Public Health Education and Promotion Commons^™

Smokers' Neurological Responses To Novel And Repeated Health Warning Labels (Hwls) From Cigarette Packages, Johann F. Fridriksson, Chris Rorden, Roger D. Newman-Norlund, Brett Froeliger, Jim Thrasher

Faculty Publications

Graphic health warning labels (HWLs) depicting bodily injury due to smoking are effective for producing changes in affect, cognition and smoking behavior in adult smokers. However, little is known about the effects of repeated presentation of graphic HWL’s on the aforementioned processes. The goal of this study was to examine neural and behavioral responses to graphic HWL’s and evaluate whether the repeated presentation of graphic HWL’s leads to repetition suppression (RS). Smokers (N = 16) performed an event-related HWL cue task while blood oxygen level dependent (BOLD) signal was collected during a functional magnetic resonance imaging (fMRI) experimental session. Consistent …

Validity Of The Food Insecurity Experience Scale For Use In Sub-Saharan Africa And Characteristics Of Food-Insecure Individuals, Edwina A. Wambogo, Hala Ghattas Ph.D., Kenneth L. Leonard, Nadine R. Sahyoun

Faculty Publications

Background

The Food Insecurity Experience Scale (FIES) is a UN FAO-Voices of the Hungry project (FAO-VoH) metric of food insecurity (FI). The FAO-VoH tested the psychometric properties of FIES with the use of global 2014 Gallup World Poll (GWP) data. However, similarities in its psychometric structure in sub-Saharan Africa (SSA) to allow aggregation of SSA results were untested.

Objectives

We aimed to 1) assess the validity of FIES for use in SSA, 2) determine the prevalence of FI by country, age group, and gender, and 3) examine the sociodemographic and economic characteristics of individuals with FI.

Methods

The Rasch modeling …

Infant And Young Child Feeding In Emergencies: Organisational Policies And Activities During The Refugee Crisis In Lebanon, Linda Shaker-Berbari, Hala Ghattas Ph.D., Andrew G. Symon, Annie S. Anderson

Faculty Publications

Appropriate infant and young child feeding (IYCF) is key to reducing mortality amongst children aged under 2. Facilitating adherence to recommended IYCF practices during emergencies includes having relevant policies to support breastfeeding and complementary feeding as well as regulating the distribution of breast milk substitutes. In the current crisis, more than 1.2 million Syrian refugees are in Lebanon and it is timely to examine organisational IYCF policies and programmes. One hundred and thirty-five non-governmental organisations providing humanitarian aid in Lebanon were invited to participate in an online survey about organisational policies and programmatic activities on IYCF. Responses were obtained from …

Prostate Cancer Information Available In Health-Care Provider Offices: An Analysis Of Content, Readability, And Cultural Sensitivity, Seul Ki Choi, Jessica S. Seel, Brooks Yelton Ma, Lmsw, Susan E. Steck Phd, Mph, Rd, Douglas P. Mccormick, Johnny Payne, Anthony Minter, Elizabeth K. Deutchki, James Hébert Scd, Daniela B. Friedman Ph.D.

Faculty Publications

Prostate cancer (PrCA) is the most common cancer affecting men in the United States, and African American men have the highest incidence among men in the United States. Little is known about the PrCA-related educational materials being provided to patients in health-care settings. Content, readability, and cultural sensitivity of materials available in providers’ practices in South Carolina were examined. A total of 44 educational materials about PrCA and associated sexual dysfunction was collected from 16 general and specialty practices. The content of the materials was coded, and cultural sensitivity was assessed using the Cultural Sensitivity Assessment Tool. Flesch Reading Ease, …

Disclosure Of Homosexual Behaviors To Healthcare Providers And Uptake Of Hiv Testing For Men Who Have Sex With Men: A Systematic Review., Shan Qiao Ph.D., Guangyu Zhou, Xiaoming Li

Faculty Publications

To promote HIV-testing and offer optimal care for men who have sex with men (MSM), health-care providers (HCPs) must first be aware of their patients’ sexual behaviors. Otherwise, HCPs may overlook MSM’s risks for HIV infection and their special health-care needs. For MSM, reporting their same-sex behaviors to HCPs (disclosure to HCPs) may promote their linkage to HIV prevention and treatment cascade and improve their health outcomes. No literature review has been conducted to examine the relationship between disclosure to HCPs and uptake of HIV-testing among MSM. The current study reviewed and synthesized findings from 29 empirical studies published in …

