Effectiveness of a Suicide Prevention Lethal Means Training Program for the General Public

To evaluate the effectiveness of Conversations on Access to Lethal Means for the General Public (CALM-GP), a training for the public focusing on reducing access to lethal means during a crisis. The program adapted Counseling on Access to Lethal Means (CALM), developed for mental health practitioners and physicians. Participants completed pre/post surveys and follow-up surveys three months afterward. Measures included comfort and confidence in talking to a suicidal individual about access to lethal means, the likelihood of follow-up, and the number of lethal means conversations before and after the program. Surveys showed improvement in comfort and confidence talking about safely storing firearms and other lethal means and the likelihood of follow-up with that individual regarding access to lethal means. Results also indicated increased conversations participants had regarding suicide and lethal means at three-month follow-up. This evaluation suggests that CALM-GP is an effective suicide prevention and lethal means program for the public.

Mobility Disability and Exercise: Health Outcomes of an Accessible Community-Based Center

Objective

The purpose of this study was to determine how support and guidance provided by trained professionals during a 12-week, community-based transition exercise program, impact health outcomes and continued engagement in physical activity for persons with a mobility disability (PwMD).

Design

A single arm pre-post design was used.

Setting

Accessible community-based health and wellness center.

Participants

The study included 244 PwMD using a mobility device.

Interventions

Participants completed a 12-week transition exercise program provided through an accessible community facility that provided education and support to complete endurance and strength related exercises as well as programming to encourage transition to self-directed engagement in exercise.

Main Outcome Measures

Bodyweight, BMI, pain, perceived exertion, speed, and distance during cardiovascular fitness testing, and strength were measured pre and post exercise program. The number of participants that signed up for a monthly membership after the program was also monitored.

Results

For the total group, average pain reported over previous 30 days decreased significantly (p < 0.01), current daily pain decreased significantly (p < 0.05), perceived exertion at the end of the 9-min endurance test decreased significantly (p < 0.05), and the four upper extremity strength exercises showed large, significant strength gains (p < 0.01) after the program. There was no significant change in bodyweight, BMI, or speed and distance completed during endurance testing. At the completion of the program, 76% of participants enrolled in a monthly membership at the facility with the intentions to continue to exercise regularly.

Conclusions

This study provides evidence that an accessible community-based exercise program, with a transitional component supported by trained professionals, can support the exercise goals of PwMD and improve strength, decrease pain, and may promote regular exercise adoption for PwMD.

Estimating the incidence of unintended births and pregnancies at the sub-state level to inform program design

Objectives

Unintended (mistimed or unwanted) pregnancies occur frequently in the United States and have negative effects. When designing prevention programs and intervention strategies for the provision of comprehensive birth control methods, it is necessary to identify (1) populations at high risk of unintended pregnancy, and (2) geographic areas with a concentration of need.

Methods

To estimate the proportion and incidence of unintended births and pregnancies for regions in Missouri, two machine-learning prediction models were developed using data from the National Survey of Family Growth and the Missouri Pregnancy Risk Assessment Monitoring System. Each model was applied to Missouri birth certificate data from 2014 to 2016 to estimate the number of unintended births and pregnancies across regions in Missouri. Population sizes from the American Community Survey were incorporated to estimate the incidence of unintended births and pregnancies.

Results

About 24,500 (34.0%) of the live births in Missouri each year were estimated to have resulted from unintended pregnancies: about 25 per 1,000 women (ages 15 to 45) annually. Further, 40,000 pregnancies (39.7%) were unintended each year: about 41 per 1,000 women annually. Unintended pregnancy was concentrated in Missouri’s largest urban areas, and annual incidence varied substantially across regions.

Conclusions

Our proposed methodology was feasible to implement. Random forest modeling identified factors in the data that best predicted unintended birth and pregnancy and outperformed other approaches. Maternal age, marital status, health insurance status, parity, and month that prenatal care began predict unintended pregnancy among women with a recent live birth. Using this approach to estimate the rates of unintended births and pregnancies across regions within Missouri revealed substantial within-state variation in the proportion and incidence of unintended pregnancy. States and other agencies could use this study’s results or methods to better target interventions to reduce unintended pregnancy or address other public health needs.