This Viewpoint summarizes results of dissemination and implementation research conducted by the US Preventive Services Task Force (USPSTF) to reevaluate the presentation of USPSTF Recommendation Statements and explains changes made to the statements and accompanying materials to increase clarity and enhance implementation of recommendations.

OBJECTIVE:Collaborative research networks are increasingly used as an effective mechanism for accelerating knowledge transfer into policy and practice. This paper explored the characteristics and collaborative learning approaches of nine health research networks.DATA SOURCES/STUDY SETTING:Semi-structured interviews with representatives from eight diverse US health services research networks conducted between November 2012 and January 2013 and program evaluation data from a ninth.STUDY DESIGN:The qualitative analysis assessed each network's purpose, duration, funding sources, governance structure, methods used to foster collaboration, and barriers and facilitators to collaborative learning.DATA COLLECTION:The authors reviewed detailed notes from the interviews to distill salient themes.PRINCIPAL FINDINGS:Face-to-face meetings, intentional facilitation and communication, shared vision, trust among members and willingness to work together were key facilitators of collaborative learning. Competing priorities for members, limited funding and lack of long-term support and geographic dispersion were the main barriers to coordination and collaboration across research network members.CONCLUSION:The findings illustrate the importance of collaborative learning in research networks and the challenges to evaluating the success of research network functionality. Conducting readiness assessments and developing process and outcome evaluation metrics will advance the design and show the impact of collaborative research networks.

Understanding behavioral resilience among at-risk adolescents may guide public policy decisions and future programs. We examined factors predicting behavioral resilience following intrauterine substance exposure in a prospective longitudinal birth-cohort study of 136 early adolescents (ages 12.4-15.9 years) at risk for poor behavioral outcomes. We defined behavioral resilience as a composite measure of lack of early substance use initiation (before age 14), lack of risky sexual behavior, or lack of delinquency. Intrauterine substance exposures included in this analysis were cocaine, tobacco, alcohol, and marijuana. We recruited participants from Boston Medical Center as mother-infant dyads between 1990 and 1993. The majority of the sample was African American/Caribbean (88%) and 49% female. In bivariate analyses, none and lower intrauterine cocaine exposure level predicted resilience compared with higher cocaine exposure, but this effect was not found in an adjusted model. Instead, strict caregiver supervision (adjusted odds ratio [AOR] = 6.02, 95% confidence interval (CI) [1.90, 19.00], p = .002), lower violence exposure (AOR = 4.07, 95% CI [1.77, 9.38], p < .001), and absence of intrauterine tobacco exposure (AOR = 3.71, 95% CI [1.28, 10.74], p = .02) predicted behavioral resilience. In conclusion, caregiver supervision in early adolescence, lower violence exposure in childhood, and lack of intrauterine tobacco exposure predicted behavioral resilience among a cohort of early adolescents with significant social and environmental risk. Future interventions should work to enhance parental supervision as a way to mitigate the effects of adversity on high-risk groups of adolescents. (PsycINFO Database Record

Background: By 2030, 171 million Americans are expected to have more than one chronic condition. The cohort of individuals with multiple chronic conditions (MCC) is growing and two thirds of healthcare costs for the US population are currently spent on the 20% of people who have MCC. Objectives: Recognizing the need for increased investment in MCC programs and research, Health and Human Services (HHS) developed the HHS Strategic Framework on MCC. The Agency for Healthcare Research and Quality (AHRQ) contributed to the goals of the framework by funding the MCC Research Network, comprising 45 diverse grants and representing one of the largest federal investment in MCC studies to date. Results: The initial body of research emerging from the AHRQ MCC Research Network included: comanagement of commonly co-occurring conditions (including by caregivers); care for patients with low-prevalence combinations of MCC; the effect of MCC patients on provider performance metrics; guidelines for preventive services; medication management in individuals with MCC; as well as MCC-specific methodological and analytical techniques. Conclusions: The authors describe a subset of research contributions made in each topic area and make 3 recommendations for future MCC research: (1) include person-centered and person-driven measures and outcomes, (2) consider the person in the context of their relationships and community, and (3) include mental healthcare as an essential part of overall healthcare.

