It is evident that father engagement in parenting contributes to child well-being, and fatherhood programs effectively enhance father engagement and employment outcomes. However, program effectiveness can be compromised if participating fathers drop out. This study investigates factors associated with program engagement (i.e., initiating treatment) and completion (i.e., attending 75% or more sessions) with a sample of primarily African American fathers recruited from a community-based organization in the United States (n = 691). The analysis showed that nearly one-third (31%) of enrolled fathers did not attend any program session, and just over half (55%) of those who attended at least one session completed the program. Being older was associated with program engagement, while having a high school diploma and being ordered by the court to pay child support were associated with program completion. Fathers expressed several barriers to program participation, including programmatic and institutional issues (Rules and Staff, Fit Misaligned with Needs), as well as scheduling and external factors (Job-Related Conflict, Logistic Issues, Challenging Life Events). These findings highlight the importance of identifying participant motivation, addressing life challenges, and implementing strengths-based practices in fatherhood programs to make fathers feel seen, welcomed, and supported.

The objective of this study was to examine differences in parenting, psychological well-being, and economic outcomes between fathers receiving two different programs offered by Fathers & Families Support Center for economically disadvantaged fathers: (a) Family Formation (FF), a 6-week/240-h program focused on economic stability/mobility, responsible fatherhood, and healthy relationships, with case management and legal services; (b) Economic Stability (ES), a 4-week/80-h program focused only on economic stability with limited case management and legal services. A randomized controlled trial (RCT) was used to compare fathers in FF (n = 350) vs. ES (n = 342). Surveys were administered at enrollment and 3- and 12-months postintervention. Linear and generalized linear mixed models were used to assess changes in program outcomes over time and across study groups. Four hundred and eighty-two fathers responded to either follow-up survey (251 FF, 231 ES). Nearly all (98%) were non-white (93% Black, 5% other/mixed race) and were on average 34 years old. Approximately 46% attended ≥75% of program sessions (FF 48% vs. ES 44%). Both FF and ES groups experienced improvements in parenting, psychological well-being, and financial outcomes after the programs, but changes in outcomes over time did not differ significantly by program. The lack of difference in outcomes between fathers in FF and ES groups could be due to a similar core focus on employment-related curriculum for both groups. Gaining financial stability could have contributed to positive improvements in other fatherhood domains. Implications for future research and practice are discussed herein.

BACKGROUND:Students with intellectual and developmental disabilities (IDD) and the staff who support them were largely in-person during the 2021-2022 school year, despite their continued vulnerability to infection with SARS-CoV-2. This qualitative study aimed to understand continued perceptions of weekly SARS-CoV-2 screening testing of students and staff amidst increased availability of vaccinations.METHODS:Twenty-three focus groups were held with school staff and parents of children with IDD to examine the perceptions of COVID-19 during the 2021-2022 school year. Responses were analyzed using a directed thematic content analysis approach.RESULTS:Four principal themes were identified: strengths and opportunities of school- and district-level mitigation policies; experience at school with the return to in-person learning; facilitators and barriers to participation in SARS-CoV-2 screening testing; and perceptions of SARS-CoV-2 testing in light of vaccine availability.IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY:Despite the increased availability of vaccines, school staff and families agreed that saliva-based SARS-CoV-2 screening testing helped increase comfort with in-person learning as long as the virus was present in the community.CONCLUSION:To keep children with IDD in school during the pandemic, families found SARS-CoV-2 screening testing important. Clearly communicating school policies and mitigation strategies facilitated peace of mind and confidence in the school district.

The coronavirus disease 2019 (COVID-19) pandemic forced the suspension of in-person education in schools serving students in kindergarten through 12th grade (K-12) across the United States. As time passed, teachers, students, and parents struggled with remote education. With limited guidance at the federal level, physicians and school leaders across the country collaborated to develop local solutions for schools. This article describes the lessons learned from the development of 4 academic-community partnerships and collaboration among these partnerships to provide national leadership on managing COVID-19 mitigation in the K-12 environment. In addition, we describe a pathway forward for using academic-community partnerships to improve child health.

