Evidence-based Behavioral Interventions Research Articles

An application of the ADAPT-ITT model to an evidence-based behavioral HIV prevention intervention for men who have sex with men in Ghana

Despite constituting only about 1% of Ghana’s population, men who have sex with men (MSM) carry a disproportionate burden of HIV infections, constituting 18% of the population of people living with HIV in the country. Scholars have associated the disproportionate infection rates of HIV among MSM with existing structural factors (such as criminalization and stigma against MSM), and individual-level factors (such as sex without a condom, and transactional sex). Nonetheless, limited scholars consider intervention as an approach to reducing HIV and STI risk among MSM in the country. As such, in collaboration with community partners, we engaged MSM through the use of the ADAPT-ITT model to adapt the Many Men Many Voices (3MV) to address the needs of MSM. We addressed HIV/STD risk factors and ways to reduce HIV/STD infections. In this paper, we describe the use of the ADAPT-ITT model in the adoption and adaptation of the 3MV with MSM in Ghana. Whereas the 3MV was a good fit for our target population, we made modifications to fit the Ghanaian cultural setting by examining HIV and STD risk in the context of bisexuality, emphasizing on secrecy in location choice, and incorporating historical colonial setting in contextualizing sexuality and stigma in the Ghanaian sociocultural context. Our implementation process shows the efficacy of collaboration with community partners to implement culturally relevant interventions in HIV and STD prevention efforts in highly stigmatized environments.

Protocol for implementation of an evidence based parentally administered intervention for preterm infants

BackgroundMulti-sensory behavioral interventions for preterm infants have the potential to accelerate feeding, growth, and optimize developmental trajectories and increase parents’ interactive engagement with their infants. However, few neonatal intensive care units (NICUs) provide evidence-based standardized early behavioral interventions as routine care. Lack of implementation is a major gap between research and clinical practice. H-HOPE, is a standardized behavioral intervention with an infant- directed component (Massage+) and a parent-directed component (four participatory guidance sessions that focus on preterm infants’ behaviors and appropriate responses). H-HOPE has well documented efficacy. The purpose of this implementation study is to establish H-HOPE as the standard of care in 5 NICUs.MethodsThe study employs a Type 3 Hybrid design to simultaneously examine the implementation process and effectiveness in five NICUs. To stagger implementation across the clinical sites, we use an incomplete stepped wedge design. The five participating NICUs were purposively selected to represent different acuity levels, number of beds, locations and populations served. Our implementation strategy integrates our experience conducting H-HOPE and a well-established implementation model, the Consolidated Framework for Implementation Research (CFIR). The CFIR identifies influences (facilitators and barriers) that affect successful implementation within five domains: intervention characteristics, outer setting (the hospital and external events and stakeholders), inner setting (NICU), implementers’ individual characteristics, and the implementation process. NICUs will use the CFIR process, which includes three phases: Planning and Engaging, Executing, and Reflecting and Evaluating. Because sustaining is a critical goal of implementation, we modify the CFIR implementation process by adding a final phase of Sustaining.DiscussionThis study builds on the CFIR, adding Sustaining H-HOPE to observe what happens when sites begin to maintain implementation without outside support, and extends its use to the NICU acute care setting. Our mixed methods analysis systematically identifies key facilitators and barriers of implementation success and effectiveness across the five domains of the CFIR. Long term benefits have not yet been studied but may include substantial health and developmental outcomes for infants, more optimal parent-child relationships, reduced stress and costs for families, and substantial indirect societal benefits including reduced health care and special education costs.Trial registrationClinicalTrials.gov registration number NCT04555590, Registered on 8/19/2020.

