Department of Health and Wellness Promotion

The demand to connect research findings with clinical practice for patients with substance use disorders has accelerated state and federal efforts focused on implementation of evidence-based practices (EBPs). One unique state driven strategy is Oregon's Evidence-Based Practice mandate, which ties state funds to specific treatment practices. Clinicians play an essential role in implementation of shifts in practice patterns and use of EBPs, but little is understood about how legislative efforts impact clinicians' sentiments and decision-making. This study presents longitudinal data from focus groups and interviews completed during the planning phase (n = 66) and early implementation of the mandate (n = 73) to investigate provider attitudes toward this policy change. Results reflect three emergent themes: (1) concern about retaining individualized treatment and clinical latitude, (2) distrust of government involvement in clinical care, and (3) the need for accountability and credibility for the field. We conclude with recommendations for state agencies considering EBP mandates.

Background:Observational studies and controlled experiments have provided evidence that airborne particulate matter (PM) is capable of acutely increasing blood pressure (BP) in certain scenarios. The goal of this study was to evaluate whether and to what extent obesity and community location affect relationships between fine particulate matter (PM2.5) and blood pressure (BP) measures.Methods:Using data from a stratified random sample survey of adults conducted in 2002–3 in Detroit, Michigan, we tested body mass index (BMI) and waist circumference (WCIR) in separate models as effect modifiers of the relationship between PM2.5 exposure and BP. We also tested interactions with community location. Models were adjusted for covariates with established pro-hypertensive effects.Results:PM2.5 exposure was positively associated with increased pulse pressure (PP) for those categorised as obese (BMI⩾30) across lags 2 (β 4.16, p<0.05) and 3 days (β 2.55, p<0.05) prior to BP measure. WCIR similarly modified the effect of exposure to PM2.5 on PP (β 4.34, p<0.003). The observed effects were enhanced in the community with closer proximity to local emissions of PM2.5, and for residents classified as obese (BMI⩾30) or with WCIR above high-risk cuts points.Conclusions:This community-based study suggests that positive associations between PM2.5 exposure and PP and systolic BP are enhanced in areas proximate to sources of PM 2.5 emissions. These patterns were observed for all residents, but were more visible and consistent among those who were obese. Research is needed to examine the mechanistic pathways by which air particles interact with obesity and location to affect BP, and inform community interventions to reduce the population burden of hypertension and related co-morbidities.