Introduction Since the launch of the National Diabetes Prevention Program (DPP) in 2010, more than 3,000 organizations have registered with the Centers for Disease and Control and Prevention to deliver the program; today, however, only approximately 2,000 organizations are registered, indicating challenges with sustainability. We used the Program Sustainability Assessment Tool (PSAT) to explore patterns of sustainability capacity among National DPP delivery organizations. Methods We used data from a cross-sectional online survey conducted in August and September 2021 of staff members (N = 440) at National DPP delivery organizations. We conducted a latent profile analysis to identify latent subpopulations on the basis of respondent PSAT domain scores. Regression analyses were used to estimate associations between derived latent classes, PSAT scores, and respondent characteristics. Results The 4-class model included 4 groups of capacity for program sustainability, ranging from low to high: low (class 1) with 8.0% of the sample, medium-low (class 2) with 22.0%, medium-high (class 3) with 41.6%, and high (class 4) with 28.4%. Program evaluation (mean score = 5.1 [SD = 1.4]) and adaptation (mean score = 5.3 [SD = 1.3]) were the domains with the highest scores, while funding stability (mean score = 4.0 [SD = 1.6]) and Partnerships (mean score = 4.0 [SD = 1.7]) had the lowest scores. In our sample of National DPP delivery organizations, most reported relatively high capacity for program sustainability, and key indicators associated with sustainability capacity were virtual delivery, location of delivery, funding sources, and organization type. Discussion Similar to sustainability capacity findings from other PSAT studies, our study found that funding stability and partnerships are areas to strengthen. This insight is useful in sustainability planning at organizational and national levels across multiple programs.

Introduction Implementation is influenced by factors beyond individual clinical settings. Nevertheless, implementation research often focuses on factors related to individual providers and practices, potentially due to limitations of available frameworks. Extant frameworks do not adequately capture the myriad organizational influences on implementation. Organization theories capture diverse organizational influences but remain underused in implementation science. To advance their use among implementation scientists, we distilled 70 constructs from nine organization theories identified in our previous work into theoretical domains in the Organization Theory for Implementation Science (OTIS) framework. Methods The process of distilling organization theory constructs into domains involved concept mapping and iterative consensus-building. First, we recruited organization and implementation scientists to participate in an online concept mapping exercise in which they sorted organization theory constructs into domains representing similar theoretical concepts. Multidimensional scaling and hierarchical cluster analyses were used to produce visual representations (clusters) of the relationships among constructs in concept maps. Second, to interpret concept maps, we engaged members of the Cancer Prevention and Control Research Network (CPCRN) OTIS workgroup in consensus-building discussions. Results Twenty-four experts participated in concept mapping. Based on resulting construct groupings' coherence, OTIS workgroup members selected the 10-cluster solution (from options of 7–13 clusters) and then reorganized clusters in consensus-building discussions to increase coherence. This process yielded six final OTIS domains: organizational characteristics (e.g., size; age); governance and operations (e.g., organizational and social subsystems); tasks and processes (e.g., technology cycles; excess capacity); knowledge and learning (e.g., tacit knowledge; sense making); characteristics of a population of organizations (e.g., isomorphism; selection pressure); and interorganizational relationships (e.g., dominance; interdependence). Discussion Organizational influences on implementation are poorly understood, in part due to the limitations of extant frameworks. To improve understanding of organizational influences on implementation, we distilled 70 constructs from nine organization theories into six domains. Applications of the OTIS framework will enhance understanding of organizational influences on implementation, promote theory-driven strategies for organizational change, improve understanding of mechanisms underlying relationships between OTIS constructs and implementation, and allow for framework refinement. Next steps include testing the OTIS framework in implementation research and adapting it for use among policymakers and practitioners.

