COVID-19 Incidence and Mortality Among American Indian/Alaska Native and White Persons - Montana, March 13-November 30, 2020.

Geographic differences in infectious disease mortality rates have been observed among American Indian or Alaska Native (AI/AN) persons in the United States (1), and aggregate analyses of data from selected U.S. states indicate that COVID-19 incidence and mortality are higher among AI/AN persons than they are among White persons (2,3).

Does a History of Gestational Diabetes Mellitus Affect Key Outcomes in Women Participating in a Diabetes Prevention Program?

Objectives To evaluate lifestyle change outcomes among women with and without a history of gestational diabetes mellitus (GDM) enrolled in the Montana Diabetes Prevention Program (DPP). Methods Participation, self-monitoring behavior, weight loss, and cardiometabolic risk reduction were compared among 5091 women at high-risk for type 2 diabetes, with and without a history of GDM, enrolled in the Montana DPP between 2008 and 2015. Results Women with a history of GDM (6% of enrolled women, n = 283) were significantly younger than women without GDM.

Telehealth delivery of the diabetes prevention program to rural communities.

The Centers for Disease Control and Prevention, State and Local Health Departments, and other organizations in the USA are working to increase population access to the Diabetes Prevention Program (DPP) lifestyle intervention. Delivering the DPP through telehealth videoconference may increase access to this intervention, particularly in rural communities. The purpose of this study was to compare participation, monitoring of diet and physical activity, and weight loss in participants receiving the intervention on-site and those participating virtually through telehealth.

Secondhand Smoke Exposure and Smoke-Free Policy Support Among Public Housing Authority Residents in Rural and Tribal Settings.

Previous research has shown that multi-unit housing (MUH) residents are at risk of secondhand smoke (SHS) exposure, which can transfer between units. The purpose of this study was to determine SHS exposure and examine attitudes towards smoking policies among public housing authority (PHA) residents in rural and tribal settings. A self-administered questionnaire was completed by 895 adult tenants (41 % response rate) living in PHA multiunit buildings in Montana in 2013.

Implementation of Strategies to Recognize and Control Hypertension in a Multispecialty Clinic, Montana, 2012-2013.

Benefis Medical Group, in Great Falls, Montana, improved identification and treatment of hypertension through multifaceted interventions. The interventions included adopting policies for collection of vital signs, enhancing system-level reporting capability, tracking patients for the registry, and conducting patient outreach activities. From baseline to follow-up (December 2012 through September 2013), the percentage of patients with a documented blood pressure increased from 67% to 80%, the percentage diagnosed with hypertension increased from 16% to 36%, and the percentage with blood pressure control increased from 41% to 64%.

High mortality rate of unintentional poisoning due to prescription opioids in adults enrolled in Medicaid compared to those not enrolled in Medicaid in Montana.

Background: Unintentional death due to prescription drug-related poisoning has been a growing problem nationally. Some sub-populations have been shown to be at higher risk than others.

Methods: In 2014, we matched death records to Medicaid eligibility files to determine enrollment status at the time of unintentional death from prescription opioid poisoning from 2003 to 2012 in Montana.

Effectiveness of an Adapted Diabetes Prevention Program Lifestyle Intervention in Older and Younger Adults.

Objectives: To compare participation, self-monitoring behaviors, and weight loss outcomes in older and younger participants in an adapted Diabetes Prevention Program (DPP) lifestyle intervention.

Design: Pre- and postevaluation of outcomes in participants enrolled in the Montana Cardiovascular Disease (CVD) and DPP lifestyle intervention from 2008 through 2012.

Setting: Community.

Prevalence and reasons for initiating use of electronic cigarettes among adults in Montana, 2013.

We used data from the 2013 Montana Adult Tobacco Survey to estimate the prevalence of electronic cigarette (e-cigarette) use and reasons for initiation among Montana adults. More than 1 in 10 (11.2%, 95% confidence interval [CI], 9.

Intensive lifestyle intervention goals can be achieved as effectively with large groups as with small groups.

Objective: The purpose of this study was to assess if group size is associated with weight loss outcomes among participants in an adapted diabetes prevention program.

Methods: Adults at high-risk (N=841) for CVD and diabetes were enrolled in the lifestyle intervention in 2011. Multiple logistic regression analyses were used to identify if group size (smaller group<16 participants; larger group ≥16 participants) was independently associated with weight loss outcomes among participants.