58096 A community-academic partnership to implement DASH diet and social/behavioral interventions in congregate meal settings to reduce hypertension among seniors aging in place

ABSTRACT IMPACT: Our implementation model translates two evidence-based nutritional and behavioral interventions to lower blood pressure, into a community-based intervention program for seniors receiving congregate meals. OBJECTIVES/GOALS: The Rockefeller University, Clinical Directors Network, and Carter Burden Network received an Administration for Community Living Nutrition Innovation grant to test whether implementation of DASH-concordant meals and health education programs together lower blood pressure among seniors aging in place. METHODS/STUDY POPULATION: n=200, >60 yr, >4 meals/week at CBN; engagement of seniors/stakeholders in planning and conduct; Advisory Committee to facilitate dissemination; menus aligned with Dietary Approaches to Stop Hypertension (DASH) and NYC Department for the Aging nutritional guidelines; interactive sessions for education in nutrition, BP management, medication adherence. Training in use of automated daily home BP monitors (Omron 20). Validated surveys at M0, M1, M3, M6. Taste preference and cost assessed through Meal Satisfaction (Likert scale) and Plate Waste measures. Primary Outcome: Change in Systolic BP (SBP) at Month 1; change in %BP controlled. Secondary: validated cognitive, behavioral, nutritional measures (SF-12, PQH-2), economics; staff/client satisfaction, trends and significant associations. RESULTS/ANTICIPATED RESULTS: n=94, x2 age =73 +/- 8 years, 65% female, 50% White, 32% Black/African American, 4% Asian, 1% American Indian, Alaskan Native, 13% Other, 32% Latino/a, 43% with income <$20,000. Mean SBP at Baseline was 137.87 +18.8 mmHg (range 98-191). Menus were adapted to provide 20% daily DASH requirements at breakfast, 50% at lunch. Participants attended classes in nutrition and medication management and were provided with and trained to use an automated home BP monitor. Meal satisfaction scores dipped briefly then met or exceed pre-DASH levels. Home BP data was downloaded every 2-4 weeks with social/behavioral support. The COVID-19 closures interfered with BP outcome data collection and meal service ceased. Primary outcome: x2 change in SBP at Month 1 = -4.41 mmHg + 18 (n=61) (p=0.713). Significant associations will be reported. DISCUSSION/SIGNIFICANCE OF FINDINGS: Our community-academic research partnership implemented the DASH diet in congregate-meal settings to address uncontrolled hypertension in seniors. COVID-19 interrupted the study, but encouraging trends were observed that may inform refinement to this community-based health intervention for seniors.

MHealth-Supported Delivery of an Evidence-Based Family Home-Visiting Intervention in Sierra Leone: Protocol for a Pilot Randomized Controlled Trial.

BackgroundPast trauma and exposure to violence have been related to poor emotion regulation and household violence, which can have persistent mental health effects across generations. The Family Strengthening Intervention for Early Childhood Development (FSI-ECD/called Sugira Muryango in Rwanda) is an evidence-based behavioral home-visiting intervention to promote caregiver mental health, positive parenting practices, and early childhood development among families facing adversity. In Sierra Leone and other lower- and middle-income countries, mobile health (mHealth) technology has the potential to improve health care delivery and health outcomes.ObjectiveThis study aims to (1) apply a user-centered design to develop and test mHealth tools to improve supervision and fidelity monitoring of community health workers (CHWs) delivering the FSI-ECD and (2) conduct a pilot randomized controlled trial of the FSI-ECD to assess feasibility, acceptability, and preliminary effects on caregiver mental health, emotion regulation, caregiving behaviors, and family violence in high-risk families with children aged 6-36 months in comparison with control families receiving standard care.MethodsWe will recruit and enroll CHWs, supervisors, and families with a child aged 6-36 months from community health clinics in Sierra Leone. CHWs and supervisors will participate in 1 problem analysis focus group and 2 user interface/user experience cycles to provide feedback on mHealth tool prototypes. Families will be randomized to mHealth-supported FSI-ECD or standard maternal and child health services. We will collect quantitative data on caregiver mental health, emotion regulation, caregiving behaviors, and family functioning at baseline, postintervention, and 3-month follow up. We will use a mixed methods approach to explore feasibility and acceptability of mHealth tools and the FSI-ECD. Mixed effects linear modeling will assess FSI-ECD effects on caregiver outcomes. Cost-effectiveness analysis will estimate costs across FSI-ECD versus standard care.ResultsFunding for this study was received from the National Institutes of Mental Health on August 17, 2020. Institutional Review Board approval was received on September 4, 2020. Data collection is projected to begin on December 15, 2020.ConclusionsThis study will provide important data on the feasibility, acceptability, and preliminary efficacy of mHealth-supported delivery of an evidence-based family home-visiting intervention in a postconflict LMIC.Trial RegistrationClinicalTrials.gov NCT04481399; https://clinicaltrials.gov/ct2/show/NCT04481399.International Registered Report Identifier (IRRID)PRR1-10.2196/25443

