A Group Randomized Intervention Trial Increases Participation in the School Breakfast Program in 16 Rural High Schools in Minnesota

BackgroundBreakfast consumption is associated with better diet quality and healthier weights, yet many adolescents miss breakfast. Nationally, 17.1% of students participate in the School Breakfast Program (SBP). Only 10% of high school students participate.ObjectiveOur aim was to evaluate an environmental intervention to increase SBP participation in high schools.DesignA group randomized trial was carried out from 2012 to 2015.Participants/settingNinth- and 10th-grade students enrolled in 16 rural schools in Minnesota (median 387 students) were randomized to intervention or control condition.InterventionA school-based intervention that included two key components was implemented over a 12-month period. One component focused on increasing SBP participation by increasing student access to school breakfast through changes in school breakfast service practices (eg, serving breakfast from a grab-n-go cart in the atrium; expanding breakfast service times). The other component focused on promoting school breakfast through student-directed marketing campaigns.Main outcome measureChange in school-level participation in the SBP was assessed between baseline (among ninth and tenth graders) and follow-up (among tenth and eleventh graders). School meal and attendance records were used to assess change in school-level participation rates in the SBP.Statistical analysesThe Wilcoxon test was used for analysis of difference in change in mean SBP participation rate by experimental group.ResultsThe median change in SBP participation rate between baseline and follow-up was 3% (interquartile range=13.5%) among the eight schools in the intervention group and 0.5% (interquartile range=0.7%) among the eight schools in the control group. This difference in change between groups was statistically significant (Wilcoxon test, P=0.03). The intervention effect increased throughout the intervention period, with change in mean SBP participation rate by the end of the school year reaching 10.3% (95% CI 3.0 to 17.6). However, among the intervention schools, the change in mean SBP participation rates was highly variable (range=–0.8% to 24.8%).ConclusionsInterventions designed to improve access to the SBP by reducing environmental and social barriers have potential to increase participation among high school students.     

Rethinking Medicaid Coverage and Payment Policy to Promote High Value Care: The Case of Long-Acting Reversible Contraception

Context

Long-acting reversible contraception (LARC) is the most effective reversible method to prevent unplanned pregnancies. Variability in state-level policies and the high cost of LARC could create substantial inconsistencies in Medicaid coverage, despite federal guidance aimed at enhancing broad access. This study surveyed state Medicaid payment policies and outreach activities related to LARC to explore the scope of services covered.

More Than a “Number”: Perspectives of Prenatal Care Quality from Mothers of Color and Providers

Introduction

African American mothers and other mothers of historically underserved populations consistently have higher rates of adverse birth outcomes than White mothers. Increasing prenatal care use among these mothers may reduce these disparities. Most prenatal care research focuses on prenatal care adequacy rather than concepts of quality. Even less research examines the dual perspectives of African American mothers and prenatal care providers. In this qualitative study, we compared perceptions of prenatal care quality between African American and mixed race mothers and prenatal care providers.

Child Food Insecurity Is Associated with Energy Intake among Fourth- and Fifth-Grade Girls

BackgroundFood insecurity is associated with poor diet and obesity among adult women, but evidence among children is mixed, and few studies have examined differences between boys and girls.ObjectiveThis study examined the relationship between self-reported food insecurity and dietary intake among boys and girls.DesignCross-sectional survey data were used from the Children’s PowerPlay! Campaign evaluation.Participants and settingIn all, 3,547 fourth- and fifth-grade students (9 to 11 years old) from 44 San Diego-area elementary schools in 2012 completed diary-assisted 24-hour recalls and a questionnaire that included five questions from the Child Food Security Assessment.Main outcome measuresIndividual dietary components (including total energy, nutrients, and sugar-sweetened beverages), Healthy Eating Index-2010 scores, and meal patterns (such as meal sizes and missed meals) were derived from 24-hour recalls.Statistical analysesMultivariable linear and logistic regression models were used to estimate the relationships between food insecurity and diet characteristics.ResultsGirls with the highest food insecurity consumed 135 total kilocalories (P<0.005) and 60 snack kilocalories (P<0.05) more per day than girls with no food insecurity. These relationships were absent among boys.ConclusionsFood insecurity among girls in grades 4 and 5 was associated with higher energy intake. Findings support the need for further research to better understand the nature of this relationship and its implications for energy balance.     

Baseline characteristics of patients in the national heart, lung, and blood institute percutaneous transluminal coronary angioplasty registry

The efficacy of PTCA was evaluated in several subgroups of patients. Of special clinical interest were the comparisons between subgroups of patients with multivessel disease vs 1-vessel disease, unstable angina vs stable angina, older age vs younger age, and female sex vs male sex. As a prerequisite for such comparisons, baseline characteristics of patients in the subgroups were examined. Compared with the subgroup with 1-vessel CAD, the subgroup with multivessel CAD had more elderly patients (age 65 years and older) and more of these patients had previous MI or CABG. PTCA was more often unsuccessful in patients with multivessel CAD because of inability to pass the catheter across the lesion. The subgroup of women tended to be older than men, and more women had severe and unstable angina, although fewer had multivessel CAD, previous MI or previous CABG. The PTCA success rate was 5% lower in women because of a greater frequency of inability to pass the lesion. Compared with younger patients, older patients had a higher prevalence of severe angina, multivessel CAD and lesions with larger diameters. The older patients had a 5% lower PTCA success rate, once again because of a greater frequency of inability to pass the lesion. The learning experience with PTCA was measured by the overall success rate as well as by the rate of ability to pass the lesion and the rate of dilating it once it was passed. These rates improved significantly by the investigators' case accumulations and independently by calendar year. Multivariate prediction of crossing the lesion and of overall success showed that favorable lesion characteristics and increasing physician experience were more important than the patient characteristics just discussed, although both female sex and multivessel CAD remained significant independent risk factors.