Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Partner-Level Intervention, Technology-Based Support,

Intervention Description: One modifiable risk factor amenable to intervention is partner support. Having women work as a team with their co-parents to meet their breastfeeding goals have been found to improve breastfeeding outcomes. eHealth resources have been found to be accessible and feasible ways to provide breastfeeding education yet, the best way to design breastfeeding interventions for mothers and their co-parents is not known. Couples allocated to the eHealth study condition (SC1) were provided with access to a previously created, publicly available eHealth breastfeeding co-parenting website, which they could access independently throughout the perinatal period. Couples allocated to the Available Resources Only condition were informed that they could assess breastfeeding resources generally available in the community. Among couples randomized to the SC1, information was collected regarding participation in the virtual meeting and use of the eHealth resource which was assessed at all follow-up time points.

Intervention Results: Breastfeeding rates were high in both groups (SC1 63% and SC2 57% ‘exclusive’ 6 months) and (SC1 71% and SC2 78% ‘any’ 12 months) and not statistically significantly different. High scores were found in both groups in secondary outcome measures. Generally available breastfeeding resources were used in both groups with websites being used often and rated as most helpful. SC1 rated the eHealth resource provided to them highly.

Conclusion: The findings suggest both mothers and their co-parents should be targeted in breastfeeding education and web-based resources designed to meet their needs.

Study Design: RCT

Setting: Online

Population of Focus: Expectant women planning to breastfeed for the first time and their co-parents

Sample Size: 113 expectant women and 104 of their co-parents

Age Range: Adults 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Peer Counselor, Telephone Support, Educational Material, PROVIDER/PRACTICE, Community Health Workers (CHWs)

Intervention Description: To assess whether a theory-based, community health worker–delivered intervention for household smokers will lead to reduced secondhand smoke exposure to children in Chinese families.

Intervention Results: Of the 318 families randomized, 98 (60%) of 164 intervention group and 82 (53%) of 154 of controls completed 6-month follow-up assessment. At the 6-month follow-up, 62% of intervention and 45% of comparison group households adopted complete smoking restrictions at home (P = .022); total exposure (mean number of cigarettes per week ± standard deviation) from all smokers at home in the past 7 days was significantly lower among children in the intervention (3.29 ± 9.06) than the comparison (7.41 ± 14.63) group (P = .021); and mean urine cotinine level (ng/mL) was significantly lower in the intervention (0.030 ± .065) than the comparison (0.087 ± .027) group, P < .001). Participants rating of the overall usefulness of the intervention was 4.8 + 0.8 (1 standard deviation) on the 5 point scale (1 not at all and 5 = very useful). Conclusions

Conclusion: The findings of this very first study in China showed that smoking hygiene intervention was effective in reducing children's exposure to secondhand smoke. These findings have implications for the development of primary health care–based secondhand smoke exposure reduction and family oriented smoking cessation interventions as China moves toward a smoke-free society.

Study Design: RCT

Setting: Community (households)

Population of Focus: Smoking parents or caregivers who had a child aged 5 years or younger

Data Source: Health center records and parent selfreport.

Sample Size: 318 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Telephone Support, Peer Counselor

Intervention Description: To examine whether telephone counselling based on the stages of change component of Transtheoretical model of behaviour change together with educational materials could help non-motivated smoking parents of young children to cease.

Intervention Results: A total of 952 smoker fathers and mothers were randomized to the intervention (n = 467) and control (n = 485) groups. Most were daily smokers (92.4%) and the mean number of cigarettes smoked per day was 14.5 (SD = 8.9). By using intention-to-treat analysis, the 7 day point prevalence quit rate at 6 month follow up was significantly greater in the intervention group (15.3%; 68/444) than the control group (7.4%; 34/459) (P < 0.001). The absolute risk reduction was 7.9% (95% confidence interval: 3.78% to 12.01%). The number needed to treat to get one additional smoker to quit was 13 (95% CI: 8-26). The crude odds ratio of quitting was 2.3(95% CI: 1.5-3.5). The adjusted odds ratio was 2.1 (95% CI: 1.4-3.4) (adjusted for age, number of years smoked, and alcohol dependency).

Conclusion: Proactive telephone counselling is an effective aid to promote smoking cessation among parents of young children.

Study Design: RCT

Setting: Community (maternal and child health centers)

Population of Focus: Smoking mothers and fathers with young children aged 5 years

Data Source: 1997 Birth Cohort Study of the Department of Community Medicine, University of Hong Kong.

Sample Size: 952 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Educational Material, Telephone Support, Parent Engagement, Patient Reminder/Invitation

Intervention Description: This study aims to test the acceptability and feasibility of SmokefreeMOM, a national smoking cessation text-messaging program for pregnant smokers.

Intervention Results: Results indicate that the SmokefreeMOM program was highly rated overall and rated more favorably than the control condition in its helpfulness at 3-month follow-up (P<.01) and in its frequency of messaging at both 1-month and 3-month follow-ups (P<.001, P<.01, respectively). Despite the presence of technical problems, the vast majority of intervention participants read all program messages, and few participants unsubscribed from the program. There were no significant differences between groups on the use of extra treatment resources or on smoking-related outcomes. However, at the 3-month follow-up, some outcomes favored the intervention group.

Conclusion: SmokefreeMOM is acceptable for pregnant smokers. It is recommended that SmokefreeMOM be further refined and evaluated.

Study Design: RCT

Setting: Obstetrics-gynecology clinics

Population of Focus: Women who are currently pregnant, English proficient, with a mobile phone and unlimited text messaging, that are currently smoking or smoked in the past 2 weeks

Data Source: Surveys and saliva sample

Sample Size: 99 participants (55 in SmokefreeMOM intervention group and 44 in control group)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, Telephone Support, Parent Engagement, Incentives

Intervention Description: The study aimed to demonstrate the feasibility and acceptability of Quit4baby for women currently enrolled in Text4baby, a perinatal health text messaging program.

Intervention Results: Most participants responded to the program favorably. Highly rated aspects included the content of the program, skills taught within the program, and encouragement and social support provided by the program. Participants reported that the program was helpful in quitting, that the program gave good ideas on quitting, and that they would recommend the program to a friend. Suggestions for improvement included increasing the message dose and making the quitpal more interactive.

Conclusion: This pilot test provides support for the feasibility and acceptability of Quit4baby. Future studies are needed to assess whether Quit4baby is effective for smoking cessation during pregnancy.

Study Design: Single group pre-post test evaluation pilot

Setting: Electronic phone application

Population of Focus: Women over 18 years of age who are currently pregnant, English proficient, that are currently smoking or smoked in the past 2 weeks

Data Source: Telephone surveys, retrospective computer records review of engagement with the technology

Sample Size: 20

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, Parent Engagement, Telephone Support

Intervention Description: The study tests whether an interactive and intensive text messaging program, Quit4baby, can promote smoking cessation for pregnant women already enrolled in a health text messaging program, Text4baby.

Intervention Results: Using an intention-to-treat analysis, 28.80% of the intervention group and 15.79% of the control group reported not smoking in the past 7 days at 1 month (p<0.01), and 35.20% of the intervention group and 22.67% of the control group reported not smoking in the past 7 days at 3 months (p<0.01). Biochemical verification of smoking status at 3 months indicated no significant differences between groups (15.60% in the intervention group and 10.93% in the control group [p=0.13]), although significant differences favoring the intervention were found for older smokers (p<0.05) and for those who enrolled in their second or third trimester of pregnancy (p<0.05). Self-report of late pregnancy 7- and 30-day point prevalence abstinence favored the intervention group (p<0.001, p<0.01). No significant differences were observed at the 6-month follow-up or in the postpartum period.

Conclusion: Results provide limited support of the efficacy of the Quit4baby text messaging program in the short term and late in pregnancy, but not in the postpartum period.

Study Design: RCT

Setting: Electronic phone application

Population of Focus: Women over 14 years of age who are currently pregnant, English proficient, that are currently smoking or smoked in the past 2 weeks, who were signed up for Text4Baby message

Data Source: Surveys and saliva sample

Sample Size: 497

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROFESSIONAL_CAREGIVER, Educational Material (caregiver), Provision of Safe Sleep Item, COMMUNITY, Presentation

Intervention Description: This study assessed the feasibility, acceptability and initial outcomes of Safe Sleep Community Baby Showers for women who speak Spanish. The Safe Sleep Baby Showers use the culture and tradition of celebratory group events to connect pregnant or recently delivered women with perinatal community resources, build social support networks, and learn about the American Academy of Pediatrics (AAP) safe sleep recommendations. The baby showers include a crib demonstration facilitated by a safe sleep instructor or board member from the Kansas Infant Death and SIDS (KIDS) Network. All education and materials are in Spanish, and include a safe sleep PowerPoint presentation and a video on the ABCs of Safe Sleep (alone, back, clutter-free crib; available at KIDSKS.org). For this study, 106 pregnant or recently delivered women who spoke Spanish completed pre- and post-assessments after attending at least one of six Safe Sleep Community Baby Showers held in Sedgwick County, Kansas. Participants who complete the post-assessment received a free safety-approved portable crib and wearable blanket, as well as infant safe sleep education handouts and materials (eg, door hangers) in Spanish.

Intervention Results: Participants had a high school diploma/General Educational Diploma (GED) or less (75.3%), and were uninsured (52.1%) or had Medicaid (n = 49; 33.6%). The majority reported being very satisfied (n = 130; 89.0%) or satisfied (n = 8; 5.5%). Compared to baseline, significant increases in intentions and confidence to follow the AAP Safe Sleep Recommendations were observed following the events. The majority of participants reported intending to place their infant on the back to sleep (98.6%), use only a safe surface (crib, portable crib, bassinet; 99.3%), and only include safe items (firm mattress, fitted sheet; 93.5%) (all p < .001).

Conclusion: Study findings support both feasibility and acceptability of modifying Safe Sleep Community Baby Showers to provide culturally and linguistically appropriate education for women who speak Spanish. Initial outcomes suggest increased intentions to follow safe sleep recommendations.

Setting: Community baby showers in Sedgwick County, Kansas

Population of Focus: Pregnant women and recently delivered mothers

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider)

Intervention Description: To increase primary care providers' use of validated tools for developmental, social/emotional, maternal depression, and domestic violence screening and to increase early awareness of autism symptoms during pediatric well-child visits in children aged 0 to 3 years.

Intervention Results: Percentage of sites screening 85% of children by 12-month well-child visit increased from 0% at baseline to 68.8% at follow-up. Sites not reaching 85% screening screened 48-83% of children at follow-up. Percentage of sites conducting social/emotional screening for 85% of children by 18-month well-child visit increased from 6% at baseline to 46.7% at follow-up. Sites not reaching 85% screening screened 5-81% of children at follow-up. Percentage of sites screening 85% of children by 24-month well-child visit increased from 0% at baseline to 68.8% at follow-up. Sites not reaching 85% screening screened 18-84% of children at follow-up.

Conclusion: The Enhancing Developmentally Oriented Primary Care (EDOPC) project enhanced confidence and intent to screen among a large group of Illinois primary health care providers. Among a sample of primary care sites at which chart reviews were conducted, the EDOPC project increased developmental screening rates to the target of 85% of patients at most sites and increased social/emotional screening rates to the same target rate in nearly half of the participating practices.

Study Design: QE: pretest-posttest

Setting: Primary care medical homes (federally qualified health centers, residency training programs, private practices) primarily in Chicago, Illinois, metropolitan area

Population of Focus: Children ages 4 to 24 months

Data Source: Child medical record

Sample Size: Chart audits at 16 sites (n=25 per site)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Outreach (School Staff), Educational Material (Provider), Patient Navigation,

Intervention Description: The intervention in the study is described as a school-based outreach pilot program aimed at increasing access and participation in State-subsidized health insurance. The specific activities of the intervention include including State-subsidized insurance marketing material in the student registration packet and providing outreach material to develop sustainable strategies for identifying uninsured children and systematically incorporating child health outreach into routine school district operations

Intervention Results: The study's results indicate that the school-based outreach program was effective in identifying uninsured children and facilitating their enrollment in State-subsidized health insurance programs. The outreach efforts resulted in a significant response rate, with a notable number of children enrolled in the program as a result of the intervention. These findings suggest that incorporating health insurance outreach into routine school district operations can be a successful strategy for reaching uninsured children and increasing their access to State-subsidized health insurance

Conclusion: The conclusion of the study suggests that integrating the collection of health insurance status into routine school communication channels is an effective way to identify uninsured children who may be eligible for State subsidized benefits. The research, conducted in Van Buren County, MI, estimates that 70% of the 1,211 uninsured children are eligible for State subsidized health insurance. A survey distributed with free and reduced lunch applications and school registration identified 156 uninsured children, raising questions about the external validity of the research. The study proposes the extrapolation of results to the entire county or even the state, emphasizing the simplicity of the survey and the statewide management of the Free and Reduced Lunch Program. The approach, already successful in several states, could provide a sustainable and everyday method for effective outreach to identify uninsured children. Additionally, the study rejects Ho2, stating there is a statistical difference in the number of applications received from a school-based outreach program during the pilot period. The analysis of application data shows a positive relationship between time and the number of applications received, with a predicted increase of 5.6593 applications in each subsequent period. The model's strength is supported by a relatively strong R² of 77.58%. However, the study acknowledges that 23% of the error remains unexplained, possibly due to factors such as the pilot outreach intervention. The actual number of applications in May 2013 exceeded the predicted range, suggesting factors not accounted for in the model.

