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Background. FUEL Your Life (FYL) is a worksite translation of the Diabetes Prevention Program (DPP). In a randomized controlled trial, participants in a phone coaching condition demonstrated greater weight loss compared to participants in a group coaching or self-study condition. The purpose of this article is to describe the differences in participant reach, intervention uptake, and participant satisfaction for each delivery mode. Method. Employees who were overweight, obese, or at high risk for diabetes were recruited from city–county governments. Process evaluation data were collected from health coach records, participant surveys, and research team records. Differences between groups were tested using Pearson chi-square test and one-way analysis of variance. Results. Employee reach of targeted enrollment was highest for the self-study condition. Overall, intervention uptake was highest in the phone coaching condition. Participants who received phone coaching had increased uptake of the participant manual and self-monitoring of food compared to participants who received group coaching or self-study. Discussion. FYL demonstrated that DPP could be effectively delivered in the worksite by three different modalities. When implemented in a self-study mode, reach is greater but intervention uptake is lower. Phone health coaching was associated with greater intervention exposure.

Background High-prevalence childhood mental health problems like early-onset disruptive behavior problems (DBPs) pose a significant public health challenge and necessitate interventions with adequate population reach. The treatment approach of choice for childhood DBPs, namely evidence-based parenting intervention, has not been sufficiently disseminated when relying solely on staff-delivered services. Online-delivered parenting intervention is a promising strategy, but the cost minimization of this delivery model for reducing child DBPs is unknown compared with the more traditional staff-delivered modality. Objective This study aimed to examine the cost-minimization of an online parenting intervention for childhood disruptive behavior problems compared with the staff-delivered version of the same content. This objective, pursued in the context of a randomized trial, made use of cost data collected from parents and service providers. Methods A cost-minimization analysis (CMA) was conducted comparing the online and staff-delivered parenting interventions. Families (N=334) with children 3-7 years old, who exhibited clinically elevated disruptive behavior problems, were randomly assigned to the two parenting interventions. Participants, delivery staff, and administrators provided data for the CMA concerning family participation time and expenses, program delivery time (direct and nondirect), and nonpersonnel resources (eg, space, materials, and access fee). The CMA was conducted using both intent-to-treat and per-protocol analytic approaches. Results For the intent-to-treat analyses, the online parenting intervention reflected significantly lower program costs (t168=23.2; P Conclusions The online-delivered parenting intervention in this randomized study produced substantial cost minimization compared with the staff-delivered intervention providing the same content. Cost minimization was driven primarily by personnel time and, to a lesser extent, by facilities costs and family travel time. The CMA was accomplished with three critical conditions in place: (1) the two intervention delivery modalities (ie, online and staff) held intervention content constant; (2) families were randomized to the two parenting interventions; and (3) the online-delivered intervention was previously confirmed to be non-inferior to the staff-delivered intervention in significantly reducing the primary outcome, child disruptive behavior problems. Given those conditions, cost minimization for the online parenting intervention was unequivocal. Trial Registration ClinicalTrials.gov NCT02121431; https://clinicaltrials.gov/ct2/show/NCT02121431

BACKGROUND High-prevalence childhood mental health problems like early-onset disruptive behavior problems (DBPs) pose a significant public health challenge and necessitate interventions with adequate population reach. The treatment approach of choice for childhood DBPs, namely evidence-based parenting intervention, has not been sufficiently disseminated when relying solely on staff-delivered services. Online-delivered parenting intervention is a promising strategy, but the cost minimization of this delivery model for reducing child DBPs is unknown compared with the more traditional staff-delivered modality. OBJECTIVE This study aimed to examine the cost-minimization of an online parenting intervention for childhood disruptive behavior problems compared with the staff-delivered version of the same content. This objective, pursued in the context of a randomized trial, made use of cost data collected from parents and service providers. METHODS A cost-minimization analysis (CMA) was conducted comparing the online and staff-delivered parenting interventions. Families (N=334) with children 3-7 years old, who exhibited clinically elevated disruptive behavior problems, were randomly assigned to the two parenting interventions. Participants, delivery staff, and administrators provided data for the CMA concerning family participation time and expenses, program delivery time (direct and nondirect), and nonpersonnel resources (eg, space, materials, and access fee). The CMA was conducted using both intent-to-treat and per-protocol analytic approaches. RESULTS For the intent-to-treat analyses, the online parenting intervention reflected significantly lower program costs (t168=23.2; P<.001), family costs (t185=9.2; P<.001), and total costs (t171=19.1; P<.001) compared to the staff-delivered intervention. The mean incremental cost difference between the interventions was $1164 total costs per case. The same pattern of significant differences was confirmed in the per-protocol analysis based on the families who completed their respective intervention, with a mean incremental cost difference of $1483 per case. All costs were valued or adjusted in 2017 US dollars. CONCLUSIONS The online-delivered parenting intervention in this randomized study produced substantial cost minimization compared with the staff-delivered intervention providing the same content. Cost minimization was driven primarily by personnel time and, to a lesser extent, by facilities costs and family travel time. The CMA was accomplished with three critical conditions in place: (1) the two intervention delivery modalities (ie, online and staff) held intervention content constant; (2) families were randomized to the two parenting interventions; and (3) the online-delivered intervention was previously confirmed to be non-inferior to the staff-delivered intervention in significantly reducing the primary outcome, child disruptive behavior problems. Given those conditions, cost minimization for the online parenting intervention was unequivocal. CLINICALTRIAL ClinicalTrials.gov NCT02121431; https://clinicaltrials.gov/ct2/show/NCT02121431

Purpose:Report the results of a randomized, controlled trial of Live Healthy, Work Healthy (LHWH), a worksite translation of the Chronic Disease Self-Management Program (CDSMP).Design:14 worksites were randomly assigned to LHWH, standard CDSMP (usual care) or no-intervention (control) group.Setting:The diverse set of work organizations centered around a rural community in SE US.Subjects:411 participants completed baseline data with 359 being included in the final analyses.Intervention:LHWH had been adapted to fit the unique characteristics of work organizations. This translated program consists of 15 sessions over 8 weeks and was facilitated by trained lay leaders.Measures:The primary outcomes including health risk, patient-provider communication, quality of life, medical adherence and work performance were collected pretest, posttest (6 mos.) and follow-up (12 mos.).Analysis:Analyses were conducted using latent change score models in a structural equation modeling framework.Results:79% of participants reported at least one chronic condition with an average of 2.7 chronic conditions reported. Results indicated that LHWH program demonstrated positive changes in a most outcomes including significant exercise (uΔ = 0.89, p < .01), chronic disease self-efficacy (uΔ = 0.63, p < .05), fatigue (uΔ = −1.45, p < .05), stress (uΔ = −0.98, p < .01) and mentally unhealthy days (uΔ = −3.47, p < .001).Conclusions:The translation of LHWH is an effective, low cost, embeddable program that has the potential to improve the health and work life of employees.

