Policy Adherence Research Articles

Preventing COVID-19 Transmission in Education Settings.

In fall 2020, community hubs opened in San Francisco, California, to support vulnerable groups of students in remote learning. Our objectives were to (1) describe adherence to coronavirus disease 2019 (COVID-19) mitigation policies in these urban, low-income educational settings; (2) assess associations between policy adherence and in-hub COVID-19 transmission; and (3) identify barriers to and facilitators of adherence. We conducted a mixed-methods study from November 2020 to February 2021. We obtained COVID-19 case data from the San Francisco Department of Public Health, conducted field observations to observe adherence to COVID-19 mitigation policies, and surveyed hub leaders about barriers to and facilitators of adherence. We summarized quantitative data using descriptive statistics and qualitative data using thematic content analysis. A total of 1738 children were enrolled in 85 hubs (39% Hispanic, 29% Black). We observed 54 hubs (n = 1175 observations of children and 295 observations of adults). There was high community-based COVID-19 incidence (2.9-41.2 cases per 100 000 residents per day), with 36 cases in hubs and only 1 case of hub-based transmission (adult to adult). Sixty-seven percent of children and 99% of adults were masked. Fifty-five percent of children and 48% of adults were distanced ≥6 ft. Facilitators of mitigation policies included the following: for masking, reminders, adequate supplies, and "unmasking zones"; for distancing, reminders and distanced seating. We directly observed COVID-19 mitigation in educational settings, and we found variable adherence. However, with promotion of multiple policies, there was minimal COVID-19 transmission (despite high community incidence). We detail potential strategies for increasing adherence to COVID-19 mitigation.

Association Between Cost-Saving Prescription Policy Changes and Adherence to Chronic Disease Medications: an Observational Study.

Pharmacy benefit design is one tool for improving access and adherence to medications for the management of chronic disease. We assessed the effects of pharmacy benefit design programs, including a change in pharmacy benefit manager (PBM), institution of a prescription out-of-pocket maximum, and a mandated switch to 90 days' medication supply, on adherence to chronic disease medications over time. We used a difference-in-differences design to assess changes in adherence to chronic disease medications after the transition to new prescription policies. We utilized claims data from adults aged 18-64, on ≥ 1 medication for chronic disease, whose insurer instituted the prescription policies (intervention group) and a propensity score-matched comparison group from the same region. The outcome of interest was adherence to chronic disease medications measured by proportion of days covered (PDC) using pharmacy claims. There were 13,798 individuals in each group after propensity score matching. Compared to the matched control group, adherence in the intervention group decreased in the first quarter of 2015 and then increased back to pre-intervention trends. Specifically, the change in adherence compared to the last quarter of 2014 in the intervention group versus controls was - 3.6 percentage points (pp) in 2015 Q1 (p < 0.001), 0.65 pp in Q2 (p = 0.024), 1.1 pp in Q3 (p < 0.001), and 1.4 pp in Q4 (p < 0.001). In this cohort of commercially insured adults on medications for chronic disease, a change in PBM accompanied by a prescription out-of-pocket maximum and change to 90 days' supply was associated with short-term disruptions in adherence followed by return to pre-intervention trends. A small improvement in adherence over the year of follow-up may not be clinically significant. These findings have important implications for employers, insurers, or health systems wishing to utilize pharmacy benefit design to improve management of chronic disease.

English

The objective of this study was to contribute to the improvement of medical prescription of antimalarials at Kisangani University Clinics. This a cross-sectional study with retrospective data collection, based on 200 medical prescriptions from patients aged 3 days to 80 years, treated for malaria from March to December 2019. The study took place between March and May, 2020. Sixty one percent of patients suffered from uncomplicated malaria and 39% from severe malaria. Information on the total quantity of medicines to be taken, the dose, the rate of administration and the duration of the treatment were not mentioned respectively in 6.5, 15.5, 5.5 and 14.5% of prescriptions. No prescription mentioned the qualification of the prescriber or his phone number. The prescribed antimalarial was not appropriate in 15.5% of prescriptions in that artesunate and artemether were used to treat uncomplicated malaria. Artesunate was slightly more prescribed than quinine for severe malaria (55.4 versus 44.6%). The prescribed dose and duration of treatment were inadequate in 4.7 and 0.6% of the prescriptions, respectively. Twenty point seven percent (20.7%) of the overall prescriptions were found to be non-compliant. The medical prescriptions of antimalarial drugs issued to patients at the university clinics of Kisangani do not always comply with national regulations and directives in this area. Although these deficiencies appear to be minimal, they might lead to ineffective treatment, treatment failures and recurrence of malaria. Prescribers should be regularly retrained as to this. Key words: Malaria, prescription practices, antimalarials, treatment guidelines, policy adherence, Tshopo, Democratic Republic of Congo.&nbsp

