Programs and Communities

Women in recovery from substance use disorders (SUD) face significant barriers to achieving reproductive well-being (RWB) and disproportionately experience unintended pregnancy. Unintended pregnancy can have serious consequences in this population. Equity-informed approaches promote the integration of reproductive health care (RHC) with recovery programs to improve both access to and quality of RHC. Arizona’s largest SUD recovery program, Crossroads, Inc. recently opened an on-site, integrated primary clinic offering RHC. A one-month pilot demonstration of One Key Question (OKQ), a pregnancy desire screening tool, was implemented with fidelity at Crossroads to identify clients with RHC needs and offer care.

IRB exempt status was obtained through Arizona State University. All female-bodied clients aged 18-49 were screened following routine admission assessments. The Institute for Healthcare Improvement Triple Aim model based on Self-Determination Theory and Motivational Interviewing was used to prioritize client autonomy. The client experience of care was measured using an adapted Interpersonal Quality of Family Planning scale. The magnitude of needs and desires were summarized with descriptive statistics. Sixty-three clients were screened with OKQ. Needs were identified in 97% of clients. Of those clients, 98% accepted referrals. Ninety percent of items measuring the client experience of care were rated as “excellent.” OKQ provided an efficient structure for person-centered screening and referral conversations to integrate RHC in a large SUD recovery program with excellent care experiences reported by clients.

The New Jersey Childhood Obesity Study was designed to provide vital information for planning, implementing, and evaluating interventions aimed at preventing childhood obesity in five New Jersey municipalities: Camden, Newark, New Brunswick, Trenton, and Vineland. These five communities are being supported by the Robert Wood Johnson Foundation’s New Jersey Partnership for Healthy Kids program to plan and implement policy and environmental change strategies to prevent childhood obesity. Effective interventions for addressing childhood obesity require community-specific information on

who is most at risk and on contributing factors that can be addressed through tailored interventions that meet the needs of the community. Based on comprehensive research, a series of reports are being prepared for each community to assist in planning effective interventions.

The main components of the study were:

• A household telephone survey of 1700 families with 3–18 year old children,

• De-identified heights and weights measured at public schools,

• Assessment of the food and physical activity environments using objective data.

This report presents the results from the household survey. Reports based on school body mass index (BMI) data and food and physical activity environment data are available at www.cshp.rutgers.edu/childhoodobesity.htm.

The maps in this chartbook describe the food environment in ewark in terms of access to supermarkets, smaller grocery stores, convenience stores, and limited service restaurants. Research shows that when residents have access to healthy food outlets, they tend to eat healthy.

• Food environment maps were created using geo-coded commercially available data of food outlets (InfoUSA, 2008 and Trade Dimensions, 2008) in Newark and in a 1 mile buffer area around Newark.

•Using the commercial data and additional investigation, food outlets were classified into different categories based on their likelihood of carrying healthy choices: supermarkets carry most healthy choices; smaller grocery stores carry fewer healthy choices; convenience stores and limited service restaurants are likely to carry mostly unhealthy choices.

• Access to different types of food outlets was computed at the census block group level based on concentration of stores / restaurants per unit area and is reported as food outlet densities.

• Food outlet density maps are compared with Census 2000 data to visualize accessibility of healthy foods in neighborhoods with different characteristics.

Data Sources: Info USA food outlet 2008 data

Trade Dimensions food outlet 2008 data

Census 2000 data

New Jersey Department of Education 2008-2009 data

The maps in this chartbook describe the food environment in Trenton in terms of access to supermarkets, smaller grocery stores, convenience stores, and limited service restaurants. Research shows that when residents have access to healthy food outlets, they tend to eat healthy.

•Food environment maps were created using geo-coded commercially available data of food outlets (InfoUSA, 2008 and Trade Dimensions, 2008) in Trenton and in a 1 mile buffer area around Trenton.

•Using the commercial data and additional investigation, food outlets were classified into different categories based on their likelihood of carrying healthy choices: supermarkets carry most healthy choices; smaller grocery stores carry fewer healthy choices; convenience stores and limited service restaurants are likely to carry mostly unhealthy choices.

• Access to different types of food outlets was computed at the census block group level based on concentration of stores / restaurants per unit area and is reported as food outlet densities.

•Food outlet density maps are compared with Census 2000 data to visualize accessibility of healthy foods in neighborhoods with different characteristics.

