Sealy Y.M.,Fordham University |
Zarcadoolas C.,CUNY - Hunter College |
Dresser M.,Bureau of Chronic Disease Prevention and Tobacco Control |
Wedemeyer L.,Public Health Detailing Program |
Short L.,Nutrition Strategy Program
Childhood Obesity | Year: 2012
Background: This paper describes the research and development of the Obesity in Children Action Kit, a paper-based chronic disease management tool of the Public Health Detailing Program (PHD) at the New York City (NYC) Department of Health and Mental Hygiene (DOHMH). It also describes PHD's process for developing the Obesity in Children detailing campaign (targeting healthcare providers working with children aged 2-18) and its results, during which the Action Kit materials were a focal point. The campaign goals were to impact healthcare provider clinical behaviors, improve the health literacy of parents and children, instigate patient-provider-parent dialogue, and change family practices to prevent obesity. Methods: Qualitative research methods consisted of healthcare provider in-depth interviews and parent focus groups to aid campaign development. Evaluation of the Obesity in Children campaign included self-reported data on uptake and usage of clinical tools and action steps of matched assessments from 237 healthcare provider initial and follow-up visits, material stock counts, and DOHMH representative qualitative visit excerpts. Results: Key themes identified in parent focus groups were concerns about childhood diabetes and high blood pressure, awareness of cultural pressure and our "supersize" culture, frustration with family communication around overweight and obesity, lack of knowledge about food quality and portion size, economic pressures, and the availability of healthy and nutritious foods. During the Obesity in Children campaign, six representatives reached 161 practices with 1,588 one-on-one interactions, and an additional 461 contacts were made through group presentations. After these interactions, there was a significant increase in the percentage of physicians self-reported use of key recommended practices: Use of BMI percentile-for-age to assess for overweight or obesity at every visit increased from 77% to 88% (p < 0.01); counseling all patients and their parents/caregivers about healthy eating and physical activity increased from 67% to 85% (p < 0.01); counseling all patients on reducing sugar-sweetened beverages increased from 63% to 78% (p < 0.01); and working with families to set realistic goals increased from 64% to 86% (p < 0.01). Clinical tools such as a soda bottle showing sugar content, pediatric plate planners, and goal setting posters were widely adopted (62%, 78%, and 41% respectively). Conclusions: The Obesity in Children campaign, as well as its predecessor, the Adult Obesity campaign and Action Kit, were amongst the best-received and most successful campaigns PHD has conducted since the inception of the program. They have elicited the most attention from healthcare providers and staff, with Obesity in Children Action Kit materials being requested throughout NYC, as well as nationally. © Mary Ann Liebert, Inc.
Yi S.S.,Bureau of Chronic Disease Prevention and Tobacco Control |
Yi S.S.,New York University |
Tabaei B.P.,Primary Care Information Project |
Rapin A.,Primary Care Information Project |
And 5 more authors.
Circulation: Cardiovascular Quality and Outcomes | Year: 2015
Hypertension is a leading risk factor for cardiovascular disease. Although control rates have improved over time, racial/ethnic disparities in hypertension control persist. Self-blood pressure monitoring, by itself, has been shown to be an effective tool in predominantly white populations, but less studied in minority, urban communities. These types of minimally intensive approaches are important to test in all populations, especially those experiencing related health disparities, for broad implementation with limited resources. Methods and Results-The New York City Health Department in partnership with community clinic networks implemented a randomized clinical trial (n=900, 450 per arm) to investigate the effectiveness of self-blood pressure monitoring in medically underserved and largely black and Hispanic participants. Intervention participants received a home blood pressure monitor and training on use, whereas control participants received usual care. After 9 months, systolic blood pressure decreased (intervention, 14.7 mm Hg; control, 14.1 mm Hg; P=0.70). Similar results were observed when incorporating longitudinal data and calculating a mean slope over time. Control was achieved in 38.9% of intervention and 39.1% of control participants at the end of follow-up; the time-to-event experience of achieving blood pressure control in the intervention versus control groups were not different from each other (logrank P value =0.91). Conclusions-Self-blood pressure monitoring was not shown to improve control over usual care in this largely minority, urban population. The patient population in this study, which included a high proportion of Hispanics and uninsured persons, is understudied. Results indicate these groups may have additional meaningful barriers to achieving blood pressure control beyond access to the monitor itself. © 2015 American Heart Association, Inc.