Best Practices For Developing And Validating Scales For Health, Social, And Behavioral Research: A Primer, Godfred O. Boateng, Torsten B. Neilands, Edward A. Frongillo Jr., Hugo R. Melgar-Quiñonez, Sera L. Young

Faculty Publications

Scale development and validation are critical to much of the work in the health, social, and behavioral sciences. However, the constellation of techniques required for scale development and evaluation can be onerous, jargon-filled, unfamiliar, and resource-intensive. Further, it is often not a part of graduate training. Therefore, our goal was to concisely review the process of scale development in as straightforward a manner as possible, both to facilitate the development of new, valid, and reliable scales, and to help improve existing ones. To do this, we have created a primer for best practices for scale development in measuring complex phenomena. …

Cohort Profile: The Maternal And Infant Nutrition Interventions In Matlab (Minimat) Cohort In Bangladesh, Shams El Arifeen, Eva-Charlotte Ekström, Edward A. Frongillo Jr., Jena Hamadani, Ashraful I. Khan, Ruchira T. Naved, Anisur Rahman, Rubhana Raqib, Kathleen M. Rasmussen, Katarina Ekholm Selling, Yukiko Wagatsuma, Lars Åke Persson

Faculty Publications

No abstract provided.

When Helping Helps: Exploring Health Benefits Of Cancer Survivors Participating In For-Cause Physical Activity Events, Renée M. Umstattd Meyer, Andrew R. Meyer, Cindy Wu, John Bernhart Ph.D., Mph, Ches

Faculty Publications

Background

Over 15.5 million Americans live with cancer and 5-year survival rates have risen to 69%. Evidence supports important health benefits of regular physical activity for cancer survivors, including increased strength and quality of life, and reduced fatigue, recurrence, and mortality. However, physical activity participation among cancer survivors remains low. Cancer organizations provide various resources and support for cancer survivors, including emotional, instrumental, informational, and appraisal support. Many cancer organizations, like the LIVESTRONG Foundation, support the cancer community by sponsoring and hosting for-cause physical activity events, providing opportunities for anyone (including cancer survivors) to “help”/support those living with cancer. The …

Dietary Diversity Predicts The Adequacy Of Micronutrient Intake In Pregnant Adolescent Girls And Women In Bangladesh, But Use Of The 5-Group Cutoff Poorly Identifies Individuals With Inadequate Intake, Phuong Hong Nguyen, Lieven Huybregts, Tina G. Sanghvi, Lan Mai Tran, Edward A. Frongillo Jr., Purnima Menon, Marie T. Ruel

Faculty Publications

Background: The Minimum Dietary Diversity for Women (MDD-W) indicator based on a 10-food group women dietary diversity score (WDDS-10) has been validated to assess dietary quality in nonpregnant women. Little is known about its applicability in pregnant women, and specifically pregnant adolescent girls with higher nutrient requirements. Objectives: This study aimed to 1) compare the adequacy of micronutrient intakes between pregnant adolescent girls and women, 2) examine the performance of WDDS-10 in predicting the mean probability of adequacy (MPA) of 11 micronutrients, and 3) assess how well the MDD-W cutoff of 5 groups performed in pregnant adolescent girls and women. …

Which Type Of Tobacco Product Warning Imagery Is More Effective And Sustainable Over Time?, Dien Anshari, Hua-Hei Yong, Ron Borland, Kamala Swayampakala, Jim Thrasher

Faculty Publications

Objective This study examined smokers’ responses to pictorial health warnings (PHWs) with different types of imagery under natural exposure conditions.

Methods Adult smokers from online panels in Canada (n=2357), Australia (n=1671) and Mexico (n=2537) were surveyed every 4 months from 2012 to 2013. Participants were shown PHWs on packs in their respective countries and asked about: (1) noticing PHWs; (2) negative affects towards PHWs; (3) believability of PHWs; (4) PHW-stimulated discussions; and (5) quit motivation due to PHWs. Country-specific generalised estimating equation models regressed these outcomes on time (ie, survey wave), PHW imagery type (ie, symbolic representations of risk, suffering …

Importance Of Coverage And Quality For Impact Of Nutrition Interventions Delivered Through An Existing Health Programme In Bangladesh, Phuong Hong Nguyen, Edward A. Frongillo Jr., Tina Sanghvi, Sunny S. Kim, Silvia Alayon, Lan Mai Tran, Zeba Mahmud, Bachera Aktar, Purnima Menon

