged < 65 years with high-risk medical condition