Kristen Hassmiller Lich

Objective: The aim of this study was to bolster strategic guidance offered to state tobacco prevention and control programs by quantifying the relative importance of criteria used in policy prioritization and examining variation in importance across policy environments. Design: A best-worst scaling (BWS) experiment was embedded in a survey. We developed 11 criteria pertinent to decision making among state tobacco prevention and control programs using qualitative interviews, quantified the criteria's relative importance using BWS, and analyzed the data using conditional logit and latent class logit models. Setting: State tobacco control programs. Participants: Qualitative interviews to inform the development of the BWS were conducted with 12 managers of state tobacco prevention and control programs in 2023. The survey and BWS experiment included individuals working in state tobacco control programs and were conducted in 2024 (n = 114/372, 30.6%). Main Outcome Measure(s): Importance scores of decision-making criteria, on average and across latent classes. Results: The BWS included 11 criteria, encompassing data and evidence, logistics and process considerations, and expected policy support. The most important criteria were addressing needs in priority populations, the availability of existing evidence that a policy works, legislative support, and state data showing a gap in outcomes. Importance varied across 2 latent classes: “Idealists” (72%) ranked addressing needs in priority populations first, while “Realists” (28%) ranked legislative support first. Both classes ranked existing evidence as second most important. Conclusions: Tobacco policy priorities are influenced by a range of important criteria, including evidence. There is variation in the drivers of decisions based on context. Findings can help researchers develop new approaches to translate research to individuals working in state tobacco control programs and inform the development of tools to support tobacco policy prioritization.

Objective: The purpose of this study was to use Group Model Building (GMB), a participatory systems thinking method, to build a system structure map of the mobile crisis workforce pipeline in Illinois (IL). Additionally, this study sought to determine if GMB effectively incorporates systems thinking into the mental models of participants. Methods: 14 stakeholders from across the mobile crisis workforce pipeline in IL gathered for a 4.5 hour GMB session, during which various systems thinking activities were performed to elicit the mental models of the workforce from participants. System structure diagrams were face-validated by at least two participants after the session. Moreover, responses to initial and final problem framing surveys were qualitatively dual coded at the level of the primary problem, potential solutions, and the level of the socioecological model associated with the solutions. These codes were compared within participants to determine if participants’ mental models shifted following GMB. Results: The GMB session produced two system structure diagrams, one for each member of the mobile crisis response dyad, that were validated by participants. Furthermore, most participants exhibited change in at least one dimension measured in the problem framing activity. Conclusions: GMB was effectively used to map the mobile crisis workforce pipeline in IL, including multiple feedback loops and multi-layered composite variables. Additionally, the initial and final problem framing activity illustrated the expansion of participant mental models.

Objective : The purpose of this study was to determine factors related to successful completion of peer support specialist training and certification. Methods : This study analyzed enrollment data to study graduation outcomes in 1,164 participants in the Certified Recovery Support Specialist (CRSS) Success Program, an intervention designed to scale up the number of peer specialists in the state by funding tuition and direct supports for students. Exploratory institutional-level binomial regression and grant funding data was used to understand the relationship between funding and graduation rate. Post-graduation survey data from 171 participants was also analyzed with logistic regression to understand factors associated with attempting and passing the peer specialist certification exam. Results : Receiving financial support beyond tuition and receiving academic accommodations were strongly associated with an increased likelihood of graduation, while requiring service supports like counseling or legal assistance decreased this likelihood. Working as a peer specialist during training also significantly boosted the probability of graduation, whereas taking a leave of absence did the opposite. Among graduates, receiving tangible support during their training and having a smaller gap between graduation and attempting the exam were associated with attempting and passing the exam, respectively. Conclusions : Direct supports for students are associated with successful progression through the peer specialist training pipeline. Workforce development programs like the CRSS Success Program can further optimize outcomes by providing additional supports, especially to students at-risk of attrition.

We implemented a centralized colorectal cancer (CRC) screening program with navigation to follow-up colonoscopy for community health center (CHC) patients

Context: Vision Zero (VZ) is a road safety initiative that seeks to address the problem of road fatalities using a Safe System approach, a holistic endeavor embedded in public health principles that seeks to build layers of protection across transportation systems to eliminate road fatalities and serious injuries. Since 2020, a multidisciplinary research team established a statewide collaborative to support communities pursuing VZ initiatives across North Carolina. Program: The North Carolina VZ collaborative “support model” was created to meet the need for community-based, multisector efforts using a Safe System approach. The support model aims to increase community capacity to more effectively build cross-disciplinary coalitions, pool needed resources, and strengthen adaptive leadership skills to reduce roadway fatalities. Implementation: The support model approach is used to engage communities in building skills in cross-sector collaboration, adaptive leadership, and evidence-based safety procedures. This is accomplished through structured monthly touchpoint meetings with small groups of community partners for peer learning, quarterly “all-hands” meetings to coordinate efforts across the state and provide resources, and an annual team-based multiday Leadership Institute. Evaluation: From 2020 to 2025, there was notable growth in community participation, from 7 to 33 communities. Of communities with more than 1 year of participation (n = 19), more than half advanced VZ implementation with communities moving from an exploration stage to an installation (n = 8) or initial implementation (n = 2) stage. In 2023, interviews with partner community leads (n = 15) indicated that partners utilized resources provided, applied skills they learned at the Leadership Institute, benefited from the peer network, and identified opportunities for increasing the benefits of the support model. Discussion: The support model demonstrates a promising practice for increasing capacity building and cross-sector collaboration for road safety initiatives requiring complex systems change such as VZ.

