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The current study conducted a preliminary test of whether community mental health clinic staff could implement a multicomponent cognitive behavioral treatment, developed for adolescents with substance misuse (alcohol and/or marijuana) and comorbid psychiatric symptoms. We randomized a total of 111 families, with an adolescent 12–18 years old, referred to a home-based services program for youth with co-occurring substance use and mental health problems, to receive treatment from either masters-level therapists who received intensive cognitive behavioral therapy (I-CBT) training or from masters-level therapists who took part in a typical brief continuing education–style CBT workshop (treatment as usual, or TAU). Each family's therapist and insurance company determined the frequency and intensity of treatment. We administered follow-up assessments at 3, 6, and 12 months. There was a small, but not statistically significant, reduction in the percent days of heavy drinking and marijuana use over time for both conditions, with the overall effect across the three follow-up points favoring the I-CBT condition. There were no differences on alcohol use days or other drug use. There was also a small, but nonsignificant, positive effect over time on externalizing symptoms, depressed mood, and anxiety, favoring the I-CBT condition. Youth in the I-CBT condition relative to TAU had significantly fewer juvenile justice contacts, while the pattern of costly service use varied, with higher rates at 6-month and lower rates at 12-month follow-ups. If therapists pay greater attention to parent training and provide more parent-adolescent communication sessions, outcomes may improve above standard community care. Training enhancements, to better meet the needs of community therapists and their clinic settings, may also produce better overall results for parents and adolescents.

Objective To evaluate the impact of a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-based intervention on the food and beverage intake, physical activity, and television watching of children ages 1-5. Design Longitudinal surveys of intervention and control participants at baseline, 6 months, and 12 months. Results Analysis of variance tests showed that the intervention had a small but significant impact on TV watching and fruit intake. The intervention was most protective for children younger than 2 years of age. Conclusions and Implications Although the impact of the intervention was relatively small and limited to the youngest children served by WIC, findings suggest that the WIC setting is appropriate for improving healthful behaviors that are linked to reducing the rates of early childhood overweight.

Objective To explore the impact of coordinated statewide nutrition education on Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) family behavior regarding fruits and vegetables, whole grains, and lower-fat milk. Design Survey of different cross-sectional samples of WIC families before and after education. Setting Intervention delivered at all WIC sites in California from April-September 2009. Participants Random samples of pregnant or postpartum women and/or caregivers of children enrolled in WIC: 3,015 before and 3,004 after coordinated nutrition education. Intervention Education directed at families to eat more, and a greater variety of, fruits and vegetables; eat more whole grains; and drink lower-fat milk instead of whole milk. Main Outcome Measures Data collected by phone interview of women and caregivers on recognition of education messages, intention to consume, and change in family consumption of target food items. Analysis Means and frequencies computed. Chi-square and t tests used to compare responses before and after education and for Spanish and English subgroups. Results Following nutrition education, women and caregivers reported increased recognition of education messages, positive movement in stage of change for target food items, increased family consumption of fruits and whole grains, and replacement of whole milk with lower-fat milk. Impacts were similar for Spanish and English speakers. Conclusions and Implications Coordinated nutrition education in WIC can significantly influence consumption toward more healthful food choices.

Objectives. We present infant feeding data before and after the 2009 Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) food package change that supported and incentivized breastfeeding. We describe the key role of California WIC staff in supporting these policy changes. Methods. We analyzed WIC data on more than 180 000 infants in Southern California. We employed the analysis of variance and Tukey (honestly significant difference) tests to compare issuance rates of postpartum and infant food packages before and after the changes. We used analysis of covariance to adjust for poverty status changes as a potential confounder. Results. Issuance rates of the “fully breastfeeding” package at infant WIC enrollment increased by 86% with the package changes. Rates also increased significantly for 2- and 6-month-old infants. Issuance rates of packages that included formula decreased significantly. All outcomes remained highly significant in the adjusted model. Conclusions. Policy changes, training of front-line WIC staff, and participant education influenced issuance rates of WIC food packages. In California, the issuance rates of packages that include formula have significantly decreased and the rate for those that include no formula has significantly increased.

