PURPOSE: The purpose of this study was to describe an exploratory partner approach to enrolling in the National Diabetes Prevention Program (National DPP), a proven 12-month lifestyle change program (LCP) for people at risk for developing type 2 diabetes. FHI360 and the University of Maryland Horowitz Center for Health Literacy created a "partner approach" to investigate whether people at risk for developing diabetes might be willing to join, complete, and be successful in the LCP if they intentionally go through the program with a partner who influences their lifestyle choices. METHODS: The research team analyzed aggregated participant self-reported weight and physical activity data, participant survey and focus group data, and lifestyle coach in-depth interview data to assess the retention, motivation, and acceptability of the partner approach. RESULTS: Across sites, retention of participants at risk of developing type 2 diabetes at the end of the year-long program was at 79%. Participants at the partner approach sites reported being motivated and successful. Lifestyle coaches reported that participants stayed in the program longer and adapted their lifestyle more than participants at other sites that did not offer the partner approach. CONCLUSIONS: People at risk of developing type 2 diabetes may respond positively to participating in a National DPP LCP when they can join with engaged partners. Based on study results, the partner approach may be a way to attract people at risk for type 2 diabetes who are more comfortable joining with a partner.

INTRODUCTION: Men in racial and ethnic minority groups are less likely than non-Hispanic White men to participate in programs designed to improve health, despite having a higher prevalence of type 2 diabetes. We sought to understand 1) the interests and preferences of racial and ethnic minority men, with or at risk for type 2 diabetes, in programs designed to improve health and 2) factors that influence participation and health practices. METHODS: We designed a 43-question web-based survey on facilitators and barriers to participation in a healthy living program. The survey was administered from August 27, 2019, through September 3, 2019. Our analytic sample consisted of 1,506 men at risk for or diagnosed with type 2 diabetes in racial and ethnic minority groups. We conducted descriptive and regression analyses of survey data. RESULTS: Most men (59%) were interested in participating in a healthy living program and/or program elements such as incentives (67%), male-specific health topics (57%), and the inclusion of family (63%). Flexibility was important, since "exercising when it is convenient for me" was the most frequently selected facilitator of physical activity and "the hours were inconvenient" was identified as a challenge in previous programs. Men in this survey were significantly more likely to be interested in participating in a health improvement program for several reasons, including if they were physically active 150 minutes or more per week (vs not) (adjusted odds ratio [AOR] = 2.2; 95% CI, 1.6-3.0) and had previously been in a healthy living program (vs not) (AOR = 1.5; 95% CI, 1.1-2.1). CONCLUSION: Our findings can be useful for recruiting and retaining racial and ethnic minority men with or at risk for type 2 diabetes in programs designed to improve health and ultimately reduce disparities in the prevalence of diabetes.

BACKGROUND: Diabetes affects millions of people in the United States and poses significant health and economic challenges, but it can be prevented or managed through health behavior changes. Such changes might be aided by voice-activated personal assistants (VAPAs), which offer interactive and real-time assistance through features such as reminders, or obtaining health information. However, there are little data on interest and acceptability of integrating VAPAs into programs such as the National Diabetes Prevention Program (National DPP) or diabetes, self-management, education, and support (DSMES) services. METHODS: We conducted individual and small-group semi-structured interviews of National DPP and DSMES staff and program participants. We used rapid-turnaround qualitative thematic analysis to identify emerging themes using an adapted version of the Consolidated Framework for Implementation Research (CFIR). RESULTS: Nearly all program participants and staff had prior experience with VAPAs, but not in the context of these programs. Most program participants felt confident in their ability to use VAPAs but were concerned about their privacy and security. Program staff were optimistic about the feasibility of integrating VAPAs into existing programs given their ability to support healthy habit formation, but staff were less optimistic about using VAPAs to share health information. Program staff also felt that additional resources to support VAPA use would help ensure that VAPAs would not create an extra burden on staff and program participants. IMPLICATIONS: Integrating VAPAs as a resource to enhance mobile applications already in use shows potential to support health behavior change. Future research should include how this technology could be further optimized to enhance utility.

BACKGROUND: While more than 2.5 million U.S. high students worked in 2020, data to assess how work affects this group are sparse. To facilitate such research, a set of occupational safety and health questions for inclusion on the Youth Risk Behavior Surveillance System (YRBSS) and other youth-focused surveys was developed. METHODS: Survey questions about occupational experiences of young workers were adapted from other surveys or created de novo. Key audiences were engaged to define priority topic areas and develop draft questions, which were further refined through cognitive interviews with working youth. RESULTS: Twenty-one resulting questions spanned multiple work-related topics: employment status; health outcomes; psychosocial exposures; and safety climate. Cognitive testing revealed that youth (aged 14-19) had difficulty with temporal concepts. Some difficulties reflected the propensity of youth to engage in multiple, online, and informal jobs. During 3 rounds of interviews, questions were adjusted to better reflect youth employment circumstances and language. Four states added at least 1 work-related question to their 2023 Youth Risk Behavior Survey questionnaire, and the full set of questions has been disseminated to federal agencies and partners. CONCLUSION: Including tailored questions about employment in surveys of youth will facilitate occupational health surveillance for this group. Analysis of resulting data can help to close knowledge gaps, provide current prevalence data, inform policy, and allow development of focused prevention and intervention strategies to reduce adverse outcomes among young workers.

