Translational Behavioral Medicine最新文献

Background: ReOpening Schools Safely and Educating Youth (ROSSEY) was a cluster randomized controlled trial of a risk communication intervention for COVID-19 prevention to promote safe return to school among students in a rural, agricultural community.

Purpose: This qualitative study evaluated the implementation of a risk communication intervention and a school district's COVID-19 testing program through parent focus groups and interviews with school staff and students.

Methods: Parents (n = 37), students (n = 19), and school staff (n = 14) from seven schools that received the intervention shared their experience via focus groups and interviews informed by the RE-AIM framework. Deductive and inductive coding was conducted by four data analysts. Themes were validated with community members.

Results: Parent focus groups, student and staff interviews provided insight into the ROSSEY study implementation. We identified five main themes: (i) social and financial drivers of participation; (ii) personal beliefs and unique challenges to research participation; (iii) intervention reinforced knowledge and shifted behavior; (iv) the appeal of comic books and videos supported adoption; and (v) multimodal communication and partnerships enhanced implementation.

Conclusions: The risk communication intervention was deemed culturally appropriate, reinforced previous knowledge, and encouraged adoption of preventive behaviors. The partnership with the school district and collaboration with the district's COVID-19 testing program ensured success of recruitment, study implementation, and adoption of preventive behaviors.

Background: Access to comprehensive lactation support services is essential for promoting successful breastfeeding practices, which have significant health benefits for both mothers and infants. Despite these benefits, disparities in lactation support persist, particularly among low-income populations reliant on Medicaid. Currently, many state Medicaid programs do not reimburse outpatient visits with International Board-Certified Lactation Consultants (IBCLCs) or other healthcare providers for breastfeeding support. This lack of coverage creates a critical gap in access for marginalized and low-income communities, which often intersect with communities of color.

Objective: To understand the current landscape of state-level Medicaid policies on outpatient lactation consultation and other breastfeeding services, and to provide recommendations for expanding coverage in states without such provisions.

Methods: A comprehensive search of Medicaid state plan amendments (SPAs) was conducted to identify state-level policies on Medicaid coverage for outpatient lactation consultants and other breastfeeding services. This search resulted in a total of nineteen SPAs from January 2012 to December 2024, which were included for further analysis.

Results: Fourteen states have amended their state Medicaid plans to include provisions for lactation coverage and/or reimbursement (CO, CT, DE, GA, IL, NE, NH, NJ, NM, NY, OH, OR, TN, and VT), with 19 approved amendment proposals, some of which apply to the same states (NH, NY, and OH). Eight SPAs explicitly recognize IBCLCs as billable provider types (CO, DE, IL, NH, NJ, OR, TN, and VT), while seven SPAs extend this designation to other lactation support providers (CO, DE, GA, IL, NH, NM, and TN). Five states have session limits for lactation support (DE, GA, NE, NJ, and OR), and two states restrict coverage to sessions conducted during the postpartum period, with exceptions allowed for medical necessity (NE and OR). Additionally, three states (CO, CT, and NH) provide reimbursement for hospital-grade breast pumps or other breastfeeding-related supplies.

Conclusion: Policy recommendations include: (i) Implementing separate reimbursement through Medicaid for IBCLC services, (ii) securing state funding to meet federal matching requirements, and (iii) developing and submitting a SPA through state Medicaid programs.