Study Design: The study is described as a cross-sectional pilot study designed to employ a school-based outreach effort utilizing existing school communications to identify children who are currently uninsured and may be eligible for State subsidized health insurance.

Setting: State of Michigan schools

Population of Focus: The target audience for the study includes K-12 students and their families, particularly those who are currently uninsured and may be eligible for State subsidized health insurance.

Sample Size: The study identifies 156 children as not having health insurance, representing more than 44% of the 358 children who are eligible for State subsidized health insurance in the participating school districts

Age Range: The age range of the children involved in the study is K-12, which typically includes children between the ages of 5 and 18 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material

Intervention Description: The policy statement endorses the 3rd edition of Caring for Our Children: National Health and Safety Performance Standards for Early Care and Education Programs published in 2011, which provides research-based standards/guidelines on health, safety, and developmental needs for children in out-of-home child care settings. It encourages child care providers, health professionals, state regulators, and the federal government to adopt and implement these standards.

Intervention Results: Of the 21 million U.S. children under 5, nearly half are enrolled in non-parental child care centers or homes, highlighting the importance of health and safety standards in these settings. High-quality child care following developmentally appropriate standards can positively impact school readiness and lifelong outcomes. While states have licensing standards, they tend to be less comprehensive than Caring for Our Children and vary across states. Adopting the enhanced Caring for Our Children standards may increase costs for child care providers but can be offset by improved quality ratings, grants, and potential for higher fees.

Conclusion: APHA endorses and encourages broad adoption of the 3rd edition of Caring for Our Children as the national standard to prioritize health, safety, and developmental needs in out-of-home child care settings. It urges child care providers, health consultants, state administrators/regulators to use these standards and encourages the federal government to support states in improving child care quality by promoting use of Caring for Our Children standards.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Individual Supports, Social Supports, Lactation Consultant

Intervention Description: The current statement updates the evidence for this conclusion and serves as a basis for AAP publications that detail breastfeeding management and infant nutrition, including the AAP Breastfeeding Handbook for Physicians,2 AAP Sample Hospital Breastfeeding Policy for Newborns,3 AAP Breastfeeding Residency Curriculum,4 and the AAP Safe and Healthy Beginnings Toolkit.

Intervention Results: Given the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding, infant nutrition should be considered a public health issue and not only a lifestyle choice. The American Academy of Pediatrics reaffirms its recommendation of exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced, with continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant. Medical contraindications to breastfeeding are rare. Infant growth should be monitored with the World Health Organization (WHO) Growth Curve Standards to avoid mislabeling infants as underweight or failing to thrive. Hospital routines to encourage and support the initiation and sustaining of exclusive breastfeeding should be based on the American Academy of Pediatrics-endorsed WHO/UNICEF “Ten Steps to Successful Breastfeeding.” National strategies supported by the US Surgeon General’s Call to Action, the Centers for Disease Control and Prevention, and The Joint Commission are involved to facilitate breastfeeding practices in US hospitals and communities. Pediatricians play a critical role in their practices and communities as advocates of breastfeeding and thus should be knowledgeable about the health risks of not breastfeeding, the economic benefits to society of breastfeeding, and the techniques for managing and supporting the breastfeeding dyad. The “Business Case for Breastfeeding” details how mothers can maintain lactation in the workplace and the benefits to employers who facilitate this practice.

Conclusion: Research and practice in the 5 years since publication of the last AAP policy statement have reinforced the conclusion that breastfeeding and the use of human milk confer unique nutritional and nonnutritional benefits to the infant and the mother and, in turn, optimize infant, child, and adult health as well as child growth and development. Recently, published evidence-based studies have confirmed and quantitated the risks of not breastfeeding. Thus, infant feeding should not be considered as a lifestyle choice but rather as a basic health issue. As such, the pediatrician’s role in advocating and supporting proper breastfeeding practices is essential and vital for the achievement of this preferred public health goal.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement, Educational Material (Provider)

Intervention Description: Increasing women's access to nonmedical interventions during labor, such as continuous labor support, also has been shown to reduce cesarean birth rates. External cephalic version for breech presentation and a trial of labor for women with twin gestations when the first twin is in cephalic presentation also can contribute to the safe lowering of the primary cesarean delivery rate.

Intervention Results: Variation in the rates of nulliparous, term, singleton, vertex cesarean births also indicates that clinical practice patterns affect the number of cesarean births performed. The most common indications for primary cesarean delivery include, in order of frequency, labor dystocia, abnormal or indeterminate (formerly, nonreassuring) fetal heart rate tracing, fetal malpresentation, multiple gestation, and suspected fetal macrosomia.

Conclusion: Published data indicate that one of the most effective tools to improve labor and delivery outcomes is the continuous presence of support personnel, such as a doula. A Cochrane metaanalysis of 12 trials and >15,000 women demonstrated that the presence of continuous one-on-one support during labor and delivery was associated with improved patient satisfaction and a statistically significant reduction in the rate of cesarean delivery.111 Given that there are no associated measurable harms, this resource is probably underutilized.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Peer Counselor, Educational Material, Home Visits

Intervention Description: To assess the efficacy of peer counseling to promote exclusive breastfeeding (EBF) among low-income inner-city women in Hartford, Conn.

Intervention Results: Significantly more mothers in the control group had not initiated breastfeeding compared to mothers in the intervention group (RR= 2.48; 95% CI: 1.04-5.90)

Conclusion: Well-structured, intensive breastfeeding support provided by hospital and community-based peer counselors is effective in improving exclusive breastfeeding rates among low-income, inner-city women in the United States.

Study Design: RCT

Setting: 3 clinic teams providing prenatal care at the Women’s Ambulatory Health Services Clinic of Hartford Hospital (CT)

Population of Focus: First stage: Recruited mothers attending the prenatal clinic on mornings of 4 predetermined weekdays who were ≥ 18 years old, ≤ 32 weeks gestational age (GA), healthy, and did not have medical conditions likely to impair successful breastfeeding Second stage: Recruited mothers considering breastfeeding who planned to deliver at Hartford Hospital, and to stay in the area for three months after delivery, living in a household earning < 185% of the federal poverty level, and available to be contacted via telephone. Third stage (Postpartum): Recruited mothers free of any medical condition that would prevent her from exclusively breastfeeding with newborns at least 36 weeks GA, weighing ≥ 2500 gm, with no complications requiring treatment in the NICU, and Apgar scores of ≥ 6 at 1 and 5 minutes.

Data Source: Medical records and mother self-report

Sample Size: Randomized • Intervention (n=90) • Control (n=92) Stage 3 Screening After Delivery • Intervention (n=77) • Control (n=85)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Peer Counselor, Educational Material, Telephone Support, PROFESSIONAL_CAREGIVER, Education/Training (caregiver)

Intervention Description: In efforts to improve breeastfeeding rates, WIC established the Breastfeeding peer Counselor program (BFPC) model to improve breastfeeding rates among participants. The Upstate New York WIC BFPC program (UNYWIC BFPC) began with volunteers who provided support to WIC participants referred to BFPC services. The BFPCs completed Loving Support training. BFPC contacts included telephone, in-person (WIC clinic or home), and mailings.

Intervention Results: Mothers who accepted BFPC referrals and had at least 1 phone conversation or in-person contact had a significant 35% to 164% increased odds of positive BF outcomes. Mailings did not significantly improve outcomes.

Conclusion: The Special Supplemental Nutrition Program for Women, Infants, and Children may need to identify barriers to BF duration and implement interventions in communities with low BF rates. Future studies may benefit from evaluating the impact of combined in-person support and phone contacts during the prenatal and postpartum periods on BF outcomes.

Study Design: Secondary data analysis

Setting: The Upstate New York WIC Breastfeeding Peer Counselor program

Population of Focus: WIC-enrolled mothers with live singleton births who accepted a Breastfeeding Peer Counselor program referral

Sample Size: 2,149 mothers

Age Range: 5 day old infants (prenatal and postnatal contact with mothers)

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), Educational Material, Screening Tool Implementation Training

Intervention Description: The document outlines national consensus standards for developing comprehensive, quality systems of care for children and youth with special health care needs (CYSHCN). The standards cover 10 core domains including screening/assessment, eligibility/enrollment, access to care, the medical home model, community-based services, family partnerships, transition to adulthood, health IT, quality assurance, and insurance/financing. Specific structural and process standards are provided for each domain, synthesized from existing frameworks, federal requirements, and input from a national workgroup of experts and stakeholders. The standards are intended for use by state programs, health plans, providers, and others serving CYSHCN.

Intervention Results: The document does not present results per se, but rather provides the full set of consensus-based system standards across the 10 core domains. Detailed standards are outlined related to components like screening processes, care coordination, access to pediatric specialty care, respite care, transition planning, health IT capabilities, quality measurement, and adequate insurance coverage and financing for needed services. Relevant existing national principles, frameworks, federal laws, and quality measures are cited for each domain.

Conclusion: The standards presented are designed to guide national, state and local stakeholders in achieving comprehensive, quality systems of care to improve health outcomes for the CYSHCN population. They are intended to supplement and align with existing federal requirements, evidence-based principles, and quality metrics. The document concludes that consensus around these core system standards is essential as states extend insurance coverage, design benefits, and implement quality initiatives affecting CYSHCN under the Affordable Care Act and other reforms. Widespread application of the standards across systems serving CYSHCN is recommended.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Peer Counselor, Telephone Support

Intervention Description: The objective of this study was to assess whether counseling both mothers and fathers reduces their infants’ exposure to secondhand smoke (SHS).

Intervention Results: The intervention was effective in reducing infant urinary cotinine levels (1-tailed p = .029). There was a greater decrease in the total daily cigarette consumption in the presence of the child in the intervention group compared with the control group, and the differences between the 2 groups were statistically significant (1-tailed p = .03). While the differences between home-smoking bans in the 2 groups were statistically significant (1-tailed p = .049), the differences between car-smoking bans did not reach significance.

Conclusion: Counseling similar to that employed in other countries can reduce infant exposure to SHS, suggesting generalizability.

Study Design: RCT

Setting: Recruited from health centers, intervention face-to-face and telephone

Population of Focus: Nonsmoking children aged less than 1 year, exposed to their fathers’ or mothers’ smoking, and recruited from a health center in southern Tehran

Data Source: Parental self-report and infant urinary cotinine.

Sample Size: 130 children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Person-to-Person Education, Peer Counselor, Motivational Interviewing, Telephone Support, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Consultation (Parent/Family)

Intervention Description: The goals were to describe a smoking cessation intervention, the Tennessee Intervention for Pregnant Smokers program, and examine the impact on quit rates compared to usual care. Additionally we sought to examine reduction in smoking levels and number of quit attempts related to the intervention and finally to examine the impact of the intervention on birth outcomes.

Intervention Results: Over 28% of intervention group women quit smoking, compared to 9.8% in the control group. Two thirds of intervention group women significantly reduced smoking by delivery, with 40%+ attempting to quit at least once. Compared to controls, intervention group women saw significantly better birth outcomes, including newborns weighing 270g more and 50% less likely to have a neonatal intensive care unit admission. Among intervention group participants, those who quit smoking had significantly better birth outcomes than those who did not quit smoking.

Conclusion: Findings point to the potential for appropriately tailored pregnancy smoking interventions to produce substantial improvements in birth outcomes within populations with health disparities.

Study Design: RCT

Setting: Prenatal care clinics

Population of Focus: Pregnant women smokers who receive Medicaid and prenatal care

Data Source: Self-report of smoking behavior, exhaled CO, urine cotinine

Sample Size: 1486

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Incentives

Intervention Description: The Centers for Medicare and Medicaid Services' Meaningful Use (MU) of Electronic Health Record (EHR) Incentive Program could increase rates of smoking assessment and cessation assistance among vulnerable populations. This study examined whether smoking status assessment, cessation assistance, and odds of being a current smoker changed after Stage 1 MU implementation.

Intervention Results: Non-pregnant patients had decreased odds of current smoking over time; odds for all other outcomes increased except for medication orders from 2010 to 2012. Among pregnant patients, odds of assessment and counseling increased across all years. Odds of discussing or ordering of cessation medications increased from 2010 compared with the other 2 study years; however, medication orders alone did not change over time, and current smoking only decreased from 2010 to 2012. Compared with non-pregnant patients, a lower percentage of pregnant patients were provided counseling.

Conclusion: Findings suggest that incentives for MU of EHRs increase the odds of smoking assessment and cessation assistance, which could lead to decreased smoking rates among vulnerable populations. Continued efforts for provision of cessation assistance among pregnant patients is warranted.