Measuring Procedural Justice Policy Adherence During Use of Force Events: The Body-Worn Camera as a Performance Monitoring Tool

This study capitalizes on a successful researcher–practitioner partnership to conduct a systematic social observation (SSO) of police body-worn camera (BWC) footage in Newark, NJ. To demonstrate th...

Measuring Procedural Justice Policy Adherence During Use of Force Events: The Body-Worn Camera as a Performance Monitoring Tool

This study capitalizes on a successful researcher–practitioner partnership to conduct a systematic social observation (SSO) of police body-worn camera (BWC) footage in Newark, NJ. To demonstrate the utility of BWCs as performance monitoring tools, we measure officer adherence to procedural justice standards throughout use of force events as mandated in the Newark Police Division’s updated policies pursuant to an ongoing federal consent decree. Overall, a slim majority of use of force events are procedurally just. However, results indicate several instances of policy noncompliance. Results are discussed, and policy recommendations related to procedural justice policy violations and BWCs for performance monitoring are provided.

Rates of Serious Surgical Errors in California and Plans to Prevent Recurrence

Despite widespread recognition and known harms, serious surgical errors, known as surgical never events, endure. The California Department of Public Health (CDPH) has developed an oversight system to capture never events and a platform for process improvement that has not yet been critically appraised. To examine surgical never events occurring in hospitals in California and summarize recommendations to prevent future events. This cross-sectional study identified 386 CDPH hospital administrative penalty reports, of which 142 were ascribable to never events occurring during surgery. These never events were identified and summarized from January 1, 2007, to December 31, 2017. A directed qualitative approach was used to analyze CDPH-mandated corrective steps to reduce future errors in this multicenter study of all accredited hospitals in California. Inclusion of surgical never event records was based on definitions established by the US Department of Health and Human Services National Quality Forum. Data analysis was performed from January 1, 2019, to November 30, 2020. Never events include death or disability of an American Society of Anesthesiologists class I patient, wrong site or wrong surgery, retained foreign objects, burns, equipment failure leading to intraoperative injury, nonapproved experimental procedures, insufficient surgeon presence or privileges, or fall from the operating room table. Incident rates, consequences, and improvement plans to prevent additional never events were outcomes of interest. A total of 142 never events were reported to the CDPH (1 per 200 000 operations). Annual surgical volume for hospitals with events was 9203 vs 3251 cases for hospitals without events (P < .001). A total of 94 of 142 events (66.2%) were retained foreign objects ranging from Kocher clamps to drain sponges. Wrong site or patient surgery accounted for 22 events (15.5%), surgical burns for 11 (7.7%), and other for 15 (10.6%). Other included insufficient surgeon presence, equipment failure, or falls in the operating room. Improvement plans included 18 unique categories of recommendations from regulators, many focusing on proper use of checklists. Regulators mandated a mean (SD) of 13 (7) corrective actions in the improvement plans. Policy adherence monitoring (119 [90.2%]), revision of existing policy (84 [63.6%]), and education regarding policy (83 [62.9%]) were common action items, whereas disciplinary action toward staff was rare (11 [8.3%]). Surgical never events are a rare issue in California. Numerous strategies have evolved to reduce errors, many involving the thorough and proper use of intraoperative checklists.

