CONTEXT:School-based nutrition interventions have the potential to promote dietary behaviors and other outcomes among children and adolescents. However, inconsistent reporting of outcomes and measurement tools limits evidence synthesis and the identification of effective intervention strategies. OBJECTIVE:This umbrella review aimed to synthesize the range of outcomes related to diet, health, well-being, and education reported in systematic reviews of school-based nutrition interventions, along with the measurement tools used. The findings will be used to inform the development of a Core Outcome Set (COS) to guide future evaluations in this field. DATA SOURCES:We conducted a systematic search across 7 databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, PsycINFO, CINAHL, Web of Science, and Scopus) to identify systematic reviews published from January 2018 to December 2023. DATA EXTRACTION:Data on outcomes related to diet, health, well-being, and education were extracted from eligible systematic reviews. When available, information on outcome measurement tools was also extracted. Additional details were retrieved from primary studies referenced within systematic reviews as needed. DATA ANALYSIS:Ninety-eight systematic reviews, comprising 965 unique studies, were included. Outcomes were categorized into 4 domains: (1) "diet" (68.8%), subdivided into "dietary intake" and "diet-related cognitive/attitudinal behaviors"; (2) "physical health" (44.8%), subdivided into "body composition" and "clinical/biochemical measures"; (3) "social and emotional well-being and behavior" (9.2%); and (4) "education" (6.4%). Substantial heterogeneity was observed across outcome domains, subdomains, and measurement tools, which presents challenges for evidence synthesis and limits comparability across studies. CONCLUSIONS:The findings of this review underscore the need for a stakeholder-informed, context-aware COS to standardize outcome reporting in school-based nutrition interventions. Such standardization is essential to improve the comparability of research findings, enhance evidence synthesis, and facilitate the translation of evidence into policy and practice. Subsequent phases of this work will involve diverse stakeholder engagement to finalize the COS and recommend appropriate tools for outcome measurement for evaluating school-based nutrition interventions. SYSTEMATIC REVIEW REGISTRATION:PROSPERO registration No. CRD42022378746.