This paper describes the programmatic costs required for implementation of the Legacy for ChildrenTM (Legacy) program at two sites (Miami and Los Angeles) and enumerate the cost-effectiveness of the program. Legacy provided group-based parenting intervention for mothers and children living in poverty. This cost-effectiveness analysis included two behavioral outcomes, behavioral problems, and attention-deficit/hyperactivity disorder (ADHD), and programmatic costs collected prospectively (2008 US$). Incremental costs, effects, the incremental cost-effectiveness ratio (ICER), and cost-effectiveness acceptability curves were estimated for the intervention groups relative to a comparison group with a 5 year analytic horizon. The intervention costs per family for Miami and Los Angeles were $16,900 and $14,100, respectively. For behavioral problems, the incremental effects were marginally significant (p=0.11) for Miami with an ICER of $178,000 per child at high risk for severe behavioral problems avoided. For ADHD, the incremental effects were significant (p=0.03) for Los Angeles with an ICER of $91,100 per child at high risk for ADHD avoided. Legacy was related to improvements in behavioral outcomes within two community-drawn sites and the costs and effects are reasonable considering the associated economic costs

Introduction Couples’ voluntary HIV counselling and testing (CVCT) is a high‐impact HIV prevention intervention in Rwanda and Zambia. Our objective was to model the cost‐per‐HIV infection averted by CVCT in six African countries guided by an HIV prevention cascade framework. The HIV prevention cascade as yet to be applied to evaluating CVCT effectiveness or cost‐effectiveness. Methods We defined a priority population for CVCT in Africa as heterosexual adults in stable couples. Based on our previous experience nationalizing CVCT in Rwanda and scaling‐up CVCT in 73 clinics in Zambia, we estimated HIV prevention cascade domains of motivation for use, access and effectiveness of CVCT as model parameters. Costs‐per‐couple tested were also estimated based on our previous studies. We used these parameters as well as country‐specific inputs to model the impact of CVCT over a five‐year time horizon in a previously developed and tested deterministic compartmental model. We consider six countries across Africa with varied HIV epidemics (South Africa, Zimbabwe, Kenya, Tanzania, Ivory Coast and Sierra Leone). Outcomes of interest were the proportion of HIV infections averted by CVCT, nationwide CVCT implementation costs and costs‐per‐HIV infection averted by CVCT. We applied 3%/year discounting to costs and outcomes. Univariate and Monte Carlo multivariate sensitivity analyses were conducted. Results We estimated that CVCT could avert between 54% (Sierra Leone) and 62% (South Africa) of adult HIV infections. Average costs‐per‐HIV infection averted were lowest in Zimbabwe ($550) and highest in South Africa ($1272). Nationwide implementations would cost between 7% (Kenya) and 21% (Ivory Coast) of a country’s President’s Emergency Plan for AIDS Relief (PEPFAR) budget over five years. In sensitivity analyses, model outputs were most sensitive to estimates of cost‐per‐couple tested; the proportion of adults in heterosexual couples and HIV prevention cascade domains of CVCT motivation and access. Conclusions Our model indicates that nationalized CVCT could prevent over half of adult HIV infections for 7% to 21% of the modelled countries’ five‐year PEPFAR budgets. While other studies have indicated that CVCT motivation is high given locally relevant promotional and educational efforts, without required indicators, targets and dedicated budgets, access remains low.

Identifying and reducing TB-related costs is necessary for achieving the End TB Strategy’s goal that no family is burdened with catastrophic costs. This study explores costs during the pre-diagnosis period and assesses the potential for using coping costs as a proxy indicator for catastrophic costs when comprehensive surveys are not feasible. Detailed interviews about TB-related costs and productivity losses were conducted with 196 recently diagnosed adult pulmonary TB patients in Kampala, Uganda. The threshold for catastrophic costs was defined as 20% of household income. Multivariable regression analyses were used to assess the influence of patient characteristics on economic burden, and the positive predictive value (PPV) of coping costs was estimated. Over 40% of patients in the study experienced catastrophic costs, with average (median) pre-diagnosis costs making up 30.6% (14.1%) of household income. Low-income status (AOR=2.91, 95% CI=1.29, 6.72), hospitalization (AOR=8.66, 95% CI=2.60; 39.54), and coping costs (AOR=3.84, 95% CI=1.81; 8.40) were significantly associated with the experience of catastrophic costs. The PPV of coping costs as a proxy indicator for catastrophic costs was estimated to be 73% (95% CI=58%, 84%). Pulmonary TB patients endure a substantial economic burden during the pre-diagnosis period, and identifying households that experience coping costs may be a useful proxy measure for identifying catastrophic costs.

BackgroundEven as many states adopt physical activity policies to promote physical activity and prevent childhood obesity, little is known about differences in policy implementation based on school characteristics. We studied association of school characteristics and changes in physical activity opportunities at the school level during the implementation of a statewide physical activity policy in the state of Georgia.MethodsA web-based school survey was administered to elementary schools at two time points (before and during policy execution). Matched respondents (289 classroom teachers, 234 administrators) reported the frequency and duration of recess and integrated physical activity time. We used paired t-test to assess changes in physical activity opportunities and chi-square tests to assess the association of change in physical activity opportunities with school characteristics. We then constructed a multiple linear regression model following a change score method to identify school-level factors that predict the magnitude of change in physical activity opportunities.ResultsThere was an overall significant increase in total physical activity opportunities across time; however, schools with higher poverty showed a decrease in physical activity time by 5.3 minutes per day (95% CI: -9.2, -1.3). Further, the changes in physical activity time for schools in suburban Georgia were smaller (-5.7, 95% CI: -9.5, -1.9) compared to schools located in towns.ConclusionsThe change in physical activity opportunities was not the same across schools and school characteristics predicted the magnitude of change. Additional efforts at the local level might be needed for equitable policy implementation based on schools' geographical location and poverty level of the student population.

Objectives. To examine the effect of Florida’s adoption of Statute 335.065—a law requiring the routine accommodation of nonmotorized road users (i.e., a “Complete Streets” policy)—on pedestrian fatalities and to identify factors influencing its implementation. Methods. We used a multimethod design (interrupted time-series quasi-experiment and interviews) to calculate Florida’s pedestrian fatality rates from 1975 to 2013—39 quarters before and 117 quarters after adoption of the law. Using statistical models, we compared Florida with regional and national comparison groups. Semistructured interviews were conducted with 10 current and former Florida transportation professionals in 2015. Results. Florida’s pedestrian fatality rates decreased significantly—by at least 0.500% more each quarter—after Statute 335.065 was adopted, resulting in more than 3500 lives saved across 29 years. Interviewees described supports and challenges associated with implementing the law. Conclusions. Florida Statute 335.065 is associated with a 3-decade decrease in pedestrian fatalities. The study also reveals factors that influenced the implementation and effectiveness of the law. Public Health Implications. Transportation policies—particularly Complete Streets policies—can have significant, quantifiable impacts on population health. Multimethod designs are valuable approaches to policy evaluations.