Faculty Publications

Understanding implementation of interventions is critical to illuminate if, how, and why the interventions achieve impact. Alive & Thrive integrated a nutrition intervention into an existing maternal, neonatal, and child health (MNCH) programme in Bangladesh, documenting improvements in women's micronutrient supplement intake and dietary diversity. Here, we examined how well the nutrition intervention was implemented and which elements of implementation explained intervention impact. Survey data were collected in 2015 and 2016 from frontline health workers (FLW) and households in areas randomized to nutrition‐focused MNCH (intensified interpersonal counselling, community mobilization, distribution of free micronutrient supplements, and weight‐gain monitoring) or standard MNCH …

Reducing High-Users’ Visits To The Emergency Department By A Primary Care Intervention For The Uninsured: A Retrospective Study, Meng-Han Tsai, Sudha Xirasagar Mbbs., Ph.D., Scott Carroll, Charles S. Bryan, Pamela J. Gallagher, Kim Davis, Edward C. Jauch

Faculty Publications

Reducing avoidable emergency department (ED) visits is an important health system goal. This is a retrospective cohort study of the impact of a primary care intervention including an in-hospital, free, adult clinic for poor uninsured patients on ED visit rates and emergency severity at a nonprofit hospital. We studied adult ED visits during August 16, 2009-August 15, 2011 (preintervention) and August 16, 2011-August 15, 2014 (postintervention). We compared pre- versus postmean annual visit rates and discharge emergency severity index (ESI; triage and resource use–based, calculated Agency for Healthcare Research and Quality categories) among high-users (≥3 ED visits in 12 months) …

Antenatal Care Satisfaction In A Developing Country: A Cross-Sectional Study From Nigeria, Dumbiri J. Onyeajam, Sudha Xirasagar Mbbs., Ph.D., Mahmud M. Khan, James W. Hardin, Oluwole Odutolu

Faculty Publications

Background

Utilization of Antenatal Care (ANC) is very low in Nigeria. Self-reported patient satisfaction may be useful to identify provider- and facility-specific factors that can be improved to increase ANC satisfaction and utilization.

Methods

Exit interview data collected from ANC users and facility assessment survey data from 534 systematically selected facilities in four northern Nigerian states were used. Associations between patient satisfaction (satisfied, not-satisfied) and patient ratings of the provider’s interactions, care processes, out-of-pocket costs, and quality of facility infrastructure were studied.

Results

Of 1336 mothers, 90% were satisfied with ANC. Patient satisfaction was positively associated with responsive service (prompt, …

Antenatal Care Satisfaction In A Developing Country: A Study From Nigeria, Dumbiri J. Onyeajam, Sudha Xirasagar, Mahmud M. Khan, James W. Hardin, Oluwole Odutolu

Faculty Publications

Background: Utilization of Antenatal Care (ANC) is very low in Nigeria. Self-reported patient satisfaction may be useful to identify provider- and facility-specific factors that can be improved to increase ANC satisfaction and utilization.

Methods: Exit interview data collected from ANC users and facility assessment survey data from 534 systematically selected facilities in four northern Nigerian states were used. Associations between patient satisfaction (satisfied, not-satisfied) and patient ratings of the provider’s interactions, care processes, out-of-pocket costs, and quality of facility infrastructure were studied.

Results: Of 1336 mothers, 90% were satisfied with ANC. Patient satisfaction was positively associated with responsive service (prompt, …

Integrating Nutrition Into Health Systems At Community Level:Impact Evaluation Of The Community‐Based Maternal Andneonatal Health And Nutrition Projects In Ethiopia, Kenya, And Senegal, Jacqueline K. Kung'u, Richard Pendame, Mame Bineta Ndiaye, Mulusew Gerbaba, Sophie Ochola, Adama Faye, Sulochana Basnet, Edward A. Frongillo Jr., Sara Wuehler, Luz Maria De‐Regil

Faculty Publications

Maternal undernutrition and mortality remain high in several African countries. Key nutrition andhealth interventions improve maternal and birth outcomes. Evidence is scarce on how tostrengthen health systems to ensure pregnant women and newborns are reached with theseinterventions. We conducted three quasi‐experimental nonrandomized Community BasedMaternal and Neonatal Health and Nutrition projects in regions of Ethiopia, Senegal, and Kenyato demonstrate how proven nutrition interventions could be integrated into health programs toimprove knowledge and practices during pregnancy, birth, and postpartum. We evaluated impacton knowledge and practices related to maternal and neonatal care using logistic regression andrepeated‐measures models with districts as a fixed variable …