The Targeted Management (TEAM) Intervention for Reducing Stroke Risk in African American Men: Rationale and Study Design of a Prospective Randomized Controlled Trial.

BackgroundAfrican American (AA) male survivors of strokes or transient ischemic attacks (TIA) have the highest risk of recurrent stroke when compared to other racial-ethnic men. However, there is a paucity of evidence-based strategies, including organizational, educational, or behavioral interventions, that targets secondary stroke risk reduction in AA men.MethodsTargeted Management for Reducing Stroke Risk (TEAM) is an ongoing, 6-month prospective, randomized controlled trial that will determine whether a curriculum-guided self-management approach, using peer dyads (men who had a stroke or TIA and their care partners) will improve post-stroke care in AA men.ResultsThe study sample will consist of 160 AA men who have experienced a stroke or TIA within 5 years, randomized to TEAM or Wait-list control group. The primary outcome changes in systolic blood pressure (BP) and high-density lipoprotein (HDL), while secondary outcomes include diastolic BP, total cholesterol, low-density lipoprotein, triglycerides, and glycemic control for diabetics. We hypothesize that AA men in TEAM will have significantly lower systolic BP and higher HDL when compared to AA men in the Wait-list control group at 6-month.ConclusionPersistent disparities for stroke burden in AA men highlight the need for novel interventions to promote secondary stroke-risk reduction. Building on promising pilot data, TEAM uses a group format, with a nurse and patient co-led intervention focused on AA men and family needs, practice in problem-solving, and attention to emotional and role management. In addition, the TEAM approach may help reduce stroke risk factors and health disparities in AA men.Clinicaltrials.gov IdentifierNCT04402125.

Common paraverbal errors during hypnosis intervention training

ABSTRACT There is growing literature to support the use of hypnosis as an evidence-based behavioral medicine intervention to manage a wide variety of symptoms and side effects associated with cancer and its treatment (e.g., pain, nausea, fatigue). However, formal training in hypnosis is often lacking among cancer care providers. The purpose of this study is to identify common paraverbal errors among hypnosis trainees in order to inform future training efforts. In a sample of 196 hypnosis trainees, paraverbal errors (i.e., tone, pacing, and phrasing) were tracked across hypnotic intervention components. Results revealed that trainees had most difficulty with hypnotic tone, particularly during the Induction, Deepening, and Alerting components. Individual trainee characteristics were unrelated to paraverbal errors.

Intervention Approaches Used for Children With Autism Spectrum Disorder—Autism Toolkit

Intervention Approaches Used for Children With Autism Spectrum Disorder—Autism Toolkit

Teaching Military Cultural Competency to Clinicians and Clinical Students: Assessing Impact and Effectiveness

Military members, veterans, and their families belong to a unique American subculture. Studies have identified the need for mental health professionals to attain military cultural competency to practice more effectively within this subculture. As an 88-year-old counseling and training agency with a record of service to the military/veteran communities, it was appropriate that Council for Relationships commit to providing training in military culture for its therapists and students. From 2017 to 2019, the course highlighted in this paper was part of an approved Institutional Review Board (IRB) study intended to assess the success of graduate-level instructional activities focused on promoting participants’ military and veteran-related cultural competency. This article includes an evaluation of the 2013–14 four-day training on military culture that preceded the course. In both, the unique cultural factors associated with military and veteran service were addressed within the context of evidence-based behavioral health treatment. A survey of the four-day participant training and qualitative interview follow-ups revealed that information about the military and its impact on veterans and families promoted changes in attitudes, knowledge, and clinical practice for both experienced and newly trained clinicians. These findings were replicated in the three-year evaluation results. This assessment provides valuable insight about military culture training for practicing and future mental health clinicians. Since there is very little information available in the literature on successful military culture competency training, sharing these results with the broader military and academic communities will give others information on the important components of effective training programs for clinicians, thus, potentially improving therapeutic services to these populations.

