Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, COMMUNITY, Community Health Services Policy

Intervention Description: The aim of this pragmatic cluster quasi-randomised controlled trial was to assess the effectiveness of implementing the Baby-friendly Initiative (BFI) in community health services.

Intervention Results: Women in the intervention group were more likely to breastfeed exclusively compared with those who received routine care: 17.9% vs. 14.1% until 6 months [cluster adjusted odds ratio (OR) = 1.33; 95% confidence interval (CI): 1.03, 1.72; P = 0.03], 41.4% vs. 35.8% until 5 months [cluster adjusted OR = 1.39; 95% CI: 1.09, 1.77; P = 0.01], and 72.1% vs. 68.2% for any breastfeeding until 6 months [cluster adjusted OR = 1.24; 95% CI: 0.99, 1.54; P = 0.06]. The intervention had no effect on breastfeeding until 12 months.

Conclusion: The Baby-friendly Initiative (BFI) in community health services increased rates of exclusive breastfeeding until 6 months.

Study Design: Pragmatic cluster quasi-experimental

Setting: 54 municipalities in six counties (Østfold,Vestfold, NordTrøndelag, Hordaland, Telemark, Finnmark)

Population of Focus: Mothers with infants ≥5 months old at the time of survey, who lived in the study area and had given birth to a singleton infant at ≥ 37 weeks GA with a birth weight ≥ 2000 gm

Data Source: Mother self-report

Sample Size: Intervention (n=1051/990)3 Control (n=981/916)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, COMMUNITY, Community Health Services Policy, Distribution of Promotional Items (Classroom/School), Distribution of Promotional Items (Community), Educational Material

Intervention Description: The intervention consists of three mailings and one brief coaching call delivered by 2-1-1 staff over 6 weeks. Emphasizes establishing a smoke-free home rather than smoking cessation.

Intervention Results: Overall, 40.1% reported creating a full household smoking ban. Among the nonsmoking adults reached at follow-up, days of SHS exposure in the past week decreased from 4.9 to 1.2. Among the 1148 smokers reached for follow-up, 211 people quit, an absolute reduction in smoking of 18.4% (p < .0001), with no differences by gender. Among those reached for 2-month follow-up, the proportion who reported establishing a smoke-free home was comparable to or higher than smoke-free home rates in the prior controlled research studies.

Conclusion: Among those reached for 2-month follow-up, the proportion who reported establishing a smoke-free home was comparable to or higher than smoke-free home rates in the prior controlled research studies.

Study Design: RCTs; 1st was efficacy trial, 2nd was effectiveness trial, 3rd was a generalizability trial, [4th-5th not described in article]

Setting: Telephone counseling for an educational intervention

Population of Focus: 5 2-1-1 centers chosen via competitive applications for a national grants program

Data Source: Participant reports; Tracking Tool for programs to record process of project

Sample Size: 2345 households at five 2-1-1 organizations

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Hospital Policies, POPULATION-BASED SYSTEMS, COMMUNITY, Community Health Services Policy, Provider Training/Education

Intervention Description: To assess the effectiveness of the Baby Friendly Community Initiative (BFCI) on exclusive breast feeding at 6 months.

Intervention Results: The crude rates of exclusive breast feeding at discharge, 3 and 6 months, and of any breast feeding at 6 and 12 months increased at each round of data collection after baseline in the early and late intervention groups. At the end of the project, 10% of infants were exclusively breast fed at 6 months and 38% were continuing to breast feed at 12 months. However, the comparison by adjusted rates and logistic regression failed to show statistically significant differences between groups and rounds of data collection in the intention-to-treat analysis, as well as when compliance with the intervention and training coverage was taken into account.

Conclusion: The study failed to demonstrate an effect of the BFCI on the rates of breast feeding. This may be due, among other factors, to the time needed to observe an effect on breast feeding following this complex intervention.

Study Design: QE: pretest-posttest time-lagged nonequivalent control group

Setting: 18 Local Health Authorities (LHAs) in 9 regions of Italy

Population of Focus: Women living in the area covered by LHA, with infants > 2000g, who spoke Italian, English, French, or Spanish (or who had a relative who spoke these languages), and without a postpartum condition that required admission to the NICU

Data Source: Mother self-report

Sample Size: Early Intervention Group5 • Enrolled (n=2846) • 12-month follow-up (n=2474) Late Intervention Group • Enrolled (n=2248) • 12-month follow-up (n=1931)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Community Health Services Policy, Motivational Interviewing/Counseling, Feedback,

Intervention Description: Contraception consultation combined with in-person brief interventions and motivational interviewing with support from community participants

Intervention Results: The study has shown preliminary success in changing behaviors and impacting how the community views the prevention of alcohol-exposed pregnancies. The CHOICES intervention was found to be acceptable and welcomed by the tribal community, indicating its potential for implementation with other interested populations. The program has demonstrated success in reducing the risk for alcohol-exposed pregnancies among participants, with the majority showing a reduction in risk through behavior changes such as increased use of birth control, reduced alcohol consumption, or a combination of both.

