Impact of direct mail as a method to recruit smoking mothers into a "quit and win" contest

In the early 1980s the concept of a Quit and Win (Q&W) contest was developed in the Minnesota Heart Health Program (MHHP) as a population-based smoking cessation strategy. The Q&W model has since spread and been applied in many countries around the world. Different communication strategies have been applied for recruiting participants for Q&W. In the Q&W contest in 1995 in Stockholm County, Sweden, direct mail was used as the main recruitment strategy among daily smoking mothers with children aged 0-6 years. Two additional strategies were employed to recruit participants, that is, ads in a local newspaper and personal communication. The target group was estimated to be approximately 4,300 women. In total 5.5% of the target group was recruited, and of those, 4.3% were recruited by direct mail. After 12 months, 14.3% of the women were sustained smoke-free, and the corresponding percentage for those women who were recruited by direct mail was 15.5%. In comparison with several other Q&W contests employing other strategies, the direct-mail technique seems not only to have been successful in recruiting participants, but also in aiding remained sustained smoke-free women after 12 months. To optimize recruitment for Q&W contests, a combination of recruiting strategies should be applied.     

Effectiveness of a nutrition intervention with rural low-income women

OBJECTIVES: To evaluate Cookin' Up Health, a computer-based interactive nutrition intervention. METHODS: After randomization to intervention and control groups, 262 women in rural clinics in West Virginia completed both a baseline and 3-month follow-up survey. RESULTS: Compared to the control group, the intervention group had significantly improved scores on knowledge of dietary fats, food label reading, and readiness to eat 5 fruits and vegetables a day and foods lower in fat. CONCLUSIONS: This brief interactive nutrition intervention shows potential as a strategy to begin the process of change, but follow-up may be needed for actual behavior change to occur.     

International quit and win 1996: standardized evaluation in selected campaign countries

BACKGROUND: Quit and Win '96 recruited 70,000 smokers in 25 countries. The participants tried to abstain from smoking for at least 4 weeks. All participating countries followed the jointly agreed rules. Half of the countries implemented the campaign nationally and half, regionally. METHODS: A 1-year follow-up study was conducted in the participating countries. The aim of this study was to provide a standardized evaluation based on data from eight European campaign sites. Three measures were used to evaluate the effectiveness of the campaigns. The first measure was the participation rate, which is the proportion of participants among the smoking population targeted in each site. The second measure was a cautious estimate for the continuous 1-year abstinence rate, which is the proportion of abstainers among the follow-up sample regarding all non-respondents as relapsed. Third was the measure of the population impact, which is the efficacy of the intervention multiplied by its reach, where the efficacy equals the abstinence rate and the reach equals the participation rate. RESULTS: The participation rates varied from 0.1 to 2%, being highest in North Karelia, Finland, and Pitka;auranta, Russia. The abstinence rates varied from 12 to 35%, being highest in Hungary, Ukraine, and Russia, where the prevalence of smoking is also relatively high. The population impacts varied from 0.02 to 0.5%, being highest in Pitka;auranta, where both the reach and the efficacy of the Quit and Win were relatively high. CONCLUSIONS: There was great variation in effectiveness, with population impact being affected more by participation rate than abstinence rate. Quit and Win contests are feasible interventions in diverse European populations. To improve the effectiveness, future campaigns should increase the reach of the intervention.     

Risk factors associated with low Apgar scores in a low-income population

Summary. The purpose of this study was to identify risk factors associated with Apgar scores of less than 7 in newborns scored at 5 minutes after birth. All newborns were delivered at Grady Memorial Hospital, Atlanta, Georgia, which primarily serves a low-income population. The data were obtained from the obstetric discharge records for 1985–89. In this case-control study, 939 newborns with Apgar scores of less than 7 were compared with 2817 new-borns with Apgar scores of 7 or higher. Low birthweight (< 2500 g) and short gestational age (< 37 weeks) were each significantly associated with low Apgar scores. Race was not a significant risk factor for low Apgar scores in this low socio-economic population. It is also demonstrated that maternal risk factors (pregnancy-induced hypertension, prolonged rupture of membranes), method of delivery (caesarean, repeat caesarean, vaginal birth after caesarean section) and male sex were significantly associated with Apgar scores of less than 7. As a result of the risks that were found to be associated with method of delivery, further study of the risks associated with caesarean delivery and of the relative advantage of a caesarean delivery versus vaginal delivery after a previous caesarean section is advocated.     

