Improving student bus-riding behavior through a whole-school intervention.

We describe a multicomponent intervention to improve bus-riding behavior of students attending an urban public school. The intervention was developed with technical assistance consultation that emphasized collaboration among students, school personnel, and bus drivers. The primary intervention procedures were identifying appropriate behaviors during transportation ("bus rules"), training bus drivers to deliver positive reinforcement, and rewarding student performance through a weekly school-based lottery. Disruptive bus behaviors, as measured by discipline referrals and suspensions, decreased with intervention relative to baseline phases in an ABAB reversal design. These positive results were maintained over the long term, with school personnel assuming responsibility for intervention in the absence of ongoing consultation

Prevalence and Duration of Postmenopausal Hormone Replacement Therapy Use in a Managed Care Organization, 1990–1995

OBJECTIVE: To determine the prevalence and duration of postmenopausal hormone replacement therapy (HRT) use and identify correlates of adherence to therapy. DESIGN: Population-based cohort study. SETTING: Staff-model health maintenance organization. PARTICIPANTS: Female members, 40 years and older. MEASUREMENTS AND MAIN RESULTS: Prevalence and duration of use were measured between 1990 and 1995. Duration was assessed by Kaplan-Meier and proportional hazards methods. Hormone replacement therapy use increased from 10.3% in 1990 to 20.7% in 1995. Greatest use (24%) occurred among menopausal women age 50 to 54 years. Less than 5% of women 75 and older used HRT. Among 1,680 first-time recipients of HRT, two thirds of initial prescriptions were written by internists. Thirty-eight percent discontinued HRT within 1 year. For the subset whose indication for therapy was ascertained, prevention of chronic disease was associated with a 33% 1-year discontinuation rate. Factors associated with longer duration of therapy included white race (relative risk [RR], 1.63; 95% confidence interval [95% CI], 1.32 to 2.02), younger age (RR, 1.02 per year; 95% CI 1.01 to 1.03), and changing the preparation or dose of estrogen (RR, 5.62; 95% CI, 4.33 to 7.25). The formulation (esterified estrogens 0.625 mg versus conjugated estrogens 0.625 mg) was also associated with greater duration of use; all other estrogens were, as a group, associated with shorter duration of use. Those who received their initial HRT prescription from an internist were more likely to continue therapy than those who received it from a gynecologist. CONCLUSIONS: Despite increased use of HRT, only a minority of women in this population used HRT, and many of those discontinued therapy within 1 year