This review assessed the effect of strategies designed to sustain the delivery of evidenced based interventions (EBIs) which target behavioural risk factors linked to leading causes of chronic disease in clinical and community settings. Seven electronic databases were searched for randomised controlled studies published from earliest record to November 2022. Studies were included if they tested a strategy to sustain the delivery of an EBI within clinical or community settings. Results were synthesised using vote counting based on direction of effect, and reported in accordance with non-meta-analytic review standards following the Synthesis Without Meta-analysis (SWiM) guidelines. Three studies met the study inclusion criteria. Two studies were community-based, with one conducted in Australian community sports clubs and the second in afterschool clubs in the United States. The single clinical-based study was conducted in community health care centres in the United States. Across the three studies, 25 strategies were employed and only two strategies were common across all studies. Synthesis using vote counting based on direction of effect indicated that two of three studies favoured the intervention as positively impacting sustainment of EBIs. Few studies have been conducted to assess the effect of strategies designed to support sustainment of EBIs for chronic disease prevention in clinical and community settings. As such, it is difficult to determine the effect of strategies designed to support sustainment. Further research with comprehensive reporting of the selection, use and testing of sustainment strategies is needed to advance understanding of how to sustain EBIs in clinical and community settings.

Traditional approaches to increase vaccination rely upon educating patients about vaccines. However, research shows that "knowing" vaccines are important is often insufficient: patients need to believe that getting vaccinated is important. Evidence-based motivational approaches, such as motivational interviewing/communication (MI/MC), have become increasingly popular for promoting good health behaviors, including vaccination. The objective of this review was to compare the efficacy of educational and MI/MC interventions on vaccination rates relative to each other and to usual/standard care. Pubmed, PsycINFO, and Cochrane trials databases were searched to identify articles that assessed vaccination rates post-patient education or MI/MC vaccine counseling in the context of adult or child vaccination (PROSPERO: CRD42019140255). Following the screening, 118 studies were included (108 educational and 10 MI/MC). The pooled effect sizes for vaccination rates corresponded to 52% for educational interventions (95% CI: 0.48-0.56) and 45% for MI/MC interventions (95% CI: 0.29-0.62) (P = .417). Fifty-nine randomized controlled studies (55 educational and 4 MI/MC) showed that, compared with usual/standard of care, exposure to education and MI/MC was associated with a 10% (RR =1.10; 95% CI =1.03-1.16, P = .002) and 7% (RR =1.07; 95% CI =0.78-1.45, P = .691) increased likelihood of getting vaccinated, respectively. Results suggest comparable efficacy of educational and MI/MC interventions on vaccination uptake and a small superiority of educational interventions compared with usual/standard of care. The overall poor quality of the studies, including lack of fidelity assessments of MI/MC studies, contributes to low confidence in the results and highlights the need for better quality intervention trials examining the efficacy of MI/MC for vaccine uptake.

Background: Childhood overweight/obesity in rural areas is a public health concern. Schools provide access to youth/families for health behavior programming but have adoption challenges.

Purpose: To explore school adoption of a family-based behavioral obesity program (iAmHealthy) from the perspective of three groups: (i) schools adopting iAmHealthy ("adopters"; took part in the iAmHealthy program), (ii) schools failing to adopt iAmHealthy ("initial adopters"; initially signed up for the iAmHealthy program, but could not continue), and (iii) schools that did not adopt iAmHealthy ("non-adopters"; never signed up for the iAmHealthy program).

Methods: Semi-structured interviews were conducted with rural school representatives (N = 33; n = 12 adopters, n = 9 initial adopters, and n = 12 non-adopters). Interviews were analyzed thematically and aligned with constructs and domains from the Consolidated Framework for Implementation Research (CFIR).

Results: Five themes emerged: (i) Regardless of the extent of healthy lifestyle programming schools offered, iAmHealthy would not compete and would benefit families, (ii) School representatives perceived a varied need for healthy behavior programming but challenges regarding limited resources were widespread, (iii) Partially due to concerns about stigma, school representatives preferred school-wide approaches that included integration with the curriculum and the community, (iv) School representatives considered many factors when deciding to participate in a health behavior program, and (v) School representatives expressed concerns about health behavior programming not being a priority for families. CFIR constructs within the domains of innovation, inner setting, outer setting, and individual characteristics aligned with the themes. Specifically, commonly cited barriers often aligned with the CFIR constructs of relative priority and local attitudes.