Factors Associated With Quit Attempts And Smoking Cessation In Brazil: Findings From The International Tobacco Control Brazil Survey, Leticia Casado, Jim Thrasher, Cristina Perez, Luiz Claudio Thuler, Geoffrey T. Fong

Faculty Publications

Background:
In Brazil, the treatment of tobacco dependence is available at no cost. This study aimed to identify factors associated with attempting to quit and of successful smoking cessation in a population-based sample of Brazilian smokers.

Methods:
Data came from the first two waves of the International Tobacco Control (ITC) Brazil Survey, conducted in 2009 and 2012/2013 in three cities: Rio de Janeiro, São Paulo, and Porto Alegre. Prospective cohort data were collected from 488 adults (≥18 years) who smoked at Wave 1 who were resurveyed at Wave 2. Crude and adjusted relative risks (RR) for two outcomes (making a …

Sociocultural And Health System Factors Associated With Mortality Among Febrile Inpatients In Tanzania: A Prospective Social Biopsy Cohort Study, Michael E. Snavely, Michael J. Maze, Charles Muiruri, Lilian Ngowi, Flora Mboya, Julia Beamesderfer, Glory F. Makupa, Anthon G. Mwingwa, Bingileki F. Lwezaula, Blandina T. Mmbaga, Venance P. Maro, John A. Crump, Jan Ostermann, Matthew P. Rubach

Faculty Publications

Introduction Communicable diseases are the leading causes of death in Tanzania despite the existence of effective treatment tools. We aimed to assess the sociocultural and health system factors associated with mortality from febrile illness in northern Tanzania.

Methods We interviewed febrile inpatients to determine prevalence of barriers in seeking or receiving care and grouped these barriers using the Three Delays model (delays at home, in transport and at healthcare facilities). We assessed 6-week mortality and, after matching on age, gender and severity of illness, measured the association between delays and mortality using conditional logistic regression.

Results We enrolled 475 children, …

Facilitators And Barriers For Hiv-Testing In Zambia: A Systematic Review Of Multi-Level Factors, Shan Qiao Ph.D., Yao Zhang, Xiaoming Li Ph.D., J. Anitha Menon

Faculty Publications

It was estimated that 1.2 million people live with HIV/AIDS in Zambia by 2015. Zambia has developed and implemented diverse programs to reduce the prevalence in the country. HIVtesting is a critical step in HIV treatment and prevention, especially among all the key populations. However, there is no systematic review so far to demonstrate the trend of HIV-testing studies in Zambia since 1990s or synthesis the key factors that associated with HIVtesting practices in the country. Therefore, this study conducted a systematic review to search all English literature published prior to November 2016 in six electronic databases and retrieved 32 …

Testing Cessation Messages For Cigarette Package Inserts: Findings From A Best/Worst Discrete Choice Experiment, Jim Thrasher, Farahnaz Islam, Rachel E. Davis, Lucy Popova, Victoria Lambert, Yoo Jin Cho, Ramzi G. Salloum, Jordan Louviere, David Hammond

Faculty Publications

This study assessed smokers’ responses to different smoking cessation topics and imagery for cigarette package inserts. Adult smokers from Canada (n = 1000) participated in three discrete choice experiments (DCEs): DCE 1 assessed five cessation benefit topics and five imagery types; DCE 2 assessed five messages with tips to improve cessation success and five imagery types; DCE 3 assessed four reproductive health benefits of cessation topics and four imagery types. In each DCE, participants evaluated four or five sets of four inserts, selecting the most and least motivating (DCEs 1 & 3) or helpful (DCE 2) for quitting. Linear mixed …

Can Integrated Interventions Create The Conditions That Support Caregiving For Better Child Growth?, Purnima Menon, Edward A. Frongillo Jr.

Faculty Publications

No abstract provided.