Study Design: Quasi experimental cross-sectional (Non- randomized evaluation of a policy change)

Setting: Community health centers (CHC)

Population of Focus: All smokers over 18 years of age with at least one primary care visit to one of the study CHCs in 2010, 2012, or 2014 as well as a subset of pregnant women

Data Source: Electronic health records

Sample Size: Review of health records for 16,802 participants in 2010, 17,631 in 2012 and 18,110 in 2014

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Expert Support (Provider), Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The Vermont Child Health Improvement Program (VCHIP) at the University of Vermont collaborated with state agencies and professional societies to conduct a survey of Vermont pediatric and family medicine practices regarding their developmental screening and autism screening processes, referral patterns, and barriers. The survey was administered in 2009 to 103 primary care practices, with a 65% response rate (89% for pediatric practices, 53% for family medicine practices).

Intervention Results: The survey results revealed that while 88% of practices have a specific approach to developmental surveillance and 87% perform developmental screening, only 1 in 4 use structured tools with good psychometric properties. Autism screening was performed by 59% of practices, with most using the M-CHAT or CHAT tool and screening most commonly at the 18-month visit. When concerns were identified, 72% referred to a developmental pediatrician and over 50% to early intervention. Key barriers to both developmental and autism screening were lack of time, staff, and training. Over 80% of practices used a note in the patient chart to track at-risk children, and most commonly referred to child development clinics, audiology, early intervention, and pediatric specialists.

Conclusion: The survey conducted by VCHIP revealed wide variation in developmental and autism screening practices among Vermont pediatric and family medicine practices. While most practices conduct some form of screening, there is room for improvement in the use of validated tools, adherence to recommended screening ages, and implementation of office systems for tracking at-risk children. The survey identified knowledge gaps and barriers that can be addressed through quality improvement initiatives, which most respondents expressed interest in participating in.

Study Design: QE: pretest-posttest

Setting: Pediatric and family medicine practices in Vermont

Population of Focus: Children up to age 3

Data Source: Child medical record; ProPHDS Survey

Sample Size: Chart audits at 37 baseline and 35 follow-up sites (n=30 per site) Baseline charts (n=1381) - Children 19-23 months (n=697) - Children 31-35 months (n=684) Follow-up charts (n=1301) - Children 19-23 months (n=646) - Children 31-35 months (n=655)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, PROVIDER/PRACTICE, Provider Education, Provider Audit/Practice Audit, Quality Improvement/Practice-Wide Intervention, Designated Clinic/Extended Hours

Intervention Description: Evaluation of a 5-year demonstration project testing a multicomponent (provider, system, and patient) intervention to increase cervical cancer screening among women who receive their health care through the Los Angeles County Department of Health Services, the second largest County Health Department in the nation.

Intervention Results: At the Hospital and Comprehensive Health Center (CHC) levels a statistically significant intervention effect was observed after controlling for baseline screening rates and case mix. No intervention effect was observed at the Public Health Center (PHC) level.

Conclusion: An intensive multicomponent intervention can increase cervical cancer screening in a large, urban, County health system serving a low-income minority population of under screened women.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Los Angeles County Department of Health Services (LACDHS) facilities: 2 large hospitals, 2 feeder Comprehensive Health Centers, and 6 of the health center’s feeder Public Health Centers

Population of Focus: Women attending LACDHS facilities

Data Source: Medical records and computerized databases held by the Los Angeles County Department of Health Services

Sample Size: Total (N=18,642) Intervention (n=9,492); Control (n=9,150) Baseline (n=5,249) Year 2 (n=5,470) Year 3 (n=5,365) First 6 months of Year 4 (n=2,558)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider)

Intervention Description: We modified the Enhancing Developmentally Oriented Primary Care (EDOPC) program to provide a formal curriculum to pediatric residents serving children in distressed neighborhoods.

Intervention Results: Percentage of ASQ screening at 12-month well-child visits increased from 11% at baseline to 100% at follow-up. Percentage of ASQ:SE screening at 18-month well-child visits increased from 0% at baseline to 95% in June 2008 and declined to 58% at last follow-up in Jan 2009. Percentage of ASQ screening at 24-month well-child visits increased from 0% at baseline to 88% at follow-up.

Conclusion: Chart audits 1 year after the intervention demonstrated increased use of screening tools and more referrals to community services. This article will discuss lessons about facilitators and barriers to teaching residents about vulnerable preschool children.

Study Design: QE: pretest-posttest

Setting: University of Chicago Pediatric Residency Program in Chicago, Illinois

Population of Focus: Children ages 6 to 24 months

Data Source: Child medical record

Sample Size: Chart audits - Baseline (n=27 of 50 selected) - Follow-up 1: (n=61 of 100 selected) - Follow-up 2: (n=82 of 100 selected) - Follow-up 3: (n=94 of 100 selected) - Follow-up 4: (n=74 of 100 selected)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Health Insurance Coverage, Access, Educational Material, Targeting Interventions to Focused Groups

Intervention Description: N/A

Intervention Results: Refugees with interrupted healthcare coverage were more likely to have an inadequate USC. Refugees who were young (age 10-19), resettled into the western region of the US, and highly educated were less likely to have an inadequate USC. Refugees with an education level higher than secondary had a significantly lower likelihood of having a severely deficient USC, while refugees with interrupted healthcare were more than twice as likely to have a severely deficient USC.

Conclusion: Considering these results alongside our previous healthcare coverage findings provides a more comprehensive understanding of sociodemographic predictors of poor healthcare access among refugees resettled into the US. This improved understanding has the potential to assist early refugee contacts toward more effective healthcare resource allocation and aid policymakers attempting to improve programs linked to refugee healthcare access.

Study Design: We used multiple binary logistic regression methods to identify sociodemographic predictors of inadequate USCs. In addition, we used multinomial logistic regression to further assess predictors of inadequate USCs with a particular focus on severely deficit USCs (i.e., emergency department dependence and USC absence).

Setting: 2016 Annual Survey of Refugees; United States

Population of Focus: Refugees

Sample Size: 4037

Age Range: 16-75

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Educational Material (Provider), Residents/Medical Students,

Intervention Description: The intervention described by the article to increase postpartum screening was a 15-minute slide presentation with essential topics, including content on antepartum and postpartum depression focusing on signs, symptoms, screening, and treatment as well as antepartum maternal depression education highlighting the importance of understanding health literacy

Intervention Results: The results of the study showed that there was an increase in mean change over time for knowledge, self-efficacy, and motivation among medical and nurse practitioner students. The second null hypothesis was rejected, indicating that there was a significant increase in motivation levels from before to after the intervention. However, there was no significant difference between medical and nurse practitioner students, and student profession did not moderate the outcome effect

Conclusion: An intervention to influence health care students' knowledge, self-efficacy, and motivation for antepartum depression screening can be included in medical and nursing curricula and can also be used with currently practicing health care providers. Doing so could possibly benefit pregnant women by enhancing the antepartum care that they receive.

Study Design: The study design/type is a quasi-experimental study design

Setting: University of South Florida, College of Nursing and College of Medicine

Population of Focus: he target audience for the study was medical and nurse practitioner students who had completed the women's health/obstetric course within the curriculum, had self-identified ability to use the online technology platform/intervention, had access to an Internet-enabled device capable of accessing the online intervention, and were fluent in the English language

Sample Size: The sample size of this study was 71 participants, including 19 medical students and 52 nurse practitioner students

Age Range: The age group of the participants is not explicitly mentioned in the given texts. However, it is stated that medical students tended to be younger than nurse practitioner students

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material

Intervention Description: This study evaluated the effect of MeFirst, an individually tailored, online educational intervention, on HPV vaccine-related knowledge, vaccination intention, and uptake among previously unvaccinated female university students.

Intervention Results: HPV vaccine uptake was similar in both the MeFirst and control groups at 3 months following the intervention (p = 0.98). Three months after the intervention, the proportion of participants with high knowledge regarding HPV vaccination increased from baseline (32% to 50%; p < 0.0001) but the proportion with favorable intention was unchanged.

Conclusion: We found that an individually tailored, online educational tool had similar effects as a nontailored factsheet on HPV-related knowledge, intention to HPV undergo vaccination, and HPV vaccine uptake among previously unvaccinated female university students.

Study Design: RCT

Setting: Online at a Midwestern university

Population of Focus: Full- or part-time female students with no prior receipt of any doses of the HPV vaccine and who were invited via email to participate

Data Source: Online surveys distributed via email

Sample Size: Total Baseline (n=661)  Intervention (n=330)  Control (n=331) Total Follow-up (Analysis) (n=332)  Intervention (n=175)  Control (n=157)

Age Range: 18-26

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Home Visit (caregiver), Educational Material (caregiver), Oral Health Product, Patient Navigation (Assistance), PROVIDER/PRACTICE, Outreach (Provider), Education/Training (caregiver)

Intervention Description: The aim of this study was to determine the effect of a dental care coordinator intervention on increasing dental utilization by Medicaid-eligible children compared with a control group.

Intervention Results: Dental utilization during the study period was significantly higher in the intervention group (43 percent) than in the control group (26 percent). The effect was even more significant among children living in households well below the Federal Poverty Level. The intervention was effective regardless of whether the coordinator was able to provide services in person or via telephone and mail.

Conclusion: The dental care coordinator intervention significantly increased dental utilization compared with similar children who received routine Medicaid member services. Public health programs and communities endeavoring to reduce oral health disparities may want to consider incorporating a dental care coordinator along with other initiatives to increase dental utilization by disadvantaged children.

Study Design: RCT

Setting: Jefferson County in Louisville, KY

Population of Focus: Children aged 4-15 years who currently or for 2 years prior had Medicaid insurance but have not had Medicaid dental claims filed for the previous 2 years

Data Source: Medicaid claims

Sample Size: Intervention (n=68) Control (n=68)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: This study investigates the experiences of women using a social media Facebook group for breastfeeding support and attempts to explore whether it has aided in extended breastfeeding success. In addition, it aims to explore the value of social cognitive theory (SCT) in explaining these experiences. Qualitativ, audio-recorded, semi-structured interviews were conducted from eight women who were members of a private Facebook group.

Intervention Results: A number of themes were identified from the women's experiences, with analysis uncovering the superordinate theme 'increased self-efficacy' which provided an understanding of how the group impacted women's experiences and aided them in breastfeeding success. The sub-themes of education, accessibility, online community, normalization, and extended goals provided a more detailed understanding of how self-efficacy was increased through group membership.

Conclusion: The symbiotic relationship between members of a social media group facilitates greater breastfeeding success and a longer duration of breastfeeding through the central concept of the SCT: reciprocal determinism. Therefore, it is posited that the SCT is a suitable theory of behaviour change which can potentially be used to develop interventions aiming to increase breastfeeding rates and duration.

Study Design: Qualitative study (exploratory, deductive approach)

Setting: Social media platform: Private Facebook group

Population of Focus: Women who were members of a private Facebook group

Sample Size: 8 women

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Educational Material, Referrals,

Intervention Description: To determine whether participation in a home visiting program increases and expedites utilization of early intervention services for suspected developmental delays. Methods Children participating in Every Child Succeeds (ECS), a large home visiting (HV) program serving greater Cincinnati, between 2006 and 2012, were propensity score matched to a sample of children identified from birth records who did not receive services from ECS. Data were linked to early intervention (EI) data acquired from the Ohio Department of Health.

Intervention Results: Among 3574 HV and 3574 comparison participants, there was no difference in the time to EI service utilization; however a higher percentage of HV participants accessed services. Overall, 6% of the HV group and 4.3% of the comparison group accessed services (p = 0.001). Modeling revealed an odd ratio = 1.43 [95% confidence interval (CI) 1.16-1.78, p value = 0.001] and hazard ratio = 1.42 [95% CI 1.15-1.75, p value = 0.001]. Differences in utilization were greatest directly after birth and between approximately 2 and 3 years.

Conclusion: Participation in home visiting was associated with greater utilization of EI services during two important developmental time points, demonstrating that home visiting may serve as an important resource for facilitating access to early intervention services.

Study Design: Retrospective Cohort Study

Setting: Every Child Succeeds (ECS) program in the Greater Cincinnati area in Ohio

Population of Focus: Children and families involved in the Every Child Succeeds (ECS) home visiting program in the Greater Cincinnati area between 2006 and 2012

Sample Size: Matched cohort of 7,148 families (3,574 families participating in the Every Child Succeeds (ECS) home visiting program in comparison with 3,574 families identified from birth records who did not receive services from ECS)

Age Range: Infants and children ages 0-3 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER, Training/Education, PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: A quality improvement project was implemented at a pediatric primary care practice to improve screening for infant safe sleep practices. The screening form was updated to include questions from the Pregnancy Risk Assessment Monitoring System (PRAMS) that better capture actual sleeping practices and allow for a more targeted response from providers. Based on individual survey responses, the providers offered and documented their specific educational feedback. Any changes/improvements reported during a 2-week callback were also documented. Study participation was encouraged by offering a chance to win a $50 Amazon gift card and a free board book, Sleep Baby, Safe and Snug, covering the basics of safe sleep in a format that can be read to the child (Charlie's Kids Foundation, 2017).