Exploring frontliners' knowledge, participation and evaluation in the implementation of a pay-for-performance program (PMAQ) in primary health care in Brazil

PurposeThis paper employs implementation theory and the political literature on performance measurement to understand how frontline health workers know, participate and evaluate the Brazilian National Program for Improving Access and Quality of Primary Care (PMAQ, 2nd round).Design/methodology/approachThis paper develops an implementation theory-driven qualitative analysis. The research is developed in the city of Goiania (Brazil): a challenging organizational context in primary care (PHC). Interviews were carried out with 25 frontliners – managers, doctors, nurses and community health workers. Data were thematically and hierarchically analysed according to theoretical concepts such as policy knowledge, policy adherence, forms of accountability, alternative logics, organizational capacity and policy feedback.FindingsResults show the need to foster organizational capacity, knowledge, participation and policy feedback at the frontline. Successful implementation would require those adaptations to counteract policy challenges/failures or the emergence of alternative logics.Research limitations/implicationsThe study was conducted in only one setting, however, our sample includes different types of professionals working in units with different levels of organization capacity, located in distinct HDs, expressing well the implementation of PMAQ/P4P. Qualitative researches need to be developed for further exploring the same/other factors.Social implicationsFindings can be used to improve discussions/planning and design of P4P programs in the city and State of Goias.Originality/valueThe majority of analysis of PMAQ are of a quantitative or results-based nature. This article focuses on politically significant and unanswered questions regarding the implementation of PMAQ.

“TIMEOUT” Before PEG Placement: A Policy Approach to Align Shared Decision-Making and Goals of Care Through Palliative Intervention (F425C)

1.Describe the performance improvement approach used to design and implement a hospital policy requiring Palliative Care consultation prior to offering percutaneous feeding tube (PEG) placement at our institution.2.Discuss measured outcomes of this quality improvement initiative and how they link high value care to palliative care. Multiple professional societies promote shared decision-making (SDM) and recommend not offering percutaneous feeding tubes (PEGs) in advanced dementia. Many patients, families, caregivers, nursing homes and clinicians may not be aware of these recommendations. To ensure that risks, benefits, and alternatives to PEGs like careful hand feeding and hospice are discussed with surrogates, NewYork-Presbyterian Queens implemented a hospital policy requiring a Palliative Care consultation (PCC) prior to offering PEG placement. This “timeout” intends to improve SDM and PCC access to patients considered for PEGs. Using a Plan-Do-Study-Act approach, we retrospectively identified 2018 PEG insertions (endoscopic/radiologic): 4% had Goals of Care (GOC) documented by the primary team, 10% a PCC, and 42% had a dementia ICD code. With stakeholder buy-in we created and implemented a hospital policy requiring a PCC prior to offering PEGs. The Hospital Medical Board approved the policy June 2019. We measured policy compliance, primary PEG insertion trends pre-policy (July 2018-March 2019) versus post-policy (July 2019-March 2020), associated PCCs and dementia ICD codes, length of stay (LOS) of patients with PEG versus no PEG, and hospice utilization for no PEG. Post-policy implementation,186 patients were considered for primary PEG insertions. Of these, no PEG (103) and PEG (83). Policy adherence was 98% (183/186 had PCC). Primary PEG insertions reduced by 55% (pre-policy=132 vs post-policy=83). Primary PEGs for dementia patients was reduced by 48% (pre-policy=60 vs post-policy=31). Average LOS reduction in PEG (25 d) versus no PEG (16 d) was 9d. Hospice was utilized by 63% (65/103) for no PEG. A PCC "timeout” can help promote SDM by aligning GOC with medical decision-making. When an alternative clinical pathway to PEGs was offered, there was an associated reduction in both primary PEG insertions and average LOS. This policy demonstrated how institutional support promotes palliative care access and links it to high value care.

Ghana beyond the epi-curve: initial lessons learned from the implementation of infection prevention and control measures in the COVID-19 response.