Sleep-related infant deaths continue to be a major, largely preventable cause of infant mortality, especially in Georgia. The Georgia Department of Public Health (DPH), as part of a multi-pronged safe infant sleep campaign, implemented a hospital initiative to (1) provide accurate safe infant sleep information to hospital personnel; (2) support hospitals in implementing and modeling safe sleep practices; and (3) provide guidance on addressing caregiver safe sleep concerns. A process evaluation was conducted to determine progress toward four goals set out by DPH: (1) all birthing hospitals have a safe infant sleep policy; (2) all safe infant sleep policies reference the AAP 2011 recommendations; (3) all safe infant sleep policies specify the type and/or content of patient safe sleep education; and (4) all hospitals require regular staff training on safe sleep recommendations. Data were collected via structured interviews and document review of crib audit data and safe sleep policies. All 79 birthing hospitals in the state participated in the statewide campaign. Prior to the initiative, 44.3% of hospitals had a safe sleep policy in place; currently, 87.3% have a policy in place. The majority (91.4%) of hospitals have provided safe sleep training to their staff at this time. Important lessons include: (1) Engagement is vital to success; (2) A comprehensive implementation guide is critical; (3) Piloting the program provides opportunities for refinement; (4) Ongoing support addresses barriers; and (5) Senior leadership facilitates success.

Over a decade ago, the Society for Prevention Research endorsed the first standards of evidence for research in preventive interventions. The growing recognition of the need to use limited resources to make sound investments in prevention led the Board of Directors to charge a new task force to set standards for research in analysis of the economic impact of preventive interventions. This article reports the findings of this group’s deliberations, proposes standards for economic analyses, and identifies opportunities for future prevention science. Through examples, policymakers’ need and use of economic analysis are described. Standards are proposed for framing economic analysis, estimating costs of prevention programs, estimating benefits of prevention programs, implementing summary metrics, handling uncertainty in estimates, and reporting findings. Topics for research in economic analysis are identified. The SPR Board of Directors endorses the “Standards of Evidence for Conducting and Reporting Economic Evaluations in Prevention Science.” Electronic supplementary material The online version of this article (10.1007/s11121-017-0858-1) contains supplementary material, which is available to authorized users.

Sleep-related infant deaths are a leading cause of infant mortality in Georgia, and these deaths are largely associated with unsafe sleep practices among caregivers. In early 2016, the Georgia Department of Public Health launched the Georgia Safe to Sleep Hospital Initiative, providing hospitals with safe infant sleep information and educational materials to be distributed to families and newborns. This study examined the knowledge and behaviors of a sample of Georgia parents after the implementation of the Hospital Initiative and identified the family characteristics and intervention components most closely associated with the knowledge and practice of safe infant sleep. The primary caretakers of all infants born in Georgia from August to October 2016 were invited to complete a web-based survey 1 month after hospital discharge. The final sample size included 420 parents of newborns, and the primary outcomes assessed included two measures of knowledge and four measures of infant sleep behaviors regarding infant sleep position and location. Most respondents demonstrated knowledge of the correct recommended sleep position (90%) and location (85%). Logistic regression revealed that receipt of information in the hospital was significantly correlated with safe sleep behaviors, and infant sleep habits tended to influence safe sleep practices. Additionally, Medicaid parents receiving bassinets from the hospital were 74% less likely to bed share (OR 0.26; 95% CI 0.007). Implementation of a statewide hospital initiative was associated with high levels of parental knowledge and behavior and may have been successful in reducing the practice of bed sharing among Medicaid parents. Electronic supplementary material The online version of this article (10.1007/s10900-017-0449-x) contains supplementary material, which is available to authorized users.

BACKGROUND. FUEL Your Life (FYL) is a worksite translation of the Diabetes Prevention Program (DPP). In a randomized controlled trial, participants in a phone coaching condition demonstrated greater weight loss compared to participants in a group coaching or self-study condition. The purpose of this article is to describe the differences in participant reach, intervention uptake, and participant satisfaction for each delivery mode. METHOD. Employees who were overweight, obese, or at high risk for diabetes were recruited from city–county governments. Process evaluation data were collected from health coach records, participant surveys, and research team records. Differences between groups were tested using Pearson chi-square test and one-way analysis of variance. RESULTS. Employee reach of targeted enrollment was highest for the self-study condition. Overall, intervention uptake was highest in the phone coaching condition. Participants who received phone coaching had increased uptake of the participant manual and self-monitoring of food compared to participants who received group coaching or self-study. DISCUSSION. FYL demonstrated that DPP could be effectively delivered in the worksite by three different modalities. When implemented in a self-study mode, reach is greater but intervention uptake is lower. Phone health coaching was associated with greater intervention exposure.

Across the U.S., states have adopted Complete Streets legislative statutes—state laws that direct transportation agencies to routinely design and operate roadways to provide safe access for all users, including pedestrians, bicyclists, motorists, and public transit users. To date, there has not been a systematic and comprehensive analysis of the content and provisions of these laws. In this study, Complete Streets state statutes were identified using legal research databases. Using established legal mapping methods, a qualitative analysis was conducted of state laws that were effective through December 2018. A codebook and open-source data set were developed to support the public use of the data. Eighteen states and Washington, DC, have adopted Complete Streets legislative statutes. A total of 21 have been adopted, with 76% (n=16) of laws adopted since 2007. While the laws vary in content, detail, and specificity, several common provisions were identified across statutes. Complete Streets legislative statutes may be essential to ensure that road networks throughout states are safe, connected, and accessible for all users. This study provides key insights into the legislative landscape of Complete Streets state laws and makes available a new data set that can support future evaluations of these laws.

Objective The aim of this study was to evaluate the effectiveness of the Fuel Your Life program, an adaptation of the Diabetes Prevention Program (DPP), utilizing implementation strategies commonly used in worksite programs-telephone coaching, small group coaching, and self-study. Methods The primary outcomes of body mass index and weight were examined in a randomized control trial conducted with city/county employees. Results Although the majority of participants in all three groups lost some weight, the phone group lost significantly more weight (4.9 lb), followed by the small groups (3.4 lb) and the self-study (2.7 lb). Of the total participants, 28.3% of the phone group, 20.6% of the small group, and 15.7% of the self-study group lost 5% or more of their body weight. Conclusions Fuel Your Life (DPP) can be effectively disseminated using different implementation strategies that are tailored to the workplace.