Implementing evidence-based public health strategies results in a greater likelihood of success for local health departments and is consistent with health department accreditation standards. Social media has the potential to allow local health departments to connect with one another and share evidence-based strategies. We sought to examine patterns of social media connections among local health departments on Twitter. Descriptive and visual network approaches were used to examine the network, exponential random graph modeling was used to model the likelihood of a Twitter connection between departments. Larger departments were central to the network and departments sharing a border were more likely connected, as were health departments in the same state. Dissemination across this network would be facilitated by larger departments and between departments in the same state. By developing the network beyond these typical connections, health departments could be exposed to new strategies or new ways of implementing existing strategies.

Abstract Background. Neurofibromatosis type 1 (NF1) is a common hereditary cancer syndrome, affecting an estimated 1/2,500 people worldwide. NF1 increases the risk of several tumor types, including pediatric brain tumors that affect an estimated 10-20% of individuals. While established risk factors for pediatric brain tumor development in this population have not been elucidated, consistent evidence from non-syndromic populations suggests a strong inverse association between asthma and brain tumors. As such, the objective of this study was to test the hypothesis that asthma is inversely associated with pediatric brain tumors in the NF1 population. Methods. In this analysis, we employed two data sources. The first dataset was assembled from the international NF1 Patient Registry Initiative (NPRI) (https://nf1registry.wustl.edu/) that enrolled individuals with NF1 over ∼2.5 years. Medical history data were collected through the online registry questionnaire. The second study used private health insurance claims data from 2006-2010 from Thompson Reuters MarketScan to assemble an NF1 group and their claims data on asthma- and brain tumor-related healthcare visits. Diagnoses were determined from ICD-9 codes. The NF1 group was defined by the presence of >2 NF1-related outpatient claims >30 days apart or one NF1-related inpatient claim. Within the NF1 group, individuals were classified as having asthma and/or brain tumors if they had >2 claims for these conditions >30 days apart. The study population for both data sources was limited to subjects who were <18 years old at the time of NPRI or insurance enrollment. Unconditional logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between pediatric brain tumors and asthma for both datasets. Results. A total of 409 individuals with NF1 were included in the analysis using NPRI data, resulting in 119 pediatric brain tumors. After adjusting for birth year, we observed an inverse association between pediatric brain tumors and asthma (OR=0.6; 95% CI 0.4-1.1). In the analysis using MarketScan data, the NF1 group included a total of 3,871 individuals <18 years at the time of insurance enrollment, of which 397 had >2 pediatric brain tumor-related claims. After controlling for number of months enrolled, birth year, and number of healthcare visits, subjects with brain tumor claims were significantly less likely to have asthma claims than those without brain tumor claims (OR=0.5; 95% CI 0.3-0.8). Conclusions. Similar to findings from non-syndromic populations, the results from this study provide strong epidemiologic evidence for an inverse association between asthma and pediatric brain tumors in the NF1 population. Acknowledgements. This work was supported by Alex's Lemonade Stand Foundation and NIH CTSA UL1 TR000448. Citation Format: Kimberly J. Johnson, Nancy Mueller, Evelyn Sharkey, Qian Liu, David H. Gutmann. The association between asthma and pediatric brain tumors in neurofibromatosis type 1. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr 1295. doi:10.1158/1538-7445.AM2014-1295

Web-based social media sites are increasingly being used by the public to find and share health information. Public health organizations, including state health departments (SHDs), have begun adopting social media to disseminate health information to consumers. The purpose of this study was to examine adoption patterns and characteristics associated with social media adoption in SHDs across the U.S. In early 2012, we used web searches to identify which SHDs had adopted Facebook or Twitter and the adoption date. Adoption of social media has grown steadily since 2008, with 28 SHDs using Facebook and 41 using Twitter as of February 2012. We used 2010 profile data from the Association of State and Territorial Health Officials to compare characteristics of adopters and non-adopters. While there were few significant differences, trends showed that adopting SHDs tended to be in more populated states with more urban residents and higher levels of internet access than non-adopters. Adopting health departments tended to have higher per capita health department expenditures, more educated health department leadership, more staff, and younger staff than non-adopters. SHDs adopting Facebook/Twitter early may be good partners in developing and disseminating social media public health strategies. More evidence is needed regarding current and effective uses of social media for public health practice.