Some evidence suggests that anhedonia is a component of nicotine withdrawal, but additional research is needed to support this conclusion and establish its clinical relevance. Secondary analyses were conducted for a comparative effectiveness smoking cessation clinical trial of combination nicotine replacement therapy, nicotine patches, and varenicline (N = 1,084). Self-reported consummatory anhedonia was assessed at multiple time points pretarget quit day (TQD) and post-TQD, and biochemically confirmed 7-day point-prevalence smoking abstinence was assessed at 4, 12, and 26 weeks post-TQD. Data collection occurred from May 2012 to November 2015. Analyses were conducted using hierarchical linear modeling, logistic regression, and general linear models. Anhedonia demonstrated a prototypical inverted-U pattern from pre- to post-TQD consistent with withdrawal, which was not moderated by medication condition (ps > .83). Greater postquit anhedonia was associated with lower odds of biochemically confirmed abstinence at 4 weeks (odds ratio [OR] = 0.96, 95% confidence interval [CI] = [0.94, 0.98], p < .001), 12 weeks (OR = 0.96, 95% CI = [0.94, 0.99], p = .001), and 26 weeks (OR = 0.95, 95% CI = [0.93, 0.98], p < .001) post-TQD. These effects remained even after controlling for other withdrawal symptoms and individual characteristics. Gold standard smoking pharmacotherapies had comparable statistical effects on anhedonia's trajectory and association with abstinence during treatment. The results replicate and extend previous research supporting anhedonia as a motivationally significant symptom of nicotine withdrawal. The results suggest anhedonia not only conforms to features of a tobacco withdrawal symptom but is associated with difficulty stopping smoking. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Abstract Background Project DAIRE was a randomised-controlled, factorial design trial which aimed to improve children’s health-related quality of life, wellbeing, food knowledge and dietary habits via two multi-component interventions: Nourish and Engage. Nourish was an intervention aiming to alter the school food environment, provide food-based experiences and expose pupils to locally produced foods. Engage was an age-appropriate cross-curricular food education intervention incorporating food, agriculture, nutrition science and related careers. The purpose of this study was to conduct a process evaluation to evaluate DAIRE implementation, mechanisms of impact (MOI) and context to elucidate trial results, and inform scalable implementation of the DAIRE approach for successful future rollout. Methods The Medical Research Council’s (MRC) framework for process evaluation was followed. Formal (questionnaires designed for process evaluation) and informal (researcher records and communications) methods were used to collect quantitative and qualitative data during the DAIRE trial in relation to process evaluation. Quantitative data were analysed using descriptive statistics and qualitative data via thematic analysis to identify key themes. Results Fifteen schools and 983 pupils (n = 495 6–7 year olds/Year 3 and n = 488 10–11 year olds/Year 7) were recruited for the 6-month DAIRE intervention; a 100% retention rate was observed at the school level and the interventions had a high level of pupil and teacher acceptability. Nourish schools delivered a higher mean dose of intervention elements (61.4%) than Engage (50%) schools but, overall, mixed implementation of both interventions occurred. DAIRE produced change through four key MOI: social learning, experimental learning, interactive engaging content and real-life connections. Lack of time was the main contextual barrier to implementation and lack of financial cost to schools indicated as a potential facilitator. Conclusions This process evaluation helped to identify important findings related to implementation, MOI and context. The most effective elements of the interventions which should be maintained include provision of interactive and engaging intervention elements at no financial cost to the school. Findings also identified suggestions for improvement including provision of increased teacher training, support and planning time, content reduction to facilitate easy integration, and implementation across the full academic year. A sustainable funding and resourcing mechanism is required for successful future roll-out across the UK and beyond. Trial registrations The original trial referenced in this process evaluation is registered as follows: National Institute of Health (NIH) U.S. National Library of Medicine Clinical Trials.gov (ID: NCT04277312; retrospectively registered 11th February 2020).

Introduction: Some populations are underrepresented in smoking treatment research. Electronic health record (EHR)-enabled referral of patients who smoke, which may enhance the representativeness of clinical trial samples. This study assessed the representativeness of smoking treatment trial electronic referral (e-referral), exclusion, enrollment, and engagement in primary care. Aims and Methods: Eighteen adult primary care clinics in two healthcare systems offered patients who smoked e-referral to smoking reduction or cessation treatment trials. Extracted EHR data were analyzed to compare rates of e-referral and enrollment across patient groups defined by sex, age, race, ethnicity, and insurance status. Trial eligibility screening data were analyzed to identify differential exclusion of patient groups by sex, race, or neighborhood disadvantage. Results: Overall, 23.3% of eligible patients were e-referred, with elevated e-referral rates among women, African American, Medicaid-eligible, and middle-aged patients. Among e-referred patients, 20.5% were excluded at trial eligibility screening, with exclusions elevated for women, minoritized individuals, and individuals from disadvantaged neighborhoods. Overall, 7.0% of patients who smoked enrolled in a smoking treatment trial, with enrollment rates elevated among women, those over age 44, and, in one health system, African American patients. Most enrollees (>87%) initiated counseling and enrollees completed 52.4-79.9% of counseling sessions, with older, college-educated, and lower-income enrollees attending more sessions. Conclusions: Proactive e-referral in primary care may improve the representation of certain groups (eg African American and Medicaid-eligible patients) in smoking treatment trials, but differential exclusion at eligibility screening may reduce sample representativeness. Relaxing nonessential eligibility criteria may enhance the inclusion of minoritized and disadvantaged populations in smoking treatment research. Implications: Electronic referral of adult primary care patients who smoke to smoking cessation and reduction trials may enhance referral of high-priority populations (eg African American patients and those eligible for Medicaid) to tobacco treatment trials. Relaxing treatment trial inclusion criteria may enhance representation of minoritized and disadvantaged patients in treatment trials.

