Live Well Springfield (LWS): Measuring Baseline Usage of the Springfield River Walk

OBJECTIVE: To measure RW usage prior to implementation of a targeted LWS intervention. METHODS: Users were automatically counted by TRAFx infrared trail counters, which were installed at three locations along the RW – Brightwood, Boathouse, and Depot. Data are expressed in counts, not in number of people, because the counters cannot determine user identity. Data represent counts from August through October 2013. RESULTS: The median daily counts for the Brightwood, Boathouse, and Depot locations were 70, 96, 181, respectively; mean counts were 69, 97, 189, respectively; and the range in counts were 39-133, 18-209, and 52-374, respectively. Hourly distributions varied. DISCUSSION: Brightwood had relatively high counts during the 6 PM hour (6:00 to 6:59), suggesting nearby residents using the trail after work. Boathouse counts showed no sharp hourly peaks, suggesting usage is less related to a typical work schedule. Depot counts peaked sharply during the 12 PM and 1 PM hours, suggesting employees from downtown using the trail on their lunch break. The range in counts at each location suggests that weather affected usage overall, while differences between locations suggest that characteristics of each location played a large role in determining counts. CONCLUSION: Results of this study will inform LWS programming and lay the foundation for post-intervention comparisons

Inpatient Hospital and Post-Acute Care for Vertebral Fractures in Women

AbstractObjectiveApproximately 700,000 vertebral fractures occur annually in the United States. Available estimates on hospital costs and length of stay for vertebral fractures do not reflect current practice patterns, nor has post-acute care utilization been reported in sufficient detail. This paper provides new estimates on acute care charges, length-of-stay (LOS), and distribution patterns of post-acute care for osteoporotic vertebral fractures in women aged 50 years and older in the United States.MethodsThe Nationwide Inpatient Sample (NIS) database (1997) was used to identify admissions with a primary diagnosis of vertebral fracture. Decision rules based on clinical criteria were developed to identify vertebral fracture cases considered to be osteoporosis-related. Charges, LOS and discharge disposition were analyzed according to patient demographics and hospital characteristics.ResultsIn 1997, there were 53,066 hospital admissions for osteoporotic vertebral fractures in women. Mean charges and LOS were $9,532 and 6.2 days, respectively, while US totals were$506 million and 329,000 days. More than 40% were discharged to long-term care (LTC); another 24.3% required other follow-up care. Charges and LOS were inversely related to age. Female patients aged 75 or more were more than five times as likely to be discharged to LTC compared to women between the ages of 50 and 64. Charges and LOS were in general, significantly higher for patients in the Northeast, urban areas, teaching hospitals and in larger hospitals, and for patients transferred from other acute care hospitals.ConclusionsVertebral fractures are more expensive and resource-intensive than previously reported. Furthermore, total costs may be much greater when the components of post-acute care are fully captured

Live Well Springfield (LWS) – A Community Transformation Initiative LWS.org Website Evaluation

The Live Well Springfield (LWS) initiative is a collaborative effort comprised of partner organizations in Springfield, Massachusetts. The project promotes healthy living by increasing knowledge and awareness of food and physical activity. A website to communicate this mission is a major strategy being employed by LWS. In addition to event and health information, the website exhibits stories (including multimedia) that depict residents practicing healthy lifestyle choices. These narratives were designed to motivate residents to engage in healthy behaviors. To date, there has been no evaluation of the website’s reach and effect. A mixed-methods approach of an online survey and focus group discussion will be used to collect data. Examining the end-users perceptions of website/content will assess the website’s quality, engagement potential, and appropriateness. Constructs adapted from eHealth evaluation literature and from theoretical models, including Expectation-Confirmation Model (ECM) and Elaboration Likelihood Model (ELM), were used to develop the online survey. The survey will be accessible via the homepage of the LWS website as well as the LWS Facebook page to collect user perceptions as quantitative data. Qualitative data collected by focus groups will explore users’ responses to affective (narratives) versus cognitive (fact-based) messaging. Survey data will be analyzed using frequencies and cross tabulation. Recurrent themes identified from focus group transcripts will be used to assess appropriateness and relevance of website content. Results will inform potential revisions of the LWS website and contribute to the wider, second phase activities of the LWS initiative