Background Public health programs can only deliver benefits if they are able to sustain activities over time. There is a broad literature on program sustainability in public health, but it is fragmented and there is a lack of consensus on core constructs. The purpose of this paper is to present a new conceptual framework for program sustainability in public health. Methods This developmental study uses a comprehensive literature review, input from an expert panel, and the results of concept-mapping to identify the core domains of a conceptual framework for public health program capacity for sustainability. The concept-mapping process included three types of participants (scientists, funders, and practitioners) from several public health areas ( e . g ., tobacco control, heart disease and stroke, physical activity and nutrition, and injury prevention). Results The literature review identified 85 relevant studies focusing on program sustainability in public health. Most of the papers described empirical studies of prevention-oriented programs aimed at the community level. The concept-mapping process identified nine core domains that affect a program’s capacity for sustainability: Political Support, Funding Stability, Partnerships, Organizational Capacity, Program Evaluation, Program Adaptation, Communications, Public Health Impacts, and Strategic Planning. Concept-mapping participants further identified 93 items across these domains that have strong face validity—89% of the individual items composing the framework had specific support in the sustainability literature. Conclusions The sustainability framework presented here suggests that a number of selected factors may be related to a program’s ability to sustain its activities and benefits over time. These factors have been discussed in the literature, but this framework synthesizes and combines the factors and suggests how they may be interrelated with one another. The framework presents domains for public health decision makers to consider when developing and implementing prevention and intervention programs. The sustainability framework will be useful for public health decision makers, program managers, program evaluators, and dissemination and implementation researchers.

Abstract Introduction: Colorectal cancer (CRC) is a leading cause of cancer death. Despite compelling evidence that screening and early detection reduce CRC incidence and mortality; about 50% of adults are screening adherent. CRC screening rates are low in our region and have been identified by our community partners as a priority. However, many interventions have only moderate impact, at best. In this study, we used a Community-Based Participatory Research (CBPR) approach to collaborate with community health centers to develop and test a systems-level intervention. CBPR assures that those who would benefit from and be affected by research fully participate in and influence decision-making. The resultant intervention is being tested in a cluster randomized controlled trial. Methods: Using a systematic approach, we reviewed literature for evidence-based recommendations for systems-intervention for CRC screening, and worked with our community partners to select intervention options by assessing acceptability, appropriateness, feasibility, and estimated sustainability. Together, we decided that our intervention would be a “menu” of intervention options, thereby allowing more choice for individual sites. Strategic planning with the health center included organizational assessments and interviews with key personnel of the health center to gauge context factors including current health center practices, capacities, and needs. We used snowball sampling to conduct additional interviews with relevant and knowledgeable personnel at each clinic, as well as presentations to group-provider meetings when possible. Results: Based on the literature, interventions in the following areas were determined to be effective: patient reminders, provider reminder and recall systems, provider assessment and feedback, and reducing structural barriers. Working with our community partners, we developed an initial intervention “menu” that included the following: instructional checklists for patients, provider checklists for referring colonoscopy, and a variety of cues and reminders for patients. Partners provided input as every stage of development. Research staff assisted the health center in implementing the chosen intervention strategies. The outcome evaluation will measure changes in screening rates but also track which strategies were adopted and how they were implemented as well as short-term maintenance of the change once the study has ended. Conclusion: Using CBPR to develop intervention content and implementation strategies is novel, and has both benefits and challenges. Challenges include the additional time spent and an increased burden placed on our community partners. However, in addition to tapping the expertise of our community partners, having their input and perspective produced an intervention that may be more sustainable, as it reflects the voice of all stakeholders. Furthermore, the process allowed stakeholders to take ownership of the intervention, enhancing the relevance and utility of the study. Last, such a process may result in a program that is more likely to be disseminated because it reflects, and works within, the reality of providing healthcare in diverse settings. Although the effort was time consuming, building in the extra time for CBPR allowed for meaningful community involvement and resulted in a more relevant intervention product. Citation Format: Aimee James, Meera Muthukrishnan, Matthew Brown, Rebekah Jacob, Nancy Mueller, Graham Colditz. Using CBPR to develop a systems-level colorectal cancer screening intervention. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B04.