An accounting of the resources necessary for implementation of efficacious programs is important for economic evaluations and dissemination.A programmatic costs analysis was conducted prospectively in conjunction with an efficacy trial of Fuel Your Life (FYL), a worksite translation of the Diabetes Prevention Program. FYL was implemented through three different modalities, Group, Phone, and Self-study, using a micro-costing approach from both the employer and societal perspectives.The Phone modality was the most costly at $354.6 per participant, compared with $154.6 and $75.5 for the Group and Self-study modalities, respectively. With the inclusion of participant-related costs, the Phone modality was still more expensive than the Group modality but with a smaller incremental difference ($461.4 vs $368.1).This level of cost-related detail for a preventive intervention is rare, and our analysis can aid in the transparency of future economic evaluations.

OBJECTIVES: This study estimated the incidence, direct medical and non-medical costs, and productivity losses due to morbidity and mortality across multiple strata for injuries that occurred in Jiangxi, China. STUDY DESIGN: Cross-sectional study. METHODS: Data came from the Jiangxi injury survey, a provincially-representative, population-based sample of 100,010 households. The major economic costs of injuries were divided into direct costs and indirect costs. Direct costs encompass medical costs and direct non-medical costs. Indirect costs refer to the productivity losses due to injury-related morbidity and mortality. RESULTS: In 2005, about one of 18 residents in Jiangxi, China, experienced an injury. Overall, fall, animal bite, and road traffic crash (RTC) injuries accounted for more than 66% of all injuries, while fall, RTC, drowning, and self-harm injuries accounted for 80% of fatal injuries. Average cost per case for a fatal injury was 163,389 RMB ($20,171) for lost productivity and 2800 RMB ($346) in direct medical & non-medical costs. A non-fatal injury resulting in hospitalisation or permanent disability on average caused 5221 RMB ($643) in direct costs and 18,437 RMB ($2276) in lost productivity and, an additional loss of three school days. A non-hospitalised non-fatal injury on average caused 303 ($37) RMB in direct costs and 491 RMB ($61) in lost productivity and, an additional loss of 0.5 school days. CONCLUSIONS: The unequivocal evidence of the substantial health and financial burden of injuries indicates to Chinese policy makers that more research and efforts are needed to find efficacious and cost-effective interventions targeting injury.Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved. Language: en

This study presents results from a randomized controlled trial of the Protecting Strong African American Families (ProSAAF) program, a family-centered intervention designed to promote strong couple, coparenting, and parent-child relationships in two-parent African American families. A total of 346 African American couples with an early adolescent child participated; all families lived in rural, low-income communities in the southern United States. Intent-to-treat growth curve analyses involving 3 waves and spanning 17 months indicated that ProSAAF participants, compared with control participants, reported greater improvements in relationship communication, confidence, satisfaction, partner support, coparenting, and parenting. More than 80% of the couples attended all six of the in-home, facilitator-led sessions; costs to implement the program averaged $1739 per family. The findings inform the ongoing debate surrounding prevention programs for low-income and ethnic minority couples.

Objective Conduct a cost-effectiveness analysis of the Fuel Your Life (FYL) program dissemination. Methods Employees were recruited from three workplaces randomly assigned to one of the conditions: telephone coaching, small group coaching, and self-study. Costs were collected prospectively during the efficacy trial. The main outcome measures of interest were weight loss and quality-adjusted life years (QALYs). Results The phone condition was most costly ($601 to $589/employee) and the self-study condition was least costly ($145 to $143/employee). For weight loss, delivering FYL through the small group condition was no more effective, yet more expensive, than the self-study delivery. For QALYs, the group delivery of FYL was in an acceptable cost-effectiveness range ($22,400/QALY) relative to self-study (95% confidence interval [CI]: $10,600/QALY-dominated). Conclusions Prevention programs require adaptation at the local level and significantly affect the cost, effectiveness, and cost-effectiveness of the program.

Disease management is gaining importance in workplace health promotion given the aging workforce and rising chronic disease prevalence. The Chronic Disease Self-Management Program (CDSMP) is an effective intervention widely offered in diverse community settings; however, adoption remains low in workplace settings. As part of a larger NIH-funded randomized controlled trial, this study examines the effectiveness of a worksite-tailored version of CDSMP (wCDSMP [n = 72]) relative to CDSMP (‘Usual Care’ [n = 109]) to improve health and work performance among employees with one or more chronic conditions. Multiple-group latent-difference score models with sandwich estimators were fitted to identify changes from baseline to 6-month follow-up. Overall, participants were primarily female (87%), non-Hispanic white (62%), and obese (73%). On average, participants were age 48 (range: 23–72) and self-reported 3.25 chronic conditions (range: 1–16). The most commonly reported conditions were high cholesterol (45%), high blood pressure (45%), anxiety/emotional/mental health condition (26%), and diabetes (25%). Among wCDSMP participants, significant improvements were observed for physically unhealthy days (uΔ = −2.07, p = 0.018), fatigue (uΔ = −2.88, p = 0.002), sedentary behavior (uΔ = −4.49, p = 0.018), soda/sugar beverage consumption (uΔ = −0.78, p = 0.028), and fast food intake (uΔ = −0.76, p = 0.009) from baseline to follow-up. Significant improvements in patient–provider communication (uΔ = 0.46, p = 0.031) and mental work limitations (uΔ = −8.89, p = 0.010) were also observed from baseline to follow-up. Relative to Usual Care, wCDSMP participants reported significantly larger improvements in fatigue, physical activity, soda/sugar beverage consumption, and mental work limitations (p < 0.05). The translation of Usual Care (content and format) has potential to improve health among employees with chronic conditions and increase uptake in workplace settings.

Background Students seeking degrees in healthcare in Ecuador participate in community improvement projects and provide free health services under the supervision of faculty health professionals. The aim of this study is to determine the impact of a community-based intervention delivered by nursing students on health-related quality of life (HRQoL) and perceived social support of a rural population in Ecuador. Methods A quasi-experimental non-equivalent control group design study was conducted in two rural communities in Tumbaco, Ecuador. Families from one rural community were invited to participate in the intervention, receiving 8 weekly home visits from nursing students. Families from a neighboring community were similarly recruited as wait-list controls. One member of each family was consented into the study; the final sample included 43 intervention participants and 55 control participants. HRQoL and perceived social support were assessed before and after the intervention in both groups. The SF-12 was used to measure HRQoL, including eight domain scores and two composite scores, and the Interpersonal Support Evaluation List was used as an indicator of perceived social support. Difference-in-differences (DD) analyses were conducted to mitigate the effects of any baseline differences in the non- equivalent control group design. Results When compared to the control group, the intervention group realized significant improvements in the physical component summary score of the SF-12 (4.20, p