Intervention Results: This updated screening better captured actual sleeping practices, allowing for more targeted education.

Conclusion: This article describes a quality improvement project implemented at a pediatric primary care practice to improve screening for infant safe sleep.

Setting: A single pediatric primary care practice

Population of Focus: Parents/caregivers of infants 0-6 months

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Person-to-Person Education, Motivational Interviewing, Other Education, Intensive Therapy, Peer Counselor

Intervention Description: This report describes tobacco use prevalence among perinatal smokers identified through an "opt-out" inpatient smoking cessation clinical service.

Intervention Results: Between February 2014 and March 2016, 533 (10%) current and 898 (16%) former smokers were identified out of 5649 women admitted to the perinatal units. Current smokers reported an average of 11 cigarettes per day for approximately 12 years. Only 10% reported having made a quit attempt in the past year. The majority of smokers (56%) were visited by a bedside tobacco cessation counselor during their stay and 27% were contacted through the IVR system. Those counselled in the hospital were twice as likely (RR 1.98, CI 1.04-3.78) to be abstinent from smoking using intent-to-treat analysis at any time during the 30 days post-discharge.

Conclusion: This opt-out service reached a highly nicotine-dependent perinatal population, many of whom were receptive to the service, and it appeared to improve abstinence rates post-discharge. Opt-out tobacco cessation services may have a significant impact on the health outcomes of this population and their children.

Study Design: Quasi experimental cross sectional evaluation

Setting: Academic medical center

Population of Focus: Smokers admitted to the perinatal units

Data Source: In-patient records and follow up phone surveys

Sample Size: 5649

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): Technology-Based Support, Educational Material, PATIENT_CONSUMER

Intervention Description: 1) Determine if using the Mother’s Milk Messaging™ app improved aspects of breastfeeding and breastfeeding rates and 2) Describe engagement as well as themes from the qualitative feedback on the app.

Intervention Results: There were a total of 346 participants in the trial, with 227 in the Intervention (n = 154 group 1 and n = 156 group 2) and 119 in the control group. Because of minimal Facebook activity, the two intervention groups 1 and 2 were combined. There were no differences in breastfeeding exclusivity and duration. (NS). Women in the intervention arm reported significantly higher confidence with breastfeeding and perceived social support to the control group (p < .05). Greater than 80% registered the app and those that engaged with the app had higher scores with time. Mothers appreciated receiving text messages and videos with reliable information. No harm was reported in this study.

Conclusion: MMM increased confidence with breastfeeding and with gathering social supports. Exclusively BF was high in all participants. Mothers perceived it as useful and dependable especially the texting.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education

Intervention Description: Six hundred thirteen women of Mexican origin in 3 treatment sites were randomized among 4 study arms: the full AMIGAS program with a video and a flip chart (n = 151), the AMIGAS program without the video (n = 154), the AMIGAS program without the flip chart (n = 155), and a usual care control group (n = 153). Six months after enrollment, women were surveyed and reported whether or not they had been screened.

Intervention Results: Women in any of the intervention arms were statistically significantly more likely to report being screened than those in the usual care group in both an intent-to-treat analysis and a per-protocol analysis. In the intent-to-treat analysis, 25% of women in the control group and 52% in the full AMIGAS program group reported having had Pap tests (P < .001); in the per-protocol analysis, the percentages were 29% and 62%, respectively (P < .001).

Conclusion: AMIGAS was effective in increasing Pap test screening among women of Mexican descent when used in a 1-to-1 setting. Future research should compare the 1-on-1 intervention with the group-based intervention.

Study Design: RCT: pretest-posttest

Setting: El Paso, TX; Houston, TX; and Yakima Valley, WA

Population of Focus: Mexican women with no Pap smear reported in the past 3 years

Data Source: Self-report and validated through medical records review

Sample Size: Intent-to-Treat Analysis (n=613) Intervention Group 1 (n=151); Intervention Group 2 (n=154); Intervention Group 3 (n=155); Control (n=153) Per-Protocol Analysis (n=513) Intervention Group 1 (n=128); Intervention Group 2 (n=125); Intervention Group 3 (n=127); Control (n=133)

Age Range: ≥21

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Motivational Interviewing/Counseling, PATIENT/CONSUMER, Motivational Interviewing, Educational Material, Pharmacotherapy (Nicotine), Educational Material (caregiver), Telephone Support

Intervention Description: In this randomized controlled trial, we tested a tobacco control intervention in families and specifically evaluated a tailored cessation intervention for the parents and/or caregivers (Ps/Cs) who were smokers while their children were simultaneously enrolled in tobacco prevention.

Intervention Results: Intervention group showed a larger increase in self-reported smoking abstinence over time than the control group. For cotinine, the intervention group showed a decrease from baseline and then maintenance through year 4, whereas the control group showed increases from baseline.

Conclusion: This study provides evidence that tailored cessation offered to Ps/Cs in their children’s schools during their children’s enrollment in tobacco prevention may contribute to more robust success in P/C cessation and a reduction of tobacco smoke exposure in children.

Study Design: 2-group RCT with repeated measures

Setting: Elementary school-based recruitment; Face-to-face or telephone motivational interviewing sessions

Population of Focus: Elementary schools with high enrollment percentages of African American children in fourth grade across 5 counties in a Southeastern state

Data Source: Parent and caregiver self-report, biochemical measures (saliva cotinine and exhaled carbon monoxide)

Sample Size: 453 parents and or caregivers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: This study evaluated the effectiveness of behavioral skills training (BTS) to teach safe infant sleep practices to “typically developing adults.” The BTS included instruction, modeling of safe sleep practices, rehearsal, and feedback. Prior to the training, participants received a folder with pamphlets, including one on safe sleep, found through the NJ Department of Health. The study included an evaluation of participant responses to both safe and unsafe infant sleeping practices before, during, and after training.

Intervention Results: BST significantly improved appropriate arrangement of a safe sleep environment for infants for all 8 participants.

Conclusion: Replications are necessary to demonstrate effective BST procedures under the most relevant circumstances, which could result in manualized trainings used to teach healthcare personnel and parents across a number of training sites (e.g., hospitals, private clinics, public support programs). Perhaps discharge policies could include safe arrangement of an infant sleep environment similar to requiring an appropriate car seat for a newborn prior to discharge.

Setting: Private suburban university

Population of Focus: College students

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material,

Intervention Description: The intervention included various tools such as brochures, posters, online training for providers, and a video game for preteens. The goal was to increase communication and education about the HPV vaccine among preteens, parents, and healthcare providers.

Intervention Results: The intervention had a positive impact on HPV vaccine initiation and completion rates among preteens, with higher rates in the intervention group compared to the comparison group. The intervention also had a greater impact on males and older preteens.

Conclusion: The communication intervention was effective in increasing HPV vaccination rates among preteens, and can serve as a model for other primary care practices.

Study Design: Quasi-experimental study with intervention and comparison groups

Setting: Primary care practices in North Carolina, USA

Population of Focus: Preteens (ages 11-13), parents, and healthcare providers

Sample Size: 147,294 individuals in NCIR who were listed as active patients in the practices eligible to participate in the Protect Them intervention

Age Range: 11-13 years old

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Peer Counselor, Educational Material, Group Education, Home Visits, Telephone Support

Intervention Description: Evaluated the single and combined effects of introducing a motivational video and peer counseling into four matched WIC clinics on breastfeeding initiation and continuation at 7-10 days among African-American WIC participants.

Intervention Results: Significant differences in the percentage of women initiating breastfeeding in the video (50%), peer counselor (62%), and video + peer counselor (52%) groups vs control group (26%)

Conclusion: Overall, trends toward a positive impact of the breastfeeding promotion activities were evident but weak, and largely gone by 7-10 days postpartum.

Study Design: Cluster RCT

Setting: 4 WIC clinics in Baltimore, MD

Population of Focus: WIC eligible African American women starting prenatal care < 24 GA, with a singleton pregnancy, planning to keep the baby and stay in the clinic’s catchment area

Data Source: Mother self-report

Sample Size: Video (n=64) • Peer Counselor (n=55) • Video + Peer Counselor (n=66) • Control (n=57)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: The support offered to mothers after hospital discharge can be decisive in maintaining exclusive breastfeeding during the first 6 months post-partum. The objective of this study was to assess the impact on the duration of exclusive breastfeeding of a participatory intervention using an online social network--Facebook. A randomized clinical trial was performed involving 251 mother–child pairings in a university hospital in the Northeast of Brazil, 123 of which assigned to the intervention group and 128 to the control group. After hospital discharge, the intervention group was followed through a closed group of an online social network, where weekly posters were published on topics related to breastfeeding and an active communication was established with the mothers. The groups were interviewed monthly over the phone until the child reached 6 months of age.

Intervention Results: The exclusive breastfeeding frequencies were higher in the intervention group in all follow-up months, reaching 33.3% in the sixth month versus 8.3% in the control group. The median exclusive breastfeeding duration was 149 days (95% CI [129.6, 168.4]) in the intervention group and 86 days (95% CI [64.9, 107.1]) in the control group (P < 0.0001). The proportional risk of early interruption of exclusive breastfeeding was 0.38 (95% CI [0.28, 0.51], P < 0.0001).

Conclusion: This intervention had a positive impact on the duration and frequency of exclusive breastfeeding.

Study Design: Single-blind, RCT

Setting: Social media platform: Facebook

Population of Focus: Mother-child pairings assisted in the maternity ward of a Baby-Friendly Hospital who used Facebook

Sample Size: 251 mother-child pairings

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Technology-Based Support, COMMUNITY, Individual Supports,

Intervention Description: Pregnancy mobile apps are becoming increasingly popular, with parents-to-be seeking information related to their pregnancy and their baby through mobile technology. This increase raises the need for prenatal apps with evidence-based content that is personalized and reliable. The primary objective of this study is to assess whether the use of a health system–sponsored mobile app—Circle by Providence—aimed at providing personalized and reliable health information on pregnancy, postpartum recovery, and infant care is associated with improved health outcomes and increased healthy behaviors and knowledge among users.

Intervention Results: A total of 567 participants were enrolled in the study—167 in the app user group and 400 in the nonuser group. We found statistically significant differences between the two groups for certain behavior outcomes: subjects who used the app had 75% greater odds of breastfeeding beyond 6 months postpartum (P=.012), were less likely to miss prenatal appointments (P=.046), and were 50% more likely to exercise 3 or more times a week during pregnancy (P=.04). There were no differences in nutritional measures, including whether they took prenatal vitamins, ate 5 fruits or vegetables a day, or drank caffeine. We found no differences in many of the infant care outcomes; however, there was an increase in awareness of “purple crying.” Finally, there were no significant differences in measured clinical health outcomes, including cesarean births, length of hospital stays (in minutes), low birth weight infants, preterm births, small-for-gestational-age births, large-for-gestational-age births, and neonatal intensive care unit stays.

Conclusion: The use of the Circle app, which provides access to personalized and evidence-based health information, was associated with an increase in certain healthy behaviors and health knowledge, although there was no impact on clinical health outcomes. More research is needed to determine the impact of mobile prenatal apps on healthy pregnancies, clinical health outcomes, and infant care.

Study Design: Observational study using surveys and electronic medical records

Setting: Providence St. Joseph Health's Consumer Innovation Team launched app in Portland, Oregon and greater Seattle, Washington areas/Online

Population of Focus: Women with four or more prenatal encounters at one of the seven selected clinics that gave birth to a live infant at a Providence hospital in the past 4-6 months

Sample Size: 567 women (167 in the app user group and 400 in the comparison nonuser group)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Nurse/Nurse Practitioner, PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, CAREGIVER, Educational Material (caregiver)

Intervention Description: The aim of this study was to evaluate the effectiveness of a nursing educational intervention with mothers of sick children to decrease passive smoking exposure.

Intervention Results: Baseline comparison showed no significant differences between the two groups in the mothers’ actions to protect the children from passive smoking exposure. More mothers in the intervention group than the control group had always moved the children away when they were exposed to the fathers’ smoke at home at 3‐month follow up (78·4% vs. 71·1%; P = 0·01) but became non‐significant at 6 and 12 months.

Conclusion: A simple health education intervention provided by nurses to the mothers in a busy clinical setting can be effective in the short-term to motivate the mothers to take actions to protect the children from exposure to passive smoking produced by the fathers.

Study Design: RCT

Setting: Hospital (pediatric ward/outpatient departments)

Population of Focus: Non-smoking mothers of sick children admitted to the pediatric ward/smoking husbands living in the same household

Data Source: Parental self-report.

Sample Size: 1483 mothers of sick children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Nurse/Nurse Practitioner, PROFESSIONAL_CAREGIVER, Patient Navigation (Assistance), Care Coordination, STATE, Multicomponent Approach

Intervention Description: The Healthy Beginnings system of care in Atlanta, GA connects children and their families to health insurance and a medical home model of care to support children’s health and development. The main components are care management + education and parent engagement + collaborative partnerships. A registered nurse, known as the health navigator, supports parents and helps them learn how to work with health care professionals on behalf of their children; they also connect parents to the Center for Working Families to ensure that they receive public benefits for which they are eligible.