Predictors of Response to an Evidence-Based Behavioral Cancer Pain Management Intervention: An Exploratory Analysis From a Clinical Trial

ContextInterventions that teach patients cognitive and behavioral strategies for managing cancer pain have demonstrated effectiveness. Systematic reviews of such interventions call for research to inform their implementation in practice, including investigations into which patients are most likely to benefit. ObjectivesWe aimed to identify predictors of response to an evidence-based behavioral intervention for cancer pain, pain coping skills training (PCST). MethodsWe conducted an exploratory secondary analysis of a randomized noninferiority trial comparing in-person to videoconference-based PCST. Using modified Poisson regression, we estimated the adjusted associations of patient characteristics with clinically meaningful reductions (≥30%) in pain severity and pain interference. ResultsOf the 178 patients who were randomized, 135 completed at least one follow-up assessment and were included in this analysis. Proportions of patients experiencing reductions in pain severity and pain interference were 34% and 46%, respectively. In multivariable analysis, education level was associated with a reduction in pain severity (adjusted relative risk, some college or technical school vs. college or higher: 0.49, 95% CI: 0.26-0.93). Patients with colorectal cancer were 61% more likely to experience a reduction in pain interference than patients with breast cancer (95% CI:1.21-2.34). Marital status was also statistically significantly associated with pain interference reduction, with married patients less likely to experience a reduction in pain interference (adjusted relative risk, married vs. not: 0.69, 95% CI: 0.49-0.98). ConclusionOur findings elucidate several subgroups of patients who may be especially likely to benefit from PCST, informing both targeted implementation efforts and opportunities to improve delivery for diverse patients.

ACTsmart: Guided Smartphone-Delivered Acceptance and Commitment Therapy for Chronic Pain-A Pilot Trial.

BackgroundAcceptance and commitment therapy (ACT) is a behavioral health intervention with strong empirical support for chronic pain but, to date, widespread dissemination is limited. Digital solutions improve access to care and can be integrated into patients’ everyday lives.ObjectiveACTsmart, a guided smartphone-delivered ACT intervention, was developed to improve the accessibility of an evidence-based behavioral treatment for chronic pain. In the present study, we evaluated the preliminary efficacy of ACTsmart in adults with chronic pain.MethodsThe study was an open-label pilot trial. The treatment lasted for 8 weeks, and participants completed all outcome measures at pretreatment and posttreatment and at 3-, 6-, and 12-month follow-ups, with weekly assessments of selected measures during treatment. The primary outcome was pain interference. The secondary outcomes were psychological flexibility, values, insomnia, anxiety, depressive symptoms, health-related quality of life, and pain intensity. All outcomes were analyzed using linear mixed-effects models.ResultsThe sample consisted of 34 adults (88% women) with long-standing chronic pain (M=20.4 years, SD=11.7). Compliance to treatment was high, and at the end of treatment, we observed a significant improvement in the primary outcome of pain interference (d = –1.01). All secondary outcomes significantly improved from pretreatment to posttreatment with small to large effect sizes. Improvements were maintained throughout 12 months of follow-up.ConclusionThe results of this pilot study provide preliminary support for ACTsmart as an accessible and effective behavioral health treatment for adults with chronic pain and warrant a randomized controlled trial to further evaluate the efficacy of the intervention.

