A Qualitative Exploration of Approaches Applied by Nutrition Educators Within Nutrition Incentive Programs.

OBJECTIVE: To explore the approaches applied by nutrition educators who work with the US Department of Agriculture Gus Schumacher Nutrition Incentive Program (GusNIP), Nutrition Incentive (NI), and Produce Prescription (PPR) programs. METHODS: Multiple data collection methods, including descriptive survey (n = 41), individual interviews (n = 25), and 1 focus group (n = 5). Interviewees were educators who deliver nutrition education as a component of GusNIP NI/PPR programs. Descriptive statistics were calculated from survey responses. Transcripts were coded using thematic qualitative analysis methods. RESULTS: Four overarching themes emerged. First, educators have many roles and responsibilities beyond providing curriculum-based nutrition education. Second, interviewees emphasized participant-centered nutrition education and support. Third, partnerships with collaborating cross-sector organizations are essential. Fourth, there are common challenges to providing nutrition education within GusNIP NI/PPR programs, and educators proposed solutions to mitigate these challenges. CONCLUSIONS: Nutrition educators promote multilevel solutions to improve dietary intake, and it is recommended they be included in conversations to improve GusNIP NI/PPR programs.

Mortality risk in a sample of emergency department patients who use cocaine with alcohol and/or cannabis.

BACKGROUND: Illicit drug use is common among emergency department (ED) patients, yet the association between drug use and subsequent mortality is not well understood. This study examines 36-month mortality rates for a sample of ED patients based on reported use of alcohol, cannabis, and cocaine, both individually and in combination. METHODS: Patients (N = 1669) from 2 urban EDs were surveyed at the time of the visit. The patient survey included the Alcohol Smoking and Substance Involvement Screening Test (ASSIST) and information on physical and mental health, health care utilization, and risk factors associated with substance use. ASSIST scores were used to categorize patients into drug risk groups. Mortality information from the National Death Index was used to calculate mortality rates from 2009 to 2012. A Cox regression model identified associations between drug risk groups and mortality while controlling for patient demographics. RESULTS: The use of cocaine and cannabis both individually and in combination was associated with significantly higher mortality risk compared with other ED patients. CONCLUSIONS: ED patients who use cannabis and cocaine have higher mortality risks than other patients. Further research is necessary to determine whether this result is stable across racial/ethnic groups.

Using process indicators to optimize service completion of an ED drug and alcohol brief intervention program.

OBJECTIVE: The strongest evidence for effectiveness of screening, brief intervention, and referral to treatment (SBIRT) programs is in primary care settings. Emergency department (ED) studies have shown mixed results. Implementation of SBIRT into ED settings is complicated by the type of patients seen and the fast-paced, high-throughput nature of the ED environment that makes it difficult to reach patients flagged for SBIRT services. This study uses data from an ED-based SBIRT program to examine the relationship between screen-positive rate, ED patient flow, and SBIRT service delivery. METHODS: Data for the study (N = 67137) were derived from weekly reports extracted directly from one hospital's electronic health record. Measures included time and day of patient entry, drug/alcohol screen result (positive or negative), and whether the patient was reached by SBIRT specialists. Factorial analysis of variance compared variations in screen-positive rates by day and time and the percentage of patients reached by SBIRT specialists during these periods. RESULTS: Overall, 56% of screen-positive patients received SBIRT services. Only 5% of patients offered SBIRT services refused. Day and time of entry had a significant interaction effect on the reached rate (F12,14166 =3.48, P < .001). Although patient volume was lowest between 11 pm and 7 am, screen-positive rates were highest during this period, particularly on weekends; and patients were least likely to be reached during these periods. CONCLUSIONS: When implementing an ED-based SBIRT program, thoughtful consideration should be given to patient flow and staffing to maximize program impact and increase the likelihood of sustainability.