Holly C. Felix

Weight Loss of Black, White, and Hispanic Men and Women in the Diabetes Prevention Program

Objective: To provide the specific weight loss outcomes for African‐American, Hispanic, and white men and women in the lifestyle and metformin treatment arms of the Diabetes Prevention Program (DPP) by race‐gender group to facilitate researchers translating similar interventions to minority populations, as well as provide realistic weight loss expectations for clinicians.

Lay health educators translate a weight-loss intervention in senior centers: A randomized controlled trial

BACKGROUND Older adults have high obesity rates and respond well to evidence-based weight-loss programs, such as the Diabetes Prevention Program (DPP) Lifestyle intervention. The goal of this study was to determine whether a translation of the DPP Lifestyle program delivered by lay health educators and conducted in senior centers is effective in promoting weight loss among older adults. DESIGN An RCT with older adults nested within senior centers. Senior centers identified lay health educators to receive training and deliver the intervention program at the senior center. Senior centers were randomized to DPP Lifestyle program or an attention control intervention (cognitive training). SETTING/PARTICIPANTS Senior centers (N=15) located throughout Arkansas. Participants (N=228) were obese (BMI=34.5±4.9) older (aged 71.2±6.6 years) adults able to engage in moderate exercise. Follow-up data were collected at 4 months on 93% of the original cohort between February 2009 and July 2010. INTERVENTIONS A 12-session translation of the Diabetes Prevention Program Lifestyle behavioral weight-control program delivered in group sessions by trained lay health educators. MAIN OUTCOME MEASURES Body weight was assessed by digital scale. Percentage weight loss from baseline and proportion achieving ≥5% and ≥7% weight loss were examined. Analyses were completed in March 2011. RESULTS Participants attending senior centers randomized to Lifestyle lost a significantly greater percentage of baseline weight (3.8%, 95% CI=2.9%, 4.6%) than those in the control senior centers (0.2%, 95% CI= -0.6%, -0.9%) after adjusting for baseline BMI and gender (p<0.001). Among participants attending senior centers offering the Lifestyle program, 38% lost ≥5% of baseline weight compared with 5% in the control arm (p<0.001). Similarly, significantly more participants (24%) in Lifestyle senior centers lost ≥7% than did control participants (3%, p=0.001). CONCLUSIONS A behavioral lifestyle weight-loss intervention delivered by a lay health educator offers a promising vehicle for translation of evidence-based obesity treatment programs in underserved areas. TRIAL REGISTRATION This study is registered at Clinicaltrials.govNCT01377506.

Effectiveness of Weight Loss Interventions for Obese Older Adults

Objective. The consequences of obesity among older adults are significant, yet few obesity interventions target this group. Unfamiliarity with weight loss intervention effectiveness and concerns that weight loss negatively affects older adults may be inhibiting targeting this group. This paper reviews the evidence on intentional weight loss and effective weight loss interventions for obese older adults to help dispel concerns and guide health promotion practice. Data Source. PubMed articles. Study Inclusion and Exclusion Criteria. Randomized controlled trials examining behavioral and pharmaceutical weight loss strategies with 1-year follow-up targeting obese (body mass index ≥30) older adults (mean age ≥60 years), and studies with quasi-experimental designs examining surgical weight loss strategies targeting older adults were examined. Data Extraction. Abstracts were reviewed for study objective relevancy, with relevant articles extracted and reviewed. Data Synthesis. Data were inserted into an analysis matrix. Results. Evidence indicates behavioral strategies are effective in producing significant (all p < .05) weight loss without significant risk to obese older adults, but effectiveness evidence for surgical and pharmaceutical strategies for obese older adults is lacking, primarily because this group has not been targeted in trials or analyses did not isolate this group. Conclusion. These findings support the promotion of intentional weight loss among obese older adults and provide guidance to health promotion practitioners on effective weight loss interventions to use with this group.

Impact of a smoke-free hospital campus policy on employee and consumer behavior.

Objective. Although smoke-free hospital campuses can provide a strong health message and protect patients, they are few in number due to employee retention and public relations concerns. We evaluated the effects of implementing a clean air policy on employee attitudes, recruitment, and retention; hospital utilization; and consumer satisfaction in 2003 through 2005. Methods. We conducted research at a university hospital campus with supplemental data from an affiliated hospital campus. Our evaluation included (1) measurement of employee attitudes during the year before and year after policy implementation using a cross-sectional, anonymous survey; (2) focus group discussions held with supervisors and security personnel; and (3) key informant interviews conducted with administrators. Secondary analysis included review of employment records and exit interviews, and monitoring of hospital utilization and patient satisfaction data. Results. Employee attitudes toward the policy were supportive (83.3%) at both institutions and increased significantly (89.8%) at post-test at the university hospital campus. Qualitatively, administrator and supervisor attitudes were similarly favorable. There was no evidence on either campus of an increase in employee separations or a decrease in new hiring after the policy was implemented. On neither campus was there a change in bed occupancy or mean daily census. Standard measures of consumer satisfaction were also unchanged at both sites. Conclusion. A campus-wide smoke-free policy had no detrimental effect on measures of employee or consumer attitudes or behaviors.