Introduction: accurate and timely laboratory diagnosis of yellow fever (YF) is critical to the Eliminate Yellow Fever Epidemics (EYE) strategy. Gavi, the Vaccine Alliance recognized the need to support and build capacity in the national and regional laboratories in the Global YF Laboratory Network (GYFLN) as part of this strategy. Method(s): to better understand current capacity, gaps and needs of the GYFLN laboratories in Africa, assessments were carried out in national and regional reference laboratories in the 25 African countries at high risk for YF outbreaks that were eligible for new financial support from Gavi. Result(s): the assessments found that the GYFLN in Africa has high capacity but 21% of specimens were not tested due to lack of testing kits or reagents and approximately 50% of presumptive YF cases were not confirmed at the regional reference laboratory due to problems with shipping. Conclusion(s): the laboratory assessments helped to document the baseline capacities of these laboratories prior to Gavi funding to support strengthening YF laboratories. Copyright © Barbara Wilmot Johnson et al.

CONTEXT: The Centers for Disease Control and Prevention supports the engagement of community health workers (CHWs) to help vulnerable populations achieve optimum health through a variety of initiatives implemented in several organizational units. PROGRAM: This article provides a unified and comprehensive logic model for these initiatives that also serves as a common framework for monitoring and evaluation. IMPLEMENTATION: We developed a logic model to fully describe the levels of effort needed to effectively and sustainably engage CHWs. We mapped monitoring and evaluation metrics currently used by federally funded organizations to the logic model to assess the extent to which measurement and evaluation are aligned to programmatic efforts. EVALUATION: We found that the largest proportion of monitoring and evaluation metrics (61%) currently used maps to the "CHW intervention level" of the logic model, a smaller proportion (37%) maps to the "health system and community organizational level," and a minimal proportion (3%) to the "statewide infrastructure level." DISCUSSION: Organizations engaging CHWs can use the logic model to guide the design as well as performance measurement and evaluation of their CHW initiatives.

Diabetes, a serious and costly condition, is characterized by illness and death from long-term microvascular and macrovascular complications (1). Additionally, numerous and well-known comorbidities can accompany diabetes, including cardiovascular disease, retinopathy, amputations, and nephropathy (1). Often these complications and comorbidities interfere with a person’s ability to self-manage their diabetes (2). The Centers for Disease Control and Prevention (CDC) projects that as many as 1 in 3 adults could have diabetes by 2050 (3). In 2012, the United States spent an estimated $245 billion on diabetes care, including $176 billion in direct medical costs and $69 billion in indirect costs from lost workdays, restricted activity, disability, and early death (4). Many costly complications among people with diabetes can be prevented or delayed with appropriate preventive care and self-management (5).

The Centers for Disease Control and Prevention (CDC) developed a cooperative agreement with health departments in all 50 states and the District of Columbia to strengthen chronic disease prevention and management efforts through the implementation of evidence-based strategies, such as CDC's National Diabetes Prevention Program. The National Diabetes Prevention Program supports organizations to deliver the year-long lifestyle change program that has been proven to prevent or delay the onset of type 2 diabetes among those at high risk. This article describes activities, barriers, and facilitators reported by funded states during the first 3 years (2013-2015) of a 5-year funding cycle.

BACKGROUND: Coronary heart disease (CHD) mortality rates have fallen dramatically over the past four decades in the Western world. However, recent data from the US and elsewhere suggest a plateauing of CHD incidence and mortality among young women. We therefore examined recent trends in CHD mortality rates in the US according to age and sex. METHODS AND RESULTS: We analyzed mortality data between 1979 and 2011 for US adults ≥25 years. We calculated age-specific CHD mortality rates and compared annual percentage changes (EAPC) during three approximate decades of data (1979-1989, 1990-1999, and 2000-2011). We then used Joinpoint regression modeling to assess changes in trends over time, based on inflection points of the mortality rates. Adults aged 65+ years showed consistent mortality declines, which became even steeper after 2000 (women, -5.0% and men, -4.4%). In contrast, young men and women (aged <55 years) initially showed a clear decline in CHD mortality from 1979 until 1989 (EAPC -5.5% in men and -4.6% in women). However, the two subsequent decades saw stagnation with minimal improvement. Notably, young women demonstrated no improvements between 1990 and 1999 (EAPC +0.1%), and only -1% EAPC since 2000. Joinpoint analyses provided consistent results. CONCLUSIONS: The dramatic decline in CHD mortality since 1979 conceals major heterogeneities. CHD death rates in older groups are now falling steeply. However, young adults have experienced frustratingly small decreases in CHD mortality rates since 1990. The drivers of these major differences in CHD mortality trends by age and sex merit urgent study.