Background Standardized methodologies for assessing economic burden of injury at the national or international level do not exist. Objective To measure national incidence, medical costs, and productivity losses of medically treated injuries using the most recent data available in the United States, as a case study for similarly developed countries undertaking economic burden analyses. Method The authors combined several data sets to estimate the incidence of fatal and non-fatal injuries in 2000. They computed unit medical and productivity costs and multiplied these costs by corresponding incidence estimates to yield total lifetime costs of injuries occurring in 2000. Main outcome measures Incidence, medical costs, productivity losses, and total costs for injuries stratified by age group, sex, and mechanism. Results More than 50 million Americans experienced a medically treated injury in 2000, resulting in lifetime costs of $406 billion; $80 billion for medical treatment and $326 billion for lost productivity. Males had a 20% higher rate of injury than females. Injuries resulting from falls or being struck by/against an object accounted for more than 44% of injuries. The rate of medically treated injuries declined by 15% from 1985 to 2000 in the US. For those aged 0–44, the incidence rate of injuries declined by more than 20%; while persons aged 75 and older experienced a 20% increase. Conclusions These national burden estimates provide unequivocal evidence of the large health and financial burden of injuries. This study can serve as a template for other countries or be used in intercountry comparisons.

Economic evaluation can help administrators and institutions make informed decisions on how to allocate resources in higher education. This essay describes methods for conducting one type of economic evaluation, benefit–cost analysis, using an example of an existing undergraduate education program, the Freshman Research Initiative at the University of Texas Austin., Institutions and administrators regularly have to make difficult choices about how best to invest resources to serve students. Yet economic evaluation, or the systematic analysis of the relationship between costs and outcomes of a program or policy, is relatively uncommon in higher education. This type of evaluation can be an important tool for decision makers considering questions of resource allocation. Our purpose with this essay is to describe methods for conducting one type of economic evaluation, a benefit–cost analysis (BCA), using an example of an existing undergraduate education program, the Freshman Research Initiative (FRI) at the University of Texas Austin. Our aim is twofold: to demonstrate how to apply BCA methodologies to evaluate an education program and to conduct an economic evaluation of FRI in particular. We explain the steps of BCA, including assessment of costs and benefits, estimation of the benefit–cost ratio, and analysis of uncertainty. We conclude that the university’s investment in FRI generates a positive return for students in the form of increased future earning potential.

Context: There is an established association between the provision of health care services and maternal mortality. Aims: The purpose of this research is to investigate Ecuadorians’ willingness to pay to prevent maternal death and disabilities due to complications of care during childbirth in the context of universal coverage. Methods and Materials: The study elicited a “contingent” market on morbidity and mortality outcomes, specific to Ecuador’s epidemiologic profiles between a hypothetical market that included a 50% reduction in the risk of maternal mortality from 100 to 50 per 100,000, and a market that included a 50% reduction in the risk of maternal morbidity from 4,000 to 2,000 per 100,000. Results: The average amount participants are willing to pay to prevent maternal mortality in the context of universal coverage, was of $176 a year (95% CI=$172, $179). The unadjusted mean WTP for a reduction in the maternal morbidity risk was $135 (95% CI=$132, $139). Translated into Value of statistical Life, participant´s from this study valued the prevention of one statistical maternal death at USD $352,000. Conclusion: Results suggest that the costs of maternal care do not outweigh the benefit of prevention, and that Ecuadorians are willing to pay a significant amount to reduce the risk of maternal mortality. Global Health implications: Reduction of maternal mortality will remain an important global developmental goal in the upcoming years. Having a monetary approximation on the value of these losses may have important implications in the allotting financial and technical resources to reduce it. Key words: Willingness to Pay • Maternal Mortality • Maternal Morbidity • Ecuador • Contingent Valuation Copyright © 2017 Roldos et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

OBJECTIVES To determine the yield of undetected active tuberculosis (TB), TB and human immunodeficiency virus (HIV) coinfection and the number needed to screen (NNS) to detect a case using active case finding (ACF) in an urban community in Kampala, Uganda. METHODS In a door-to-door survey conducted in Rubaga community from January 2008 to June 2009, residents aged ≥15 years were screened for chronic cough (≥2 weeks) and tested for TB disease using smear microscopy and/or culture. Rapid testing was used to screen for HIV infection. The NNS to detect one case was calculated based on population screened and undetected cases found. RESULTS Of 5102 participants, 3868 (75.8%) were females; the median age was 24 years (IQR 20-30). Of 199 (4%) with chronic cough, 160 (80.4%) submitted sputum, of whom 39 (24.4%, 95%CI 17.4-31.5) had undetected active TB and 13 (8.1%, 95%CI 6.7-22.9) were TB-HIV co-infected. The NNS to detect one TB case was 131 in the whole study population, but only five among the subgroup with chronic cough. CONCLUSION ACF obtained a high yield of previously undetected active TB and TB-HIV cases. The NNS in the general population was 131, but the number needed to test in persons with chronic cough was five. These findings suggest that boosting the identification of persons with chronic cough may increase the overall efficiency of TB case detection at a community level.

Programmatic cost analyses of preventive interventions commonly have a number of methodological difficulties. To determine the mean total costs and properly characterize variability, one often has to deal with small sample sizes, skewed distributions, and especially missing data. Standard approaches for dealing with missing data such as multiple imputation may suffer from a small sample size, a lack of appropriate covariates, or too few details around the method used to handle the missing data. In this study, we estimate total programmatic costs for a prevention trial evaluating the Strong African American Families-Teen program. This intervention focuses on the prevention of substance abuse and risky sexual behavior. To account for missing data in the assessment of programmatic costs we compare multiple imputation to probabilistic sensitivity analysis. The latter approach uses collected cost data to create a distribution around each input parameter. We found that with the multiple imputation approach, the mean (95 % confidence interval) incremental difference was $2,149 ($397, $3,901). With the probabilistic sensitivity analysis approach, the incremental difference was $2,583 ($778, $4,346). Although the true cost of the program is unknown, probabilistic sensitivity analysis may be a more viable alternative for capturing variability in estimates of programmatic costs when dealing with missing data, particularly with small sample sizes and the lack of strong predictor variables. Further, the larger standard errors produced by the probabilistic sensitivity analysis method may signal its ability to capture more of the variability in the data, thus better informing policymakers on the potentially true cost of the intervention.