Conclusion: Findings indicate health behavior programming would fill an unmet need, but that there are adoption barriers, including limited resources, weight-related stigmatization concerns, and differing priorities across schools, communities, and families.

The Society for Behavioral Medicine supports permanent federal funding for Food is Medicine services to address nutrition-related chronic conditions. The Section 1115 Demonstration Waivers are currently serving as a temporary funding mechanism to pilot interventions aimed at improving health-related social needs, including food-related programs that support the prevention, management, and treatment of nutrition-related chronic conditions; however providing permanent funding for Food is Medicine services covered under Section 1115 Demonstration Waivers will allow states to utilize their federally set budgets to provide nutrition supports as a healthcare service. The sense of impermanency of the nutrition programs being implemented during the pilot period makes it challenging to establish effective workflow and implementation at scale.

Introduction: Lung cancer is a leading cause of cancer mortality among Asian-Americans. Despite the potential of lung cancer screening (LCS) to detect disease at an earlier stage and reduce mortality, the uptake of LCS remains low. This is particularly concerning among Asian subgroups with high smoking prevalence. Additionally, there are scarce intervention programs tailored specifically for Asian-Americans. The purpose of this pilot study was to develop and evaluate the Connect4LungHealth intervention to enhance LCS adoption and promote smoking cessation in high-risk Chinese and Korean communities via a Community-Health Worker (CHW)-driven approach integrated with mobile text messaging (TXT) strategies.

Methods: Connect4LungHealth intervention is a culturally sensitive, linguistically tailored program, facilitated by CHWs, collaboratively developed with our local Chinese and Korean community stakeholders to improve lung cancer control. Guided by our Community Advisory Board, LCS-eligible individuals were invited through community advertisements and social networks. Enrolled participants attended a Lung Health in-person workshop at a community setting and were then randomized to the Connect4LungHealth or an attention control (AC) group on the workshop level for a one-month intervention duration with a baseline, 1-month, and 3-month follow ups. Participants in the Connect4LungHealth arm received three tailored text messages per week, covering topics such as smoking cessation knowledge, self-regulatory skills, and raising LCS awareness with proactive CHW weekly check-in phone calls. The AC group received the same frequency of messages about healthy eating and was given information for connecting with CHW. Participants interested in LCS were directed to our institution's centralized LCS Program, supported by CHWs who could connect patients to insurance resources and accompany participants to an in-person shared decision-making visit performed by the LCS Program nurse navigator, followed immediately by a same-day low-dose CT (LDCT) scan.

Results: Among 48 LCS eligible community individuals we reached via community workshops, 36 (75%, 19 Chinese American and 17 Korean American) agreed, consented, and completed baseline assessment. Enrolled participants were randomized to the Connect4LungHealth (N=20) or the (AC) group (N=16). Participants were an average of 61 years old, 86.1% were males and 80.6% had education level of high school or below and 50% had limited English proficiency. The retention rate was above 75% with high satisfaction reported by the intervention participants. Although not statistically significant, potentially due to the small sample size, we observed a greater reduction in cigarette use and an increase in self-efficacy from baseline to 3-month follow-up in the Connect4LungHealth group compared to the AC group. Further, Connect4LungHealth group achieved a 40% LDCT com

Background: Theories, models, and frameworks (TMFs) are central to the development and evaluation of implementation strategies supporting evidence-based practice (EBP). However, evidence on how and to what extent TMFs are used in implementation trials remains limited.

Purpose: This study aimed to examine the nature and extent of TMF use in implementation trials, identify which TMFs are most frequently employed, and explore temporal trends in their use.

Methods: A secondary analysis was conducted on 151 randomized trials of implementation strategies targeting EBP in nursing. Trials and their protocols were coded in NVivo 14 using a framework adapted from Painter's continuum of theory use (2005) and Michie and Prestwich's theory coding scheme (2010). The framework categorized theory use as "informed by," "applied," "tested," or "built" theory. Descriptive statistics were calculated in R, and temporal trends in TMF use across categories were analyzed.