An adaptive clinical trial design for cocaine use disorder: Extended-release amphetamine salts for early behavioral intervention non-responders

Background/aimsCocaine use disorder (CUD) persists as a major public health problem in the United States. Response to evidence-based behavioral treatment has been shown to be predicted by dopaminergic dysfunction. Amphetamine formulations modulate dopaminergic systems and are one of the few agents with positive clinical findings but are associated with unique risks. We aimed to find a model for determining the most appropriate patients for treatment with mixed amphetamine salts-extended-release (MAS-ER) for CUD using an adaptive trial design. MethodsWe are enrolling treatment-seeking adults ages 18–60 years. All eligible participants receive bi-weekly individual counseling augmented with a computer-based intervention based on the community reinforcement approach with contingency management (CRA + CM) for 4 weeks. Participants who fail to achieve abstinence are additionally randomly assigned to 10 weeks of either MAS-ER, titrated up to 80 mg daily, or placebo. All participants complete a follow-up assessment after 12 weeks. ResultsFrequency and amount of cocaine use, cravings, retention, and quality of life will be compared between groups. The primary outcome will be having at least 3 weeks of urine toxicology-confirmed self-reported abstinence. Analyses will also be conducted to identify variables that may help identify who is more or less likely respond to the behavioral intervention during the first 4-weeks of treatment. ConclusionsThis trial more closely mimics a personalized medicine approach that is often used in clinical practice. It will help us understand who may be appropriate for psychostimulant therapy as an enhancement to evidence-based behavioral interventions, while limiting exposure to those who would respond to a psychosocial intervention alone.ClinicalTrials.gov Identifier: NCT01986075

Implementation of two alcohol reduction interventions among persons with hazardous alcohol use who are living with HIV in Thai Nguyen, Vietnam: a micro-costing analysis

ABSTRACT Background Hazardous alcohol use is detrimental to persons with HIV (PWH), impacting medication adherence and liver function, yet globally resources to target alcohol use behavior in this population are limited. Few studies have identified the costs of integrating alcohol reduction interventions into HIV care. Objective To estimate the costs of implementing and delivering two evidence-based behavioral counseling interventions targeting hazardous alcohol use among persons with HIV and to estimate the costs of scale-up in ART clinics in Thai Nguyen, Vietnam. Methods We undertook a micro-costing approach to determine the costs of delivering two adapted evidence-based interventions to reduce alcohol use: an intensive combined cognitive behavioral therapy and motivational enhancement therapy-informed intervention (CoI) and an abbreviated brief alcohol intervention (BI). A total of 294 participants with hazardous alcohol use were identified through a brief screening tool and received the CoI (n = 147) and the BI (n = 147) over 3 months. We estimated costs using time and motion studies, budget analysis, staff interviews, and participant questionnaires. Data were collected from 2016 to 2018 in VND and converted to USD. Results The total cost of implementation and administration of the intervention to 147 participants receiving the CoI was $13,900 ($95 per participant) and to 147 participants receiving the BI was $5700 ($39 per participant). Implementation and startup costs including training accounted for 27% of costs for the CoI and 28% for the BI. Counselor costs accounted for a large proportion of both the CoI (41%) and the BI (30%). Conclusions Implementing and delivering alcohol reduction interventions to people with HIV in Vietnam with appropriate fidelity is costly. These costs may be reduced, particularly counselor labor costs, by using an evidence-based brief intervention format. Future research should explore the budgetary impact of brief and combined interventions to reduce hazardous alcohol use, particularly among vulnerable populations.

Depression in Youth-Onset Type 2 Diabetes.

The current review summarizes extant knowledge regarding the prevalence of depression in youth-onset type 2 diabetes (T2D) and how depression might impact glycemic control through stress-related behavioral and physiological mechanisms. The current review also discusses depression intervention studies in adult-onset T2D, as there are no such studies in youth-onset T2D, and provides recommendations for clinical research. The prevalence of elevated depression symptoms in youth-onset T2D is approximately 20%. Some studies suggest depression may negatively impact glycemic control through inadequate medication adherence and disordered eating, but there is a dearth of studies investigating associations with depression and physical activity/sedentary time, sleep, and stress-related physiological mechanisms. In adult-onset T2D, evidence-based behavioral interventions tailored to address diabetes-related issues have shown positive effects for depression and glycemic control. Future research is needed to characterize the epidemiology of depression in youth-onset T2D and test interventions to improve depression, glycemic control, and health outcomes in this specific pediatric population.