This study explored the effects of Project Daire, a school-based food intervention, on secondary dietary outcomes Diet Diversity Score (DDS) and Diet Quality Score (DQS), among 6–7 and 10-11-year-old children. A randomised-controlled, factorial design trial was conducted in 15 Northern Ireland primary schools across four intervention arms: Nourish, Engage, Nourish and Engage, and Control (Delayed). Nourish modified the school food environment and increased exposure to local foods, while Engage delivered educational activities on nutrition, food, and agriculture. Food consumption data were collected at baseline and at up to a 6-month follow-up. DDS and DQS (at home, at school and/or total) were determined based on the UK Eatwell Guide. A total of 445 children aged 6–7 and 458 aged 10–11 completed the trial. Among the 10-11-year-olds who received the Nourish intervention, significant increases were observed in the school DDS (adjusted mean difference = 2.79, 95

BACKGROUND:Though tobacco use treatment (TUT) after a cancer diagnosis can improve cancer treatment outcomes and survival, delivery of evidence-based TUT remains underutilized in cancer care. The National Cancer Institute (NCI) Cancer Center Cessation Initiative (C3I) implemented TUT across 52 NCI-Designated Cancer Centers, but there is little information on its long-term sustainment. This study assesses TUT sustainment beyond initial implementation in C3I. METHODS:A web-based survey across 52 C3I centers was conducted during the sustainment phase (2023-2024) following NCI C3I funding. The surveys assessed program funding and the sustainment of the overall program, program components and practices, assessment of implementation and patient outcomes, partnerships, and program scale-out across settings. The survey data were analyzed using descriptive statistics. RESULTS:Among 47 responding sites (90% response rate), 83% reported continued TUT activity after NCI funding ended with annual operating budgets between $100,000 and $250,000. Most sites (78.7%) reported some institutional support, while few relied on fee-for-service reimbursement (27.7%), bundled payments (8.1%), or support from grants (27.7%) and philanthropic donations (21.3%). Key program components including electronic health record modifications, outcomes reporting, and staff training were largely maintained, with nearly all (46) sites continuing to screen for tobacco use and refer patients to TUT. Perceived program partnerships were strongest with clinicians and departmental leadership, and some programs were scaled out to primary care and other specialties. CONCLUSIONS:Results confirm that most cancer centers sustained key TUT program functions and partnerships with some increasing TUT delivery across larger cancer treatment settings.

Background: The Project DAIRE trial aimed to improve children’s health-related quality of life, wellbeing, food knowledge and dietary habits via two multi-component interventions: Nourish, and Engage. Nourish was an intervention aiming to alter the school food environment, provide food-based experiences and expose pupils to locally produced foods. Engage was an age-appropriate cross-curricular food education intervention incorporating food, agriculture, nutrition science and related careers. The purpose of this study was to conduct a mixed methods process evaluation to evaluate DAIRE implementation, mechanisms of impact (MOI) and context, and inform scalable implementation of the DAIRE approach. Methods: The Medical Research Council’s (MRC) framework for process evaluation was followed. Formal and informal methods were used to collect quantitative and qualitative data during the DAIRE trial in relation to process evaluation. Quantitative data were analysed using descriptive statistics and qualitative data via thematic analysis to identify key themes. Results: Fifteen schools and 983 pupils (n=495 Key Stage 1 (KS1) and n=488 Key Stage 2 (KS2) pupils) were recruited for the 6-month DAIRE intervention; a 100% retention rate was observed at the school level and the interventions had a high level of acceptability. Nourish schools implemented a higher mean intervention dose (57.2%) than Engage (50%) schools but, overall, mixed implementation of both interventions occurred. DAIRE produced change through four key MOI: social learning, experimental learning, interactive engaging content and real-life connections. Lack of time was the main contextual barrier to DAIRE implementation and lack of financial cost to schools was indicated as a potential facilitator. Conclusions: This process evaluation helped to identify important findings related to implementation, MOI and context. The most effective elements of the interventions which should be maintained include provision of interactive and engaging intervention elements and ensure these are at no financial cost to the school. Findings also identified suggestions for improvement including provision of increased teacher training, support and planning time, content reduction to facilitate easy integration into the school curriculum, and implementation across the full academic year. A sustainable funding and resourcing mechanism is required for successful future roll-out. Trial Registration : The original trial referenced in this process evaluation is registered as follows: National Institute of Health (NIH) U.S. National Library of Medicine Clinical Trials.gov (ID: NCT04277312)

