Aim To test the potential benefit of extending cognitive-behavioral therapy (CBT) relative to not extending CBT on long-term abstinence from smoking. Design Two-group parallel randomised controlled trial. Patients were randomized to receive non-extended CBT (n=111) or extended CBT (n=112) following a 26-week open-label treatment. Setting Community clinic in the USA. Participants 219 smokers (mean age: 43 years; mean cigarettes/day: 18). Intervention All participants received 10 weeks of combined CBT + bupropion sustained release (bupropion SR) + nicotine patch and were continued on CBT and either no medications if abstinent, continued bupropion + nicotine replacement therapy (NRT) if increased craving or depression scores, or varenicline if still smoking at 10 weeks. Half of participants were randomized at 26 weeks to extended CBT (E-CBT) through week 48 and half to non-extended CBT (no additional CBT sessions). Measurements The primary outcome was expired CO-confirmed, seven-day point-prevalence (PP) at 52-week and 104-week follow-up. Analyses were based on intention-to-treat. Findings PP-abstinence rates at the 52-week follow-up were comparable across non-extended CBT (40%) and E-CBT (39%) groups [OR 0.99; 95% CI (0.55,1.78)]. A similar pattern was observed across non-extended CBT (39%) and E-CBT (33%) groups at the 104-week follow-up [OR 0.79; 95% CI (0.44,1.40)]. Conclusion Prolonging cognitive-behavioral therapy from 26 to 48 weeks does not appear to improve long-term abstinence from smoking.

Objective: The objective of this study was to investigate how a 1-hour education session that highlights American Heart Association/American Diabetes Association’s Know Diabetes by Heart (KDBH) messaging changed the knowledge and behavioural intention of participants. Design: Single group, quasi-experimental study evaluating the impact of the KDBH education intervention on participants’ knowledge and intentions to engage in risk-lowering behaviours related to the link between diabetes and cardiovascular disease. Setting: A free, 1-hour, synchronously delivered education session was offered through an online platform and facilitated by Cooperative Extension agents. Methods: A pre- and post-Qualtrics survey was used to assess changes in knowledge and intended behaviours. Slides were provided by the American Diabetes Association and tailored for clarification and evaluation purposes. Results: The study included 259 adults with an average age of 54 years (standard deviation [ SD] = 16.67) and 72.97% being 46 years or older. When participants were asked if having type 2 diabetes put them at risk for development of hypertension, unhealthy cholesterol levels, heart attack, or stroke, 84.84% answered correctly at baseline. After session completion, the percentage correct increased to 92.2% ( p = .002). Individual’s knowledge of cardiovascular disease as the leading cause of death for people with type 2 diabetes was assessed; 66.80% answered correctly pre-intervention. After completing the KDBH programme, 95.37% answered correctly ( p = .001). In addition, more than half of those with type 2 diabetes reported intended to adopt several behaviours related to reducing the risk of cardiovascular disease at the completion of the programme. Conclusions: The pilot study indicates successful information transfer in a 1-hour education session focused on chronic disease risks associated with T2DM. Results support the use of synchronous online platforms for diabetes and heart disease information transfer. Future prospective studies measuring sustained knowledge, behaviour adoption and incidence of heart-disease before and after education are needed.

Objective The goals of this study were to determine whether completion of a community-based diabetes self-management support (DSMS) program delivered through a university Cooperative Extension network increased Patient Activation Measure (PAM) scores and to examine predictors of improvement in PAM score in individuals participating in the DSMS. Methods The Health Extension for Diabetes (HED) is a 4-month program delivered via a paraprofessional extension agent in partnership with an established diabetes self-management education and support program. The study population included 148 adults (median age 69 years; interquartile range 60–74 years) with diabetes recruited from local community organizations. Data for the analysis was collected before and after participation in the intervention as part of a longitudinal study, using the PAM and Self-Efficacy for Diabetes instruments. Descriptive statistics were gathered and hypothesis tests and simple and multivariable regression analyses were conducted. Results The mean PAM score increased by 6.58 points, with a 5-point change considered clinically significant. From pre- to post-intervention, PAM scores significantly decreased for 23 participants, decreased for 6, did not change for 14, increased for 21, and significantly increased for 84. Higher pre-intervention PAM scores, younger age, greater educational attainment, and higher baseline self-efficacy scores were associated with increased post-intervention PAM scores when not controlling for potential covariates. Age was no longer associated with higher PAM scores after controlling for covariates. Conclusion Community-based DSMS interventions can be effective in generating positive change in individuals’ activation. HED provides a feasible and accessible DSMS option that addresses key diabetes self-management components while effectively improving individuals’ activation. It is recommended that people living with diabetes attend a DSMS program such as HED to increase their ability to effectively self-manage various components of their chronic condition.

Fewer than 25% of individuals in the United States with hypertension have controlled blood pressure (Centers for Disease Control and Prevention, 2021). Hypertension Management Program (HMP) adopted the Health Coaches for Hypertension Control© (HCHC©) curriculum and adapted it for delivery by Extension agents. Eight lessons with intermittent health coaching calls were delivered. Pre/post-participation surveys determined changes in knowledge and self-reported weight, systolic (SBP), and diastolic blood pressure (DBP). The pandemic forced a shift in methodology from in-person to virtual delivery, and results were compared. In both traditional and virtual programs, significant differences were found in weight, knowledge scores, and SBP from pre- to post-participation. Mean reduction in weight for in-person and virtual programs was 1.9 lb (p = 0.0047) and 3.5 lb (p = 0.043) respectively. Knowledge scores increased significantly for in-person (p = 0.000) and virtual program (p = 0.0006) participants. Mean reduction in SBP of 5.5 mmHg (p = 0.0009) and 1.9 (p = 0.0338) was observed in in-person and virtual participants, respectively. DBP significantly decreased by a mean of 8.5 mmHg (p = 0.0421) for virtual HMP participants and approached significance in traditional programs (decrease of 5.5 mmHg, p = 0.0649). Results suggest that participation in HMP, whether in-person or virtual, could help participants reduce their risk of cardiovascular events through blood pressure self-management.

Background: Given the increasing number of individuals with diabetes who live in settings with limited access to care, new models of care delivery for management of diabetes are critical. Health Extension for Diabetes (HED), a community-based non-clinical diabetes education program delivered by a Health Extension Agent, is based on the AADE7 Self-Care Behaviors for Managing Diabetes. Methods: This intervention is a mixed-methods research study with a primary outcome to reduce/prevent complications associated with diabetes. Goal assessment metrics were selected by clinical, non-clinical and evaluation staff, and resulted in 3 categories: health behaviors, health outcomes, and healthcare utilization. Pre/post analysis of graduates in HED cohorts 1-3 focuses on health behaviors and health outcomes with emphasis on 2 crucial measures, diet and exercise. Pre/post data were compared using Stata 15. Results: Table 1 shows client demographics and the pre/post analysis of several variables collected during evaluation process. Conclusion: Overall, this novel educational diabetes self-management support intervention was found to be effective shown through the short-term outcome measures. This new method increased client physical activity and confidence (self-efficacy) in regard to diabetes management while lowering consumption of sugary beverages. Disclosure C.J. Dietz: None. P. Tilkemeier: None. W.W. Sherrill: None. D.E. McFall: None. M.D. Stancil: None. M.A. Parisi: None. C. Beauchamp: None. H.N. White: None. Funding Greenville Health Authority