Abstract Purpose of study: Practitioners and researchers often promote “early detection” as a key message in colorectal cancer (CRC) screening programs and as a strategy to reduce disparities in CRC mortality. To better understand the experience of CRC for individuals who face substantial health and income inequalities, this qualitatively research examines the meanings and understandings of “early detection” that may be overlooked by quantitative approaches. This study suggests that early detection messages are contextualized and interpreted within lived experiences. Procedures: Six focus groups and 21 open-ended interviews were conducted during 2006 and 2007 to examine understandings of CRC screening and detection. The study took place at an urban community health center in a U.S. Midwestern city and focused on adults age 45 years and older. Most participants were female, African American, unemployed, and had no more than a high school education. Nearly half were without any type of health insurance. Transcripts were analyzed by two coders, who used an inductive data analysis approach. Summary of Data: Four key findings were identified throughout the transcripts. First, participants made sense of CRC through comparisons to a range of diseases experienced in their families and communities and seen in public health campaigns. Second, they utilized statements about early and late detection of cancer to make sense of past personal and family experiences with cancer. Most participants had experienced multiple deaths of family and friends to cancer and were drawing on early detection messages to grapple with their sadness, guilt, and blame over why loved ones had died. Third, CRC screening and detection were viewed within the context of possible treatments and treatment outcomes. Ideas about treatment accessibility and effectiveness heavily influenced participants' approaches to accessing screenings. Finally, rather than an avoidance of health-seeking behavior, participants demonstrated and discussed their persistence in attempting to achieve diagnoses and treatment with limited resources. Conclusion: The study findings suggest that frequently invoked constructs in preventive health, such as early detection and the treatability of cancer in its earliest stages, take on much more complex meanings than researchers, practitioners, and clinicians may expect. Examining these meanings offers a starting point for understanding and redressing CRC disparities in populations that have experienced significant inequities in access to quality healthcare, which have sometimes endured over generations. Researchers should consider social contexts and deeper meanings when developing communications that emphasize early detection and when using measures that ask individuals about early detection beliefs and behaviors. Citation Format: Jean M. Hunleth, Nancy Mueller, Aimee James. Contextualizing early detection: Lessons from lay definitions of colorectal cancer early detection. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A93.

Significant racial, socioeconomic, and geographic disparities exist nationwide in cancer screenings, treatments, and outcomes. Differences in health and social service provision and utilization may contribute to or exacerbate these disparities. We evaluated the composition and structure of a referral network of organizations providing services to underserved cancer patients in an urban area in 2007. We observed a need for increased awareness building among provider organizations, broader geographic coverage among organizations, and increased utilization of tobacco cessation and financial assistance services.

OBJECTIVESWe studied 5 members of the National Network Consortium on Tobacco Control in Priority Populations. These networks, which consist of governmental and nongovernmental organizations, targeted lesbian, gay, bisexual, and transgender persons; Asian Americans, Native Hawaiians, and Pacific Islanders; American Indians and Alaska Natives; African Americans; and persons with low socioeconomic status, respectively.METHODSWe used statistical network analysis modeling to examine collaboration among these national networks in 2007.RESULTSNetwork size and composition varied, but all 5 networks had extensive interorganizational collaboration. Location and work area were significant predictors of collaboration among network members in all 5 networks. Organizations were more likely to collaborate with their network's lead agency; collaborations with other agencies were more likely if they were geographically close. Collaboration was perceived to be important for achieving the goals of the national network.CONCLUSIONSThe similarity of collaboration patterns across the 5 networks suggests common underlying partnership formation processes. Statistical network modeling promises to be a useful tool for understanding how public health systems such as networks and coalitions can be used to improve the nation's health.