Data Sources: Info USA food outlet 2008 data

Trade Dimensions food outlet 2008 data

Census 2000 data

New Jersey Department of Education 2008-2009 data

Purpose: This project examined the effectiveness of an online educational module on basic Motivational Interviewing (MI) techniques for Nurse Practitioners (NPs) providing obesity management to middle-aged women.

Background: Middle-aged women experience distinct physiological and psychosocial factors that contribute to weight gain and make obesity management especially challenging. The evidence supports the use of motivational interviewing (MI) interventions as a highly effective approach to obesity management in combination with standard medical weight loss programs. Educating NPs that provide medical weight loss on basic MI counseling techniques is necessary to facilitate the use of this intervention.

Methods: NP providers at a group of seven medical weight loss clinics in the southwestern United States completed an online MI educational module that was developed for this project. The module content covered basic MI counseling techniques. MI knowledge was assessed using a 6-item pre/post-test. Participants completed an 8-item course evaluation to provide additional feedback.

Results: Ten of the 13 NPs eligible participated in the project. The overall response to the project was positive as demonstrated by high scores on the course evaluation. The average post-test knowledge scores increased after completion of the module, however no statistical significance was noted.

Conclusions: The basic MI education module was beneficial for NPs providing obesity management and future research should focus on developing standardized MI weight loss interventions.

One in every three deaths in the United States results from cardiovascular disease (CDC, 2013). Cardiovascular Rehabilitation (CR) is a medically supervised program designed to help improve cardiovascular health for patients who have experienced heart attack, heart failure, angioplasty, or heart surgery (AHA, 2016). A hospital in the southwestern region of the United States of America reports their 2016 CR attendance rate of 79 %, which is much lower than the national average of 94% (AACVPR, 2016). Motivational interviewing (MI) is a proven method used to promote a positive behavior change for cardiac rehab patients. MI includes quality improvement activities such as peer support and cardiac rehab educational classes that have shown to increase health related quality of life measures and decreased depression symptoms (Pietrabessa et al., 2017; Pack et al., 2013).

Despite all the knowledge about CR and its benefits for health nationally, there are low attendance rates, therefore the purpose of this evidence-based project is to improve CR attendance rates using MI. Patients enrolled into CR participated in the motivational interviewing for eight classes. At the end of the class, they were given notecards to create Specific Measurable Achievable Realistic and Timely (SMART) Goals for themselves for that week. The measurement tools, the PHQ-9 and Dartmouth COOP is a simple, reliable, and valid tool for assessing functional status of cardiac patients and the current CR program utilizes this tool and is familiar with explaining this tool (Eaton, Young, Fergussion, Garrett, & Kolbe, 2005).

A Pearson correlation coefficient was calculated for the relationship between the MI classes and the CR attendance, depression scores, and quality of life. A strong positive correlation was found (r (82)= .456, p< .001) indicating a significant linear relationship between motivational interviewing and cardiac rehab attendance. A weak correlation that was not significant for depression symptoms and quality of life. The impact of this evidence-based project is to give cardiac rehab programs further evidence that the implementation of motivational interviewing can positively influence cardiac rehab attendance rates.

The maps in this chartbook describe the physical activity environment in Newark in terms of geographic distribution of parks and physical activity facilities. Research shows that people who have access to these facilities are more likely to be physically active.

• The maps in this chartbook were created using physical activity facilities data from a commercial database (lnfoUSA, 2008), data from city departments, as well as information obtained from systematic web searches. The maps present data for the city of Newark and for a 1 mile buffer area around Newark.

• Physical activity centers include private and public facilities which offer physical activity opportunities for children 3-18 years of age.

• Physical activity environment maps are compared with Census 2000 data to visualize accessibility of physical activity opportunities in neighborhoods with different characteristics.

• Poverty level presented in this chartbook are based on the 2000 Federal Poverty Guidelines.

• Crime rates in Newark are presented at the census block group level as relative crime risk (CrimeRisk) obtained from a commercial data source (Applied Geographic Solutions, 2008). CrimeRisk - an index value derived from modeling the relationship between crime rates and demographics data - is expressed as the risk of crime occurring in a specific block group relative to the national average. For this chartbook, data on total CrimeRisk, which includes personal and property crimes, are reported.