Purpose The Strong African American Families–Teen (SAAF–T) program, a family-centered preventive intervention that included an optional condom skills unit, was evaluated to determine whether it prevented unprotected intercourse and increased condom efficacy among rural African American adolescents. Ancillary analyses were conducted to identify factors that predicted youth attendance of the condom skills unit. Methods Sixteen-year-old African American youths (N = 502) and their primary caregivers were randomly assigned to SAAF–T (n = 252) or an attention control (n = 250) intervention. SAAF–T families participated in a 5-week family skills training program that included an optional condom skills unit. All families completed in-home pretest, posttest, and long-term follow-up interviews during which adolescents reported on their sexual behavior, condom use, and condom efficacy. Because condom use was addressed only in an optional unit that required caregiver consent, we analyzed efficacy using complier average causal effect analyses. Results Attendance in both SAAF–T and the attention control intervention averaged 4 of 5 sessions; 70% of SAAF–T youth attended the condom skills unit. Complier average causal effect models indicated that SAAF–T was efficacious in reducing unprotected intercourse and increasing condom efficacy among rural African American high school students. Exploratory analyses indicated that religious caregivers were more likely than nonreligious caregivers to have their youth attend the condom skills unit. Conclusions Results suggest that brief condom skills educational modules in the context of a family-centered program are feasible and reduce risk for sexually transmitted infections and unplanned pregnancies.

It has been demonstrated that intimate partner violence (IPV) victimization is costly to employers, but little is known about the economic consequences associated with employing perpetrators. This study investigated propensity for partner abuse as a predictor of missed work time and on-the-job decreases in productivity among a small sample of male employees at a state agency ( N = 61). Results suggest that greater propensity for abusiveness is positively associated with missing work and experiencing worse productivity on the job, controlling for level of education, income, marital status, age, and part-time versus full-time employment status. Additional research could clarify whether IPV perpetration is a predictor of decreased productivity among larger samples and a wider variety of workplace settings. Employers and IPV advocates should consider responding to potential IPV perpetrators through the workplace in addition to developing victim-oriented policies and prevention initiatives.

Objectives. We sought to assess the difference in a preference-based measure of health among adults reporting maltreatment as a child versus those reporting no maltreatment. Methods. Using data from a study of adults who reported adverse childhood experiences and current health status, we matched adults who reported childhood maltreatment (n = 2812) to those who reported no childhood maltreatment (n = 3356). Propensity score methods were used to compare the 2 groups. Health-related quality-of-life data (or “utilities”) were imputed from the Medical Outcomes Study 36-Item Short Form Health Survey using the Short Form–6D preference-based scoring algorithm. Results. The combined strata-level effects of maltreatment on Short Form–6D utility was a reduction of 0.028 per year (95% confidence interval=0.022, 0.034; P Conclusions. Persons who experienced childhood maltreatment had significant and sustained losses in health-related quality of life in adulthood relative to persons who did not experience maltreatment. These data are useful for asessing the cost-effectiveness of interventions designed to prevent child maltreatment in terms of cost per quality-adjusted life years saved.

This paper uses longitudinal and nationally representative survey data to investigate the direct relationship between three forms of child maltreatment (neglect, physical abuse, and sexual abuse), and future intimate partner violence (IPV) perpetration in the USA. We further examine the indirect effect that child maltreatment has on future IPV perpetration through the presence of youth violence perpetration, and the roles of socioeconomic factors on committing youth violence and IPV. Analyses indicate that gender differences exist for the developmental relationship between child maltreatment and young adult IPV perpetration, and the effects of socioeconomic factors on youth violence and IPV perpetration. For males, the direct effects of being neglected/physically abused as a child on IPV perpetration are not significant. However, the indirect effects of being neglected/physically abused on IPV perpetration through the presence of youth violence perpetration are significant. For females, the direct effects of being neglected/physically abused on IPV perpetration are significant. The indirect effect of being neglected on IPV perpetration is significant, while the indirect effect of childhood physical abuse is not significant. Childhood sexual abuse is not significantly directly associated with IPV perpetration for females; however, for males, it is the strongest (i.e., largest effect size) direct predictor of IPV perpetration. The indirect effects of childhood sexual abuse on IPV perpetration are not significant for both females and males.

Background Understanding the cycle of violence, from victimization to perpetration across the life span, is critical for designing successful prevention interventions. This study uses a nationally representative sample to examine the developmental relationships among three forms of child maltreatment, youth violence perpetration or victimization, and young adult intimate partner violence (IPV) perpetration or victimization. Methods Data describing self-reported youth violence perpetration (or victimization) from Wave I of the National Longitudinal Study of Adolescent Health (1994–1995) were matched with self-reported IPV perpetration (or victimization) in young adult sexual relationships and retrospective reports of child maltreatment collected during Wave III (2001–2002). Bivariate probit regression models were used to analyze the developmental relationships between child maltreatment, youth violence, and IPV. Analyses were completed in September 2006. Results Compared to nonvictims of child maltreatment, victims of child maltreatment are more likely to perpetrate youth violence (a likelihood increase ranging from −1.2% to 6.6% for females and 3.7% to 11.9% for males) and young adult IPV (an increase from 8.7% to 10.4% for females and from 1.3% to 17.2% for males), although the direct and indirect effects vary by type of child maltreatment experienced. Gender differences exist in the links between child maltreatment, youth violence and IPV, and in the effects of socioeconomic factors on youth violence and IPV. Conclusions Results suggest that it may be important to account for gender differences when designing violence prevention programs, and an integrative approach is critical for stopping the developmental trajectory of violence.

Background: The Georgia Charitable Care Network (GCCN) is a non-profit organization whose primary mission is to foster collaborative partnerships to deliver compassionate health care to low-income, uninsured individuals. Hypertension screening and management is a service provide by 90+ clinics in the GCCN statewide. Methods: With data from N=1661 patients who were screened and treated for hypertension at n=12 clinics in 2013, the impact of hypertension management on blood pressure levels, the incidence of coronary heart disease (CHD) and stroke, and utilization of emergency departments (EDs) were examined. The resulting changes in healthcare utilization were converted to changes in healthcare costs and compared to the expenditures for clinics providing screening and treatment services to the same population over a one-year period. Results: Patients with an initial diagnosis of hypertension or prehypertension experienced average reductions of 10.27 mmHg and 6.32 mmHg in systolic and diastolic blood pressure, respectively, during their follow-up visits. These changes were associated with 32.0% and 44.3% reductions in the relative risk of CHD and stroke, respectively. The savings from this reduction in blood pressure and avoided ED visits for 1661 hypertensive patients produced positive net benefits in 2013 US$, of more than $400,000, with a benefit-cost ratio of 1.6. Conclusions: For every dollar invested in GCCN clinics for hypertension screening and management, there is a benefit to the healthcare system through reduced costs of $1.60. GCCN clinics are a cost-saving delivery model for underserved communities with poor health status and high ED usage.