ImportanceA single round of standard tobacco quitline treatment may not be sufficient to sustain abstinence, particularly among people experiencing socioeconomic disadvantage. Adaptive retreatment may help more individuals with socioeconomic disadvantage achieve abstinence and reduce disparities in smoking cessation outcomes.ObjectiveTo evaluate 4 evidence-based strategies for adults with limited education, no insurance, or Medicaid eligibility who continued smoking after quitline treatment.Design, Setting, and ParticipantsA factorial randomized clinical trial with 4 factors adapting quitline strategies was conducted for participants enrolled from June 7, 2018, to January 25, 2023, with 6-month follow-up. Adults using the Wisconsin Tobacco Quit Line who were smoking cigarettes 3 to 6 months after prior quitline treatment who were uninsured, Medicaid insured, or had no more than a high school education were included.InterventionsQuitline retreatment strategies were (1) increased counseling intensity (4 calls vs 1 call), (2) increased nicotine replacement therapy intensity (4 weeks of combination nicotine patch plus nicotine lozenge vs 2 weeks of nicotine patch), (3) text-message support (National Cancer Institute SmokefreeTXT program vs none), and (4) financial incentives for engagement in counseling and SmokefreeTXT ($30/call and/or 6-week SmokefreeTXT retention vs no incentives).Main Outcomes and MeasuresPrimary outcome was 7-day point-prevalence biochemically confirmed abstinence 26 weeks after the target quit day. Intention-to-treat analysis was performed.ResultsOf 6019 people assessed for eligibility, 1316 (21.9%) participants were randomized (mean [SD] age, 53.1 [11.9] years; 760 [57.8%] women), and 919 (69.8%) provided final follow-up. Intention-to-treat analyses showed 162 participants (12.3%) had biochemically confirmed abstinence at 26 weeks (368 [28.0% self-reported abstinence]). There were no significant main effects for the primary outcome: 1 call (11.6% [77 of 662]) vs 4 calls (13.0% [85 of 654]) (odds ratio [OR], 1.04; 95% CI, 0.88-1.24), 2-week patch (11.2% [73 of 654]) vs 4-week combination nicotine replacement therapy (13.4% [89 of 662]) (OR, 1.12; 95% CI, 0.94-1.34), no SmokefreeTXT (13.4% [88 of 657]) vs SmokefreeTXT (11.2% [74 of 659]) (OR, 0.88; 95% CI, 0.74-1.05), and no financial incentives (12.8% [85 of 662]) vs financial incentives (11.8% [77 of 654]) (OR, 0.94; 95% CI, 0.78-1.11).Conclusions and RelevanceIn this randomized clinical trial evaluating enhancements to tobacco quitlines for adults with socioeconomic disadvantage who were smoking after quitline treatment, none of the adaptive treatment strategies robustly improved long-term abstinence. Strategies are needed to enhance quitline retreatment effectiveness for adults with socioeconomic disadvantage.Trial RegistrationClinicalTrials.gov Identifier: NCT03538938