INTRODUCTION:In order to better understand how tobacco control efforts are coordinated across agencies of the Department of Health and Human Services (DHHS), we assessed tobacco control-related communication between tobacco control leaders across DHHS.METHODS:Cross-sectional surveys were collected from individuals representing 11 DHHS agencies, and social network analyses were used to assess linkages and map agencies' tobacco control communication.RESULTS:Individuals within the Office of the Secretary and Centers for Disease Control and Prevention (CDC) were most central to the network, and those of highest rank were most likely to be central to the network (F = 4.03, p = .024). The Centers for Medicare and Medicaid Services, Food and Drug Administration, Health Resources and Services Administration, and Substance Abuse and Mental Health Services Administration had no or almost no contact with other agencies. There was considerable between-agency contact variability, and the CDC was the most central agency.DISCUSSION:Tobacco control communication across DHHS agencies was present but extremely variable. This inconsistency may compromise the ability of the DHHS to address tobacco use, a critical public health problem, in a coordinated and efficient fashion. In light of the new leadership at DHHS, this analysis describes a systems approach that can be reimplemented as a means of understanding and improving communication and collaboration to improve public health.

BACKGROUND:School tobacco control policies vary widely in their strength, extensiveness, and enforcement. Currently, no standardized method exists to assess the comprehensiveness of school tobacco policies. The purpose of this study was to develop a new practical rating system for school tobacco policies, assess its reliability, and present preliminary validation data.METHODS:This study presents the systematic development of a rating system to assess the strength of school tobacco policies. Based on the empirical literature and the expertise of an advisory panel consisting of educational leaders and tobacco control advocates and practitioners, a "gold standard" school tobacco policy was developed and guided the content of the 40-point rating system. The 4 domains of the School Tobacco Policy Index were: Tobacco-free environment (14 points), Enforcement (12 points), Prevention and treatment services (6 points), and Policy organization (8 points).RESULTS:The Index was pilot-tested using 95 Missouri public school district tobacco policies and proved to be highly reliable among coders. The evaluated policies varied greatly between school districts, with the lowest total policy score of phi and the highest score of 21. School district policy scores were significantly related to a number of county-level tobacco policy characteristics, including support for a tobacco excise tax increase.CONCLUSIONS:The Index is a user-friendly, practical tool for tobacco control professionals and educators, providing them with the ability to easily evaluate their own school policies. Their evaluation efforts will be useful in strengthening existing policies and developing new comprehensive policies to protect the health of students, staff, administrators, and visitors.

In the United States, tobacco control activities are organized primarily in state tobacco control programs. These programs are comprised of public and private agencies working together to reduce tobacco use. The human, financial, and informational resources that go into state tobacco control programs are documented, and the outcomes of these programs have been studied in terms of health and health behavior. However, little is known about the organizational infrastructure that transforms the human, financial, and informational resources into positive health outcomes. This study examined the inter-organizational relationships among key partner agencies in eight state tobacco control programs. The state programs varied in terms of funding level, funding stability, and region of the country. Using a network analytic approach we asked an average of 14 agencies in each state program about their contacts and partnerships with the other key tobacco control agencies in their state program. Using network visualization and statistics we determined that the state networks shared some common features such as a highly central lead agency, but also had differences in network structure in terms of density and centralization. Using blockmodeling we found that, despite differences in state and program characteristics, there was a common organizational structure among the eight state programs. Understanding the inter-organizational relationships and the common organizational structures of state programs can aid researchers and practitioners in enhancing program capacity and in developing strategies for organizing effective public health systems.