Conclusion: By incorporating community input and making appropriate modifications to the intervention materials, the program has been successful in addressing the issue of alcohol-exposed pregnancies within the American Indian community. The study highlights the importance of community-based participatory research (CBPR) in developing and implementing effective prevention programs. The researchers suggest that future implementation efforts can benefit from the methods and results discussed in the study to sustain and expand this important alcohol-exposed pregnancy prevention program. Overall, the study underscores the significance of primary prevention efforts, such as increasing the utilization of birth control, in reducing the risk of alcohol-exposed pregnancies, particularly among at-risk populations like American Indians

Study Design: The study design involves the modification and implementation of an existing alcohol-exposed pregnancy prevention program, Project CHOICES, to fit the needs and norms of the American Indian community, specifically the Oglala Sioux Tribe.

Setting: Oglala Sioux Tribe community,

Population of Focus: Non-pregnant American Indian women, particularly within the Oglala Sioux Tribe community

Sample Size: Not specified

Age Range: Reproductive age

Intervention Components (click on component to see a list of all articles that use that intervention): Community Health Services Policy, Motivational Interviewing/Counseling, Feedback,

Intervention Description: The intervention included MI counseling techniques, such as reflective listening and open questioning, to encourage participants to decrease binge drinking and/or increase birth control use to reduce the risk of alcohol-exposed pregnancies. The interventionists provided either two or four CHOICES sessions, held approximately 1-2 weeks apart, depending on the site's preference. Participants were given gift card incentives for participating in the intervention sessions and completing follow-up data collection. Additionally, referrals to local health care providers for birth control were provided, and participants were encouraged to make appointments to discuss their birth control options

Intervention Results: The results of the study showed a significant decrease in the risk of alcohol-exposed pregnancies (AEP) among American Indian women enrolled in the program

Conclusion: Even with minor changes to make the CHOICES intervention culturally and linguistically appropriate and the potential threats to program validity those changes entail, we found a significant impact in reducing AEP risk. This highlights the capacity for the CHOICES intervention to be implemented in a wide variety of settings and populations

Study Design: Pre-post intervention design

Setting: Three sites, two located on a reservation and a third that serves American Indian women in an urban setting

Population of Focus: Non-pregnant American Indian women at-risk for alcohol-exposed pregnancies due to binge drinking and being at-risk for unintended pregnancy

Sample Size: 193 women

Age Range: 18-46

Intervention Components (click on component to see a list of all articles that use that intervention): Community Health Services Policy, , COMMUNITY

Intervention Description: To assess the association between the change in statewide smoke-free laws and the rate of preterm or low birth weight delivery hospitalizations.

Intervention Results: Non-Hispanic black mothers had a higher rate of preterm or low birth weight delivery hospitalization than other racial/ethnic groups. Overall, there was no association between the change in smoke-free laws and preterm or low birth weight delivery rate. Among non-Hispanic black mothers, the change in statewide smoke-free laws was associated with a 0.9-1.9 percentage point (P < .05) reduction in preterm or low birth weight delivery rate beginning in the third year after the laws took effect. There was no association among non-Hispanic white mothers. A decline in the black-white disparity of 0.6-1.6 percentage points (P < .05) in preterm or low birth weight delivery rates was associated with the change in state smoke-free laws.

Conclusion: The change in state smoke-free laws was associated with a reduction in racial/ethnic disparities in preterm or low birth weight delivery hospitalizations in selected US states.

Intervention Components (click on component to see a list of all articles that use that intervention): Designated Clinic/Extended Hours, Community Health Services Policy, Public Insurance (Health Care Provider/Practice),

Intervention Description: The intervention described in the study involved granting free access to daytime and out-of-hours general practice services for all children aged younger than 6 years in the Republic of Ireland. This policy change allowed additional children to have free visits to both daytime and out-of-hours care settings, leading to a significant increase in healthcare service utilization among this age group

Intervention Results: In the year after granting of free general practice care for children younger than 6 years, 9.4% more children attended the daytime services and 20.1% more children were seen in the out-of-hours services. Annual number of visits by patients increased by 28.7% for daytime services and by 25.7% for outof-hours services, translating to 6,682 more visits overall. Average visitation rate for children this age increased from 2.77 visits per year to 3.25 visits per year for daytime services, but changed little for out-of-hours services, from 1.52 visits per year to 1.59 visits per year.

Conclusion: Offering free childhood general practice services led to a dramatic increase in visits. This increase has implications for future health care service planning in mixed public and privately funded systems.

Study Design: The study design was a retrospective analysis of electronic health record data before and after the implementation of a policy change.

Setting: Republic of Ireland, specifically in 8 daytime general practice services and their local out-of-hours service called NorthDoc.

Population of Focus: Healthcare providers, policymakers, and researchers interested in healthcare utilization and access to care for children.

Sample Size: The study used anonymized retrospective visit data from general practice electronic health record systems for all 440,000 children aged younger than 6 years in the Republic of Ireland.