PURPOSE In 2017, the National Cancer Institute (NCI) funded the Cancer Center Cessation Initiative (C3I) to implement and expand tobacco treatment programs in routine oncology care. Many C3I programs developed specialty care programs staffed by tobacco treatment specialists (TTSs) to deliver evidence-based treatment to adult patients who smoke. People involved in specialty tobacco treatment programs can help to identify implementation strategies and adaptations that may enhance tobacco treatment reach and effectiveness in cancer care and help more patients with cancer quit using tobacco. METHODS We conducted semistructured interviews with TTSs from 21 C3I-funded cancer centers and applied content analysis to interview transcripts from 37 TTSs and 17 respondents in other program roles. We used the Consolidated Framework for Implementation Research to code interview data. We identified final themes and implementation strategies and adaptations recommended by respondents on the basis of these codes. RESULTS Respondents shared that implementation of specialty tobacco treatment programs in cancer care settings could be facilitated by training staff to provide patient connection to services, incorporating prescription of no- or low-cost cessation medications, hiring additional staff to deliver tobacco treatment, allocating space to the program, and automating electronic health record workflows. CONCLUSION TTSs and others involved in specialty tobacco treatment in NCI-designated cancer centers identified ways to improve tobacco treatment access, use, and effectiveness by (1) adapting specialty tobacco treatment delivery to meet patient needs; (2) facilitating referrals and pharmacotherapy coordination; and (3) committing staffing, space, and support resources to tobacco treatment programs. Key program participants suggested that these approaches would help more oncology patients connect with evidence-based tobacco treatment and quit smoking.

Although the harmful effects of smoking after a cancer diagnosis have been clearly demonstrated, many patients continue to smoke cigarettes during treatment and beyond. The NCCN Guidelines for Smoking Cessation emphasize the importance of smoking cessation in all patients with cancer and seek to establish evidence-based recommendations tailored to the unique needs and concerns of patients with cancer. The recommendations contained herein describe interventions for cessation of all combustible tobacco products (eg, cigarettes, cigars, hookah), including smokeless tobacco products. However, recommendations are based on studies of cigarette smoking. The NCCN Smoking Cessation Panel recommends that treatment plans for all patients with cancer who smoke include the following 3 tenets that should be done concurrently: (1) evidence-based motivational strategies and behavior therapy (counseling), which can be brief; (2) evidence-based pharmacotherapy; and (3) close follow-up with retreatment as needed.

Although the harmful effects of smoking after a cancer diagnosis have been clearly demonstrated, many patients continue to smoke cigarettes during treatment and beyond. The NCCN Guidelines for Smoking Cessation emphasize the importance of smoking cessation in all patients with cancer and seek to establish evidence-based recommendations tailored to the unique needs and concerns of patients with cancer. The recommendations contained herein describe interven-tions for cessation of all combustible tobacco products (eg, cigarettes, cigars, hookah), including smokeless tobacco products. However, rec-ommendations are based on studies of cigarette smoking. The NCCN Smoking Cessation Panel recommends that treatment plans for all pa-tients with cancer who smoke include the following 3 tenets that should be done concurrently: (1) evidence-based motivational strategies and behavior therapy (counseling), which can be brief; (2) evidence-based pharmacotherapy; and (3) close follow-up with retreatment as needed. J Natl Compr Canc Netw 2023;21(3):297-322 doi: 10.6004/jnccn.2023.0013

American Indian and Alaska Native (AI/AN) individuals are more likely to die with COVID-19 than other groups, but there is limited empirical evidence to explain the cause of this inequity. The objective of this study was to determine whether medical comorbidities, area socioeconomic deprivation, or access to treatment can explain the greater COVID-19 related mortality among AI/AN individuals. The design was a retrospective cohort study of harmonized electronic health record data of all inpatients with COVID-19 from 21 United States health systems from February 2020 through January 2022. The mortality of AI/AN inpatients was compared to all Non-Hispanic White (NHW) inpatients and to a matched subsample of NHW inpatients. AI/AN inpatients were more likely to die during their hospitalization (13.2% versus 7.1%; odds ratio [OR] = 1.98, 95% confidence interval [CI] = 1.48, 2.65) than their matched NHW counterparts. After adjusting for comorbidities, area social deprivation, and access to treatment, the association between ethnicity and mortality was substantially reduced (OR 1.59, 95% CI 1.15, 2.22). The significant residual relation between AI/AN versus NHW status and mortality indicate that there are other important unmeasured factors that contribute to this inequity. This will be an important direction for future research.