Infection prevention and control (IPC) measures remain crucial to breaking transmission of the virus in the wake of inconclusive efforts underway to find an effective vaccine and treatment. While acknowledging that many lessons evolve as the pandemic unfolds, an initial understanding and recognition of the complexities that surround IPC policy implementation and adherence is vital for effective control of on-going pandemic in particular and to inform national IPC policies beyond the epi-curve. This short communication therefore seeks to unravel initial thoughts, themes and concepts that have unfolded in the implementation of IPC policies and guidelines in the context of the ongoing outbreak response in Ghana. A rapid desk review was done. Reflexive journals, field notes, observations and workshop experiences were compiled and overlapped with authors’ experience as a member of the COVID-19 national response team for Infection Prevention and Control (IPC). Thematic content analysis was then used to categorize the lessons into common themes. While aligning with global strategies, the concept of ‘looking within’ for initial solutions and strengths have proven useful for a public health emergency response in Ghana. Future IPC policies must inculcate perspectives from the politics and economics of IPC practices and employ varieties of multidisciplinary approaches required to broaden the scope of IPC practice.

Dress Code Policy Adherence and Self-Discipline of University Students

Dress Code Policy Adherence and Self-Discipline of University Students

487. Patient Outcomes of Contact Tracing for COVID-19 in a Pediatric Hospital

BackgroundContact tracing is a critical component in controlling the spread of infectious diseases. During the COVID-19 pandemic, the demands for contract tracing far exceeded the resources available to infection prevention and control (IPC) programs. Leveraging our Poison Control Center, our organization established a Contact Tracing Center (CTC) with content expertise and oversight by IPC and Occupational Health. The CTC identifies exposed patients and employees, provides testing guidance and scheduling, and offers post-exposure recommendations for employees. We describe patient outcomes due to employee exposures in a pediatric healthcare system.MethodsExposure data about employee to patient exposures (EPE) were captured real-time by scripted telephone interviews by our CTC. Chart review was performed to determine outcomes of exposed patients. A concerning exposure from a direct patient care provider to a patient was defined as unprotected contact at less than 6 feet for greater than 5 minutes in the 24 hours prior to developing symptoms. Data were analyzed to determine COVID-19 conversion rates for children exposed to pre-symptomatic and symptomatic employees based upon exposure risk stratification, window of exposure, and employees who worked with symptoms.ResultsFrom March 2020 – present, we identified 38 EPE that involved 10 employees; 26 EPE were pre-symptomatic and 12 EPE symptomatic exposures. The average number of EPE per employee was 3.8 (SD 3.01). There were no secondary transmission events to patients from either pre-symptomatic or symptomatic employees. After instituting universal masking, the number of concerning exposures to patients were 3 compared to 35 prior to universal masking.ConclusionWe describe the experience of a novel Contact Tracing Center, leveraging alternate staffing pools to track EPE resulting in no secondary transmission to patients either before or after universal masking. We credit sick policy adherence, high hand hygiene compliance, use of standard precautions, universal masking, robust contact tracing operations and a strong data collection system to identify process gaps.Disclosures All Authors: No reported disclosures

Trends and Contributing Factors to Contraceptive Use in Kenya: A Large Population-Based Survey 1989 to 2014.

Kenya is among the leading nations in family planning in Africa, having the first official nationwide family planning program in sub-Saharan Africa. However, Kenya is still one of the most highly populated countries in Africa with a population of more than 52 million. The objective of this study was to assess the trends and contributing factors of contraceptive use. We conducted a multi-wave cross-sectional study using both the demographic health survey (DHS) and family planning effort index (FPE) datasets, analyzing five-year waves from 1989 to 2014. This study indicates that contraceptive use increased from 24.0% to 42.6%, with a change % of 77.5%. Despite changes in women’s characteristics, these characteristics posed little on the time trend of contraceptive use in Kenya. In addition, the policy component of FPE scores had a positive association with contraceptive use with negligible change after adjusting for social and demographic factors 1.055 (1.046–1.065). There was a fluctuating trend of the additional FPE components throughout the years. Women with lower education, those married to husbands with lower education, unmarried, and rural women remain behind in family planning service utilization. Targeted programs are still needed for these special groups. Policy adherence is vital for continued progress.

Becoming a tobacco-free campus: A survey of student attitudes, opinions and behaviors.