Objective: This study examined relationships between dimensions of social capital (SC) (social trust, network diversity, social reciprocity and civic engagement) and fruit, vegetable, and sugar-sweetened beverage (SSB) consumption among rural adults. Potential moderators (neighbourhood rurality, food security, gender and race/ethnicity) were explored to develop a more nuanced understanding of the SC–healthy eating relationship. Design: Data were from a 2019 mailed population-based survey evaluating an eleven-county initiative to address health equity. Participants self-reported health behaviours, access to health-promoting resources and demographics. Logistic regression models were used to analyse relationships between predictors, outcomes and moderators. Setting: Five rural counties, Georgia, USA. Participants: 1120 participants. Results: Among participants who lived in the country (as opposed to in town), greater network diversity was associated with consuming ≥ 3 servings of fruit (OR = 1·08; 95 % CI 1·01, 1·17, P = 0·029), yet among participants who lived in town, greater civic engagement was associated with consuming ≥ three servings of fruit (OR = 1·36; 95 % CI 1·11, 1·65, P = 0·003). Both food-secure and food-insecure participants with greater social reciprocity had lower odds of consuming 0 SSB (OR = 0·92; 95 % CI 0·86, 0·98, P = 0·014, OR = 0·92; 95 % CI 0·86, 0·99, P = 0·037, respectively). Men with greater social trust were more likely to consume 0 SSB (OR = 1·09; 95 % CI 1·01, 1·18, P = 0·038), and Whites with greater network diversity were more likely to meet daily vegetable recommendations (OR = 1·10; 95 % CI 1·01, 1·19, P = 0·028). Conclusions: Findings provide a basis for future qualitative research on potential mechanisms through which SC and related social factors influence healthy eating in rural communities.

Licensee MDPI, Basel, Switzerland. The goal of this research was to assess patterns of beverage consumption and the contribution of total beverages and classes of beverages to overall energy intake and weight status. We conducted an analysis in a community-based study of 280 low-income overweight and obese African American women residing in the rural South. Participants provided baseline data including demographic characteristics, weight and two 24-h food and beverage dietary recalls. Mean energy intake from beverages was approximately 273 ± 192 kcal/day or 18.3% of total energy intake. The most commonly reported beverage was plain water, consumed by 88.2% of participants, followed closely by sweetened beverages (soft drinks, fruit drinks, sweetened teas, sweetened coffees and sweetened/flavored waters) consumed by 78.9% of participants. In multiple regression analyses total energy and percent energy from beverages and specific categories of beverages were not significantly associated with current body mass index (BMI). It is widely accepted that negative energy balance may lead to future weight loss. Thus, reducing consumption of beverages that contribute energy but not important nutrients (e.g., sugar sweetened beverages) could be an effective strategy for promoting future weight loss in this population.

Background: Although observational data suggest that men's attempts and behavior at quitting smoking are often stimulated during their spouses' pregnancy, few studies have systematically examined this phenomenon. Methods: This was a cross-sectional study which examined Chinese men's smoking behaviors during and after their wives' pregnancy. Women who visited community health centers for routine immunization of their children were approached. Information was mainly collected on men's tobacco use before, during and after pregnancy in July to August 2011. Individual and socio-environmental factors were examined by non-conditional logistical regression analysis to find potential reasons behind men's quitting during pregnancy and maintained this change till the post-partum period. Results: Totally 765 of 811 eligible women (94.3%) completed the interview. Prior to pregnancy, 42.9% of husbands smoked; this decreased to 36.34% during pregnancy, a reduction of 6.53%. Although the rate increased to a higher level (43.79%) after delivery, positive changes in men's smoking behavior were detected. One-third (29.88%) reduced the daily number of cigarettes smoked, and nearly half (45.12%) relocated themselves to smoke when their pregnant wives were nearby. Noticeably, those who quit were most likely occasional smokers (Odds Ratio(OR) = 4.83, 95%CI [2.22, 10.48]), smoking less than ten years (OR = 2.80, 95%CI [1.19, 6.58]), not smoking at home (OR = 4.48, 95%CI [1.94, 10.39]), not smoking for social use (OR = 4.05, 95%CI [1.74, 9.41]), under lower financial pressure after the birth of child (OR = 5.28, 95%CI [2.14, 13.02]) and influenced by family members (OR = 2.82, 95%CI [1.25, 6.38]). However, only 22% of spontaneous cessation was maintained postpartum. Most relapses occurred within 6 months after delivery. Conclusions: Pregnancy offers an opportunity to decrease smoking amongst Chinese males. Intervention programs involving expectant fathers may be effective to further reduce prevalence of smoking among men in China.