Cooperative strategies to develop effective stroke and heart attack awareness messages in rural american Indian communities, 2009-2010.

Introduction: National initiatives to improve the recognition of heart attack and stroke warning signs have encouraged symptomatic people to seek early treatment, but few have shown significant effects in rural American Indian (AI) communities.

Methods: During 2009 and 2010, the Montana Cardiovascular Health Program, in collaboration with 2 tribal health departments, developed and conducted culturally specific public awareness campaigns for signs and symptoms of heart attack and stroke via local media. Telephone surveys were conducted before and after each campaign to evaluate the effectiveness of the campaigns.

Prevalence of asthma among adults in metropolitan versus nonmetropolitan areas in Montana, 2008.

Introduction: Most US studies on asthma prevalence have been conducted in urban areas, and few have assessed the prevalence of asthma among residents of rural areas versus urban areas. The objective of this study was to compare the prevalence of asthma among adults living in metropolitan versus nonmetropolitan counties in Montana.

Methods: We analyzed data from 6,846 adult Montanans who completed the Behavioral Risk Factor Surveillance System survey in 2008.

Implementation of diabetes prevention programs in rural areas: Montana and south-eastern Australia compared.

Objective: To identify the key elements that enabled the Greater Green Triangle Diabetes Prevention Project (GGT DPP) and the Montana Cardiovascular Disease and Diabetes Prevention (CDDP) programs successful establishment and implementation in rural areas, as well as identifying specific challenges or barriers for implementation in rural communities.

Methods: Focus groups were held with the facilitators who delivered the GGT DPP in Australia and the Montana CDDP programs in the USA. Interview questions covered the facilitators' experiences with recruitment, establishing the program, the components and influence of rurality on the program, barriers and challenges to delivering the program, attributes of successful participants, and the influence of community resources and partnerships on the programs.

Capacity of diabetes education programs to provide both diabetes self-management education and to implement diabetes prevention services.

Objective: The purpose of this study was to assess the capacity of diabetes self-management education (DSME) programs in urban and rural counties to provide services to patients with diagnosed diabetes, lifestyle services to persons at high risk for developing diabetes, and to assess the potential barriers to providing diabetes prevention services.

Methods: In 2009, the Montana Department of Public Health and Human Services conducted an Internet-based survey of all DSME programs in Montana.

Results: Thirty of the 39 (77%) DSME programs completed the survey.

Factors associated with achieving a weight loss goal among participants in an adapted Diabetes Prevention Program.

Aims: To assess the factors associated with achieving the 7% weight loss goal among participants enrolled in an adapted Diabetes Prevention Program (DPP).

Methods: Adults at high-risk (N=989) for CVD and diabetes were enrolled in the lifestyle intervention. Multiple logistic regression analyses were used to identify factors associated with achieving the weight loss goal.

Factors associated with the maintenance or achievement of the weight loss goal at follow-up among participants completing an adapted diabetes prevention program.

Aims: This study evaluated factors associated with achievement or maintenance of a 7% weight loss goal post intervention among adults at high-risk for cardiovascular disease (CVD) and diabetes who participated in an adapted Diabetes Prevention Program (DPP) intervention.

Materials And Methods: High-risk adults completed the intervention in 2008 or 2009 (N=466). In 2010, we conducted a follow-up survey of participants to assess characteristics, behaviors and barriers associated with the maintenance or achievement of the weight loss goal.

Statewide efforts to narrow the rural-urban gap in acute stroke care.

Background: Rural-urban gaps in stroke care remain challenging in part because of the lack of resources, personnel, and necessary infrastructure.

Purpose: The purpose of this study was to assess changes in the acute stroke diagnosis and treatment capacity among rural hospitals before and after implementation of a regionwide stroke initiative.

Methods: In 2004, the Montana Cardiovascular Health Program partnered with stroke stakeholders throughout the state and surveyed hospitals in Montana and northern Wyoming to assess the availability of technology, services, and personnel for acute stroke care.

Implementing a state-based cardiovascular disease and diabetes prevention program.

Objective: To evaluate weight loss and cardiometabolic risk reduction achieved through an adapted Diabetes Prevention Program intervention among adults at high risk for cardiovascular disease (CVD) and diabetes.

