Factors Affecting Implementation of the California Childhood Obesity Research Demonstration (CA-CORD) Project, 2013.

IntroductionEcological approaches to health behavior change require effective engagement from and coordination of activities among diverse community stakeholders. We identified facilitators of and barriers to implementation experienced by project leaders and key stakeholders involved in the Imperial County, California, Childhood Obesity Research Demonstration project, a multilevel, multisector intervention to prevent and control childhood obesity.MethodsA total of 74 semistructured interviews were conducted with project leaders (n = 6) and key stakeholders (n = 68) representing multiple levels of influence in the health care, early care and education, and school sectors. Interviews, informed by the Multilevel Implementation Framework, were conducted in 2013, approximately 12 months after year-one project implementation, and were transcribed, coded, and summarized.ResultsRespondents emphasized the importance of engaging parents and of ensuring support from senior leaders of participating organizations. In schools, obtaining teacher buy-in was described as particularly important, given lower perceived compatibility of the intervention with organizational priorities. From a program planning perspective, key facilitators of implementation in all 3 sectors included taking a participatory approach to the development of program materials, gradually introducing intervention activities, and minimizing staff burden. Barriers to implementation were staff turnover, limited local control over food provided by external vendors or school district policies, and limited availability of supportive resources within the broader community.ConclusionProject leaders and stakeholders in all sectors reported similar facilitators of and barriers to implementation, suggesting the possibility for synergy in intervention planning efforts

Cigarette Smoking Among Low-Income African Americans: A Serious Public Health Problem

Background This study examines the current prevalence of cigarette smoking and the number of cigarettes smoked in a community-based sample of 1021 low-income African-American men and women. Methods Participants were selected using a two-stage, area probability sample design. Data were collected in 2002–2003 in face-to-face interviews and analyzed in 2005. All data and analyses were weighted to account for the complex sampling design. Results Fifty-nine percent of men and 41% of women were current smokers, with younger individuals apparently initiating smoking at an earlier age than older individuals. Conclusions The high prevalence of cigarette use provides further evidence that the excess burden of tobacco-related disease among low-income African-American families may be on the rise. This is of great concern, and if confirmed by further research, indicates an urgent need for preventive intervention

Clinically Determined and Self-Reported Dental Caries Status During and After Pregnancy Among Low-Income Hispanic Women

This analysis assessed, during and one-year after pregnancy: 1) the prevalence of and relationship between self-reported and clinically determined dental caries and oral health status, and whether self-reports are a potential proxy for professional determination; 2) factors associated with high levels of professionally determined or self-reported oral disease

Heterogeneity in periodontitis prevalence in the Hispanic Community Health Study/Study of Latinos

To examine acculturation and established risk factors in explaining variation in periodontitis prevalence among Hispanic/Latino subgroups

Periodontitis and Sleep Disordered Breathing in the Hispanic Community Health Study/Study of Latinos

To investigate the association between sleep disordered breathing (SDB) and severe chronic periodontitis

Infections up to 76 days after stroke increase disability and death

Early infection after stroke is associated with a poor outcome. We aimed to determine whether delayed infections (up to 76 days post-stroke) are associated with poor outcome at 90 days. Data came from the international Efficacy of Nitric Oxide Stroke (ENOS, ISRCTN99414122) trial. Post hoc data on infections were obtained from serious adverse events reports between 1 and 76 days following stroke in this large cohort of patients. Regression models accounting for baseline covariates were used to analyse fatalities and functional outcomes (modified Rankin Scale (mRS), Barthel Index, Euro-Qol-5D) at 90 days, in patients with infection compared to those without infection. Of 4011 patients, 242 (6.0%) developed one or more serious infections. Infections were associated with an increased risk of death (p < 0.001) and an increased likelihood of dependency (measured by mRS) compared to those of all other patients (p < 0.001). This remained when only surviving patients were analysed, indicating that the worsening of functional outcome is not due to mortality (p < 0.001). In addition, the timing of the infection after stroke did not alter its detrimental association with fatality (p = 0.14) or functional outcome (p = 0.47). In conclusion, severe post-stroke infections, whether occurring early or late after stroke, are associated with an increased risk of death and poorer functional outcome, independent of differences in baseline characteristics or treatment. Not only are strategies needed for reducing the risk of infection immediately after stroke, but also during the first 3 months following a stroke. This study is registered: ISRCTN registry, number ISRCTN99414122, ClinicalTrials.gov Identifier, NCT00989716

Mothers' self -efficacy and oral health in low -income African American children in Detroit.

Dental caries, the most common disease affecting humans, is disproportionately more prevalent in poor and minority populations in the U.S. This study seeks to advance knowledge of the social determinants of oral health, by examining how several specific maternal health beliefs, self-efficacy in particular, and psychosocial factors relate to young children's dental outcomes and practices. Survey and dental exam data were obtained from the Detroit Dental Health Project (DDHP), an NIH-funded 7-year research project (NIDCR grant U-54 DE 14261-01) that aims to study why some low-income children have dental caries and others do not even when they live in similar socioeconomic environments. Health belief scales reflecting efficacy, fatalism, and knowledge of appropriate bottle use and children's oral hygiene needs were constructed based on exploratory factor analysis. Mothers' brushing habits and psychosocial measures of depressive symptoms (CES-D), parenting stress, availability of social support and background characteristics were also predictors. The outcomes were children's brushing frequency, Early Childhood Caries (ECC) status, and mothers' subjective oral health rating. Descriptive and regression analyses were conducted in SUDAAN with a population-based sample of 719 African-American children aged 1--5 and their mothers who participated in DDHP in 2002--3. Efficacy, brushing behavior, and transportation support were significantly positively associated with children's brushing, while less hygiene knowledge, fatalism, and financial support were negatively associated. If mothers lacked bottle use knowledge, were depressed, more educated, and if the child had a restorative dental visit, it was more likely that 1--3 year olds' oral health was rated fair/poor. Among 4--5 year olds, having dental insurance, and mothers with more education and less bottle knowledge reduced their likelihood of a fair/poor rating, while less hygiene knowledge and help with errands increased the likelihood. Mothers' ratings were congruent with caries status based on dental exams. Higher parenting stress was inversely related to disease severity. Restorative dental treatment among 1--3 year olds increased the likelihood of ECC, and higher family income reduced the likelihood. Fatalism and less hygiene knowledge increased the likelihood of ECC for 4--5 year olds, while more education reduced the likelihood. Although some findings are counterintuitive and warrant further exploration, mothers' social cognitive and psychosocial characteristics affect her child's brushing frequency and dental health. Since cognitions are potentially modifiable, results can inform the design of a tailored intervention to improve children's oral health in earliest childhood.Ph.D.Black studiesDentistryHealth and Environmental SciencesPsychologyPublic healthSocial SciencesSocial psychologyUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/124784/2/3163794.pd