Age Range: The age range of the study population was children under 6 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): Community Health Services Policy, Quality Improvement, Screening Tool Implementation,

Intervention Description: The intervention involved universal screening for postpartum depression (PPD) using the Edinburgh Postnatal Depression Scale (EPDS) at multiple obstetric and pediatric practices in Houston, Texas. The EPDS is a 10-item self-report questionnaire that screens for symptoms of PPD. The intervention also included facilitating referrals for evaluation and treatment for women who screened positive for PPD. The study reports that the intervention was designed to increase access to perinatal mental health services. The intervention described in the study aligns with a discernable strategy of universal screening for PPD and facilitating referrals for evaluation and treatment. The study reports that the intervention was based on the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) guidelines for perinatal mental health.

Intervention Results: The study reports that a total of 102,906 screens for postpartum depression (PPD) were completed between May 2014 and July 2018. Of those, 6.3% screened positive for PPD. The obstetric practices completed 18,919 screens, and the pediatric practices completed 83,987 screens. The study also reports that 2,222 referrals were made, with 1,702 (76.6%) completed appointments. The remaining pediatric practices had 4,608 positive screens resulting in 1,390 (30.2%) referrals and 278 (20.0%) completed appointments. The study does not report on the women who received mental health care outside the TCH system.

Conclusion: This project demonstrated that with planning, systems review and trained staff, PPD screening can be integrated into obstetric and pediatric practices and high screening and referral rates can be achieved.

Study Design: The study design/type is a quality improvement project. The project was designed to increase access to perinatal mental health services through universal screening for postpartum depression (PPD) and facilitating referrals for evaluation and treatment, at a multi-site, integrated system of pediatric and obstetric practices in Houston, Texas. The study reports on the results of the project, including the number of screens completed, positive screens identified, referrals made, and appointments completed.

Setting: The study was conducted in an integrated multi-site pediatric and obstetric setting, which includes three hospitals and a Pavilion for Women (PFW) that provides inpatient and outpatient services in obstetric and gynecologic care. The Women’s Place—Center for Reproductive Psychiatry (The Women’s Place) is also located within the PFW and is dedicated to the treatment of women’s mental health

Population of Focus: The target audience for the study is healthcare providers, particularly those working in obstetric and pediatric practices, who are interested in implementing routine screening and referrals for perinatal mood disorders. The study provides a successful model for increasing access to perinatal mental health services in an integrated multi-site setting.

Sample Size: The sample size for the study is not explicitly stated in the given texts. However, the study reports that a total of 102,906 screens for postpartum depression were completed between May 2014 and July 2018, and 6487 (6.3%) of those screens were positive. The study also involved multiple obstetric and pediatric practices in Houston, Texas.

Age Range: The age group is not explicitly stated in the given texts. However, the study involved perinatal mental health services, which typically refers to the period during pregnancy and up to one year postpartum. The study also involved pediatric practices that screened women at the 2 week and 2, 4, and 6-month well-baby visit. Therefore, it can be inferred that the study focused on women who were pregnant or had recently given birth, as well as their infants.

Intervention Components (click on component to see a list of all articles that use that intervention): Community Health Services Policy, COMMUNITY

Intervention Description: We examined associations between implementation of a federal smoke-free housing rule by the New York City Housing Authority (NYCHA) and pediatric Medicaid claims for asthma, lower respiratory tract infections, and upper respiratory tract infections in the early post-policy intervention period.

Intervention Results: In New York City, introduction of a smoke-free policy was not associated with lower rates of Medicaid claims for any outcomes in the early postpolicy period. Exposure to the smoke-free policy was associated with slightly higher than expected rates of outpatient upper respiratory tract infection claims (incidence rate ratio = 1.05, 95% confidence interval: 1.01, 1.08), a result most pronounced among children aged 3-6 years.

Conclusion: Ongoing monitoring is essential to understanding long-term health impacts of smoke-free housing policies.

Intervention Components (click on component to see a list of all articles that use that intervention): Community Health Services Policy, , COMMUNITY, Media Campaign (Print Materials, Radio, TV)

Intervention Description: In this study, our aim was to establish whether the TiRO campaign was followed by a decrease in hospital admissions for childhood asthma and other respiratory conditions related to second-hand smoke exposure across Scotland.

Intervention Results: After TiRO in 2014, we identified a decrease relative to the underlying trend in the slope of admissions for asthma (-0·48% [-0·85 to -0·12], p=0·0096) in younger children (age <5 years), but not in older children (age 5-15 years). Asthma admissions did not change after TiRO among children 0-15 years of age when data were analysed according to area deprivation quintile. Following the 2006 legislation, independent of TiRO, asthma admissions decreased in both younger children (-0·36% [-0·67 to -0·05], p=0·021) and older children (-0·68% [-1·00 to -0·36], p<0·0001), and in children from the most deprived (SIMD 1; -0·49% [-0·87 to -0·11], p=0·011) and intermediate deprived (SIMD 3; -0·70% [-1·17 to -0·23], p=0·0043) area quintiles, but not in those from the least deprived (SIMD 5) area quintile.

Conclusion: Our findings suggest that smoke-free home interventions could be an important tool to reduce asthma admissions in young children, and that smoke-free public space legislation might improve child health for many years, especially in the most deprived communities.