Background: Dietary behaviors are influenced by many individual and environmental factors. This study explores how dietary fat intake in high-risk midlife adults living in the rural south is influenced by three behavior settings, i.e. in the home, at work, and at church. Methods: Self-report data were collected from rural African American or Caucasian adults age 40–70 at three time points at baseline, 6, and 12 months post baseline. Multilevel analyses investigated the impact of determinants of fat intake over time. Results: Home and work environments varied significantly over time in regard to healthy eating while church environments remained stable. Age, gender, and self-efficacy for healthy eating were individual factors associated with fat intake. In the home, presence of more high fat items, a time-varying variable, was significant. In the work environment, having access to healthy foods as well as healthy eating programs has positive impact as did hearing healthy eating messages and availability of healthy foods at church. Conclusions: Understanding stability and variability of dietary fat intake from a social ecologic perspective will aid in identifying targets of change for intervention. Understanding which components of key behavior settings are dynamic and which are relatively stable will help to disentangle the complexity of multi-level determinants of dietary behavior.

BACKGROUND: Exposure to secondhand smoke (SHS) causes significant disease and death. We assessed the prevalence and correlates of perceptions about the health harm of SHS among U.S. adults at the national and state level. METHODS: Data came from the 2009-2010 National Adult Tobacco Survey, a national landline and cellular telephone survey. Perceptions about the health harms of SHS were assessed as follows: 'not at all harmful', 'somewhat harmful', and 'very harmful'. Descriptive statistics were used to assess the prevalence of SHS harm perceptions by tobacco use and sociodemographic factors, including sex, age, race/ethnicity, education, marital status, annual household income, region, sexual orientation, children in the household, and smoke-free law coverage. Logistic regression was used to assess odds of perceiving SHS to be "very harmful" (vs. "not at all harmful" or "somewhat harmful"), adjusting for the aforementioned factors. RESULTS: Nationally, 64.5 % of adults perceived SHS as 'very harmful' (state range: 73.5 % [Utah] to 53.7 % [Kentucky]). By tobacco use, the perception that SHS is 'very harmful' was: 76.5 % among nonusers of tobacco; 62.1 % among noncombustible only users; 47.9 % among combustible only users; and 40.8 % among dual combustible and noncombustible users. Following adjustment, the perception that SHS was 'very harmful' was higher among females, non-Hispanic minorities and Hispanics, respondents living with children, and states with 100 % smoke-free law coverage. Among current tobacco users the odds of perceiving SHS to be 'very harmful' was lower in the Midwest than the West. CONCLUSIONS: Almost two-thirds of American adults perceive SHS as 'very harmful'; however, currently only half of all Americans are protected by comprehensive state or local smoke-free laws. These findings underscore the importance of public education campaigns to increase awareness of SHS exposure harm and the benefits of smoke-free environments. Expanding comprehensive smoke-free laws could protect all Americans from SHS.