Exploration of Challenging Behaviors in Pediatric OT

Abstract Date Presented 03/28/20 When children receive OT, they are expected to willingly engage in tasks that are difficult. This is often not the case. This research surveyed OTs nationwide to examine the impact of challenging behaviors on a child’s therapy participation. Results indicated that children primarily exhibit behaviors to escape the demands of therapy, with therapists expressing safety concerns, lost time, and frustration. Knowledge and feasibility of an evidence-based behavioral intervention were also explored. Primary Author and Speaker: Sandra Brown Additional Authors and Speakers: Claire Cote, Ashley Mills, Brooke Page, Sheila Norris, Brooke Whitley

CDC’s Community-Based Organization Behavioral Outcomes Project: Perspectives for Researchers, Implementers and Funders

Behavioral interventions have been a crucial tool for the prevention of HIV transmission since early in the epidemic. The Centers for Disease Control and Prevention (CDC) has provided funding for evidence-based behavioral interventions (EBIs) at health departments and community-based organizations (CBOs) since 2004. From 2006 to 2015, CDC funded 25 CBOs to evaluate one or more of seven EBIs designed to prevent HIV through the Community-based Organization Behavioral Outcomes Project (CBOP) as implemented outside of a research setting. For each EBI, CBOP showed that most HIV risk behaviors improved after the intervention, and improvements were similar to those observed in research studies. Our findings show that behavioral interventions can be successfully implemented in real-world settings. Although the focus of HIV prevention has largely shifted toward biomedical interventions in recent years, successful implementation often depends on behavioral components. Lessons from CBOP can inform future efforts to develop and implement behavioral interventions for HIV and other areas of public health.

Self-Administered Skills-Based Virtual Reality Intervention for Chronic Pain: Randomized Controlled Pilot Study.

BackgroundPatients with chronic pain often have limited access to comprehensive care that includes behavioral pain management strategies. Virtual reality (VR) is an immersive technology and emerging digital behavioral pain therapy with analgesic efficacy for acute pain. We found no scientific literature on skills-based VR behavioral programs for chronic pain populations.ObjectiveThe primary aim of this study is to evaluate the feasibility of a self-administered VR program that included content and skills informed by evidence-based behavioral treatment for chronic pain. The secondary aim is to determine the preliminary efficacy of the VR program in terms of average pain intensity and pain-related interference with activity, stress, mood, and sleep, and its impact on pain-related cognition and self-efficacy. The tertiary aim was to conduct a randomized controlled trial (RCT) and compare the VR treatment with an audio-only treatment. This comparison isolated the immersive effects of the VR program, thereby informing potential mechanisms of effect.MethodsWe conducted an RCT involving a web-based convenience sample of adults (N=97) aged 18-75 years with self-reported chronic nonmalignant low back pain or fibromyalgia, with an average pain intensity >4 over the past month and chronic pain duration >6 months. Enrolled participants were randomly assigned to 1 of 2 unblinded treatments: (1) VR: a 21-day, skills-based VR program for chronic pain; and (2) audio: an audio-only version of the 21-day VR program. The analytic data set included participants who completed at least 1 of 8 surveys administered during the intervention period: VR (n=39) and audio (n=35).ResultsThe VR and audio groups launched a total of 1067 and 1048 sessions, respectively. The majority of VR participants (n=19/25, 76%) reported no nausea or motion sickness. High satisfaction ratings were reported for VR (n=24/29, 83%) and audio (n=26/33, 72%). For VR efficacy, symptom improvement over time was found for each pain variable (all P<.001), with results strengthening after 2 weeks. Importantly, significant time×group effects were found in favor of the VR group for average pain intensity (P=.04), pain-related inference with activity (P=.005), sleep (P<.001), mood (P<.001), and stress (P=.003). For pain catastrophizing and pain self-efficacy, we found a significant declining trend for both treatment groups.ConclusionsHigh engagement and satisfaction combined with low levels of adverse effects support the feasibility and acceptability of at-home skills-based VR for chronic pain. A significant reduction in pain outcomes over the course of the 21-day treatment both within the VR group and compared with an audio-only version suggests that VR has the potential to provide enhanced treatment and greater improvement across a range of pain outcomes. These findings provide a foundation for future research on VR behavioral interventions for chronic pain.