INTRODUCTIONThe effectiveness of tobacco-free campus policies in preventing and mitigating tobacco use relies on students’ perceptions, opinions, and adherence to clean-air restrictions. The purpose of this study was to gather data regarding student attitudes, opinions and tobacco use behaviors, one year following implementation of the tobacco-free campus initiative.METHODSData were gathered using an anonymous, online survey of graduate and undergraduate students at a public university, one year following implementation of a tobacco-free campus policy. Survey items included tobacco use behaviors, nicotine dependence, opinions towards the policy, challenges in policy adherence among tobacco users, and awareness of tobacco cessation resources for students. Analysis primarily included descriptive statistics.RESULTSOf 108 respondents, only 18 were habitual tobacco users with most using: cigarettes, cigars or cigarillos (38%), vaping (17.8%), hookah (11.9%), and smokeless tobacco (11.9%). Several reported multiple use. Common motives for tobacco use were relaxation and mood regulation. Tobacco users rated a moderate level of difficulty in adhering to the policy. Only half of the total respondents were aware of cessation resources, specifically peer counseling. Most tobacco users (71%) believed that they could quit without assistance.CONCLUSIONSPreliminary data show 21.8% prevalence of tobacco use within the sample. Information on student opinions and behaviors, including lower risk perception, dual use, and lack of awareness of cessation resources can inform more effective prevention and mitigation strategies, in addition to the tobaccofree campus policy. Further research is needed to monitor policy adherence and changes in student tobacco behaviors.

Technological paradigm-based construction and demolition waste supply chain optimization with carbon policy

The shortage of landfill space and the environmental pollution from urbanization and industrialization have led to an increase in the recycling and reuse of construction and demolition waste (CDW). Based on the technological paradigm, this paper proposes a closed-loop supply chain (CLSC) that integrates forward and reverse logistics and has multiple centers that regulate end-of-life CDW recycling and promote new product remanufacturing. Carbon price (CP) and carbon trading (CT) policies are then innovatively applied to manage the proposed supply chain, incentivize technological CDW disposal improvements, encourage policy adherence, and ensure that the economic and environmental benefits are built into the proposed CLSC. A mixed integer nonlinear programming model (MINLP) is developed to optimize the proposed CLSC by minimizing the total costs under the two carbon policies, and a real case study from China is given. Scenario analyses under the two carbon polices and practical policy suggestions are given, and comprehensive conclusions are provided in the conclusions. It was found that with the adjustment of recycling ratio, the proposed CDW CLSC was able to minimize total costs and overall carbon emissions. Moreover, the CP policy could improve the CDW recycling ratio from 19.4% to 85.3% and reduced carbon emissions by 6393 tonnes, and the CT policy should be an incentive policy to further encourage a higher recycling ratio and lower carbon emissions.

Variation in School District Nutrition Policies and Practices: Community Context Matters

ABSTRACT Background The school nutrition environment has a large impact on child diet. However, there is a paucity of nationally representative research on factors that predict effective nutrition policies, practices, and education in schools. Purpose: The current study utilized Centers for Disease Control and Prevention (CDC) data from the 2016 School Health Policies and Practices Survey (SHPPS) to explore the impact of poverty and community type (i.e., urban/rural spectrum) on these variables. Methods: Data from the 2016 SHPPS included 740 U.S. public schools. Composite scores were created from survey items related to dietary policies and practices. Results: Schools of greater rurality and urbanicity had more nutrition policies and education but fewer practices than suburban districts. Rural districts generally had fewer nutrition policies, practices, and education than urban districts. Poverty did not consistently predict these variables. Discussion: Community type is a crucial variable in the school nutrition environment and may better explain discrepancies among schools than poverty. Future efforts might focus on improving school nutrition policy and practice adherence, especially in rural areas. Translation to Health Eduation Practice: Further research using nationally representative data can help health educators better understand what interventions may produce the best results within their unique community type.

