Disordered eating behaviors may pose a risk for poor long-term health outcomes in patients with type 1 diabetes (T1D). This cross-sectional study examined relations of disordered eating behaviors with diet quality, diet-related attitudes, and diabetes management in adolescents with T1D (N=151, 48% female). Participants, recruited July 2008 through February 2009, completed 3-day diet records and survey measures, including the Diabetes Eating Problem Survey (DEPS) and measures of eating-related attitudes. Biomedical data were obtained from medical records. Participants scoring >1 SD above the mean DEPS were classified as at-risk for disordered eating. The Healthy Eating Index-2005 was calculated to assess diet quality. ANCOVA was used to test for differences between risk groups in diet quality, eating attitudes, and diabetes management, controlling for age, sex, and BMI percentile. Youth at-risk for disordered eating were more likely to be overweight/obese (59.1% vs. 40.9% p=0.01). The at-risk group had poorer diet quality (p=0.003), as well as higher intake of total (p=0.01) and saturated (p=0.007) fat than the low-risk group. The at-risk group reported lower self-efficacy (p=0.005), greater barriers (p<0.001), and more negative outcome expectations (p<0.001) for healthful eating, as well as worse dietary satisfaction (p=0.004). The at-risk group had lower diabetes adherence (p<0.01), less frequent blood glucose monitoring (p<0.002), and higher HbA1c (p<0.001). The constellation of excess weight, poorer dietary intake, and poorer diabetes management associated with youth at-risk for disordered eating suggests potential risk of future poor health outcomes. Attention should be given to healthful weight management, especially among overweight youth with T1D.

While controlled trials are important for determining the efficacy of public health programs, implementation studies are critical to guide the translation of efficacious programs to general practice. To implement an evidence-based injury prevention program and examine program use and completion rates in two implementation phases, Safe N′ Sound, an evidence-based program, was implemented in five pediatric clinics. Data on program use were collected from program files and patient census data. Program use averaged 12.1% of eligible patients during implementation and 9.5% during the continuation phase. Program completion averaged 9.7% and 6.5%, respectively. Findings from this study can inform the dissemination of evidence-based public health programs, particularly in practice-based clinical settings.

This study identified behavioral and organizational barriers and facilitators related to the implementation of a clinic-based pediatric injury prevention program. Safe N′ Sound (SNS), an evidence-based tailored injury prevention program designed for pediatric primary care, was implemented in five pediatric clinics in North Carolina. Office managers participated in structured interviews; health care providers participated in focus groups. Waiting room observations were conducted in participating clinics. Qualitative data captured perceptions of program implementation, including experience in integrating the program into clinical practice, usage by parents and providers, and recommendations for improving implementation. Reported facilitators of program use included usefulness and likeability of customized materials by parents and physicians and alignment with clinic priorities for injury prevention. Barriers included perceived staff burden despite the program’s low staff requirements. Consequently, practices experienced difficulty integrating the program into the waiting room environment and within existing staff roles. Recommendations included formalizing staff roles in implementation. Waiting room observations supported greater technology maintenance and staff involvement. Findings suggest a dynamic relationship between program implementation and the adopting organization. In addition to considering characteristics of the intervention, environment, and personnel in intervention development, implementation may require customization to the organization’s capacity.

Safe N’ Sound is a computer-based tool that prioritizes key injury risks for toddlers and infants and provides tailored feedback. The program was implemented in 5 pediatric sites. Caregiver risk behaviors were analyzed and compared with corresponding national and state morbidity and mortality data. The priority risks identified were generally consistent with the incidence of injury. Frequencies of several risk behaviors varied across sites and differences were observed across ages. Use of a prioritization scheme may facilitate risk behavior counseling and reasonably result in a decrease in injury mortality or morbidity.