Background: By 2030, 171 million Americans are expected to have more than one chronic condition. The cohort of individuals with multiple chronic conditions (MCC) is growing and two thirds of healthcare costs for the US population are currently spent on the 20% of people who have MCC.Objectives: Recognizing the need for increased investment in MCC programs and research, Health and Human Services (HHS) developed the HHS Strategic Framework on MCC. The Agency for Healthcare Research and Quality (AHRQ) contributed to the goals of the framework by funding the MCC Research Network, comprising 45 diverse grants and representing one of the largest federal investment in MCC studies to date.Results: The initial body of research emerging from the AHRQ MCC Research Network included: comanagement of commonly co-occurring conditions (including by caregivers); care for patients with low-prevalence combinations of MCC; the effect of MCC patients on provider performance metrics; guidelines for preventive services; medication management in individuals with MCC; as well as MCC-specific methodological and analytical techniques.Conclusions: The authors describe a subset of research contributions made in each topic area and make 3 recommendations for future MCC research: (1) include person-centered and person-driven measures and outcomes, (2) consider the person in the context of their relationships and community, and (3) include mental healthcare as an essential part of overall healthcare.

Objective: To ascertain whether level of intrauterine cocaine exposure (IUCE) is associated with early adolescent delinquent behavior, after accounting for prenatal exposures to other psychoactive substances and relevant psychosocial factors. Methods: Ninety-three early adolescents (12.5–14.5 years old) participating since birth in a longitudinal study of IUCE reported delinquent acts via an audio computer-assisted self-interview. Level of IUCE and exposure to cigarettes, alcohol, and marijuana were determined by maternal report, maternal and infant urine assays, and infant meconium assays at birth. Participants reported their exposure to violence on the Violence Exposure Scale for Children—Revised at ages 8.5, 9.5, and 11 years and during early adolescence, and the strictness of supervision by their caregivers during early adolescence. Results: Of the 93 participants, 24 (26%) reported ≥3 delinquent behaviors during early adolescence. In the final multivariate model (including level of IUCE and cigarette exposure, childhood exposure to violence, and caregiver strictness/supervision) ≥3 delinquent behaviors were not significantly associated with level of IUCE but were significantly associated with intrauterine exposure to half a pack or more of cigarettes per day and higher levels of childhood exposure to violence, effects substantially unchanged after control for early adolescent violence exposure. Conclusions: In this cohort, prospectively ascertained prenatal exposure to cigarettes and childhood exposure to violence are associated with self-reported delinquent behaviors during early adolescence. Contrary to initial popular predictions, intrauterine cocaine is not a strong predictor of adolescent delinquent behaviors in this cohort.

Whether intrauterine exposures to alcohol, tobacco, marijuana, or cocaine predispose offspring to substance use in adolescence has not been established. We followed a sample of 149 primarily African American/African Caribbean, urban adolescents, recruited at term birth, until age 16 to investigate intrauterine cocaine exposure (IUCE). We found that in Kaplan–Meier analyses higher levels of IUCE were associated with a greater likelihood of initiation of any substance (licit or illicit), as well as marijuana and alcohol specifically. Adolescent initiation of other illicit drugs and cigarettes were analyzed only in the “any” summary variable since they were used too infrequently to analyze as individual outcomes. In Cox proportional hazard models controlling for intrauterine exposure to alcohol, tobacco, and marijuana and demographic and post-natal covariates, those who experienced heavier IUCE had a greater likelihood of initiation of any substance, and those with lighter intrauterine marijuana exposure had a greater likelihood of initiation of any substance as well as of marijuana specifically. Time-dependent higher levels of exposure to violence between ages of 8 and 16 were also robustly associated with initiation of any licit or illicit substance, and of marijuana, and alcohol particularly.