Public Health Professionals as Policy Entrepreneurs: Arkansas's Childhood Obesity Policy Experience

In response to a nationwide rise in obesity, several states have passed legislation to improve school health environments. Among these was Arkansass Act 1220 of 2003, the most comprehensive school-based childhood obesity legislation at that time. We used the Multiple Streams Framework to analyze factors that brought childhood obesity to the forefront of the Arkansas legislative agenda and resulted in the passage of Act 1220. When 3 streams (problem, policy, and political) are combined, a policy window is opened and policy entrepreneurs may advance their goals. We documented factors that produced a policy window and allowed entrepreneurs to enact comprehensive legislation. This historical analysis and the Multiple Streams Framework may serve as a roadmap for leaders seeking to influence health policy.

Personal Care Assistance Needs of Obese Elders Entering Nursing Homes

OBJECTIVES To assess the personal care assistance needs of obese (body mass index [BMI] >or=30) elders (>or=65 years) entering nursing homes in Arkansas between 1999 and 2004. DESIGN Retrospective cross-sectional study, using descriptive statistics and inferential statistics including multivariate logistic regression. SETTING The United States. PARTICIPANTS Participants were 47,932 unduplicated elders (>or=65 years) upon first admission to a nursing home in Arkansas from 1999 through 2004. MEASUREMENTS Clinical assessment of height and weight and personal care assistance needs reported on the initial Minimum Data Set (MDS) admission assessment. RESULTS Obese elders had significantly (P < .01) greater odds (1.18 to 1.70) of needing extensive assistance to perform the selected activities of daily living (ADLs) compared to non-obese (BMI 16 to 29) elders. CONCLUSIONS Excessive body weight of newly admitted elderly nursing home residents is associated with greater use of personal care staff to perform selected ADLs. Other research has shown that increased ADL dependency is associated with increased cost, which coupled with the current finding suggests rising rates of obesity among the elderly and those entering nursing homes may strain the long-term care (LTC) system in terms of staffing and cost. Interventions to address these potential impacts should therefore be developed and tested.

Recruitment of rural health care providers: a regional recruiter strategy.

CONTEXT Access to care in rural areas is a major problem. Despite more than 20% of the US population residing in these areas, only 9% of physicians practice there. Extensive research has documented multiple issues that affect where physicians decide to locate and maintain practices. Creative strategies have been used to influence these recruitment and retention decisions. An emerging strategy, borne out of the Robert Wood Johnson Foundations Southern Rural Access Program (SRAP), effectively uses a targeted regional approach to assist rural communities and health care facilities in assessing health care needs and recruiting primary care providers. PURPOSE This article examines the issues surrounding recruitment and retention of primary care providers to rural areas and describes the experiences of the regional recruitment strategy in several states and in particular in the Mississippi Delta region of Arkansas. METHODS A case study approach is used to examine the targeted regional recruiter strategy in the Mississippi Delta region of Arkansas. FINDINGS The regional recruiter strategy, which combines traditional recruitment efforts with community development activities, has been successful in recruiting health care providers to rural communities. The cost-effective strategy can be easily replicated in other rural states. CONCLUSIONS Community factors affect provider decisions on practice locations. Addressing community factors in recruitment efforts through community development activities may increase their success.

Examination of costs for a lay health educator-delivered translation of the Diabetes Prevention Program in senior centers

OBJECTIVE Older adults in the U.S. have high rates of obesity. Despite the demonstrated efficacy of lifestyle interventions among older adults, lifestyle interventions are not widely implemented in community settings. Program delivery by lay health educators (LHEs) might support greater dissemination because of lower delivery cost and greater accessibility. We examined the costs of a LHE-delivered translation of the Diabetes Prevention Program (DPP) evidence-based lifestyle intervention for older adults in Arkansas senior centers. METHODS This examination of costs used data from a cluster randomized control trial (conducted 2008-2010) in which 7 senior centers (116 participants) were randomized to implement a LHE-delivered 12-session translation of the DPP lifestyle intervention. We compiled direct lifestyle intervention implementation costs, including training, recruitment, materials, and ongoing intervention implementation support. Weight loss data (at 4-month follow-up) were collected from participants. RESULTS Participant weight loss averaged 3.7kg at 4-months. The total estimated cost to implement the lifestyle intervention is

Family planning provider referral, facilitation behavior, and patient follow-up for abnormal Pap smears.

2731 per senior center, or

Health status in the Mississippi River Delta region.

165 per participant. The implementation cost per kilogram lost is