Results: Among the 151 trials, 54 (36%) reported using a TMF. Of these, most applied TMFs to guide implementation strategy design (28%), followed by justifying the study's purpose, aims, or objectives (15%). Testing theory was infrequent (9%), and no trials reported refining or building theory. Classic theories, such as the theory of planned behavior and social cognitive theory, were the most frequently cited. No clear temporal trend was found in TMF use across the categories.

Conclusions: TMFs remain underutilized in implementation trials, with their application primarily limited to justifying study rationale or informing implementation strategy development. Greater emphasis on the testing and refinement of TMFs is recommended to advance implementation science.

Registration information: Review registration: PROSPERO CRD42019130446.

Background: Electronic Nicotine Delivery System (ENDS) use, particularly among young adults, is increasingly more popular than combustible cigarettes. Despite concerns over potential harm, standardized methods to assess ENDS device and liquid characteristics are lacking in behavioral surveillance and clinical studies. We adapted a dietary assessment method to develop the eCigTrackerTM app, which uses image-based tracking and app-based reminders (i.e. ecological momentary assessments) to prompt participants to capture device characteristics and estimate nicotine intake in real time.

Purpose: This study reports on the development and validity testing of the eCigTrackerTM app.

Methods: ENDS users participated in two study phases: an in-lab phase and a 14-day in-field phase. For the in-lab phase, we estimated nicotine concentration and liquid volume consumed by comparing rater assessment vs. laboratory measurements. Image uploads and EMA were used to assess the feasibility of determining device use patterns and liquid consumption by device type during the in-field phase. T-tests and Cohen's d were used to evaluate rater vs. lab assessments, while ANOVA and Tukey HSD tested differences in ENDS liquid consumption by device type.

Results: Rater vs. lab assessments closely matched, with mean differences of -0.70 mL (t=-1.08, P=.28, -3.2% mean error) for liquid volume and 0.66 mg/mL (t = 0.50, P=.62, 3.0% mean error) for nicotine concentration. In-field assessments effectively captured device use patterns, showing significant differences in nicotine intake by device type (F(2,36)=18.71, P<.001). User satisfaction was high, with 82% reporting ease of use and 86% disagreeing the app complex.

Conclusion: The eCigTracker™ app, developed primarily as a research tool to support real-time, image-based data collection in behavioral and epidemiological studies, is an accurate tool for measuring ENDS usage and estimating nicotine intake across diverse settings.

Emerging evidence suggests that bi-directional communication and referral pathways, when employed strategically, can lead to favorable health outcomes by connecting patients with complex, multi-faceted health and social needs to appropriate services and resources. However, despite these benefits, patient acceptance of referrals via these pathways remains suboptimal. In this study, we describe individual and clinical factors associated with patient acceptance of these referrals. We extracted individual-level demographic and clinical data for patients referred primarily from a large safety-net health system to a multi-purpose resource hub co-located on the campus of its largest hospital, for the period October 2019 to June 2023. Descriptive statistics, Chi-square analyses, and multinomial regression modeling were performed to examine these data. Of 1865 patients in the study sample, 54.2% accepted a referral, 27.4% were lost to follow-up, and 18.4% declined. Most patients who accepted referrals were female (67.1%), Latino (81.5%), and had hypertension and/or prediabetes or diabetes (84.1%). In modeling analyses, those who accepted referrals tended to be female, and were referred from primary care clinics; many were referred for multiple service/resource categories. We found associations between patient acceptance of referrals and gender and source of referral. Drawing upon these results as well as experience implementing these systems, we propose several practical strategies for increasing successful referrals, including identifying and addressing barriers for patients who declined or were lost to follow-up; using standardized screening tools to routinely assess for multi-faceted health and social needs; increasing provider awareness about the benefits and functioning of these pathways; and monitoring progress so mid-course adjustments can be made when necessary.