Abstract B041: Community-health worker delivered weight loss and maintenance intervention for rural African American adults

Abstract Introduction: Excess body weight is a critical modifiable risk factor for numerous cancers and one of the top public health problems in the country. Unfortunately, underserved groups bear a disproportionate burden, with African Americans having the highest rates of obesity. Behavioral weight loss interventions have been recommended by several governmental agencies to treat obesity and improve cancer risk, control, and survivorship. However, health care provider shortages in underserved areas have resulted in access gaps. Community Health Workers (CHWs), trusted community members, have filled these gaps and been successful in changing health behaviors (e.g. dietary intake, screening), associated with weight loss or cancer, but have not been thoroughly engaged to deliver evidence-based behavioral weight loss interventions. To increase reach among the underserved, community-based weight loss and maintenance interventions are critical. Methods: Building on a 10+ year partnership between community and academic researchers, an evidence-based behavioral weight loss program was adapted for African Americans of faith to create a group-based, CHW-delivered weight loss and maintenance intervention. With the intention of recruiting two CHWs per church, a total of 61 CHWs were recruited and underwent 28 hours of training over 4-6 weeks to deliver the intervention. A total of 31 churches were randomized to a Weight Loss Only arm (16 core lessons) or a Weight Loss + Maintenance arm (16 core + 12 maintenance lessons) in this cluster randomized controlled trial (n=440). Actual weight and height (BMI—body mass index), dietary behaviors, and physical activity were assessed at 0, 6, 12, and 18 months. Linear mixed models and fit by restricted maximum likelihood were implemented using SAS 9.2. All analyses were conducted with the intention-to-treat principle. Results: The intervention produced significant weight loss from baseline to 6-months (-2.47 (-3.13, -1.80)), with 23.7% of all participants losing at least 5% of their body weight. Among those with clinically significant weight loss (≥5%) at 6 months, there was a statistical trend of lower weight regain in the Weight Loss + Maintenance at 12 months. Participants in the Weight Loss + Maintenance arm also reported higher levels of physical activity at 12 months. There were no significant differences between arms at 18 months. Discussion: The intervention produced significant weight loss from baseline to 6-months on par with other evidence-based weight loss interventions for African Americans, including adaptations that utilized health professionals. Compared to health-care professionals, CHWs may be a more cost-effective way to deliver evidence-based behavioral weight loss interventions. Engagement of institutional infrastructures already in place in communities, such as churches, may be a feasible way to sustainably implement and disseminate evidence-based weight loss interventions for those not reached by traditional healthcare institutions Citation Format: Karen Yeary, Carol Cornell, Page Moore, C. Heath Gauss, Elaine Prewitt, Jerome Turner. Community-health worker delivered weight loss and maintenance intervention for rural African American adults [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr B041.

Impact of a Preschool Obesity Prevention (I-POP) Program on Nutrition Knowledge Scores of Head Start Parents and Teachers

Abstract Objectives To determine the effectiveness of an evidence-based preschool obesity prevention intervention on rural, low-income parents’ and Head Start teachers’ nutrition knowledge relative to advice from experts, nutrient content of foods, and health benefits of foods. Methods Parent-child dyads were recruited from 9 randomized Head Start centers with 5 centers in the experimental group and 4 centers in the control. The intervention consisted of 8 weekly evidence-based nutrition education sessions for children delivered by the Head Start teachers; a teacher workshop on the use of Positive Behavior Interventions and Supports (PBIS) in the classroom; and 8 parent workshops using an evidence-based behavioral intervention, Parent Child Interaction Therapy (PCIT). The PBIS and PCIT reinforced nutrition education sessions by including instruction for positive meal-time behaviors. A repeated measures design consisted of data collected at pre- (T1), post-intervention (T2), and a 6-month follow-up (T3). T1 and T2 results of a validated and reliable nutrition knowledge survey to address the sub-objective of the main study are reported here. Results 175 parents and 75 teachers participated in T1 data collection, of which 95 parents and 64 teachers completed T2. There were no significant differences in total scores within or between parent or teacher groups, scoring an average of 34% and 38% out of 100% for parents and teachers, respectively. However, there was a significant change in the knowledge of health benefits of foods survey section (31.6% to 39.5% correct) for parents in the experimental group from T1 to T2 (P &amp;lt; .05). Conclusions Overall, parents and teachers had poor knowledge of advice from experts, nutrient content of foods, and health benefits of foods at T1. Parents and teachers did have minimal, indirect nutrition education during PCIT and PBIS, which may have contributed to parents’ increase in awareness of health benefits of food at T2. However, there may be a lack of knowledge of how to apply nutrition principles. Nutrition education and intervention should target parents and teachers of children with a specific aim in application of nutrition principals. Funding Sources US Department of Health and Human Services, Office of Minority Health.