Intervention Results: Healthy Beginnings coordinated care approach has ensured that participating children and families have health insurance (97%) and receive regular immunizations (92%), ongoing health care from a primary care physician and dental health provider, and regular developmental screenings (98%) and follow-up care. Healthy Beginnings has dramatically increased children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Conclusion: By building upon the partnerships formed through the foundation’s community change effort, Healthy Beginnings has dramatically increased neighborhood children’s access to health care and forms the basis for a cost-effective approach that can be replicated in other communities.

Study Design: Program evaluation

Setting: Community (Community-based organizations in Atlanta, Georgia)

Population of Focus: Low-income young children and families

Data Source: Questionnaire data

Sample Size: 279 children

Age Range: 0-10 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Peer Counselor, CAREGIVER, Educational Material (caregiver), Motivational Interviewing/Counseling

Intervention Description: The aim of the "Don't smoke in our home" trial was to evaluate a counseling intervention focused on promoting totally smoke-free homes and cars (TSFHC) delivered to women with children resident in four Tuscan towns.

Intervention Results: Outcomes were: Reported smoking restrictions in home and car and change in smoking status reported. All participants independently of the study arm recorded significant increases of 12 and 15 percentage points in TSFH and TSFC, respectively. Few smokers quit smoking (7%), stopped smoking indoors (5%), and stopped smoking in cars (7%), with no differences between the intervention and control groups.

Conclusion: Adding brief counseling to written materials did not significantly increase TSFHC. However, delivering written materials only may produce modest but noteworthy TSFHC increases at the population level, even though the participants in the study did not represent a population-based sample, given the high proportion of highly educated women. Further studies are required to confirm these results.

Study Design: Two-group randomized controlled trial

Setting: Pediatric well visit

Population of Focus: Children exposed to SHS

Data Source: The trial staff recruited women aged 30-49 years with children in the waiting rooms of public health facilities, hospitals and outside of supermarkets

Sample Size: 218 women 30 to 49 years of age with children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Group Education, Telephone Support, Educational Material, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: This study examined the effects of a parent–child interactive program on reducing children’s exposure to ETS at home and enhancing parents’ and children’s prevention strategies.

Intervention Results: The percentage of children with urine cotinine levels greater than or equal to 6ng/ml was significantly lower in the intervention group than it was in the control group at both the 8-week and 6-month assessments. The intervention significantly reduced parental smoking in the presence of children and increased parents’ prevention of children’s ETS exposure and children’s ETS avoidance behavior from the baseline to the 20-week assessment.

Conclusion: This is a preliminary study design aimed at creating a program for reducing children’s ETS exposure at home. Further research to produce evidence supporting the application of the parent–child interactive program in primary schools is suggested. The theoretical basis of the intervention design can serve as a reference for nursing education and the design of health education programs.

Study Design: Single-blind, two-group, repeated-measures clustered randomized controlled trial design

Setting: Community (schools)

Population of Focus: School-aged children’s reduction of SHSe

Data Source: Elementary schools were the unit of assignment

Sample Size: 75 parent and child dyads in 6 elementary schools (grades 3 to 6)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, CAREGIVER, Educational Material (caregiver)

Intervention Description: To test a low-intensity physician's office-based intervention strategy using infant urine cotinine measurements, aimed at reducing infant exposure to environmental tobacco smoke.

Intervention Results: Follow-up urine cotinine measurements were obtained in 27 (52%) of 52 infants from the intervention group and in 29 (57%) of the 51 controls 2 months later. The mean log ratio of the follow-up to initial urine cotinine measurements was 6% lower in the intervention group than in the control group. This difference was not statistically significant.

Conclusion: The low-intensity intervention strategy did not significantly influence infant exposure to environmental tobacco smoke in the household.

Study Design: RCT

Setting: Pediatric well visit

Population of Focus: Infants exposed to second hand smoke

Data Source: Two hospital-based clinics in Portland Maine.

Sample Size: 103 mothers smoking ≥ 10 cigarettes/d with infants presenting to a well-baby check

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, PATIENT_CONSUMER, Community Events, COMMUNITY, Nurse/Nurse Practitioner, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The study aimed to evaluate the effectiveness of a cervical cancer prevention education program for rural Korean immigrant women. A total of 46 Korean immigrant women who had not been screened in the past three years participated. The experimental group participated in the intervention program once a week for four weeks and completed a post-program survey in week 12.

Intervention Results: The experimental group participated in the intervention program once a week for four weeks and completed a post-program survey in week 12. Compared to the control group, significant increases were detected in level of knowledge of cervical cancer prevention (p = .001), behavioral attitude toward cervical cancer prevention (p = .029) and behavioral intention regarding cervical cancer prevention (p = .005) in the experimental group. Pap screening rate of the experimental group was significantly increased (p = .029), but the rate of change in the selection of primary care providers was not significant.

Conclusion: The results suggest the need for a multilevel approach to address cultural and systemic barriers to Korean immigrant women in promotion of cervical cancer prevention behavior.

Intervention Components (click on component to see a list of all articles that use that intervention): Engagement with Payers, Educational Material, Media Campaign (Print Materials, Public Address System, Social Media),

Intervention Description: - The interventions include developing a jurisdiction-wide collaborative initiative with stakeholders, implementing education and skill-building strategies targeting providers, conducting AFIX enhanced with individualized clinician-to-clinician feedback, and conducting a comprehensive communication campaign targeting the public.

Intervention Results: - The results include increased HPV vaccine coverage rates among adolescents, with specific details on the number of clinics showing increases in vaccine coverage after AFIX peer-to-peer feedback sessions and the estimated reach and effectiveness of the public information campaign.

Conclusion: - The conclusion of the study is not explicitly mentioned in the provided excerpts.

Study Design: - The study design involves a combination of interventions including developing a jurisdiction-wide collaborative initiative, implementing education and skill-building strategies targeting providers, conducting AFIX enhanced with individualized clinician-to-clinician feedback, and conducting a comprehensive communication campaign targeting the public.

Setting: - The setting of the study is Chicago, Illinois, from 2013 to 2015.

Population of Focus: - The target audience includes adolescents aged 11 to 17 years, their parents or guardians, and healthcare providers in Chicago.

Sample Size: - The sample size is not explicitly mentioned in the provided excerpts.

Age Range: - The age range of the target audience is 11 to 17 years for adolescents and older than 18 years for accompanying adults.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Educational Material (Provider),

Intervention Description: Training health professionals for the skills and capacity to respond adequately to children and adults who have been exposed to adverse childhood experiences is recognized as an essential need in health care. Accessible opportunities to educate physicians and physician-trainees are limited. Four computer-based e-modules were created focusing on addressing childhood adversity and implementing trauma-informed care in the pediatric primary care setting. These childhood adversity and trauma-informed care (CA-TIC) e-modules were designed as an individualized, self-directed experience to allow for distance learning with flexibility to be embedded into existing coursework. To foster an engaging learning environment, we narrated the modules, prioritized images, and included the opportunity for participant interaction via multiple-choice and short-answer questions. Twenty-eight pediatric residents, two medical students, four attending physicians, and one fellow at Children's National Hospital completed the e-modules.

Intervention Results: Overall, participants rated the CA-TIC e-modules 4.6 (SD = 0.5) out of 5 for design and quality. Using paired t tests and Wilcoxon signed rank tests, we found statistically significant score increases from presession to postsession for participants' knowledge, attitudes, practice, and confidence related to CA-TIC. The most commonly cited learning points and practice changes included asking about trauma in practice and the seven C's of resilience.

Conclusion: A trauma-informed, strengths-based approach to care can assist health care providers in mitigating the link between adversity and related poor health outcomes. The CA-TIC e-modules provide an opportunity to train health professionals using an innovative, self-directed, and low-resource mechanism.

Study Design: Pre-post study

Setting: Pediatric primary care practices in connection with Children’s National Hospital

Population of Focus: Pediatric health care providers (pediatric residents, medical students, attending physicians, and fellows)

Sample Size: 35 pediatric health care providers 28 pediatric residents, 2 medical students, 4 attending physicians, and 1 fellow

Age Range: Adults who take care of pediatric populations

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Educational Material (caregiver), Quality Improvement,

Intervention Description: The intervention described in the article is the implementation of the Edinburgh Postnatal Depression Scale (EPDS) screening tool at two primary care pediatric clinics in an urban, multicultural, low socioeconomic immigrant community in San Diego, United States of America. The EPDS screening was conducted at the 2-week weight check and 1-, 2-, and 4-month well-baby visits. For mothers with positive screens, providers referred them to mental health care and updated their child’s electronic health record diagnosis to prompt reassessment for future visits. Educational materials were also created for patients and clinic staff about the significant impact PPD can have on infants and their development.

Intervention Results: Of the 523 eligible visits, 437 (83.5%) were screened using the EPDS tool and documented into the EHR. The overall incidence rate of at-risk mothers for PPD was 9.5%. Of those mothers who screened positive, 73.1% had documentation demonstrating a referral to mental health services. 63.2% of mothers referred attended their mental health appointments.

Conclusion: This project successfully implemented the American Academy of Pediatrics PPD screening guidelines and could be applicable to other pediatric outpatient settings.

Study Design: The PDF file does not explicitly state the study design or type. However, it is described as an evidence-based practice (EBP) project, which suggests that it is a quality improvement initiative aimed at implementing a specific intervention (in this case, PPD screening) in a real-world clinical setting. The project used the Iowa Model, which is a framework for implementing evidence-based practice changes in healthcare settings.

Setting: The evidence-based practice project was implemented at two primary care pediatric clinics in an urban, multicultural, low socioeconomic immigrant community in San Diego, United States of America

Population of Focus: The target audience for this study is healthcare providers and professionals who work in pediatric primary care clinics, particularly those serving immigrant and low-income populations.

Sample Size: The PDF file does not provide a specific sample size for the study. However, it does mention that the clinics served a lower socioeconomic pediatric population, and the majority (85%) of infants were insured by Medicaid. Additionally, provides some data on the number of mothers who were screened and followed up at the clinics, but it does not provide a total sample size for the study.

Age Range: The study focuses on infants and their mothers in the postpartum period. The screening for postpartum depression (PPD) was conducted during well-child visits for infants aged 1-6 months, with a focus on the 2-week visit and deferral of screening at the 6-month visit. The follow-up data in Table 2 is presented for infants at 12 months of age, which suggests that the study followed infants and their mothers for at least a year.

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material,

Intervention Description: The intervention involved a reminder mailing campaign utilizing the NYSIIS records. The mailing included a brief letter signed by the Director of the NYSDOH Bureau of Immunization, urging parents to talk to their child’s provider about HPV vaccines and providing information about the HPV vaccine recommendation, safety, efficacy, and importance of early vaccination. The mailing also listed a dedicated email address for any questions or concerns

Intervention Results: The reminder mailing resulted in a 2 percent increase in HPV vaccine series initiation among adolescents aged 11 to 13 years. The intervention reached the parents of 41 percent of adolescents in the routine vaccination age range and resulted in the immunization of an additional 0.9 percentage points of 11- to 13-year-olds residing in the catchment area

Conclusion: The study concluded that the reminder mailing campaign was effective in improving HPV vaccine series initiation among 11- to 13-year-old adolescents in New York State, excluding New York City

Study Design: The study utilized a randomized control trial (RCT) to assess the effect of a reminder mailing on initiation of the HPV vaccine series

Setting: The setting of the study was New York State, excluding New York City, and the intervention utilized the New York State Immunization Information System (NYSIIS) records

Population of Focus: The target audience for the intervention was adolescents aged 11 to 13 years who were due for HPV vaccination in New York State, excluding New York City

Sample Size: A total of 303,965 adolescents who had no record of HPV vaccination were randomized into intervention and comparison groups. After exclusions, a total of 81,558 intervention and 80,894 control records were analysis eligible

Age Range: The study focused on adolescents aged 11 to 13 years who were due for HPV vaccination

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Continuing Education of Hospital Providers, Policy/Guideline (Hospital), Educational Material (Provider), Guideline Change and Implementation

Intervention Description: We hypothesized that a pragmatic, multilevel treatment model including (ask, advise, refer [AAR]) coupled with individualized, telephone-based behavioral counseling promoting child tobacco smoke exposure (TSE) reduction would demonstrate greater child TSE reduction than would standard AAR.

Intervention Results: Complete case analysis demonstrated that compared with control parents (29.9%), significantly more parents in the experimental condition (45.8%) eliminated their children’s exposure to all sources of tobacco smoke both inside and outside their homes at 3-month follow-up. In addition, more parents in AAR/counseling than in AAR/attention control eliminated all sources of TSE (45.8% vs. 29.9%) and quit smoking (28.2% vs. 8.2%).

Conclusion: The results indicate that the integration of clinic- and individual-level smoking interventions produces improved TSE and cessation outcomes relative to standalone clinic AAR intervention. Moreover, this study was among the first in which researchers demonstrated success in embedding AAR decision aids into electronic health records and seamlessly facilitated TSE intervention into routine clinic practice.