Associations between the Patient-Centered Medical Home and Preventive Care and Healthcare Quality for Non-Elderly Adults with Mental Illness: A Surveillance Study Analysis

Background Patient-centered medical homes (PCMHs) may improve outcomes for non-elderly adults with mental illness, but the extent to which PCMHs are associated with preventive care and healthcare quality for this population is largely unknown. Our study addresses this gap by assessing the associations between receipt of care consistent with the PCMH and preventive care and healthcare quality for non-elderly adults with mental illness. Methods This surveillance study used self-reported data for 6,908 non-elderly adults with mental illness participating in the 2007–2012 Medical Expenditure Panel Survey. Preventive care and healthcare quality measures included: participant rating of all healthcare; cervical, breast, and colorectal cancer screening; current smoking; smoking cessation advice; flu shot; foot exam and eye exam for people with diabetes; and follow-up after emergency room visit for mental illness. Multiple logistic regression models were developed to compare the odds of meeting preventive care and healthcare quality measures for participants without a usual source of care, participants with a non-PCMH usual source of care, and participants who received care consistent with the PCMH. Results Compared to participants without a usual source of care, those with a non-PCMH usual source of care had better odds of meeting almost all measures examined, while those who received care consistent with the PCMH had better odds of meeting most measures. Participants who received care consistent with the PCMH had better odds of meeting only one measure compared to participants with a non-PCMH usual source of care. Conclusions Compared with having a non-PCMH usual source of care, receipt of care consistent with the PCMH does not appear to be associated with most preventive care or healthcare quality measures. These findings raise concerns about the potential value of the PCMH for non-elderly adults with mental illness and suggest that alternative models of primary care are needed to improve outcomes and address disparities for this population

Feasibility of Using a Web-Based Nutrition Intervention Among Residents of Multiethnic Working-Class Neighborhoods

Introduction: Using the Internet to promote behavior change is becoming more desirable as Internet use continues to increase among diverse audiences. Yet we know very little about whether this medium is useful or about different strategies to encourage Internet use by various populations. This pilot study tested the usefulness of a Web-based intervention designed to deliver nutrition-related information to and increase fruit and vegetable consumption among adults from working-class neighborhoods. Methods: Participants (N = 52) had access to the Web site for 6 weeks and received three e-mail reminders encouraging them to eat fruits and vegetables. The Web site provided information about overcoming barriers to healthy eating, accessing social support for healthy eating, setting goals for healthy eating, and maintaining a healthy diet, including recipes. We collected data on participants' use of the Web site, their Internet access and use, and their fruit and vegetable consumption. Results: The mean age of the participants was 46 years, 73% were white, 46% did not have a college degree, and 12% had household incomes at or below 185% of the federal poverty index. They reported consuming an average of 3.4 servings of fruits and vegetables per day. More than half of the participants owned a computer, 75% logged onto the Web site at least once, and those who visited the site averaged 3.8 visits and viewed an average of 24.5 pages. The number of log-ons per day declined over the study period; however, reminder e-mails appeared to motivate participants to return to the Web site. Roughly 74% of participants viewed information on goal setting, 72% viewed information on dietary tracking, and 56% searched for main course recipes. Conclusion: The results of this pilot study suggest that Internet-based health messages have the potential to reach a large percentage of adults from working-class neighborhoods who have access to the Internet

Live Well Springfield (LWS) -- A Community Transformation Initiative. Springfield MENU Program Evaluation