Background: Diagnostic uncertainty is ubiquitous in emergency medicine (EM).Training to prepare students to communicate uncertainty with emergency department (ED) patients is limited in UME.Previous work has integrated the Uncertainty Communication Checklist (UCC) in EM resident education.Implementation in the EM clerkship has not yet been examined.We developed a curricular intervention that implements uncertainty training into the EM clerkship for third-year medical students.Objectives: Students will be able to describe diagnostic uncertainty and its impact on patients and provider, explain the UCC during patient conversations, practice using checklist during simulated encounters, and apply the checklist to patient conversations on shift.Curricular Design: At our institution, students complete a required 3-week EM clerkship.Students were first tasked with completing prework in the form of an Articulate Rise module on communicating diagnostic uncertainty.An additional didactic session was included in the clerkship orientation.Students then engaged in peer role play, as either patient or physician during a simulated case of discharging a patient with an uncertain diagnosis.The session ended with a debriefing.While in the department, we assessed students' performance in applying each aspect of the checklist while communicating diagnostic uncertainty with patients through a standardized direct observation tool.Impact: As students grapple with diagnostic uncertainty during their EM clerkship for the first time, the clerkship itself may serve as an ideal time to implement training on navigating these conversations.The breadth of patient encounters in the ED allows for deliberate practice of this skill.The UCC was successfully implemented into our clerkship.Initial data shows that students perform well and complete most elements of the checklist (83%).We plan to continue with implementation, data collection, and dissemination of this innovation.

Background:Cancer patients who receive evidence-based tobacco-dependence treatment are more likely to quit and remain abstinent, but tobacco treatment programs (TTPs) are not consistently offered. In 2017, the U.S. National Cancer Institute, through the Cancer Moonshot, funded the Cancer Center Cessation Initiative (C3I). C3I supports 52 cancer centers to implement and expand evidence-based tobacco treatment in routine oncology care. Integration into routine care involves the use of health information technology (IT), including modifying electronic health records and clinical workflows. Here, we examine C3I cancer centers' IT leadership involvement and experiences in tobacco-dependence treatment implementation.Method:This qualitative study of C3I-funded cancer centers integrated data from online surveys and in-person, semistructured interviews with IT leaders. We calculated descriptive statistics of survey data and applied content analysis to interview transcripts.Results:Themes regarding IT personnel included suggestions to involve IT early, communicate regularly, understand the roles and influence of the IT team, and match program design with IT funding and resources. Themes regarding electronic health record (EHR) modifications included beginning modifications early to account for long lead time to make changes, working with IT to identify and adapt existing EHR tools for TTP or designing tools that will support a desired workflow developed with end-users, and working with IT personnel to make sure TTPs comply with system and state policies (e.g., privacy laws).Conclusions:The experiences of C3I cancer centers regarding the use of health IT to enhance tobacco-dependence treatment program implementation can guide cancer centers and community oncology practices to potentially enhance TTP implementation and patient outcomes.

