The Use of Refundable Tax Credits to Increase Low-Income Children's After-School Physical Activity Level.

OBJECTIVE: The current study investigates the extent to which a refundable tax credit could be used to increase low-income children's after-school physical activity levels. METHODS: An experimental study was conducted evaluating the effectiveness of an intervention offering a simulated refundable tax credit to parents of elementary-school-age children (n = 130) for enrollment in after-school physical activity programs. A randomized controlled design was used, with data collected at baseline, immediately following the 4-month intervention (postintervention), and 6 weeks after the end of the intervention (follow-up). Evaluation measures included (1) enrollment rate, time spent, weekly participation frequency, duration of enrollment, and long-term enrollment patterns in after-school physical activity programs and (2) moderate to vigorous physical activity. RESULTS: The simulated tax credits did not significantly influence low-income children's rates of enrollment in after-school physical activity programs, frequency of participation, time spent in after-school physical activity programs, and overall moderate-to-vigorous intensity physical activity at postintervention or follow-up. CONCLUSIONS: The use of refundable tax credits as incentives to increase participation in after-school physical activity programs in low-income families may have limited effectiveness. Lawmakers might consider other methods of fiscal policy to promote physical activity such as direct payment to after-school physical activity program providers for enrolling and serving a low-income child in a qualified program, or improvements to programming and infrastructure.

Creating opportunities for training California's public health workforce.

INTRODUCTION: Today there are significant challenges to public health, and effective responses to them will require complex approaches and strategies implemented by a qualified workforce. An adequately prepared workforce requires long-term development; however, local health departments have limited financial and staff resources. Schools and programs accredited by the Council for Education on Public Health (CEPH) are required to provide continuing education but are constrained by the lack of resources, limited time, and geography. METHOD: To meet these challenges, a statewide university/community collaborative model for delivering continuing education programs was developed. A needs assessment of California's public health workforce was conducted to identify areas of interest, and two continuing education trainings were developed and implemented using innovative distance education technology. RESULTS: Thirty-six percent of the participants completed electronic evaluations of learning outcomes and use of the digital technology platform. Participants indicated a significant increase in knowledge, reported that the trainings were cost effective and convenient, and said that they would participate in future online trainings. Collaborative partners found that this model provides a cost-effective, environmentally sound, and institutionally sustainable method for providing continuing education to public health professionals. DISCUSSION: Offering continuing education via distance technology requires substantial institutional infrastructure and resources that are often beyond what many public institutions can provide alone. This project provides a model for collaborating with community partners to provide trainings, using a digital technology platform that requires minimal training and allows presenters and participants to log on from anywhere there is Internet access.

Costs and cost-effectiveness of adolescent compliance with treatment for latent tuberculosis infection: results from a randomized trial.

PURPOSE: Assess the costs and cost-effectiveness of an incentive-based tuberculosis (TB) program designed to promote adolescents' compliance with treatment for latent TB infection (LTBI). METHODS: Randomized controlled trial. Adolescents between the ages of 11 and 19 years who were referred to one of two participating clinics after being screened for TB and receiving a positive diagnosis indicating LTBI (n = 794) were assigned to one of four groups: usual care, peer counseling, contingency contracting, and combined peer counseling/contingency contracting. Primary outcome variables were completion of isoniazid preventive therapy (IPT), total treatment costs, and lifetime TB-related costs per quality-adjusted life year (QALY) in each of the four study groups (three treatment, one control). Cost effectiveness was evaluated using a five-stage Markov model and a Monte Carlo simulation with 10,000 trials. RESULTS: Average costs were 199 dollars for usual care (UC), 277 dollars for peer counseling (PC), 326 dollars for contingency contracting (CC), and 341 dollars for PC + CC combined. The differences among these groups were all significant at the p = .001 level. Only the PC + CC group improved the rate of IPT completion (83.8%) relative to usual care (75.9%) (p = .051), with an overall incremental CE ratio of 209 dollars per QALY relative to usual care. CONCLUSION: Incentives combined with peer counseling are a cost-effective strategy for helping adolescents to complete care when combined with peer counseling.

Indices of lifetime polydrug use among adolescents.

The functional equivalency for three indices of lifetime polydrug use was examined in a sample of adolescents (N = 794). The following indices were included in analyses: (a) a count of lifetime self-report of substances used; (b) an index weighted by the severity of the substances used; and (c) a hierarchical index of substance use. Analyses for each index was conducted twice with abstinent youth (no report of substances over their lifetime) included and excluded from analyses. Relationships between the indices with gender, age, ethnicity, and country of origin were examined. The only difference between the indices found was for ethnicity in the full sample. African Americans had higher scores on the hierarchical substance use index than Latinos or Asian/Pacific Islanders. With the exception of the relationship between the hierarchical index and ethnicity, the relationships between the other demographic variables with indices were consistent. Implications for utilizing the count or weighted index versus a hierarchical index of lifetime polydrug use are discussed.

Assessment of tuberculosis treatment completion in an ethnically diverse population using two data sources. Implications for treatment interventions.

Many adolescents who are prescribed therapy for tuberculosis (TB) infection fail to complete it. This article presents the results of a demographic and epidemiological assessment of TB treatment completion in adolescent populations using (a) surveillance data from the Los Angeles Health County Department and (b) a prospective/retrospective medical chart review from targeted clinics. Patients who did not complete the 6-month recommended medical treatment for latent tuberculosis therapy (LTBI) averaged 13 weeks in care. Younger age (OR = 1.15; 95% CI 1.03-1.29), birth in the United States (OR = 1.92; 95% CI 1.14-3.22, compared to Mexico), and Asian ethnicity were associated with completion of care. In multiple logistic regression analysis, age (OR = .88; 95% CI .78-.98) and Latino ethnicity (OR = .53; 95% CI .29-.95) remained significant predictors of completion of treatment. These findings indicate the need for age-specific educational reinforcement and cultural differentials in completing care for LTBI.