State of Infection Prevention and Control in Home Healthcare Agencies

<h3>Background</h3> Home healthcare (HHC) is becoming a leading source of post-acute services. Currently, most HHC patients have multiple chronic conditions, thereby increasing their risk of infections and rehospitalizations. With a nationally-representative survey, we aimed to better understand the current state of infection prevention and control (IPC) at HHC agencies. <h3>Methods</h3> A national survey, directed at administrators and clinical managers, was conducted from October 2018 to November 2019. Agencies were recruited from a national HHC conference, and a national random sample of 1,505 agencies stratified by census region, ownership status and rural/urban location. Questions were asked about IPC staffing, IPC compliance and training, and current IPC policies and procedures. Descriptive statistics were computed using Stata 13. <h3>Results</h3> 575 HHC agencies (35% response rate) responded; 63% had for-profit ownership. At responding agencies, 35.4 % of staff members in charge of IPC had received no specific IPC training, and 5.6% reported that they currently did not have a staff member in charge of IPC. Over 60% of agencies provided staff training on IPC topics either annually or at new employee orientation. 82.3% reported measuring adherence to hand hygiene policies; policy adherence was measured by shadowing (84.9%) and knowledge assessments (71.8%). Most HHC agencies (87.6%) reported collecting and reviewing infection data to identify trends. Overall, only 31% of agencies required staff influenza vaccination; however, a majority (61.4%) offered free influenza vaccinations to their staff. During the past influenza season, 62.7% of agencies had 75% or more of their employees vaccinated for influenza, and 9% reported not tracking that data. <h3>Conclusions</h3> This national study examining the current state of IPC in HHC can be used as a benchmark for quality improvement initiatives. Particularly, we learned that staff training around IPC and policies and procedures related to staff vaccination are currently inadequate.

Adherence to the infant vitamin D supplementation policy in Ireland

From September 2010 until November 2019, Ireland's infant vitamin D supplementation policy recommended administration of 5μg/day of vitamin D3 from birth to 12months to all infants, regardless of feeding method. This study aims to examine policy adherence. In the prospective COMBINE birth cohort study (recruited 2015-2017), detailed longitudinal supplement data were examined in 364 infants across the first year of life, according to product type, dose, frequency, and duration. Vitamin D supplement use at 2, 6, and 12months in COMBINE was compared with the BASELINE cohort (recruited 2008-2011, n = 1949). In COMBINE, 92% of infants initiated supplementation at birth. The median supplementation duration was 51 (40, 52) weeks, with a range of 3-52weeks. While supplementing, most parents (92%) used an exclusive vitamin D supplement as recommended and 88% gave 5µg/day. Half (51%) gave vitamin D daily and a further 33% supplemented at least 3-6 times/week. Overall, 30% adhered fully to the policy, providing 5µg vitamin D3 daily from birth to 12months. A further 16% were broadly compliant, giving 5µg frequently for the full 12months. Vitamin D supplement use at 2, 6, and 12months in COMBINE was 93%, 89%, and 72%, considerably higher than our earlier BASELINE cohort at 49%, 64%, and 44% at the same time points (all P < 0.001). We report a high level of vitamin D supplementation initiation at birth, with full to broad policy adherence among more than half of infants. There is scope to improve overall compliance by focusing on supplementation frequency.

The Impact of Antimicrobial Stewardship Programme on Regulating the Policy Adherence and Antimicrobial Usage in Selected Intensive Care Units in a Tertiary Care Center - A Prospective Interventional Study

AbstractPurpose: Antimicrobial resistance (AMR) presents a significant threat to human health. The root cause for this global problem is irrational antimicrobial usage. Antimicrobial stewardship (AMS) emphasises on the appropriate use of antibiotics and ensures strict implementation of antimicrobial policy guidelines. This study was conducted to evaluate the impact of auditing of AMS programme on regulating the antimicrobial policy adherence and antimicrobial usage in hospital intensive care units. Materials and Methods: This was a prospective interventional study. It consisted of pre-implementation and implementation phases 6 months each. Two hundred and eighty patients were enrolled. Details of antibiotic consumption, surgical prophylaxis, culture/sensitivity patterns, de-escalation rates, etc., were collected in both phases. The implementation phase, in addition, included stewardship audit rounds. Results: In pre-implementation phase and implementation phases: policy adherence rates were 23.7% and 41.8%, respectively, de-escalation rates were 22.73% and 43.48%, respectively. Cultures were sent before the initiation of antimicrobials in 36.73% cases during the pre-implementation phase, which improved to 60.41% during the implementation phase. Defined daily dose (DDD) for the antibiotics was 98.66 DDD 100BD during the pre-implementation phase, which reduced to 91.62 DDD 100BD in the implementation phase. Total days of therapy (DOT) in the pre-implementation phase were 561 DOT1000BD, which reduced to 463 DOT1000BD during the implementation phase. Conclusions: Implementation of continuous monitoring of the AMS programme, therefore, has a definite role in reducing the antimicrobial consumption and improving the compliance to the policy guidelines. A more robust study for a prolonged period is, however, necessary to have a better analysis of the outcome.