6571 Background: Persistent smoking after cancer diagnosis causes adverse clinical outcomes. ASCO and other organizations view smoking assessment and treatment as indicators of high-quality cancer care. Yet, adoption of clinical practice guidelines like the 3As (Ask, Advise and Assist) for smoking assessment and treatment has been slow and inconsistent in cancer care settings. Methods: Led by the American College of Surgeons Cancer Programs’ Commission on Cancer (CoC) and National Accreditation Program for Breast Centers (NAPBC), the “Just ASK” national quality improvement project focuses on enhancing smoking assessment and treatment in cancer care settings. All CoC/NAPBC programs (n~2000) were invited to participate, which consisted of educational webinars, online resources, and 3 online surveys (baseline, 6- and 12-month) collecting information on smoking assessment and treatment practices, plus other variables (e.g., organizational priority, implementation barriers). Program participation was incentivized by fulfillment of accreditation standards. Results: In total, 776 programs (731 CoC, 45 NAPBC), participated. At baseline, most programs strongly endorsed the importance of addressing smoking within cancer care and the majority of programs reported routinely assessing smoking (90%) and advising all patients reporting current smoking to quit (71%). However, routine delivery of evidence-based smoking cessation assistance (e.g., quitline referral, cessation medications, counseling services) was low (all < 30%). Program retention was excellent (91%). As shown in the table, the 12-month follow-up revealed marked improvements in evidence-based Ask, Advise and Assist, practices. Conclusions: At enrollment, the importance of addressing smoking was evident and high rates of smoking assessment were reported. At 12-month follow-up, marked improvement was reported in all quality indicators of the 3As. These findings guided the sharing of strategies for improving patient assessment, clinical workflow and documentation. Suboptimal delivery of smoking cessation assistance persisted despite overall improvements, which highlight persistent challenges and opportunities for implementing smoking assessment and treatment in cancer care settings. [Table: see text]

Introduction: Smoking is the leading preventable cause of death and disease in the U.S. This study evaluates the cost-effectiveness from a healthcare system perspective of a comprehensive primary care intervention to reduce smoking rates. Methods: This pragmatic trial implemented electronic health record prompts during primary care visits and employed certified tobacco cessation specialists to offer proactive outreach and smoking cessation treatment to patients who smoke. The data, analyzed in 2022, included 10,683 patients in the smoking registry from 2017 to 2020. Pre-post analyses compared intervention costs to treatment engagement, successful self-reported smoking cessation, and acute health care utilization (urgent care, emergency department visits, and inpatient hospitalization). Cost per quality-adjusted life year was determined by applying conversion factors obtained from the tobacco research literature to the cost per patient who quit smoking. Results: Tobacco cessation outreach, medication, and counseling costs increased from $2.64 to $6.44 per patient per month, for a total post-implementation intervention cost of $500,216. Smoking cessation rates increased from 1.3% pre-implementation to 8.7% post-implementation, for an incremental effectiveness of 7.4%. The incremental cost-effectiveness ratio was $628 (95% CI: $568, $695) per person who quit smoking, and $905 (95% CI: $822, $1,001) per quality-adjusted life year gained. Acute health care costs decreased by an average of $42 (95% CI: -$59, $145) per patient per month for patients in the smoking registry. Conclusions: Implementation of a comprehensive and proactive smoking cessation outreach and treatment program for adult primary care patients who smoke meets typical cost-effectiveness thresholds for healthcare. (c) 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Identifying patients at risk for readmission after severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection could facilitate care planning and prevention. This retrospective cohort study of 60‐day readmission included 105 543 COVID‐19 patients at 21 US healthcare systems who were discharged alive between February 2020 and November 2021. Generalized linear mixed regression analyses tested predictors of 60‐day readmission and severity. The all‐cause readmission rate was 15% (95% confidence interval [CI] = 10%–21%), with 22% (95% CI = 18%–26%) of readmitted patients needing intensive care, and 6% (95% CI = 05%–07%) dying. Factors associated with readmission included male sex, government insurance, positive smoking history, co‐morbidity burden, longer index admissions, and diagnoses at index admission (e.g., cancer, chronic kidney disease, and liver disease). Death and intensive care rates at readmission declined postvaccine availability. Receiving at least two COVID‐19 vaccine doses, which were more common among older patients and those with comorbid conditions, was not independently associated with readmission but predicted a reduced risk of death at readmission. This retrospective cohort study identified factors associated with all‐cause readmission for patients re‐admitted to the same health system after hospitalization with SARS‐CoV‐2 infection. Patients who are male, who smoke, who have a higher comorbidity burden, and have government insurance may benefit from additional postacute care planning.