Costs of implementing genomic testing innovations extend beyond the cost of sequencing, affecting personnel and infrastructure for which little data are available. We developed a time and motion (T&M) study within the Clinical Sequencing Evidence‐Generating Research (CSER) consortium to address this gap, and herein describe challenges of conducting T&M studies within a research consortium and the approaches we developed to overcome them. CSER investigators created a subgroup to carry out the T&M study (authors). We describe logistical and administrative challenges associated with resource use data collection across heterogeneous projects conducted in real‐world clinical settings, and our solutions for completing this study and harmonizing data across projects. We delineate processes for feasible data collection on workflow, personnel, and resources required to deliver genetic testing innovations in each CSER project. A critical early step involved developing detailed project‐specific process flow diagrams of innovation implementation in projects' clinical settings. Analyzing diagrams across sites, we identified common process‐step themes, used to organize project‐specific data collection and cross‐project analysis. Given the heterogeneity of innovations, study design, and workflows, which affect resources required to deliver genetic testing innovations, flexibility was necessary to harmonize data collection. Despite its challenges, this heterogeneity provides rich insights about variation in clinical processes and resource implications for implementing genetic testing innovations.

Background: Adoption of colorectal cancer (CRC) screening has lagged in community health center (CHC) populations in the USA. To address this implementation gap, we developed a multilevel intervention to improve screening in CHCs in our region. We used the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide this effort. Here, we describe the use of implementation strategies outlined in the Expert Recommendations for Implementing Change (ERIC) compilation in both the Exploration and Preparation phases of this project. During these two EPIS phases, we aimed to answer three primary questions: (1) What factors in the inner and outer contexts may support or hinder colorectal cancer screening in North Carolina CHCs?; (2) What evidence-based practices (EBPs) best fit the needs of North Carolina CHCs?; and (3) How can we best integrate the selected EBPs into North Carolina CHC systems? Methods: During the Exploration phase, we conducted local needs assessments, built a coalition, and conducted local consensus discussions. In the Preparation phase, we formed workgroups corresponding to the intervention’s core functional components. Workgroups used cyclical small tests of change and process mapping to identify implementation barriers and facilitators and to adapt intervention components to fit inner and outer contexts. Results: Exploration activities yielded a coalition of stakeholders, including two rural CHCs, who identified barriers and facilitators and reached consensus on two EBPs: mailed FIT and navigation to colonoscopy. Stakeholders further agreed that the delivery of those two EBPs should be centralized to an outreach center. During Preparation, workgroups developed and refined protocols for the following centrally-delivered intervention components: a registry to identify and track eligible patients, a centralized system for mailing at-home stool tests, and a process to navigate patients to colonoscopy after an abnormal stool test. Conclusions: This description may be useful both to implementation scientists, who can draw lessons from applied implementation studies such as this to refine their implementation strategy typologies and frameworks, as well as to implementation practitioners seeking exemplars for operationalizing strategies in early phases of implementation in healthcare.

To support implementation of important public health policies, policymakers need information about implementation costs over time and across stakeholder gr

The average U.S. woman wants to have two children; to do so, she will spend about three years pregnant, postpartum, or trying to become pregnant, and three decades trying to avoid pregnancy. However, few studies have examined individual patterns of contraceptive use over time. These trajectories are important to understand given the high rate of unintended pregnancy and how little we know about the complex relationship between contraceptive use, pregnancy intention, and patterns of reproductive behavior. We use data from the 2015–2017 National Survey of Family Growth to examine reproductive behavior and pregnancies across three years of calendar data. We identify seven behavior typologies, their prevalence, how women transition between them, and how pregnancies affect transitions. At any given time, half of women are reliably using contraception. A small proportion belong to a high pregnancy risk profile of transient contraceptive users, but some transition to using condoms or other methods consistently. An unintended pregnancy may initiate a transition into stable contraceptive use for some women, although that is primarily condom use. These findings have important implications for the ways contraception fits into women's lives and how that behavior interacts with relationships, sex, and life stage trajectories.