OBJECTIVE: This article describes the impact of a bilingual literacy intervention conducted with nearly 118 000 children in Special Supplemental Nutrition Program for Women, Infants and Children (WIC) sites in Los Angeles County, California. METHODS: All WIC participants at 6 WIC sites in Los Angeles County participated in the literacy intervention. Three cohorts of participants were selected to participate in the evaluation of the intervention. A control group of 200 families received no intervention, 103 families received 2 years of intervention, and 102 families received 4 years of intervention. Participants were predominantly Hispanic (92%), 3- to 4-year-old children and their parents. All families had low income levels, and more than one-half were Spanish-speaking. School readiness assessments were conducted with the children; parent literacy resources and activities at home were observed. Structural equation modeling was used to allow for simultaneous testing of relationships between variables. RESULTS: The Spanish-speaking subset showed a strong intervention effect. Among Spanish speakers, the 4-year intervention group (P < .001) and the 2-year intervention group (P < .05) had significantly higher school readiness scores, compared with the control group. The structural equation model revealed that exposure to the intervention significantly enhanced literacy resources and activities at home, which in turn led to greater school readiness. CONCLUSION: WIC-based literacy intervention significantly increased low-income, Spanish-speaking children's school readiness.

Objective To explore the impact of the new Special Supplemental Nutrition Program for Women, Infants and Children (WIC) food package on WIC participant consumption of fruit, vegetables, whole-grain food, and lower-fat milk. Design Telephone surveys of cross-sectional samples of California WIC families before and after the changes to the food package. Participants Random samples of pregnant or postpartum women and/or caregivers of children enrolled in WIC: 3,004 in September, 2009; 2,996 in March, 2010. Main Outcome Measures Consumption of fruit, vegetables, whole-grain food, and lower-fat milk. Analysis Comparisons of outcome variables were made by examining the differences by time point, adjusted for sociodemographic variables, using ANOVA (for means) or logistic regression (for percentages). Results Following the changes to the WIC food package, consumption of whole-grain food increased by 17.3 percentage points, a 51% increase over baseline. Caregivers and children who usually consumed whole milk decreased by 15.7 and 19.7 percentage points, respectively, a 60%-63% reduction over baseline. Accompanying increases in lower-fat milk consumption were demonstrated. Small but significant increases in consumption of fruits and vegetables were also observed. Conclusions and Implications Federal policy changes to the WIC program had the intended effect of increasing consumption of the prescribed food items.

Background The use of immunization assessment and referral (A/R) in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) has been shown to produce dramatic improvements in vaccination coverage when coupled with parental incentive; however, data are lacking to support the use of A/R alone. Objective To determine the effectiveness of A/R in increasing immunization coverage among WIC participants. Design Participating WIC centers were assigned to1 of 3 interventions that delivered A/R of varying frequency or a control group. Setting Twenty of the largest Public Health Foundation Enterprises–WIC centers in Los Angeles County. Participants Children continuously enrolled in participating WIC centers from 6 to 24 months of age. Intervention Assessment of child's vaccination status followed by referral to a health care provider for those lacking indicated vaccinations. Main Outcome Measure Up-to-date (UTD) status at 24 months of age for all recommended vaccines. Results Baseline coverage rates were similar among all study sites (overall, 77% UTD). After the study period, compared with the controls (88% UTD), we found no differences in immunization coverage among WIC centers that administered A/R at every visit (every 2 months) to all children (90% UTD; adjusted odds ratio [OR], 1.02; 95% confidence interval [CI], 0.54-1.94), every 6 months to all children (89% UTD; OR, 0.98; 95% CI, 0.62-1.56), or every visit to children found to be behind at 8 months of age (89% UTD; OR, 0.89; 95% CI, 0.48-1.68). Conclusion In this urban population of WIC children with high baseline immunization coverage, A/R was not effective in increasing immunization coverage.