Increasing populations of big game animals are a problem for private landowners in some parts of western North America. Infbrence of big game costs, bunting-related income, noneconomic benefits, size of private land holding, and proportion of total income from agriculture upon landowner management goals as well as perception of damage to forage resources were studied in 1989-1990 using a mail survey of 858 randomly selected soutbwestern Montana landowners. They reported that elk (Cervus canadensis) populations increased, did not change, or decreased on 71%, 25%, or 4% of their private lands, respectively. Similar trends were reported for mule deer (Odocoileus hemionus), whitetail deer (Odocoileus virginio), and antelope (Antilocapra americana). More than 50% of the respondents thought that big game damaged forage and crop yields, while less than 2% of the respondents thought that big game was beneficial to forage and crop yields. Big game consumed a mean of 511 AUMs per private landowner, which contributed to the mean big game cost of S6,353 per Iandowner. Respondents desiring fewer elk, deer, and antelope outnumbered those desiring more by a 4-to-1 margin. As costs of big game increased and as dependency on agricultural income for livelihood increased, respondents desired fewer big game animals and perceived the impact of big game to be more harmful to forage and crop yields. Landowner attitudes toward big game were not significantly affected by economic returns from big game. Although owners with larger land holdings were more likely to allow bunters access to bunt big game, owners of large-and of small-sized ranches generally regarded big game populations similarly. Results from this survey should be useful in forming natural resource policy.

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What is already known about this topic?Interventions focused on patient education, skill-building, and selfmanagement have been shown to be effective in combatting racial disparities in hypertension control. What is added by this report?This study presents results from the implementation of group-based hypertension self-management classes among patients of a federally qualified health center and identifies policy barriers to providing patient education resources.What are the implications for public health practice?Patients can make significant improvements to their blood pressure through continued reinforcement of culturally appropriate key concepts. Health care reimbursement and quality reporting systems should take steps to better encourage and support effective patient education interventions.

Background:The high prevalence of uncontrolled hypertension (systolic blood pressure [SBP] ≥140 mmHg or diastolic blood pressure [DBP] ≥90 mmHg) in Black patients represents a significant racial health disparity in the United States.Aims: This study evaluated the efficacy of a telephone-based strategy for inviting highrisk patients with severe hypertension to weekly self-management education classes.Further, the study assessed how the outreach intervention correlated with relevant quality improvement outcomes, including improved blood pressure and primary care follow-up among our clinic population of Black men with severe hypertension. Methods: A cohort of 265 Black men aged ≥18 years with SBP ≥160 mmHg or DBP ≥100 mmHg at the most recent clinic visit were identified using Epic reports formatted for Federal Uniformed Data Set annual reporting. Telephone outreach was used to invite the cohort to attend weekly in-person classes facilitated by various healthcare professionals. Logistic regression was performed to determine the associations between being reached by phone with (1) class attendance and (2) follow-up appointment attendance. Results: Most of the Black men were single (57.4%, n = 152), 49.1% had history of alcohol or substance use (n = 130), and 35.8% (n = 95) was uninsured. The average age was 55.6 years (SD = 11.6). After controlling for sociodemographic factors, being reached by phone was significantly associated with an increased likelihood of patient attendance at follow-up appointments (OR = 1.91, p = .038) but not with class attendance (OR = 2.45, p = .155). Patients who attended a follow-up appointment experienced significant reductions in both SBP and DBP at 9 months. Linking evidence to action: Telephone outreach was labor-intensive but effective in keeping under-resourced patient populations engaged in primary care. Future work should aim to develop more efficient strategies for engaging high-risk patients in selfmonitoring education to manage hypertension.

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