Objectives We examined factors associated with sustaining tobacco screening and treatment at Federally Qualified Health Centers (FQHCs), 2020 through 2024. Methods We analyzed 2020–2024 Uniform Data System data for 1354 FQHCs with complete data. The primary outcome was sustained treatment, defined as meeting the ≥80% tobacco screening/treatment benchmark each year. Logistic models estimated associations between center characteristics (patient composition, receipt of special population funding, rurality) and performance. Results Centers served a median of 13,739 patients. The mean proportion of patients with incomes ≤200% federal poverty level was 60.0%, the mean covered by Medicaid was 43.9%, and the mean uninsured was 21.5%. Less than half of the centers (41.6%, n = 563/1354) sustained ≥80% tobacco screening/treatment performance across all study years; the odds increased with greater patient volume (OR = 1.45, 95%CI:1.26,1.68), higher proportions of Hispanic patients (OR = 2.23, 95%CI:1.22, 4.08), and higher proportions of patients ≤200% of federal poverty level (OR = 2.79, 95%CI:1.53, 5.06). Centers with higher proportions of Black patients (OR = 0.42, 95%CI:0.23, 0.76) and those that received homeless population funding (OR = 0.61, 95%CI:0.45, 0.84) had lower odds of sustained performance. Conclusions Patient volume and composition were associated with sustained tobacco treatment performance which may reflect differences in organizational capacity.
Objective Active lifestyles and adapted physical activity (APA) are promoted for primary, secondary, tertiary chronic disease prevention, but multilevel barriers limit engagement. Sport-health gateways could address this implementation gap by providing APA and referrals to sport-health services. This study examined short- and long-term associations of gateway participation with functional capacity and long-term health behavior changes, in real-world settings. Methods We studied the Limousin Sport Santé (LSS) gateways cohort (France, 2015–2025), including participants in primary or secondary/tertiary prevention. The 6-Minute Walk Test (6MWT) and Recent Physical Activity Questionnaire (RPAQ) were administered at baseline(T0). After supervised APA program, 6MWT and attendance were recorded at completion(T1). After referral to sport-health structures, 6MWT, RPAQ, and physical activity practice were assessed at 1-year follow-up(T2). Results Among 3318 participants, 6MWT distance was higher at T1 (550.0 (125.0) m) and T2 (570.0 (125.0) m) vs baseline (525.0 (130.0) m; p < 0.001). Sedentary time was 48 min/day lower at T2; leisure energy expenditure was over three-fold higher (p < 0.001). Patterns were similar across prevention groups. At T2, 61.6% maintained APA (three sessions/week), with higher maintenance in primary prevention. Conclusions LSS gateways were associated with better functional capacity and health behaviors over time, supporting their potential as a sustained model for chronic disease prevention.