Study Design: RCT

Setting: Community (home)

Population of Focus: Tobacco-smoking parents living in low-income, urban communities with children <11 years old exposed daily to tobacco smoke in the home. Additional inclusion criteria: daily smoker, >17 years old, and speaking English

Data Source: Structured telephone interviews for baseline data collection and 3-month follow-up.

Sample Size: 334 providers. 327 participants (n=163 AAR and counseling, n=164 AAR and control)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Access, Educational Material, Policy/Guideline (State)

Intervention Description: The report investigates and reports out on Enhancing perinatal health through quality, safety and performance initiatives

Intervention Results: Primary Recommendations: Assuring the uptake of robust perinatal quality improvement and safety initiatives Creating equity and decreasing disparities in perinatal care and outcomes Empowering women and families with information to enable the development of full partnerships between health care providers and patients and shared decision-making in perinatal care Standardizing the regionalization of perinatal services Strengthening the national vital statistics system

Conclusion: Ultimately, reaching a more efficient, more accountable system of perinatal care will require a level of collaboration, services integration and communication that lead to successful perinatal quality improvement initiatives, many of which are described throughout this book. In addition to the consistent collection of data and measurement and the application of evidence-based interventions, successful collaborations, like all perinatal quality improvement, depend on the engagement, support and commitment of everyone reading this book: health care professionals and hospital leadership, public health professionals and community-based service providers, research scientists, policymakers and payers, as well as patients and families. TIOP III is the call to action and the tool that can inspire and guide their efforts toward improving the outcome of pregnancy.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, , PATIENT_CONSUMER

Intervention Description: The aim of this study was to pilot test the feasibility in a tertiary referral center for neonatal care of a post-natal educational intervention (the Diary) designed to provide mothers with basic information concerning newborn care and breastfeeding. Furthermore, we aimed to evaluate its effect on exclusive breastfeeding rates at discharge and at 48 h post-discharge, and on maternal perceived support during hospital stay, compared to standard care. A single-center two-phase interventional study was carried out from 1 December 2018 to 2 June 2019.

Intervention Results: The Diaries filled out and returned were 62.2%. Overall, mothers rated the information received through the Diary as “clear and comprehensive”. Exclusive breastfeeding rates at discharge resulted in being higher in Phase 1 than in Phase 2 (80.6% vs. 72.5%, p = 0.04), whereas no difference emerged in terms of exclusive breastfeeding rates at 48 h. In both phases, the median NPST total score (4.05) was high.

Conclusion: In conclusion, we propose a new instrument of in-hospital post-natal maternal education and, in line with the current literature, we support well-designed written educational materials to promote mothers’ knowledge and satisfaction with post-partum hospital assistance. Further studies that are multicentric and with a longer follow-up period are needed to evaluate the potential impact of the Diary on exclusive breastfeeding duration.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Motivational Interviewing, Telephone Support, CAREGIVER, Educational Material (caregiver), Motivational Interviewing/Counseling

Intervention Description: Evaluate a smoking cessation intervention for women.

Intervention Results: The main outcome measure was self-reported abstinence from smoking 12 months after enrollment in the study, defined as not smoking, even a puff, during the 7 days prior to assessment. At both follow-ups, abstinence rates were twice as great in the intervention group as in the control group. The 12-month difference was statistically significant.

Conclusion: A pediatric clinic smoking cessation intervention has long-term effects in a socioeconomically disadvantaged sample of women smokers. The results encourage implementation of evidence-based clinical guidelines for smoking cessation in pediatric practice.

Study Design: Two-arm randomized trial (usual care vs. intervention)

Setting: Pediatric clinics serving ethnically diverse population of low-income families

Population of Focus: Self-identified women smokers whose children received care at participating clinics

Data Source: Women smokers whose children received care at participating clinics self-report.

Sample Size: 303 women smokers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Assessment (caregiver), PROFESSIONAL_CAREGIVER, PARENT_FAMILY, Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: To evaluate formative evaluation, a pedagogic method that sensitizes mothers to sudden infant death syndrome (SIDS), as a new way to improve prevention of SIDS.

Intervention Results: At follow-up, 91.9% and 86.8% of the mothers reported practicing supine sleep position in the intervention and control group respectively (p=0.16; OR=1.7, 95% CI: 0.7-4.0).

Conclusion: Formative evaluation using an educative questionnaire could improve maternal awareness on SIDS risk factors and their compliance with recommendations about SIDS prevention.

Study Design: RCT

Setting: Maternity department of the Rennes University Hospital

Population of Focus: Mothers hospitalized during the immediate postpartum period between Jun 19 and Aug 28, 2005 who were not hospitalized for abnormal or high-risk pregnancies and did not have newborns hospitalized in neonatology

Data Source: Mother report

Sample Size: Baseline (n=320) Follow-up (n=292)  Intervention (n=148)  Control (n=144)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Technology-Based Support, Telephone Support, PATIENT_CONSUMER

Intervention Description: This study was conducted to determine the effect of tele-education offered to mothers during the COVID-19 pandemic on breastfeeding success and perceived breastfeeding self-efficacy.

Intervention Results: It was determined that the tele-education given to mothers about breastfeeding during the COVID-19 pandemic increased breastfeeding success and perceived breastfeeding self-efficacy.

Conclusion: The researchers provided a 4-week long education and counseling service to mothers in the experimental group via direct phone calls and text messages. It was determined that the tele-education given to mothers about breastfeeding during the COVID-19 pandemic increased breastfeeding success and perceived breastfeeding self-efficacy.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Nurse/Nurse Practitioner, CAREGIVER, Motivational Interviewing/Counseling, Assessment (caregiver), PATIENT/CONSUMER, Educational Material, Online Material/Education/Blogging, Motivational Interviewing, PARENT/FAMILY, Consultation (Parent/Family), Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: A study was undertaken to determine the effectiveness of two brief multi-strategic child health nurse delivered interventions in: decreasing the prevalence of infants exposed to SHS; decreasing the prevalence of smoking amongst parent/carers of infants and increasing the prevalence of household smoking bans.

Intervention Results: When compared to the Control group at 12 months, no significant differences in the prevalence of infant exposure to SHS were detected from baseline to follow-up for Treatment condition 1 or Treatment condition 2. Similarly, no significant differences were detected in the proportion of parent/care givers who reported that they were smokers, or in the proportion of households reported to have a complete smoking ban.

Conclusion: Further research is required to identify effective interventions that can be consistently provided by child health nurses if the potential of such settings to contribute to reductions in child SHS exposure is to be realised.

Study Design: Cluster randomized controlled trial

Setting: Community well-child health clinics

Population of Focus: s Infants exposed to second hand smoke

Data Source: Data was collected via computer during the visit, child health clinic records

Sample Size: 1424 parents of children aged 0 to 4 years attending well-child health checks

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Parent Engagement, Educational Material,

Intervention Description: The interventions in the reviewed trials involved face-to-face communication aimed at providing information or education to parents or expectant parents about childhood vaccination. The content of the interventions focused on increasing children’s vaccination status, knowledge, understanding of vaccination, attitudes, and intention to vaccinate. The interventions varied in length, with some being single-session discussions and others being multi-session interventions. Additionally, the majority of the interventions focused on immunization alone, while some also included information about other child health topics such as breastfeeding ,[object Object],.

Intervention Results: The results of the reviewed trials suggest that face-to-face information or education delivered to parents or expectant parents may improve children’s vaccination status, parents’ knowledge or understanding of vaccination, and parents’ intention to vaccinate. However, the certainty of the evidence was low for all outcomes except for parents’ knowledge or understanding, which had a moderate certainty of evidence. The interventions may lead to little or no difference in parental attitudes or anxiety related to the intervention ,[object Object],.

Conclusion: Information or education about childhood vaccination delivered through face-to-face communication may improve vaccination coverage and parents' knowledge. This practice is likely already taking place in the majority of clinical encounters related to childhood vaccination, and supports the key role of the health-care provider in communicating about vaccines with parents.

Study Design: The reviewed trials used various study designs, including randomized controlled trials (RCTs) and quasi-experimental designs. The interventions were delivered in a face-to-face format to parents or expectant parents, and the control groups received neither education, printed materials, general routine vaccination information, nor an educational video covering the same topic as the face-to-face intervention ,[object Object],. The authors of the review excluded multi-component interventions, where the impact of the face-to-face communication elements could not be isolated ,[object Object],.

Setting: The review included trials conducted in various settings, including both high-income countries and low- or middle-income countries such as Nepal and Pakistan ,[object Object],. Additionally, the interventions were delivered in different settings, including individual sessions and group sessions ,[object Object],. This diversity in settings provides a broad perspective on the effects of face-to-face interventions for informing or educating parents about early childhood vaccination.

Population of Focus: The target audience for the face-to-face interventions in the reviewed trials was parents or expectant parents. The interventions aimed to provide information or education to this specific audience to increase children’s vaccination status, knowledge, understanding of vaccination, attitudes, and intention to vaccinate ,[object Object],.

Sample Size: The sample sizes in the reviewed trials varied, with half of the studies involving 100–250 participants and the other half involving more than 400 participants. Additionally, three trials were conducted in low- or middle-income countries, and two trials delivered the intervention to a group, while the rest were delivered to individuals ,[object Object],. This variation in sample sizes and settings provides a diverse perspective on the effects of face-to-face interventions for informing or educating parents about early childhood vaccination.

Age Range: The reviewed trials focused on interventions aimed at parents or expectant parents to increase children’s vaccination status. Therefore, the age range of the target audience was not explicitly mentioned in the information provided in the document. However, it can be inferred that the interventions were targeted at parents or expectant parents of young children who would be receiving vaccinations according to the childhood immunization schedule.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Reminder/Invitation, Educational Material,

Intervention Description: The intervention strategies include tailored HPV vaccination reminder postcards for parents, clinic-wide HPV vaccination trainings, quarterly review of HPV vaccination data, a physician champion, and clinic visual cues such as examination room posters, educational handouts, lanyards, and pins

Intervention Results: The primary outcomes of analyses were HPV vaccine initiation and completion rates

Conclusion: there was an increase in HPV vaccine uptake among adolescent patients ages 11–17. The proportion of adolescent patients who had initiated the HPV vaccine series was significantly greater at follow-up compared to baseline, with an increase from 52.4% to 82.7%. Similarly, the proportion of adolescent patients who had completed the HPV vaccine series was also significantly greater at follow-up compared to baseline, with an increase from 27.0% to 58.0%

Study Design: The study is described as a pilot study with a multilevel (ML) intervention design

Setting: The setting of the study is a rural health clinic in the United States, with a focus on Native American and rural communities

Population of Focus: The target audience includes parents, caregivers, and adolescent patients ages 11–17

Sample Size: The sample size is not explicitly mentioned in the provided excerpt.

Age Range: The study focuses on adolescent patients ages 11–17

Intervention Components (click on component to see a list of all articles that use that intervention): Social Media, Educational Material, Media Campaign (Print Materials, Public Address System, Social Media),

Intervention Description: Enrolling a community pharmacy as a Vaccines for Children (VFC) provider to provide free HPV vaccines to eligible adolescents. The intervention included a multi-faceted campaign to promote vaccination, including printed mailers, posters, informational pamphlets, social media strategy, and follow-up cards for adolescents who were vaccinated to remind them when to come back for their next dose. The pharmacy also held a community back-to-school vaccine clinic and block party to distribute school supplies, educational information regarding HPV and HPV vaccination, and vaccines were offered.

Intervention Results: Over the 8-month study, 166 total vaccines were administered to 89 adolescents. The county-level HPV vaccination uptake and completion rates increased from 20.5% to 33.3% and from 12.8% to 22.2%, respectively.

Conclusion: Enrolling a community pharmacy as a VFC provider to provide free HPV vaccines to eligible adolescents is a feasible strategy to increase HPV vaccination rates in rural, medically underserved areas.

Study Design: Feasibility study

Setting: Rural, medically underserved Alabama county

Population of Focus: Adolescents aged 10-18 years old

Sample Size: 89 adolescents

Age Range: 10-18 years old

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Supports, Social Media

Intervention Description: In the United States, there are lower rates of breastfeeding among African American mothers, particularly those who are younger women. Recent epidemiological studies have shown a strong association of more aggressive types of breast cancer (estrogen receptor negative) among African American women, with a higher risk in African American women who did not breastfeed their children. This study aims to describe the process evaluation of recruitment and educational strategies to engage pregnant African American participants for a pilot study designed to determine whether social media messaging about breast cancer risk reduction through breastfeeding may positively influence breastfeeding rates.

Intervention Results: More than 3000 text messages were sent and received through WIC e-blasts and keyword responses from flyers. A total of 472 women were recruited through WIC e-blast, and 161 responded to flyers and contacts through the local health care network, community-based organizations, Facebook, and friend referrals. A total of 633 women were assessed for eligibility to participate in the study. A total of 288 pregnant African American women were enrolled, consented, and completed presurvey assessments (102.8% of the goal), and 22 participants attended focus groups or interviews reporting on their experiences with Facebook and the educational messages.

