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Although limited by small sample size, the study found that parents who left geographically diverse weight management clinics/programs reported similar reasons for attrition. Future efforts should include offering alternative visit times, more treatment options, and financial and transportation assistance and exploring family expectations.

IntroductionImproving access to sterile injection equipment is a key component in community-based infectious disease prevention. Implementation of syringe access programs has sometimes been complicated by community opposition and police interference.Case descriptionIn 2006, the Delaware legislature authorized a pilot syringe exchange program (SEP). A program designed to prevent, monitor, and respond to possible policing and community barriers before they had a chance to effect program implementation and operation. A program designed to prevent, monitor, and respond to these barriers was planned and implemented by a multidisciplinary team of legal practitioners and public health professionals.DiscussionWe report on an integrated intervention to address structural barriers to syringe exchange program utilization. This intervention employs community, police and client education combined with systematic surveillance of and rapid response to police interference to preempt the kinds of structural barriers to implementation observed elsewhere. The intervention addresses community concerns and stresses the benefits of syringe exchange programs to officer occupational safety.ConclusionsA cohesive effort combining collaboration with and educational outreach to police and community members based on the needs and concerns of these groups as well as SEP clients and potential clients helped establish a supportive street environment for the SEP. Police-driven structural barriers to implementation of public health programs targeting populations engaged in drug use and other illicit behavior can be addressed by up-stream planning, prevention, monitoring and intervention strategies. More research is needed to inform the tailoring of interventions to address police-driven barriers to HIV prevention services, especially among marginalized populations.

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Objective: This study aimed to examine whether 1-month BMI improvement is predictive of superior 6-and 12-month BMI changes in a national sample of youth in pediatric weight management treatment. Methods: Participants were 4-to 18-year-olds from the Pediatric Obesity Weight Evaluation Registry, a prospective study collecting data from 31 pediatric weight management programs across the United States. Response at 1 month was defined as ≥ 3% BMI reduction; success at 6 and 12 months was defined as ≥ 5% BMI reduction from baseline. Analyses used linear and logistic regression with robust variance estimation. Results: Primary analyses were completed with 687 participants (mean age 12.2 years). One-month responders demonstrated significant improvements in BMI compared with nonresponders at 6 months (BMI, −2.05 vs. 0.05; %BMI, −5.81 vs. 0.23; P < 0.001 for all) and 12 months (BMI, −1.87 vs. 0.30; %BMI, −5.04 vs. 1.06; P < 0.001 for all). The odds of success for 1-month responders were 9.64 (95% CI: 5.85-15.87; P < 0.001) times that of nonresponders at 6 months and 5.24 (95% CI: 2.49-11.02; P < 0.001) times that of nonresponders at 12 months. Conclusions: In treatment-seeking youth with obesity, early BMI reduction was significantly associated with greater long-term BMI reduction. Nonresponders may benefit from early treatment redirection or intensification.