Background Implementing evidence-based practices (EBPs) to increase cancer screenings in safety net primary care systems has great potential for reducing cancer disparities. Yet there is a gap in understanding the factors and mechanisms that influence EBP implementation within these high-priority systems. Guided by the Consolidated Framework for Implementation Research (CFIR), our study aims to fill this gap with a multiple case study of health care safety net systems that were funded by an American Cancer Society (ACS) grants program to increase breast and colorectal cancer screening rates. The initiative funded 68 safety net systems to increase cancer screening through implementation of evidence-based provider and client-oriented strategies. Methods Data are from a mixed-methods evaluation with nine purposively selected safety net systems. Fifty-two interviews were conducted with project leaders, implementers, and ACS staff. Funded safety net systems were categorized into high-, medium-, and low-performing cases based on the level of EBP implementation. Within- and cross-case analyses were performed to identify CFIR constructs that influenced level of EBP implementation. Results Of 39 CFIR constructs examined, six distinguished levels of implementation. Two constructs were from the intervention characteristics domain: adaptability and trialability. Three were from the inner setting domain: leadership engagement, tension for change, and access to information and knowledge. Engaging formally appointed internal implementation leaders, from the process domain, also distinguished level of implementation. No constructs from the outer setting or individual characteristics domain differentiated systems by level of implementation. Conclusions Our study identified a number of influential CFIR constructs and illustrated how they impacted EBP implementation across a variety of safety net systems. Findings may inform future dissemination efforts of EBPs for increasing cancer screening in similar settings. Moreover, our analytic approach is similar to previous case studies using CFIR and hence could facilitate comparisons across studies.

BACKGROUND: Lung cancer screening recommendations are based on results from the National Lung Screening Trial (NLST). The authors determined how the screening-eligible US population differs from NLST participants in terms of characteristics that affect their ability to benefit from screening. METHODS: The authors identified respondents to the 2012 Health and Retirement Study (HRS), a national survey of individuals aged ≥50 years who are eligible for screening based on US Preventive Services Task Force and Centers for Medicare and Medicaid Services criteria. Comorbidities, life expectancy, smoking history, and other characteristics were compared between the screening-eligible population and NLST participants. RESULTS: The authors estimated that in 2013, 8.4 million individuals (95% confidence interval, 7.9–8.9 million individuals) would have met the eligibility criteria for lung cancer screening established by the US Preventive Services Task Force. Compared with NLST participants, HRS screening-eligible respondents were older, more likely to be current smokers, and more likely to have been diagnosed with comorbidities. The 5-year survival rate was 87% in the HRS screening-eligible individuals versus 93% in the NLST participants (P<.001, based on a 2-sided test). Life expectancy was 18.7 years in the HRS screening-eligible individuals versus 21.2 years in the NLST participants. CONCLUSIONS: The US population eligible for lung cancer screening is probably less likely to benefit from early detection than NLST participants because they face a high risk of death from competing causes. The results of the current study highlight the need for smoking cessation interventions targeting those patients eligible for screening and tools to help clinicians determine the potential benefits of screening in individual patients.

In the United States (U.S.), secondhand smoke (SHS) exposure causes more than 41,000 deaths among nonsmoking adults annually. Adoption of smoke-free laws in public areas has increased, but private settings such as vehicles remain a source of SHS exposure. This study assessed change in voluntary smoke-free vehicle rules and SHS exposure in personal vehicles among U.S. adults between two periods, 2009-2010 and 2013-2014, using data from the National Adult Tobacco Survey (NATS). NATS is a national landline and cellular telephone survey of non-institutionalized adults aged ≥18 years in the 50 U.S. states and the District of Columbia. We assessed percentage change in the prevalence of smoke-free vehicle rules among all adults and SHS exposure in vehicles among nonsmoking adults, overall, by sociodemographic factors (sex, age, race/ethnicity, education, marital status, annual household income, U.S. region), and by cigarette smoking status. During 2009-2010 to 2013-2014, the percentage of adults with a 100% smoke-free vehicle rule increased from 73.6% to 79.5% (% change = +8.0%; p < 0.05). Among nonsmokers, SHS exposure in vehicles in the previous 7 days decreased from 9.2% to 8.2% (% change = -10.9%; p < 0.05). Smoke-free rules in private settings such as vehicles, in coordination with comprehensive smoke-free policies in indoor public settings, can help reduce SHS exposure and promote smoke-free norms.