Teens As Teachers In The Garden: Cultivating A Sustainable Model For Teaching Healthy Living, Virginia Bolshakova, John Gieng, C. Sheena Sidhu, Mary Vollinger, Lorena Gimeno, Jessica Guild

Faculty Publications

School gardens are an ideal space to deliver a healthy living curriculum, such as nutrition and physical activity education, to elementary school youth. However, public schools often lack the resources and support to establish sustainable garden-based programming. We created the Healthy Living Ambassador program, a collaborative after-school garden program in low-income communities that brought together resources from schools, community programs, and University of California Cooperative Extension. This school garden program featured culturally competent teens as teachers to serve as near-peer educators and mentors to elementary school youth. The program development model incorporated lessons from sustainable community-based health program interventions and …

Blood Pressure Self-Monitoring In Pregnancy: Examining Feasibility In A Prospective Cohort Study, Katherine L. Tucker, Kathryn S. Taylor, Carole Crawford, James A. Hodgkinson, Clare Bankhead, Tricia Carver, Elizabeth Ewers, Margaret Glogowska, Sheila M. Greenfield, Lucy Annang Ingram Phd, Lisa Hinton, Khalid S. Khan, Louise Locock, Lucy Mackillop, Christine Mccourt, Alexander M. Pirie, Richard Stevens, Richard J. Mcmanus

Faculty Publications

BACKGROUND: Raised blood pressure (BP) affects approximately 10% of pregnancies worldwide, and a high proportion of affected women develop pre-eclampsia. This study aimed to evaluate the feasibility of self-monitoring of BP in pregnancy in women at higher risk of pre-eclampsia. METHODS: This prospective cohort study of self-monitoring BP in pregnancy was carried out in two hospital trusts in Birmingham and Oxford and thirteen primary care practices in Oxfordshire. Eligible women were those defined by the UK National Institute for Health and Care Excellence (NICE) guidelines as at higher risk of pre-eclampsia. A total of 201 participants were recruited between 12 …

Introduction Of Iodised Salt Benefits Infants’ Mental Development In A Community-Based Cluster-Randomised Effectiveness Trial In Ethiopia, Karim Bougma, Frances E. Aboud, Tizita M. Lemma, Edward A. Frongillo Jr., Grace S. Marquis

Faculty Publications

The effectiveness of salt iodisation in improving the mental development of young children has not been assessed. We implemented a community-based cluster-randomised effectiveness trial in sixty randomly selected districts in the Amhara region of Ethiopia. We randomly allocated each district to treatment and randomly selected one of its villages. In parallel to national salt iodisation efforts, iodised salt was brought early into the markets of the thirty intervention villages before it became widely available in the thirty control villages 4–6 months later. The primary outcome was children’s mental development scores on the Bayley Scales. This was an intention-to-treat analysis using …

Examining The Relationship Between Park Neighborhoods, Features, Cleanliness, And Condition With Observed Weekday Park Usage And Physical Activity: A Case Study, Kerry Hamilton, Andrew T. Kaczynski, Melissa L. Fair, Lucie Levesque

Faculty Publications

Background. Little research has comprehensively explored how park features, quality indicators, and neighborhood environments are associated with observed park usage and physical activity (PA). This case study examined whether weekday park usage and PA differ by neighborhood type, across numerous categories of park features, and according to park feature condition and cleanliness. Methods. Direct observation was used to capture the number of users and PA levels within 143 park features in 6 parks (3 urban, 3 suburban) over the course of six weeks. Audits of park environments assessed the type, condition, and cleanliness of all features and amenities. …

The Association Between Gastro-Oesophageal Reflux Disease And Subsequent Rheumatoid Arthritis Occurrence: A Nested Case–Control Study From Taiwan, Herng-Ching Lin, Sudha Xirasagar, Cha-Ze Lee, Chung-Chien Huang, Chao-Hung Chen

Faculty Publications

Objective Gastro-oesophageal reflux disease (GORD) is a common comorbidity among patients with rheumatoid arthritis (RA). While GORD has been attributed to the antirheumatic medications, no studies of human cohorts have investigated a link between GORD and RA. This study investigates whether GORD is associated with a subsequent RA diagnosis over a 5-year follow-up using a population-based dataset.