Abstract B37 Eleven Department of Health and Human Services agencies (eg NIH, FDA, CDC, etc) were included in a social network analysis to determine the extent to which they were communicating and coordinating to address tobacco use - which is the leading cause of preventable death in the US. Result Individuals within the DHHS tobacco network showed a high level of awareness of the tobacco work being carried out by other network members across DHHS (density = 0.30), but much less actual contact between agencies (0.17). Some agencies, such as the FDA, had no or almost no contact with other agencies, and there was considerable between-agency contact variability. CDC was the most central agency. Conclusion Considerable trans-DHHS awareness of tobacco control efforts exists, but does not always translate into agencies working together in a coordinated fashion to address tobacco use. Citation Information: Cancer Prev Res 2008;1(7 Suppl):B37.

OBJECTIVE:To evaluate the effectiveness of different strategies for disseminating evaluation results to program stakeholders.METHODS:The results from a process evaluation of eight states' tobacco control programs were disseminated to the state programs that were assigned to one of four dissemination conditions: print reports only, reports and web site, reports and workshop, or all three dissemination modes. Key measures included levels of usefulness of the evaluation results and satisfaction of participation by study participants.RESULTS:Although exposure to the web site and workshop individually did not provide a statistically higher degree of usefulness, a clear upward trend was observed in usefulness as the number of dissemination modes increased. Participants who engaged in all three dissemination modes found the results more useful (P < .05) for their work and the work of their agency than participants using one or two dissemination modes. Participants who engaged in the three dissemination modes also appeared to be more likely to share the results with their colleagues (P = .06).CONCLUSIONS:This study shows that disseminating evaluation results through multiple, active modes increased usefulness, satisfaction, and further dissemination of the results. Evaluators should consider implementing more than one mode of dissemination to share findings with stakeholders.

Despite negative financial conditions in recent years, several states were able to successfully maintain funding for tobacco prevention and control, which provided an opportunity to understand the factors associated with success. One explanation may be the level of long-term program sustainability in some states. According to a model developed by Saint Louis University researchers, the five elements critical to tobacco control sustainability are state political and financial climate; community awareness and capacity; program structure and administration; funding stability and planning; and surveillance and evaluation. Five states (Nebraska, New York, Indiana, Virginia, and Colorado) maintained funding for their tobacco control programs. Four of these states gained additional legislative appropriations or prevented a massive reduction; Colorado used a statewide ballot initiative to increase funding. On the basis of the sustainability framework, case studies, and prior research, the major lessons learned for maintaining funding were the importance of (1) strong and experienced leadership, (2) broad and deep organizational and community ties, (3) coordinated efforts, (4) strategic use of surveillance and evaluation data, (5) active dissemination of information about program successes, and (6) policy maker champions. The sustainability framework and lessons learned may provide valuable insights for other public health programs facing funding threats.

Background: The Best Practices for Comprehensive Tobacco Control Programs by the Centers of Disease Control and Prevention was the first national resource to define the nine required components of a comprehensive state tobacco control program. This evaluation examined how states used the guidelines in their program planning, and identifies strengths and weaknesses of the guidelines.Methods: During 2002-2003, data were collected and analyzed from ten state tobacco control programs on familiarity, funding, and use of the guidelines. Data were collected via written surveys and qualitative interviews with key tobacco control partners in the states. The typical number of participants interviewed was 17, representing an average of 15 agencies per state.Results: Lead agencies and advisory agencies were the most familiar with the guidelines, while other state agencies were less aware of the guidelines. Participants' prioritization of the nine components was closely related to the lead agencies' estimated category expenditures. Three states modified the guidelines to develop more-tailored frameworks. Major strengths of the guidelines included providing a basic program framework and state-specific funding recommendations. The guidelines did not address implementation strategies or tobacco-related disparities, and had not been updated with current evidence-based research.Conclusions: The guidelines are important recommendations for state tobacco control programs. To continue to be useful to states, the guidelines need to be updated to address implementation and tobacco disparities, and include additional evidence-based examples. Active dissemination of updated guidelines needs to be increased beyond typical consumers to other tobacco control partners such as coalitions and other state agencies.