Conclusion: This process evaluation suggests that using electronic, smartphone apps with social media holds promise for both recruitment and conduct of health education intervention studies for pregnant African American women. Providing messaging and resources through social media to reinforce and educate women about breastfeeding and potentially provide lactation support is intriguing. Convenience (for researchers and participants) is an attribute of social media for this demographic of women and worthy of further research as an educational tool.

Study Design: Process evaluation

Setting: Social media platform: Facebook

Population of Focus: Pregnant African American women recruited through WIC

Sample Size: 472 women

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material,

Intervention Description: the interventions included education, shared decision-making, and logistical strategies

Intervention Results: There was no significant difference in 3-dose HPV vaccine uptake between the intervention and control groups. However, the percentage of returned consent forms in intervention schools was higher than in control schools, and there was a shorter mean time to vaccinate 50 students at dose 3 in the intervention group

Conclusion: The study did not find a significant increase in 3-dose HPV vaccine uptake with the complex intervention. However, there were some positive outcomes related to consent form return rates and the time to vaccinate students

Study Design: Cluster-randomized trial

Setting: The study was undertaken in high schools in Western Australia and South Australia between 2013 and 2015

Population of Focus: Adolescents aged 12-13 years

Sample Size: 40 schools with 6,967 adolescents

Age Range: Adolescents aged 12-13 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, CAREGIVER, Educational Material (caregiver), Outreach (caregiver), Telephone Support

Intervention Description: This study tested the value of a self-help guide tailored specifically for women with young children.

Intervention Results: Two indicators of smoking behavior change were used to compare the effectiveness of the self-help guides. 1) % of those who reported in the follow-up interview that they had made at least one serious attempt to stop smoking, and 2) % of those who were nonsmokers for at least 1 week at time of follow-up. There were no significant differences between subjects in the three groups in use of the self-help guides, methods used to attempt quitting, and quitting behavior.

Conclusion: Findings from this study do not support the hypothesis that using a tailored stop smoking guide increases the targeted audience's cessation rate or affects quitting-related behavior. However, it should be noted that the smokers who called were predominantly in the contemplation or action stages.

Study Design: Quasi-randomized

Setting: Telephone smoking cessation helpline

Population of Focus: Women smokers with young children (under the age of 6)

Data Source: Cancer Information Service calls.

Sample Size: 873 mothers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Designated Clinic/Extended Hours

Intervention Description: Evaluate the effectiveness of an invitation letter on cervical screening participation among unscreened women 30 to 69 years of age.

Intervention Results: Women who were sent an invitation letter were significantly more likely to have had a Pap test in the next 6 months compared with women who were not sent an invitation letter (odds ratio [OR]=2.60, 95% confidence interval [CI] 2.09-3.35, p<0.001).

Conclusion: Sending invitation letters increased cervical screening participation but because the overall effect was small, additional strategies that remove barriers to screening for unscreened women are also necessary.

Study Design: Cluster RCT

Setting: Manitoba

Population of Focus: Women who had no Pap smear reported since 2001 and had been registered in the screening registry for at least 5 years (as of June 2010), with no history of gynecological cancer or hysterectomy, and who were covered by provincial health care insurance

Data Source: Cervical cancer screening registry

Sample Size: Total (N=31,452) Intervention (n=17,068); Control (n=14,384)

Age Range: 30-69

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Quality Improvement/Practice-Wide Intervention, Designated Clinic/Extended Hours, Female Provider, Needs Assessment, PATIENT_CONSUMER, HOSPITAL

Intervention Description: Translational research (TR) and continuous quality improvement (CQI) processes used to identify and address barriers and facilitators to Pap smear screening within an urban Aboriginal Community Controlled Health Service (ACCHS).

Intervention Results: There was a statistically significant increase in Pap smear numbers during Plan-Do-Study-Act (PDSA) cycles, continuing at 10 months follow up.

Conclusion: he use of TR with CQI appears to be an effective and acceptable way to affect Pap smear screening. This model is transferrable to other settings and other health issues.

Study Design: QE: pretest-posttest

Setting: An urban Aboriginal Community Controlled Health Service (ACCHS)

Population of Focus: All women within eligible age range

Data Source: Electronic medical records

Sample Size: Total (N=213)

Age Range: 18-70

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material

Intervention Description: To examine the associations of duration of exclusive breastfeeding with infections in the upper respiratory (URTI), lower respiratory (LRTI), and gastrointestinal tracts (GI) in infancy. This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life onward in the Netherlands. Rates of breastfeeding during the first 6 months (never; partial for <4 months, not thereafter; partial for 4-6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended infections in the URTI, LRTI, and GI until the age of 12 months were assessed by questionnaires and available for 4164 subjects.

Intervention Results: Compared with never-breastfed infants, those who were breastfed exclusively until the age of 4 months and partially thereafter had lower risks of infections in the URTI, LRTI, and GI until the age of 6 months (adjusted odds ratio [aOR]: 0.65 [95% confidence interval (CI): 0.51-0.83]; aOR: 0.50 [CI: 0.32-0.79]; and aOR: 0.41 [CI: 0.26-0.64], respectively) and of LRTI infections between the ages of 7 and 12 months (aOR: 0.46 [CI: 0.31-0.69]). Similar tendencies were observed for infants who were exclusively breastfed for 6 months or longer. Partial breastfeeding, even for 6 months, did not result in significantly lower risks of these infections.

Conclusion: Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants. Our findings support health-policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries.

Study Design: population-based prospective cohort study

Setting: Netherlands

Data Source: embedded in the Generation R Study, a population-based prospective cohort study from fetal life onward in the Netherlands

Sample Size: 4164 subjects

Age Range: Newborns 6-12 months

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Early identification of children with developmental and behavioral delays is important in primary care practice, and well-child visits provide an ideal opportunity to engage parents and perform periodic screening. Integration of this activity into office process and flow is necessary for making screening a routine and consistent part of primary care practice.

Intervention Results: In the North Carolina Assuring Better Child Health and Development Project, careful attention to and training for office process has resulted in a significant increase in screening rates to >70% of the designated well-child visits. The data from the project prompted a change in Medicaid policy, and screening is now statewide in primary practices that perform Early Periodic Screening, Diagnosis, and Treatment examinations.

Conclusion: Although there are features of the project that are unique to North Carolina, there are also elements that are transferable to any practice or state interested in integrating child development services into the medical home.

Study Design: QE: pretest-posttest

Setting: Partnership for Health Management, a network within Community Care of North Carolina

Population of Focus: Children ages 6 to 60 months receiving Early Periodic Screening, Diagnosis, and Treatment services

Data Source: Child medical record

Sample Size: Unknown number of charts – screening rates tracked in 2 counties (>20,000 screens by 2004)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Home Visits, Telephone Support, Motivational Interviewing

Intervention Description: The objective of this study was to determine whether a motivational intervention for smoking parents of young children will lead to reduced household passive smoke exposure.

Intervention Results: The 6-month nicotine levels were significantly lower in MI households. Repeated measures analysis of variance across baseline, 3-month, and 6-month time points showed a significant time-by-treatment interaction, whereby nicotine levels for the MI group decreased significantly and nicotine levels for the SH group increased but were not significantly different from baseline.

Conclusion: This study targeted a large sample of racially and ethnically diverse low-income families, in whom both exposure and disease burden is likely to be significant. This is the first study to our knowledge that has been effective in reducing objective measures of passive smoke exposure in households with healthy children. These findings have important implications for pediatric health care providers, who play an important role in working with parents to protect children's health. Providers can help parents work toward reducing household passive smoke exposure using motivational strategies and providing a menu of approaches regardless of whether the parents are ready to quit.

Study Design: Randomized control study

Setting: Recruitment at community health centers, home based intervention

Population of Focus: Diverse low-income populations

Data Source: Air nicotine assessments and assessment of the participant’s carbon monoxide level with caregiver selfreport.

Sample Size: 291 participants

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Educational Material, CAREGIVER, Educational Material (caregiver), Assessment (caregiver)

Intervention Description: An information programme on measures to prevent passive smoking by children, designed for use during well-child visits, was tested

Intervention Results: There was no significant difference between the groups with respect to change in smoking behavior. None of the families had contacted the smoking cessation resources provided to the intervention group.

Conclusion: We found no significant differences between the groups with respect to change in smoking behaviour.

Study Design: Randomized, parallel group, clinical trial

Setting: Clinic based well-child intervention

Population of Focus: Families bringing their children to the participating health centers for 6-week, 2 or 4 year well-child visits

Data Source: Self-report by parents

Sample Size: 443 families initially, 80 families dropped out

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): HEALTH_CARE_PROVIDER_PRACTICE, Training/Education, Educational Material (provider), Audit/Attestation (provider), PROFESSIONAL_CAREGIVER, Education/Training (caregiver), HOSPITAL, Quality Improvement, Crib Card

Intervention Description: This quality improvement project used an interprofessional, multimodal approach to improve sleep safety for hospitalized infants. The working group for this project included the Director of Quality Improvement for the Department of Pediatrics, a Pediatric Hospitalist, a Senior Advanced Practice Nurse in Pediatrics, Senior Associate Counsel for the Office of Counsel, and a medical student with a background in social work. The interdisciplinary group met to review and discuss improvements to communication and facilitated the development of five family interventions: a designated safe sleep web page, a clear bedside guide to safe sleep, additional training for nursing staff in motivational interviewing, a card audit system, and electronic health record smart phrases. A short survey was conducted to assess how the safe sleep toolkit has been useful to care providers in the Children’s Hospital. 

Intervention Results: With the initial pilot implementation of the K-cards, staff reported increased ease of audits. Adherence to recommended safer sleep measures was a major barrier in previous attempts to improve institutional sleep safety (1). By making adherence easier, providers may be more likely to both participate in quality improvement tracking measures and follow-up with families directly.

Conclusion: These coordinated interventions reflect advantages of an interprofessional and family-centered approach: building rapport and achieving improvements to infant sleep safety.

Setting: Golisano Children’s Hospital

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): Other Person-to-Person Education, PATIENT_CONSUMER, Educational Material, Provider Training/Education, HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: This study was a controlled trial study with longitudinal design. The sample consisted of 156 women (intervention = 78, control = 78) who registered in hearing-impaired associations in Izmir, Turkey. The education about cervical cancer and Pap smear test was given to intervention group with face-to-face interviews by using Turkish sign language. Three months later, the women were contacted and asked whether they have had a Pap smear test, and the total knowledge score of intervention groups was evaluated.

Intervention Results: There was not a statistically significant difference between the mean total score of knowledge about cervical cancer and Pap smear test in intervention (0.6 ± 1.6) and control (1.1 ± 1.9) groups. After 3 months, having a Pap smear test was found to be statistically significantly higher between groups (intervention = 29.5%, control = %1.2), and the mean cervical cancer and Pap smear knowledge score of the intervention group (9.2 ± 1.4) was found to be statistically significantly higher than the score before education (0.6 ± 1.6).

Conclusion: Education of cervical cancer and Pap smear test increased knowledge level and behaviour of Pap smear test of the women.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation, PATIENT_CONSUMER, Educational Material

Intervention Description: This study examines breast and cervical cancer screening uptake in a cancer education and patient navigation (PN) program for residents of rural and border counties in Texas by level of participation (education only, PN only, or education and PN). Data collected from March 1, 2012, to November 5, 2016, included 6663 follow-up surveys from participants aged 21–74.

Intervention Results: Logistic regression models assessed program participation on the odds of completing breast or cervical cancer screening. For women aged 40–74 years (N = 4942; mean age = 52 years), 58.4% reported a mammogram within 6 months on average from initial contact. In the breast cancer screening model, women who only received PN (OR: 6.06, CI: 4.87–7.53) or who participated in both the education plus PN program (OR: 3.33, CI: 2.77–4.02) had higher odds of mammogram screening compared to women who only received education. For women aged 21–64 years (N = 6169; mean age = 46 years), 37.7% received a Papanicolaou (Pap) test within 6 months on average from initial contact.

Conclusion: In the Pap screening model, both education and PN (OR: 3.23, CI: 2.66–3.91) and PN only (OR: 2.35, CI: 1.88–2.93) groups had higher odds of screening for cervical cancer compared to those only receiving education. Graphed predicted probabilities examined significant interactions between race/ethnicity/language and program participation (P < 0.0001) for both screenings. PN, solely or in combination with education, is an effective strategy to increase screening for breast and cervical cancer, beyond educational outreach efforts alone, among un-/underserved, racially/ethnically diverse women in rural and border Texas counties.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient Navigation , Referrals, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: We pilot tested a Perinatal Wellness Navigator (PWN) program for a group of high-risk perinatal women (N = 50; n = 42 with OUD) that consisted of (a) one-on-one tobacco treatment, (b) comprehensive assessment of cessation barriers, and (c) linkage to clinical/social services.