The control of solid waste with the participation of a low-income population

Two studies were undertaken with a view to improving the health conditions of a shanty town area in the city of S. Paulo, Brazil. The objective was to modify littering behavior and to implement litter-control procedures with the participation of the inhabitants. Results demonstrated the adequacy of the procedures adopted and suggest a possible contribution on the part of psychology to public health.     

Financial incentives to promote smoking cessation: evidence from 11 quit and win contests.

In an effort footline to motivate smokers across New York State to stop smoking, tobacco control programs across the state held 'Quit and Win' incentive-based stop-smoking contests. These contests encouraged smokers to make a quit attempt by offering a chance to win cash prize (usually 1,000 dollars) for successfully stopping smoking for at least 1 month. Between 2001 and 2004, 11 different Quit and Win Contests involving 5,504 adult smokers were sponsored in different communities across New York State. Follow-up surveys were conducted 4 to 6 months after each contest ended to evaluate participants' success in quitting smoking. Expenditures for promoting contests varied from a high of 91,441 dollars to a low of 4,345 dollars, with a median of 25,928 dollars. An average of 0.55 percent of smokers was recruited to join contests across the 11 communities. Among smokers who enrolled in a contest, 9 out of 10 reported making a quit attempt, and between 53 percent and 72 percent reported quitting for the full month of the contest. At 4 to 6 months follow-up, self-reported quit rates (7-day point prevalence) among contestants ranged from 22 percent to 49 percent, with an average of 31 percent. Based on a statewide population survey, 8 of the 11 programs showed quit rates that were significantly higher (P < .001 by Wilcoxon rank-sum test) than the estimated quit rate of 21 percent seen among smokers making a quit attempt in the past year. This study shows that for a relatively modest investment of resources, thousands of smokers can be recruited to make a serious quit attempt, with many remaining smoke-free months later.     

Risk factors associated with very low birth weight in a low-income population

This study aimed to identify risk factors associated with very low birth weight in a general hospital in Caxias do Sul, Rio Grande do Sul State, Brazil. This was a case-control study of 200 newborns with birth weight from 500 to 1,499 g (cases) and 400 with birth weight from 3,000 to 3,999 g (controls). Infants were from singleton pregnancies, and their mother had received prenatal care at public health services. The dependent variable was birth weight, and independent variables included socioeconomic status, schooling, and gestational and birth status. Univariate and multivariate analyses were performed with a 5% level of significance. Mortality in very low birth weight newborns was 32.5%. The limits of viability were 600 g for birth weight and 26 weeks for gestational age. Variables related to very low birth weight were: maternal age > 35 years (p = 0.01), lack of prenatal care (p < 0.0001), illness during the index pregnancy (p = 0.03), maternal hypertension (p = 0.007), hospitalization during pregnancy (p < 0.0001), and prior history of low birth weight (p < 0.0001). Many premature births were due to avertable factors.     

Barriers to influenza immunization in a low-income urban population

BACKGROUND: Although influenza immunization significantly reduces mortality from influenza, over one third of elderly Americans are not immunized each year. Low rates of immunization are particularly concerning among African-American low-income populations. Preliminary interviews suggested that fear of undisclosed ingredients in the influenza vaccine may impede vaccine acceptance in this vulnerable population. OBJECTIVES: To assess the role of concern about vaccine contents and other factors in the use of influenza immunization among a predominantly African-American low-income urban population.Methods: Cross-sectional, health-system-population-based, telephone survey of a random sample of West Philadelphia residents aged > or =65 years. RESULTS: Of 659 eligible individuals, 486 (73.8%) were successfully interviewed. Concern about undisclosed shot contents was reported by 132 (20%) respondents and was inversely associated with vaccine receipt (OR 0. 49, 95% CI 0.26-0.91). This association was similar among African Americans and Caucasians. In addition, receipt of influenza vaccine was inversely associated with belief that immunization is inconvenient (OR 0.14, 95% CI 0.05-0.36), belief that immunization is painful (OR 0.21, 95% CI 0.08-0.54), and history of previous side effects (OR 0.33, 95% CI 0.18-0.60), and positively associated with physician recommendation (OR 3.22, 95% CI 1.76-5.93). CONCLUSIONS: In a low-income urban population, concern about undisclosed vaccine contents appears to impede acceptance of influenza immunization among both African Americans and Caucasians. Directly addressing this concern offers a new approach to increasing immunization in this vulnerable population.     