Testing a self-directed lifestyle intervention among veterans: The D-ELITE pragmatic clinical trial

Nearly half of Veterans have obesity, fueling chronic diseases. The Department of Veterans Affairs (VA) offers an evidence-based behavioral weight management intervention called MOVE!, mostly delivered through in-person group sessions. Few eligible Veterans participate due to factors like distance and preferences, mirroring barriers in the general population. Practical alternatives to standard in-person programs are needed to improve access and engagement. A self-directed lifestyle intervention called D-ELITE—delivered through pre-recorded videos by DVD or online streaming—previously efficacious in a general primary care population, may provide such an alternative. This pragmatic clinical trial will evaluate whether D-ELITE improves weight and general health status among Veterans with obesity, relative to VA usual care. The yearlong intervention includes one orientation by phone, supplemental lifestyle coaching primarily via technology-based messages, 12 DVD or online streaming sessions over 3 months, and continued self-directed weight management for months 4–12. Participants use MyFitnessPal.com or paper booklets for self-monitoring weight, diet, and physical activity. Follow-up assessments at 12 and 24 months are administered by mail or phone. The study hypothesis is that compared with usual care, D-ELITE will lead to greater improvements in 12-month weight loss, per VA electronic health records, and general physical health status, assessed using the self-reported SF-12 physical composite score. We will also explore D-ELITE's effects on secondary biometric (e.g., HbA1c) and intermediate (e.g., diet) outcomes, reach, and budget impact. If effective, D-ELITE will offer a potentially scalable, low-cost alternative to VA's existing weight loss interventions by mitigating barriers presented by distance and technology.

Early Childhood Sleep Intervention in Urban Primary Care: Caregiver and Clinician Perspectives.

Despite significant income-related disparities in pediatric sleep, few early childhood sleep interventions have been tailored for or tested with families of lower socio-economic status (SES). This qualitative study assessed caregiver and clinician perspectives to inform adaptation and implementation of evidence-based behavioral sleep interventions in urban primary care with families who are predominantly of lower SES. Semi-structured interviews were conducted with (a) 23 caregivers (96% mothers; 83% Black; 65% ≤125% U.S. poverty level) of toddlers and preschoolers with insomnia or insufficient sleep and (b) 22 urban primary care clinicians (physicians, nurse practitioners, social workers, and psychologists; 87% female; 73% White). Guided by the Consolidated Framework for Implementation Research, the interview guide assessed multilevel factors across five domains related to intervention implementation. Qualitative data were analyzed using an integrated approach to identify thematic patterns across participants and domains. Patterns of convergence and divergence in stakeholder perspectives emerged across themes. Participants agreed upon the importance of child sleep and intervention barriers (family work schedules; household and neighborhood factors). Perspectives aligned on intervention (flexibility; collaborative and empowering care) and implementation (caregiver-to-caregiver support and use of technology) facilitators. Clinicians identified many family barriers to treatment engagement, but caregivers perceived few barriers. Clinicians also raised healthcare setting factors that could support (integrated care) or hinder (space and resources) implementation. Findings point to adaptations to evidence-based early childhood sleep intervention that may be necessary for effective implementation in urban primary care. Such adaptations could potentially reduce significant pediatric sleep-related health disparities.