Healthy Default Beverages in Kids’ Meals: Evaluating Policy Adherence and Impact in California

Abstract Objectives Healthy default beverage policies for restaurant kids’ meals have been identified as a top strategy to improve beverage intake in young children and reduce obesity and diabetes risk. California passed a statewide policy (SB1192), effective January 2019, specifying kids’ meal default beverages as water, unflavored milk, or a nondairy alternative. Although other localities have adopted similar policies, there have been no studies on their effectiveness. The aim of this study was to assess changes in beverages offered with kids’ meals before and after a healthy default beverage policy took effect and to quantify policy adherence in menus and cashier orders in quick service restaurants (QSR). Methods The study employed a pre-post policy design. Baseline data on beverages offered as part of kids’ meals were collected from 111 QSR in low-income areas in California in late 2018, prior to policy implementation. Follow-up data were collected from the same restaurants one year later. Data were collected by menu observation and purchase of kids’ meals. Both walk-in and drive-through settings were assessed where available. Full policy adherence was defined as offering only SB1192-compliant beverages, and was assessed 3 ways: menu board, cashier order, and a combined metric. Results At baseline, prior to any legislative requirement, 6 (6.3%) restaurant menu boards, 5 (4.5%) cashier orders, and 0 restaurants overall were already fully adherent. At follow-up, 64 (66.0%) restaurant menu boards, 1 (0.9%) cashier order, and 0 restaurants overall were fully adherent. Generalized estimating equations, clustered by restaurant chain, were used to test pre-post policy changes. Adherence in menu boards increased (59.7%, p = &amp;lt; .0001). There were no changes in adherence in cashier orders or overall adherence. Conclusions California's healthy default beverage policy for restaurant kids’ meals was effective in changing QSR menu board offerings but did not impact cashier order processes. Additional staff training may improve policy implementation. Studies are underway to assess the impact of staff training and customer behavior change. Funding Sources University of California Division of Agriculture and Natural Resources, Robert Wood Johnson Foundation Healthy Eating Research, CA Department of Public Health/USDA.

Status of Beverages Served to Young Children in Child Care After Implementation of California Policy, 2012-2016.

IntroductionSince 2012, licensed California child care centers and homes, per state policy, are required to serve only unflavored low-fat or nonfat milk to children aged 2 years or older, no more than one serving of 100% juice daily, and no beverages with added sweeteners, and they are required to ensure that drinking water is readily accessible throughout the day. We evaluated adherence to the policy after 4 years in comparison to the adherence evaluation conducted shortly after the policy went into effect.MethodsLicensed California child care sites were randomly selected in 2012 and 2016 and surveyed about beverage practices and provisions to children aged 1–5 years. We used logistic regression to analyze between-year differences for all sites combined and within-year differences by site type and participation in the federal Child and Adult Care Food Program (CACFP) in self-reported policy adherence and beverage provisions.ResultsRespondents in 2016 (n = 680), compared with those in 2012 (n = 435), were more adherent to California’s 2010 Healthy Beverages in Child Care Act overall (45.1% vs 27.2%, P < .001) and with individual provisions for milk (65.0% vs 41.4%, P < .001), 100% juice (91.2% vs 81.5%, P < .001), and sugar-sweetened beverages (97.4% vs 93.4%, P = .006). In 2016, centers compared with homes (48.5% vs 28.0%, P = .001) and CACFP sites compared with non-CACFP sites (51.6% vs 27.9%, P < .001) were more adherent to AB2084 overall.DiscussionBeverage policy adherence in California child care has improved since 2012 and is higher in CACFP sites and centers. Additional policy promotion and implementation support is encouraged for non-CACFP sites and homes. Other states should consider adopting such policies.