Setting Taiwan

Participants We used data from the Taiwan Longitudinal Health Insurance Database. The study group consisted of 13 645 patients with an ambulatory claim showing a GORD diagnosis. We used propensity score matching to select 13 645 comparison patients (one per study …

Examining The Need & Potential For Biomedical Engineering To Strengthen Health Care Delivery For Displaced Populations & Victims Of Conflict, Devika Nadkarni, Imad Elhajj, Zaher Dawy, Hala Ghattas Ph.D., Muhammad H. Zaman

Faculty Publications

Conflict and the subsequent displacement of populations creates unique challenges in the delivery of quality health care to the affected population. Equitable access to quality care demands a multi-pronged strategy with a growing need, and role, for technological innovation to address these challenges. While there have been significant contributions towards alleviating the burden of conflict via data informatics and analytics, communication technology, and geographic information systems, little has been done within biomedical engineering. This article elaborates on the causes for gaps in biomedical innovation for refugee populations affected by conflict, tackles preconceived notions, takes stock of recent developments in promising …

A Mixed-Method Multiple Case Study Of Three Business Models For Local Healthy Food Delivery Systems In Underprivileged Urban Areas, Gretchen Elizabeth Krivak, Garth B. Woodruff, S. Forrest, Hannah Mbungu, Kechler Orcel, Soraya Fish, Sherine R. Brown-Fraser

Faculty Publications

Define a USDA food desert Analyze the three business models for benefits and deficiencies Identify methods for starting a sustainable mobile farmers market program. Over 40% of Berrien County Michigan land use is agricultural. Many products are fruits and vegetables. Yet, the county has six identified USDA defined Food Deserts. Past research, based on a mobile farmers market, confirmed local trends and deficits. The purpose for this research is to define a sustainable business model that delivers healthy local food options to USDA Food Deserts combating food inequity. A mixed method multiple case study was created to test three business …

Evaluation Of Programs To Improve Complementary Feeding In Infants And Young Children, Edward A. Frongillo Jr.

Faculty Publications

Evaluation of complementary feeding programs is needed to enhance knowledge on what works,to document responsible use of resources, and for advocacy. Evaluation is done during program conceptualization and design, implementation, and determination of effectiveness. This paper explains the role of evaluation in the advancement of complementary feeding programs,presenting concepts and methods and illustrating them through examples. Planning and investments for eval-uations should occur from the beginning of the project life cycle. Essential to evaluation is articu-lation of a program theory on how change would occur and what program actions are required for change. Analysis of program impact pathways makes explicit …

College Freshmen Students’ Perspectives On Weight Gain Prevention In The Digital Age: Web-Based Survey, Courtney M. Monroe, Gabrielle Turner-Mcgrievy, Chelsea A. Larsen, Karen Magradey, Heather M. Brandt, Sara Wilcox, Beth Sundstrom, Delia Smith West

Faculty Publications

BACKGROUND: College freshmen are highly vulnerable to experiencing weight gain, and this phenomenon is associated with an increased risk of chronic diseases and mortality in older adulthood. Technology offers an attractive and scalable way to deliver behavioral weight gain prevention interventions for this population. Weight gain prevention programs that harness the appeal and widespread reach of Web-based technologies (electronic health or eHealth) are increasingly being evaluated in college students. Yet, few of these interventions are informed by college students' perspectives on weight gain prevention and related lifestyle behaviors. OBJECTIVE: The objective of this study was to assess college freshmen students' …

Integrating Nutrition Interventions Into An Existing Maternal, Neonatal, And Child Health Program Increased Maternal Dietary Diversity, Micronutrient Intake, And Exclusive Breastfeeding Practices In Bangladesh: Results Of A Cluster-Randomized Program Evaluation, Phuong Hong Nguyen, Sunny S. Kim, Tina Sanghvi, Zeba Mahmud, Lan Mai Tran, Sadia Shabnam, Bachera Aktar, Raisul Haque, Kaosar Afsana, Edward A. Frongillo Jr., Marie T. Ruel, Purnima Menon

Faculty Publications

Maternal undernutrition is a major concern globally, contributing to poor birth outcomes. Limited evidence exists on delivering multiple interventions for maternal nutrition simultaneously. Alive & Thrive addressed this gap by integrating nutrition-focused interpersonal counseling, community mobilization, distribution of free micronutrient supplements, and weight-gain monitoring through an existing Maternal, Neonatal, and Child Health (MNCH) program in Bangladesh. We evaluated the effect of providing nutrition-focused MNCH compared with standard MNCH (antenatal care with standard nutrition counseling) on coverage of nutrition interventions, maternal dietary diversity, micronutrient supplement intake, and early breastfeeding practices. We used a cluster-randomized design with cross-sectional surveys at baseline (2015) …