Health status of a low-income vulnerable population in a community health center

Healthcare safety net providers are under increasing pressure to meet the physical and mental health--as well as the range of social service-needs of traditionally vulnerable and hard-to-reach populations. The extent to which health center patients are less well and in poorer health than is the rest of society, thus requiring greater depth and breadth of service, has not generally been the focus of systematic assessment. This case study uses the 12-Item Short-Form Health Survey (SF-12) and selected years of healthy life questions from the National Health Interview Survey to assess the self-perceived health status of patients at one Section 330 community health center in central Massachusetts. Five hundred thirteen patients completed all questions on the SF-12; 619 completed each of the years of healthy life questions. Respondents' physical and mental component summary scores were significantly lower than national norms for all age groups (P < .001). Respondents were also significantly more likely than the civilian noninstitutionalized population to be unable to perform major activities (P < .0001) and to be in fair or poor health (P < .0001). Analyses give an indication of the magnitude of difference in self-perceived health status between this poor, vulnerable population and the citizenry at large and suggest implications for policy related to safety net healthcare facilities.     

Impact of food pantry donations on diet of a low-income population

Objective: This cross-sectional study assessed the effect of food donations on total nutrient intake of clients of a food pantry in Central Texas.

Methods: Nutrient intakes of total, base and food donation diets were estimated for 112 food pantry recipients using specific questionnaires; and then compared to the dietary reference intakes (DRI) and 2015–2020?US Dietary Guidelines.

Results: Food donations accounted for more than half of the client’s daily intake of energy, carbohydrates, vitamin B₆, phosphorus, copper and selenium. Yet, daily total intake remained less than their DRIs for carbohydrates, poly-unsaturated fats, dietary fiber, fat soluble vitamins and vitamin C, and was even lower for calcium, magnesium and potassium. Total food intake of clients almost met the US Dietary Guidelines for refined grains, fruits, vegetables, and meat; however, the amount of whole grains and dairy was inadequate.

Conclusions: Supplemental foods offered at food pantries are an important resource for improving nutrient intake of low-income populations.     

Social support as a predictor of dietary change in a low-income population

Social support has been found to predict success with healthbehavior change but, as yet, few studies examine the relationshipbetween social support and dietary change in a low-income population.We developed a social support for dietary change measure fora low-income, hypercholesterolemic population and tested itspredictive utility in a clinical trial with a dietary intervention.Questions were administered by telephone to 443 patients enrolledin the trial. Dietary change was measured by the Dietary RiskAssessment. Factor analysis revealed three social support factors:friend, family and negative support, and a fourth factor, motivationto change. Multiple regression analysis revealed that motivationto change was predictive of change to a less atherogenic diet.Results of a gender-stratified analysis revealed that friendsupport was a significant predictor of dietary change for womenbut not for men. Interaction effects indicated that high friendsupport increased the relationship between greater motivationand diet improvement, and that motivation was a stronger predictorfor men than women. Results of this study indicate that friendsupport is especially helpful for women who are trying to changetheir diets while, for men, the most important factor is motivation.     

Blood pressure measurement and antihypertensive treatment in a low-income African-American population.

OBJECTIVES: The purpose of this study was to describe blood pressure measurement and hypertension treatment in an inner-city African-American community. METHODS: A random-digit dialing telephone survey of adults more than 18 years of age was carried out in 12 predominantly African-American zip code areas in Houston, Texas. RESULTS: More than 90% of subjects reported a blood pressure measurement within the past 2 years, and 87% of known hypertensives reported current medication use. CONCLUSIONS: Further improvements in hypertension control among African Americans in this country are likely to depend primarily on changes in diagnosis and management practices of health care providers and on maintaining primary care access for all socioeconomic groups.     

