One-year postpartum outcomes following a weight management intervention in pregnant women with obesity.

Objective: This analysis was focused on 1-year maternal and infant follow-up of a randomized trial that tested a weight management intervention conducted during pregnancy.

Methods: One hundred fourteen women with obesity (mean BMI 36.7 kg/m(2) ) were randomly assigned at a mean of 15 weeks gestation to a weight management intervention or usual care control condition.

Efficacy of a group-based dietary intervention for limiting gestational weight gain among obese women: a randomized trial.

Objective: Observational studies suggest that minimal gestational weight gain (GWG) may optimize pregnancy outcomes for obese women. This trial tested the efficacy of a group-based weight management intervention for limiting GWG among obese women.

Methods: One hundred and fourteen obese women (BMI [mean ± SD] 36.

Healthy Moms, a randomized trial to promote and evaluate weight maintenance among obese pregnant women: study design and rationale.

Background: Obesity and excessive weight gain during pregnancy are associated with adverse pregnancy outcomes. Observational studies suggest that minimal or no gestational weight gain (GWG) may minimize the risk of adverse pregnancy outcomes for obese women.

Objective: This report describes the design of Healthy Moms, a randomized trial testing a weekly, group-based, weight management intervention designed to help limit GWG to 3% of weight (measured at the time of randomization) among obese pregnant women (BMI≥30 kg/m(2)).

Biobank Recruitment: Motivations for Nonparticipation.

Molecular data, essential for genomics research, can be captured more efficiently in large-scale, population-based biobanks of genetic material rather than by individual studies. Biobanks also offer improved quality and reliability of genetic samples and access through automated sample retrieval. However, it is challenging to adequately inform participants of the broad nature of the research and participation risks and benefits.

A brief intervention designed to increase breast cancer self-screening.

Purpose: To assess the efficacy of an intervention designed to increase appropriate use of breast self-examination (BSE).

Methods: Two-armed randomized clinical trial of cancer-control interventions in women that compared a BSE intervention program to a dietary intervention, which served as the control group. The study was conducted at a large health maintenance organization in Portland, Oregon.

Effectiveness of the 5-As tobacco cessation treatments in nine HMOs.

Background: Smoking remains the leading cause of preventable mortality in the US. The national clinical guideline recommends an intervention for tobacco use known as the 5-As (Ask, Advise, Assess, Assist, and Arrange). Little is known about the model's effectiveness outside the research setting.

Development and implementation of an integrated, multi-modality, user-centered interactive dietary change program.

Computer-tailored behavior change programs offer the potential for reaching large populations at a much lower cost than individual or group-based programs. However, few of these programs to date appear to integrate behavioral theory with user choice, or combine different electronic modalities. We describe the development of an integrated CD-ROM and interactive voice response dietary change intervention that combines behavioral problem-solving theory with a high degree of user choice.

Using web-based screening to enhance efficiency of HMO clinical trial recruitment in women aged forty and older.

Background: Screening potential participants for clinical trials can be labor-intensive, particularly when using long questionnaires administered by telephone.

Purpose: This report describes the development and use of an interactive recruitment website as a supplemental screening strategy for a study using telephone screening interviews.

Methods: Female HMO members, aged 40 and older, were recruited for a study testing dietary change interventions.

Natural language processing in the electronic medical record: assessing clinician adherence to tobacco treatment guidelines.

Background: Comprehensively assessing care quality with electronic medical records (EMRs) is not currently possible because much data reside in clinicians' free-text notes.

Methods: We evaluated the accuracy of MediClass, an automated, rule-based classifier of the EMR that incorporates natural language processing, in assessing whether clinicians: (1) asked if the patient smoked; (2) advised them to stop; (3) assessed their readiness to quit; (4) assisted them in quitting by providing information or medications; and (5) arranged for appropriate follow-up care (i.e.

Relationship between tobacco control policies and the delivery of smoking cessation services in nonprofit HMOs.

Background: This project examined tobacco policies and delivery of cessation services in nonprofit HMOs that collectively provide comprehensive medical care to more than 8 million members.

Methods: Three annual surveys with health plan managers showed that all of these health plans had written tobacco control guidelines that became more comprehensive over the span of this study. We also surveyed a random sample of 4207 current smokers who had attended a primary care visit in the past year (399-528 at each of nine health plans).

Tobacco-cessation services and patient satisfaction in nine nonprofit HMOs.

Background: The U.S. Public Health Service clinical practice guideline calls for clinicians and healthcare organizations to identify and treat every tobacco user seen in a healthcare setting.

Tobacco control efforts in managed care: what do the doctors think?

Objectives: To use physician reports to evaluate their awareness of health plan tobacco control guidelines and cessation support coverage and to validate the extent to which health plan cessation support material had been disseminated and implemented in clinical settings.

Study Design: Comparison of survey responses of physicians with tobacco control activities reported by key informants in the health plans with which those physicians were associated.

Methods: A total of 100 primary care physicians in the care delivery organizations associated with 9 nonprofit health plans were randomly selected to receive a survey asking about their health plan's tobacco cessation guidelines, coverage, and support for clinician action.

Cost-effectiveness of a tailored intervention to increase screening in HMO women overdue for Pap test and mammography services.

Background: Research has established the societal cost-effectiveness of providing breast and cervical cancer screening to women. Less is known about the cost of motivating women significantly overdue for services to receive screening.

Methods: In this intent-to-treat study, a total of 254 women, aged 52-69, who were overdue for both Pap test and mammography, were randomized to two groups, a tailored, motivational outreach or usual care.

Screening rarely screened women: time-to-service and 24-month outcomes of tailored interventions.

Background: Managed care organizations and others reaching out to underscreened women seek strategies to encourage mammogram and Pap screening.

Methods: Female HMO members aged 50-69 years and overdue for a mammogram and a Pap test (n = 501) were followed for 24 months after interventions began. An Outreach intervention (tailored letters and motivational telephone interviews), an Inreach intervention (motivational interview delivered in clinics), and a Combined Inreach/Outreach intervention were compared to Usual Care at 24 months.

One-year results from a brief, computer-assisted intervention to decrease consumption of fat and increase consumption of fruits and vegetables.

Background: Current cancer prevention recommendations include reducing consumption of fat and increasing consumption of fruits and vegetables.

Methods: Healthy women health maintenance organization members (n = 616) ages 40-70 were randomly assigned to either a nutrition intervention or a control intervention unrelated to diet. Intervention included two 45-min counseling sessions plus two brief follow-up telephone contacts.

Tobacco-control policies in 11 leading managed care organizations: progress and challenges.

Context: Although evidence-based national guidelines for tobacco-dependence treatment have been available since 1996, translating these guidelines into clinical practice is challenging.

Practice Pattern Examined: Policies regarding tobacco-dependence treatment (e.g.

Randomized trial of a brief dietary intervention to decrease consumption of fat and increase consumption of fruits and vegetables.

Purpose: This study tested the efficacy of a computer-assisted counseling intervention to reduce diet-related cancer risk.

Design: Randomized controlled trial.

Subjects: Healthy women HMO members (n = 616) aged 40 to 70.

Screening HMO women overdue for both mammograms and pap tests.

Background: Regular screening has the potential to reduce breast and cervical cancer mortality, but despite health plan programs to encourage screening, many women remain unscreened. Tailored communications have been identified as a promising approach to promote mammography and Pap test screening.

Methods: The study used a four-group randomized design to compare with Usual Care the separate and combined effects of two tailored, motivational interventions to increase screening-a clinical office In-reach intervention and a sequential letter/telephone Outreach intervention.