This study estimated the health and economic burden of child maltreatment in the East Asia and Pacific region, addressing a significant gap in the current evidence base. System- atic reviews and meta-analyses were conducted to estimate the prevalence of child physical abuse, sexual abuse, emotional abuse, neglect, and witnessing parental violence. Population Attributable Fractions were calculated and Disability-Adjusted Life Years (DALYs) lost from physical and mental health outcomes and health risk behaviors attributable to child mal- treatment were estimated using the most recent comparable Global Burden of Disease data. DALY losses were converted into monetary value by assuming that one DALY is equal to the sub-region’s per capita GDP. The estimated economic value of DALYs lost to violence against children as a percentage of GDP ranged from 1.24% to 3.46% across sub-regions defined by the World Health Organization. The estimated economic value of DALYs (in constant 2000 US$) lost to child maltreatment in the EAP region totaled US $151 billion, accounting for 1.88% of the region’s GDP. Updated to 2012 dollars, the estimated economic burden totaled US $194 billion. In sensitivity analysis, the aggregate costs as a percentage of GDP range from 1.36% to 2.52%. The economic burden of child maltreatment in the East Asia and Pacific region is substantial, indicating the importance of preventing and responding to child mal- treatment in this region. More comprehensive research into the impact of multiple types of childhood adversity on a wider range of putative health outcomes is needed to guide policy and programs for child protection in the region, and globally.

Introduction While smoke alarm installation programs can help prevent residential fire injuries, the costs of running these programs are not well understood. Method We conducted a retrospective cost analysis of a smoke alarm installation program in 12 funded communities across four states. Costs included financial and economic resources needed for training, canvassing, installing, and following-up, within four cost categories: (a) personnel, (b) transportation, (c) facility, and (d) supplies. Results Local cost per completed home visit averaged $214.54, with an average local cost per alarm installed of $115.02. Combined state and local cost per alarm installed across all four states averaged $132.15. For every 1% increase in alarm installation, costs per alarm decrease by $1.32. Conclusions As more smoke alarms are installed, the average installation cost per alarm decreases. By demonstrating effective economies of scale, this study suggests that smoke alarm programs can be implemented efficiently and receive positive economic returns on investment.

Summary Objectives: Falls in the older adults are a major public health concern. The growing population of adults 65 years or older, advances in medical care and changes in the costs of care motivated our study of the acute health care costs of fall-related injuries among the older adults in the United States of America. Design and settings: The MarketScan ® Medicare Supplemental database 1998 was used to estimate reimbursed costs for hospital, emergency department (ED), and outpatient clinic treatments for unintentional falls among older adults. Results: A fall on the same level due to slipping, tripping, or stumbling was the most common mechanism of injury (28%). Mean hospitalisation cost was US$ 17,483 (S.D.: US$ 22,426) in 2004 US$. Femur fracture was the most expensive type of injury (US$ 18,638, S.D.: US$ 19,990). The mean reimbursement cost of an ED visit was US$ 236 and US$ 412 for an outpatient clinic visit. Conclusion: The magnitude of the economic and social costs of falls in older adults underscores the need for active research in the field of falls prevention.

Differences in prevalence, injury, and utilization of services between female and male victims of intimate partner violence (IPV) have been noted. However, there are no studies indicating approximate costs of men’s IPV victimization. This study explored gender differences in service utilization for physical IPV injuries and average cost per person victimized by an intimate partner of the opposite gender. Significantly more women than men reported physical IPV victimization and related injuries. A greater proportion of women than men reported seeking mental health services and reported more visits on average in response to physical IPV victimization. Women were more likely than men to report using emergency department, inpatient hospital, and physician services, and were more likely than men to take time off from work and from childcare or household duties because of their injuries. The total average per person cost for women experiencing at least one physical IPV victimization was more than twice the average per person cost for men.

In programs of therapeutic foster care, youth who cannot live at home are placed in a foster home in which foster parents are trained to provide a structured environment for learning social and emotional skills. Youth in the program are monitored at home, in school, and in leisure activity; program personnel work closely with foster parents, and may collaborate with teachers, probation officers, employers, and others in the youth's environment to ensure prosocial learning and behavior. Evaluations have examined the effects of therapeutic foster care on violence among children with severe emotional disturbance and among adolescents with chronic delinquency. Two studies of therapeutic foster care for children with severe emotional disturbance yielded inconsistent results; evidence to date is insufficient to determine effectiveness. Three studies of therapeutic foster care for adolescents with chronic delinquency by one research team indicated that this intervention can reduce subsequent violence in this population. The Task Force on Community Preventive Services (the Task Force) recommends therapeutic foster care for the reduction of violence among adolescents with chronic delinquency.

In early childhood home visitation programs, parents and children are visited at home during the child's first 2 years of life by trained personnel who provide some combination of information, support, or training about child health, development, and care. Home visitation has been used to meet a wide range of objectives, including improvement of the home environment, family development, and the prevention of child behavior problems. The Task Force on Community Preventive Services (the Task Force) has conducted a systematic review of scientific evidence of the effectiveness of early childhood home visitation for preventing violence, with a focus on violence by and against juveniles. The Task Force recommends early childhood home visitation for preventing child abuse and neglect, on the basis of strong evidence of effectiveness. The Task Force found insufficient evidence to determine the effectiveness of early childhood home visitation in preventing violence by visited children, violence by visited parents (other than child abuse and neglect), or intimate partner violence in visited families. This report gives additional information about the findings, including diverse outcome measures and results in study population subsamples, describes how the reviews were conducted, provides information that can help in applying the intervention locally, and recommends additional research.

Background Rising health care costs and limited resources necessitate trade-offs between resources allocated toward prevention and those toward treatment. Information from opinion polls suggests citizens favor spending a higher proportion of all health care dollars on prevention rather than treatment. Objectives To assess the policy implications of willingness to pay (WTP) for use in cost-benefit analysis (CBA) as a method for capturing individual preferences for prevention and treatment in the context of resource allocation decisions. Methods The authors recruited a random sample of 1456 US residents age 18 years and greater by telephone using random-digit dialing. The survey was designed as a 3-stage (phone-mail-phone) process and was conducted between December 1998 and March 1999. For all persons completing the survey (N = 1104), the authors 1st collected respondents’ opinions about the costs and effectiveness of prevention versus treatment programs in general. Half of respondents were then asked to state their WTP for a hypothetical prevention scenario and half were asked to state their WTP for a hypothetical treatment scenario. Both scenarios were specific to the same health context and included an identical reduction in mortality risk. Results WTP for treatment was significantly greater than WTP for prevention, $665 and $223, respectively. Prior opinions on the relative effectiveness afforded by preventive and treatment interventions moderately influenced the WTP estimates for persons randomized to either scenario. Prior opinions on costs had no significant effect on WTP estimates for either scenario. WTP significantly increased with age and household income in the full sample but was not significantly affected by gender or educational attainment. Conclusions The aggregated WTP responses from the prevention and treatment scenarios presented in our study would imply that treatment is more strongly preferred by society than prevention when the health context is the same and benefits of each are held constant. A better understanding is needed of the discrepancy between citizens’ stated preferences for prevention (e.g., through polling) and our findings that they were willing to pay substantially more for treatment than for prevention.