Parental attitudes about a pregnancy predict birth weight in a low-income population

BACKGROUND: Low birth weight remains the primary cause of neonatal morbidity and mortality in the United States. We examined whether maternal happiness about a pregnancy, in addition to her report of the father's happiness, predicts birth weight and risk for low birth weight (<2,500 g). METHODS: In this prospective cohort study, the mother's report of her and her partner's happiness about the pregnancy was measured before 21 weeks' gestation on a scale from 1 to 10 (1 to 3 unhappy, 4 to 7 ambivalent, or 8 to 10 happy). "Mother reports partner happier" occurred when the mother perceived the father's happiness score at least 5 points greater than her own. Information on birth weights and maternal sociodemographic, medical, and psychosocial factors were obtained from surveys and medical records. RESULTS: Of 162 live births, 9 were low birth weight (5.6%). Compared with women who reported happiness with the pregnancy, risk for low birth weight was greater when the mother reported partner happier about the pregnancy (relative risk 10.0, 95% confidence interval, 3.1-32.4). This predictor of birth weight remained significant in multivariate linear regression analyses (coefficient = -472 g, SE = 171 g, P = .007) after adjustment for other known predictors of birth weight. CONCLUSIONS: Maternal report of greater partner happiness about a pregnancy is associated with birth weight and appears to define low- and high-risk subgroups for low birth weight in a low-income population. Further study in larger samples is needed to confirm our findings and to assess whether maternal report of greater partner happiness is itself a modifiable factor or is a marker for other factors that might be modified with targeted interventions.     

Concurrent quit & win and nicotine replacement therapy voucher giveaway programs: participant characteristics and predictors of smoking abstinence.

This study compares the participant characteristics, program costs, and outcomes of a Quit & Win contest and a nicotine replacement therapy (NRT) voucher giveaway promotion. Both programs were conducted simultaneously so that smokers could enroll in either one program alone (n = 849 and 690, respectively) or both programs (Combination group; n = 230). A follow-up telephone survey of a random sample of participants was conducted 4 to 7 months after enrollment to evaluate smoking status. At enrollment, participants in the three groups were comparable on most smoking and demographic variables, although Quit & Win participants were, on average, younger than those who signed up to get the NRT voucher. Compared with the characteristics of smokers in the region, those who enrolled in the intervention programs were heavier smokers and had more years of formal education. At follow-up, the self-reported quit rates were similar across the three intervention groups, ranging between 25 percent and 30 percent. The only evidence for a higher quit rate among those in the Combination group was among younger smokers. On a simple estimated cost per quit basis, the Quit & Win (130 dollars) and NRT (179 dollars) voucher interventions appear roughly comparable. In all groups, abstinence rates were higher among lighter smokers (<21 cigarettes per day), participants who did not live with another smoker, and those who were married. Both the Quit & Win and NRT voucher giveaway programs were effective in recruiting smokers to make a quit attempt, although combining both interventions did not generally increase abstinence rates.     

Utilizing a diabetic registry to manage diabetes in a low-income Asian American population

Racial and income disparities persist in diabetes management in America. One third of African and Hispanic Americans with diabetes receive the recommended diabetes services (hemoglobin A1c [A1c] testing, retinal and foot examinations) shown to reduce diabetes complications and mortality, compared to half of whites with diabetes. National data for Asian Americans are limited, but studies suggest that those with language and cultural barriers have difficulty accessing health services. A diabetic registry has been shown to improve process and clinical outcomes in a population with diabetes. This study examined whether a community center that serves primarily low-income Asian American immigrants in Santa Clara County, California, could improve diabetes care and outcomes by implementing a diabetic registry. The registry was built using the Access 2007 software program. A total of 580 patients with diabetes were identified by reviewing charts, the appointment database, and reimbursement records from Medicaid, Medicare, and private insurance companies. Utilizing the registry, medical assistants contacted patients for follow-up appointments, and medical providers checked and tracked the patients' A1c results. Among the 431 patients who returned for treatment, the mean A1c was reduced from 7.27% to 6.97% over 8 months (P<0.001). Although 10.8% of the patients changed from controlled to uncontrolled diabetes post intervention, 32.6% of patients with uncontrolled diabetes converted to controlled diabetes (P<0.001). The diabetes control rate improved from 47% to 59% at the end of the study. This study demonstrated that a diabetic registry is an effective tool to manage an underserved population with diabetes, thereby reducing disparities in diabetes management.