Studies have shown that low-income and minority Americans have a poor diet quality, which increases obesity and chronic disease risk. According to the Massachusetts Department of Public Health, Springfield is among the top five poorest cities in the state. To promote healthy eating behaviors among Springfield residents, Mason Square Health Task Force, a Live Well Springfield (LWS) partner, created a 6-session nutrition curriculum, entitled The MENU Program. The goal is to increase overall health awareness and healthy eating behaviors among residents in communities that are being targeted by the LWS initiative. The program was piloted with a group of female Mason Square residents, aged 60-85 years (n=12), at the Dunbar YMCA in Springfield, MA. Pre-and post-surveys were administered at sessions #1 and #6 to assess nutrition-related knowledge, attitudes and behaviors. Brief process evaluations were administered at the end of each 60 to 90 minute session to identify program strengths and limitations. Preliminary analysis reveals that participants increased their vegetable intake by 34% and consumption of fresh/frozen fruits and vegetables (vs. canned) increased by 9% and 18%, respectively. Those who reported “always” or “usually” reading nutrition labels increased from 54% to 72%, and those who reported “always” or “usually” shopping at a farmer’s market increased from 18% to 36%. Process evaluations showed positive responses to most of the material presented, particularly information regarding My Plate, portion control, and nutrition label reading. Further data analysis will inform revision of The MENU Program for use with larger, more diverse groups of Springfield residents

Changes in colorectal cancer screening intention among people aged 18–49 in the United States

Background: To determine whether exposure to a peer-led intervention focused on colorectal cancer (CRC) screening, physical activity, and multi-vitamin intake can lead to increased intentions to be screened for CRC once age eligible among adults under the age of 50. Methods: Participants were residents of low-income housing sites, and CRC screening intentions were assessed at baseline and at follow-up (approximately 2 years later) to determine changes in screening intentions and factors associated with changes in intentions. Results: Participants (n = 692) were 78.4% female, 42.6% Hispanic and 50.8% black. At follow-up, 51% maintained their intention to be screened and 14.6% newly intended to get screened. Individuals newly intending to get screened were more likely to have participated in the intervention, be older, male, and born in Puerto Rico or the United States compared to those who maintained their intention not to get screened (p < 0.05). Conclusion: Exposure to CRC prevention messages before the age of 50 can increase screening intentions among individuals who did not initially intend to get screened. Peer-led interventions to promote CRC screening should include individual less than 50 years of age, as this may contribute to increased screening at the recommended age threshold

Relationships between Social Resources and Healthful Behaviors across the Age Spectrum

Background. We examined cross-sectional relationships of social resources with health behaviors in adults ages 18–93 years. Methods. Baseline data from a 2009 risk behavior intervention trial were used to measure social resources, physical activity, and fruit and vegetable intake in 2,440 adults. To evaluate associations overall and within 4 age groups (18–34, 35–49, 50–64, and 65–93 y), we used multivariable regression. Results. Mean (SD) age was 49.4 (15) years, physical activity was 346 (304) minutes/week, and fruit and vegetable intake was 3.4 (2.4) servings/day. Mean social resource score was 1.2 (0–4 scale) in 18–34 year olds, 1.1 in all other age groups (P = 0.04). In multivariable models, for each one-point increment in social resource score, the odds ratio for getting 150–959 minutes of physical activity/wk (compared to <150 min/wk) was 3.7 (95% CI 3.0–4.6). Each one-point increment in score was also associated with 29% (95% CI: 23–35%) more servings of fruit and vegetables. We did not observe effect modification by age group. Conclusions:. Although younger adults reported slightly higher resources than older adults, the magnitude of association between social resources and healthful behaviors did not differ between them

Patient Follow-Up After Participating in a Beach-Based Skin Cancer Screening Program

Many skin cancer screenings occur in non-traditional community settings, with the beach being an important setting due to beachgoers being at high risk for skin cancer. This study is a secondary analysis of data from a randomized trial of a skin cancer intervention in which participants (n = 312) had a full-body skin examination by a clinician and received a presumptive diagnosis (abnormal finding, no abnormal finding). Participants’ pursuit of follow-up was assessed post-intervention (n = 283). Analyses examined: (1) participant’s recall of screening results; and (2) whether cognitive and behavioral variables were associated with follow-up being as advised. Just 12% of participants (36/312) did not correctly recall the results of their skin examination. One-third (33%, 93/283) of participants’ follow-up was classified as being not as advised (recommend follow-up not pursued, unadvised follow-up pursued). Among participants whose follow-up was not as advised, 71% (66/93) did not seek recommended care. None of the measured behavioral and cognitive variables were significantly associated with recall of screening examination results or whether follow-up was as advised. Research is needed to determine what factors are associated with follow-up being as advised and to develop messages that increase receipt of advised follow-up care