The Guide to Community Preventive Service's methods for systematic reviews were used to evaluate the effectiveness of various approaches to increasing physical activity: informational, behavioral and social, and environmental and policy approaches. Changes in physical activity behavior and aerobic capacity were used to assess effectiveness. Two informational interventions ("point-of-decision" prompts to encourage stair use and community-wide campaigns) were effective, as were three behavioral and social interventions (school-based physical education, social support in community settings, and individually-adapted health behavior change) and one environmental and policy intervention (creation of or enhanced access to places for physical activity combined with informational outreach activities). Additional information about applicability, other effects, and barriers to implementation are provided for these interventions. Evidence is insufficient to assess a number of interventions: classroom-based health education focused on information provision, and family-based social support (because of inconsistent findings); mass media campaigns and college-based health education and physical education (because of an insufficient number of studies); and classroom-based health education focused on reducing television viewing and video game playing (because of insufficient evidence of an increase in physical activity). These recommendations should serve the needs of researchers, planners, and other public health decision makers.

Introduction: Resources for public health (PH) are scarce and policymakers face tough decisions in determining their funding priorities. The difficulty of making these decisions is compounded by current PH accounting systems, which are ill-equipped to link fiscal resources to PH outcomes. This paper examines the types of revenues and expenditures, health services, and health outcomes that are being tracked at the local and state PH levels. The authors provide recommendations for strengthening the ability of local and state governments to link expenditures to PH outcomes, both within and across jurisdictions.Framework and Next Steps: The source of revenue data for most local jurisdictions is the accounting systems used for the budgeting and auditing of fiscal activities, and these are primarily linked to specific PH programs. In contrast, expenditure data are mostly generic and typically span multiple PH programs with no link to specific PH activities. Many challenges exist to then link PH activities to health outcomes data, which are often collected through separate reporting systems at the local, state, and national levels. Policy change at the state level and implementation strategies that are standardized across local health departments are required to assess the costs and health outcomes of PH activities.Conclusion: Information linking PH expenditures to health outcomes of PH services could greatly inform the decision-making process. This information will allow investments in PH to be better understood and will provide a strong foundation for the PH services and systems research community to understand variation and drive improvement. Ultimately, these data could be used to improve accountability at the local and state PH department levels.

In adopting evidence-based practices (EBP), program administrators most frequently focus on program effectiveness. But there is growing recognition of the importance of program cost and of economic analysis for allocating scarce resources for prevention and intervention programs.1 Economic analysis includes the assessment of programmatic costs using a micro-costing approach (precise individual resource valuation) to value the resources required to implement programmatic processes and activities so that programs can be compared to each other.2–5 Differences in program cost are typically driven by differences in program length, staff requirements to implement the program and materials. However, another key source of program cost is the implementation strategy. Program administrators must consider the costs to adopt or implement a program. Translation or implementation science focuses on the processes by which EBP are implemented. Less rigorous implementation procedures often fail to yield implementation with fidelity, which is needed to achieve program outcomes.6 More rigorous strategies are more expensive, but there is evidence that they are needed to achieve implementation with fidelity.7,8 Thus, the consideration of implementation costs is an important area of study. That is, just as intervention scientists have studied how much intervention is needed for behavior change, implementation scientists must study how much implementation is necessary to achieve fidelity. To date, however, few studies have considered costs in implementation research,9 and fewer still have specifically focused on the costs of implementing EBP in the field of child maltreatment (CM) prevention.10 To our knowledge there are no studies that have calculated implementation costs for variants on a model and then related those costs to implementation outcomes. This paper presents a calculation of marginal implementation costs for 2 variants of a training program for the SafeCare® model, an evidence-based parenting model for child maltreatment prevention. SafeCare® has been disseminated to child welfare systems across 20 U.S. states. The SafeCare® dissemination model includes a “train-the-trainer” component in which staff external to the purveyor (the National SafeCare® Training and Research Center [NSTRC]) are trained over time to train local staff. The training of trainers is notoriously difficult and often fails because of the lack of follow-up support.11 In the study reported here, we trained trainers under 2 different models to examine the impact of trainee and client outcomes. A first step in understanding the impact of the 2 models is to calculate marginal cost differences in the 2 training models. The 2 training models differed primarily in their provision of support to new trainers following completion of the train-the-trainer program. Trainers were randomly assigned into 1 of 2 models for training, standard or enhanced. In the “standard” approach, the model includes a 5-day workshop with skill demonstration and proficiency improvement through role-playing activities and live training sessions. The model includes some ongoing support from NSTRC training staff, and in turn, trainers provide some support to the providers they train. The second model, the “enhanced” approach, provided extensive ongoing consultation from NSTRC training staff for 6 months upon completion of the trainer training workshop. In this paper, we present data collected to determine marginal cost differences between the 2 models. Although we do not present data on implementation and client outcomes, this paper serves as an example of how data collection on this topic can be accomplished and how marginal costs are computed.

We investigate the validity of contingent valuation (CV) estimates of the value per statistical life (VSL). We test for sensitivity of estimated willingness to pay (WTP) to the magnitude of mortality-risk reduction and for the theoretically predicted proportionality of WTP to risk reduction using alternative visual aids to communicate risk. We find that WTP is sensitive to the magnitude of risk reduction for independent subsamples of respondents presented with each of three alternative visual aids, but not for the subsample presented with no visual aid. Estimated WTP is consistent with proportionality to risk reduction for the subsamples presented with a logarithmic scale or an array of 25,000 dots, but not for the subsample receiving a linear scale. These results suggest that CV can provide valid estimates of WTP for mortality-risk reduction if appropriate methods are used to communicate the risk change to respondents.

Context: Because human and financial resources are limited, health efforts must focus on prevention strategies that yield the most benefit for the investment. Many current strategies identified in the literature offer opportunities to promote health at a reasonable cost. Objective: To present a literature-based review of evidence demonstrating that prevention can be an effective and wise use of resources through CDC’s An Ounce of Prevention … What Are the Returns? Second Edition. Design: Systematic review of cost-effectiveness literature for a selected group of prevention strategies. Setting: Prevention strategies relevant to the U.S. population. Results: Data indicate that the health conditions considered can be addressed through prevention strategies that are either cost effective or cost saving. Conclusions: An Ounce of Prevention … What Are the Returns? Second Edition can be used to conveniently access information on prevention strategies, the diseases and injuries they address, and their cost effectiveness. It also complements other comprehensive prevention guides. However, limitations of the available cost-effectiveness studies indicate that standardized procedures should be followed for studies of all recommended prevention strategies. Researchers must standardize review procedures to improve both the quality and comparability of studies.