Research Design And Methods: Eight health care facilities implemented a group-based lifestyle intervention beginning in 2008. Participants attended 16 weekly core sessions followed by 6 monthly after core sessions.

Effectiveness of a lifestyle intervention program among persons at high risk for cardiovascular disease and diabetes in a rural community.

Purpose: To evaluate the feasibility of translating the Diabetes Prevention Program (DPP) lifestyle intervention into practice in a rural community.

Methods: In 2008, the Montana Diabetes Control Program worked collaboratively with Holy Rosary Healthcare to implement an adapted group-based DPP lifestyle intervention. Adults at high risk for diabetes and cardiovascular disease were recruited and enrolled (N = 101).

Adapted diabetes prevention program lifestyle intervention can be effectively delivered through telehealth.

Purpose: The purpose of this study was to assess the feasibility of delivering an adapted group-based version of the Diabetes Prevention Program's (DPP) lifestyle intervention through telehealth video conferencing.

Methods: In 2009, the Montana Department of Public Health and Human Services in collaboration with Holy Rosary Heathcare implemented the DPP lifestyle intervention, which was provided to an on-site group in 1 community and simultaneously through telehealth to a second group in a remote frontier community. Participants obtained medical clearance from their primary care physician and were eligible if they were overweight and had 1 or more of the following risk factors: prediabetes, impaired glucose tolerance/impaired fasting glucose (IGT/IFG), a history of gestational diabetes (GDM) or the delivery of an infant >9 pounds, hypertension, or dyslipidemia.

Impact of media on community awareness of stroke warning signs: a comparison study.

Prompt identification of the warning signs of ischemic stroke is critical to ensure appropriate and timely treatment. We implemented a 20-week public education campaign in one media market to increase community awareness of warning signs for stroke and the need to call 911. Telephone surveys were conducted in adults aged 45 years and older in the intervention county and a comparison county before and after the campaign to evaluate its impact.

Characteristics and abstinence outcomes among tobacco quitline enrollees using varenicline or nicotine replacement therapy.

Introduction: Telephone counseling through quitlines combined with cessation medication is an effective strategy to support tobacco cessation. This study assessed the characteristics of quitline enrollees selecting varenicline (Chantix) compared with nicotine replacement therapy (NRT) medication and evaluated the cessation outcomes (7-day point prevalence) among these enrollees at 3 and 6 months after program completion.

Methods: A retrospective study analyzed demographic, tobacco use history, and abstinence outcome information of participants who enrolled in the Montana Tobacco Quit Line program and selected varenicline (n = 3,116) or NRT (n = 3,697).

Educational outreach to improve emergency medical services systems of care for stroke in Montana.

Objective: To improve stroke knowledge, identification, and acute care among first responders (FRs) and emergency medical technicians (EMTs) through educational outreach and support.

Methods: Beginning in 2006, the Montana Stroke Initiative implemented outreach to FRs and EMTs and emergency medical services (EMS) statewide. Cross-sectional telephone surveys of FRs and EMTs were used to evaluate changes in stroke knowledge and practice in 2006 (n = 988) and 2009 (n = 944), overall and in rural and urban counties.

The Montana cardiac rehabilitation regional outcomes project.

Purpose: Outcomes evaluation is a critical component in early outpatient cardiac rehabilitation (CR). The goal of this project was to develop a regional CR outcomes program to help facilitate quality improvement.

Methods: The Montana Outcomes Project initiated data collection on a uniform set of outcomes indicators.

Factors associated with workforce retention among emergency medical technicians in Montana.

Objective: To assess potential factors associated with workforce retention among emergency medical technicians (EMTs).

Methods: In 2008, the Montana Department of Public Health and Human Services conducted a telephone survey of a representative sample of licensed EMTs to assess factors associated with workforce retention. Respondents were asked whether they were considering leaving the profession in the next 12 months and the next five years.

Translating the diabetes prevention program into practice in the general community: findings from the Montana Cardiovascular Disease and Diabetes Prevention Program.

Purpose: The purpose of this study was to evaluate the feasibility of translating the Diabetes Prevention Program (DPP) lifestyle intervention into practice in the general community.

Methods: In 2008, the Montana Diabetes Control Program, working collaboratively with 4 health care facilities, implemented an adapted group-based DPP lifestyle intervention. Adults at high risk for diabetes and cardiovascular disease were recruited and enrolled (n = 355).