Intervention Results: Outcome measures were assessed at baseline and postintervention. Participants smoked 10 fewer cigarettes per day (p = .05) at postintervention and were less dependent on nicotine (p < .01). Mean postnatal depression scores (p = .03) and perceived stress (p = .03) decreased postintervention. Participants received at least one referral at baseline (n = 106 total), and 10 participants received an additional 18 referrals at postintervention to address cessation barriers.

Conclusion: The PWN program was minimally effective in promoting total tobacco abstinence in a high-risk group of perinatal women, but participants experienced reductions in cigarettes smoked per day, nicotine dependence, stress, and depression.

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Referrals, YOUTH, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: To develop, implement, and assess implementation outcomes for a developmental monitoring and referral program for children in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

Intervention Results: In both phases, all surveyed staff (n = 46) agreed the program was easy to use. Most (≥ 80%) agreed that checklists fit easily into clinic workflow and required ≤ 5 min to complete. Staff (≥ 55%) indicated using checklists with ≥ 75% of their clients. 92% or more reported referring one or more children with potential developmental concerns. According to 80% of staff, parents indicated checklists helped them learn about development and planned to share them with healthcare providers. During the second phase, 18 of 20 staff surveyed indicated the program helped them learn when to refer children and how to support parents, and 19 felt the program promoted healthy development. Focus groups supported survey findings, and all clinics planned to sustain the program.

Conclusion: Initial implementation outcomes supported this approach to developmental monitoring and referral in WIC. The program has potential to help low-income parents identify possible concerns and access support.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visit (caregiver), Adult-led Support/Counseling/Remediation, Educational Material, PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER, YOUTH

Intervention Description: This article reports methods and results of Alabama's continuous quality improvement (CQI) project and lessons learned in developing CQI capabilities among state and local public health practitioners.

Intervention Results: On the basis of CQI interventions, Alabama reached its goal; 12 of 20 primary caregivers in 2 home visiting programs made quit attempts. Alabama utilized multiple CQI tools to reach an ambitious, behavior-based aim;

Conclusion: these same concepts could be broadly applied to quality improvement initiatives in any federal or state public health program to guide process- and outcomes-based improvement efforts.

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), PARENT_FAMILY, Training (Parent/Family), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Peer Counselor, Parent Mentors

Intervention Description: The aim of the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) study was to evaluate the effects of parent mentors – Latino parents with children covered by Medicaid or the Children’s Health Insurance Program (CHIP) – on insuring Latino children in a community-based trial of uninsured children from 2011-2015. Parent mentors were trained to assist families in getting insurance coverage, accessing health care, and addressing social determinants of health. The intervention group was assigned parent mentors – trained, fluently bilingual Latino parents who had at least one child insured by Medicaid or CHIP for at least one year. Parent mentors attended a two-day training and received training manuals in English and Spanish with 9 training topics and one on sharing experiences. Parents mentors provided 8 services to intervention children and families (e.g., teaching about types of insurance programs and application processes; helping parents complete and submit children’s insurance applications; acting as family advocates by liaising between families and Medicaid or CHIP agencies; and helping parents complete and submit applications for coverage renewal).

Intervention Results: The study found that parent mentors were more effective than traditional methods in insuring children (95% vs. 69%), achieving faster coverage and greater parental satisfaction, reducing unmet health care needs, providing children with primary care providers, and improving the quality of well-child and subspecialty care. Children in the parent-mentor group had higher quality of overall and specialty care, lower out-of-pocket spending, and higher rates of coverage two years after the end of the intervention (100% vs. 70%). Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities. Parent mentors, as a special category of community health workers, could be an excellent fit with and complement to current state community health worker models. This RCT documented that the Kids’ HELP intervention is significantly more efficacious than traditional Medicaid and CHIP methods of insuring Latino children. Kids’ HELP eliminates coverage disparities for Latino children, insures children more quickly and with greater parental satisfaction than among control parents, enhances health care access, reduces unmet needs, improves the quality of well-child and subspecialty care, reduces out-of-pocket spending and family financial burden, empowers parents, ad creates jobs.

Conclusion: Parent mentors are highly effective in insuring uninsured Latino children and eliminating disparities.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Uninsured children 0-18 years old whose primary caregiver identified them as Latino and uninsured and reported meeting Medicaid/CHIP eligibility criteria for the child

Data Source: Kids’ HELP trial data; questionnaires

Sample Size: 155 subjects (children and parents); 75 in the control group and 80 in the intervention group

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), Educational Material (Provider), PARENT_FAMILY, Training (Parent/Family), PROFESSIONAL_CAREGIVER, Outreach (caregiver), PATIENT_CONSUMER, Peer Counselor, Parent Mentors

Intervention Description: This study examined the effects of parent mentors on insuring minority children in the Kids’ Health Insurance by Educating Lots of Parents (Kids’ HELP) program. Parent mentors were experienced parents with ≥1 Medicaid/CHIP-covered child who received 2 days of training, then assisted families for 1 year with insurance applications, retaining coverage, medical homes, and social needs; controls received traditional Medicaid/CHIP outreach. Parent mentors received monthly stipends for each family mentored. Parents mentors and intervention participants were matched by race/ethnicity and zip code, whenever possible. Latino families were matched with fluently bilingual Latino parent mentors. Session content for the 2-day training was based on training provided to community case managers in the research team’s previous successful RCT and addressed 9 topics (e.g., why health insurance is so important; being a successful parent mentor; parent mentor responsibilities; Medicaid and CHIP programs and the application process; the importance of medical homes).

Intervention Results: In the Kids’ HELP trial, the intervention was more effective than traditional outreach/enrollment in insuring uninsured minority children, resulting in 95% of children obtaining insurance vs. 68% of controls. The intervention also insured children faster, and was more effective in renewing coverage, improving access to medical and dental care, reducing out-of-pocket costs, achieving parental satisfaction and quality of care, and sustaining insurance after intervention cessation. This is the first RCT to evaluate the effectiveness of parent mentors in insuring uninsured children. Kids’ HELP could possibly save $12.1 to $14.1 billion. Parent mentors were more effective in improving access to primary, dental, and specialty care; reducing unmet needs, achieving parental satisfaction with care, and sustaining long-term coverage. Parent mentors resulted in lower out-of-pocket costs for doctor and sick visits, higher well-child care quality ratings, and higher levels of parental satisfaction and respect from children’s physicians.

Conclusion: PMs are more effective than traditional Medicaid/CHIP methods in insuring uninsured minority children, improving health care access, and achieving parental satisfaction, but are inexpensive and highly cost-effective.

Study Design: RCT

Setting: Community (Communities in Dallas County, Texas with the highest proportions of uninsured and low-income minority children)

Population of Focus: Primary caregiver had ≥1 child 0 to 18 years old who lacked health insurance but was Medicaid/CHIP eligible, and the primary caregiver self-identified the child as Latino/Hispanic or African-American

Data Source: Kids’ HELP trial data; questionnaires; national, state, and regional surveys

Sample Size: 237 participants; 114 in the control group and 123 in the intervention group

Age Range: 0-18 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education, Other Media, COMMUNITY, POPULATION-BASED SYSTEMS

Intervention Description: Evaluate the effect of an educational intervention on four domains of health care utilization and cervical cancer prevention and screening in a Hispanic population.

Intervention Results: Educational interventions designed to meet the needs identified by the sample group led to an increase in HPV awareness throughout the entire population surveyed and an increase in health care service utilization and HPV vaccine acceptance for women living in the US for <5 years.

Conclusion: These tools should be promoted to reduce the cervical cancer burden on vulnerable populations.

Study Design: QE: pretest-posttest

Setting: Boston, MA

Population of Focus: Hispanic women in the Boston area

Data Source: Written survey in English or Spanish

Sample Size: Baseline (n=318) Follow-up (n=295)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Home Visits, CAREGIVER, Home Visit (caregiver), Education/Training (caregiver), Educational Material (caregiver), Assessment (caregiver), Motivational Interviewing/Counseling, Motivational Interviewing

Intervention Description: The aim of this study is to evaluate effects of the counseling method “Smoke-free children” that focuses on protection of infants.

Intervention Results: Forty-one mothers participated in the study, 26 in the intervention group and 15 in the control group. Cotinine was collected from 22 subjects in the intervention and 8 in the control group. Before the intervention, the mean cotinine level was 185 ng/mL in the intervention group and 245 ng/mL in the control group. After the intervention, cotinine levels were reduced in the intervention group (165 ng/mL) and increased in the control group (346 ng/mL). Yet, after the intervention, the mothers themselves reported more smoking in the intervention group than in the control group. Only weak correlations were found between self-reported smoking and cotinine.

Conclusion: The statistical analysis supports the view that a client-centered intervention, aimed at increasing self-efficacy, exerts a positive effect on maternal smoking in the prevention of infant exposure to ETS, when applied in a routine clinical setting.

Study Design: RCT

Setting: Child health centers

Population of Focus: Swedish mothers who had given birth to a healthy child

Data Source: Self-reporting of smoking; cotinine levels of mothers’ saliva

Sample Size: 26 mothers in the intervention group and 15 in the control group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Lactation Consultant, Educational Material, Assessment (PATIENT_CONSUMER)

Intervention Description: Primary prevention utilizing consistent visits with lactation professionals with a group of new mothers may efficiently address a care gap to meet breastfeeding goals. Mother-infant dyads attending a newborn care clinic for 6 weeks received feeding assessment and standard-of-care guidance from an Internationally Board-Certified Lactation Consultant (IBCLC). This study is an evaluation of a cost-effective easy-to-deliver strategy provided to an at-risk population attending a primary care clinic in the normal course of postnatal care.

Intervention Results: The number and timing of IBCLC visits was correlated with EDB at 6 weeks PP. Maternal/infant dyads seen at day 3 had 2.5 times higher odds of EDB at 6 weeks than those not receiving IBCLC standard-of-care feeding assessment. Dyads seen at days 3 and 14 had 3.4 times higher odds of EDB than those with less follow-up. Bottle use correlated with decreased odds of AB at 6 weeks PP; similarly, dyads seen only at day 14 PP had decreased odds of EDB. When looking at timing of the first involvement, dyads seen at 3 days had higher odds of EDB than dyads first seen at day 14 PP.

Conclusion: This primary prevention strategy of early minimal intervention using an IBCLC increased the odds of EDB and AB at 6 weeks PP. These data support the conclusion that early feeding assessment the first 2 weeks PP with an IBCLC may increase breastfeeding at 6 weeks PP.

Study Design: Retrospective comparison cohort study

Setting: Hospital-affiliated primary care clinic serving the underinsured and uninsured in the community

Population of Focus: Mother-infant dyads attending a newborn care clinic

Sample Size: 640 mother-infant dyads

Age Range: Infants at 6 weeks postpartum

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Lactation Consultant, Provision of Breastfeeding Item, Group Education, Incentives, Professional Support, COMMUNITY, Individual Supports,

Intervention Description: The Canada Prenatal Nutrition Program (CPNP) aims to improve birth outcomes and promote and support breastfeeding among vulnerable women. Using charitable donations, the Parkdale Parents' Primary Prevention Project (5Ps) CPNP provides postnatal lactation support to its clients in addition to standard prenatal services (group education workshops, individualized support from public health nurses and dieticians, community referrals, snacks, two public transit tokens, grocery store gift card, self-serve food bank, and childcare). This lactation support program was designed and implemented by 5Ps CPNP staff and includes three components: 1) gift package of breastfeeding and infant care supplies; 2) IBCLC visits within 48 h of referral; and 3) double electric breast pump.

Intervention Results: Ninety-one percent of participants were born outside of Canada; 55% had incomes below the Low-Income Cut-Off; and 55% reported food insecurity. All participants initiated breastfeeding, 84% continued for 6 months and 16% exclusively breastfed for 6 months. Among breastfed infants, ≥76% received vitamin D supplementation. Approximately 50% of infants were introduced to solids before 6 months. Only high school education or less and food insecurity were associated with lower breastfeeding rates. Overall, 75% of participants received at least one visit with a lactation consultant and 95% of these received a breast pump.

Conclusion: This study provides initial evidence that postnatal lactation support can be delivered within a CPNP site, with high uptake by clients. While all participants initiated breastfeeding and 84% continued for 6 months, adherence to the recommended 6 months of exclusive breastfeeding was low. Further research is needed to better understand the barriers to exclusive breastfeeding and how to support this practice among vulnerable women.

Study Design: Evaluation data

Setting: A Canada Prenatal Nutrition Program site in Toronto

Population of Focus: Pregnant women in the catchment area

Sample Size: 199 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Collaboration with Local Agencies (State), Educational Material (caregiver), STATE, Multicomponent Approach

Intervention Description: In New York, to maximize comprehensive insurance coverage for CYSHCN, a Service Integration Model was formed between the Office of Health Insurance Services and the Early Intervention Program. The 3 key components include educational messaging (jointly prepared messages about health insurance benefits and enrollment assistance offered by the Office of Health Insurance Services through the Early Intervention Program) + data from program databases (data matching with the Early Intervention Program) + individual counseling using program staff (incorporation of the Office of Health Insurance Services program staff—child benefit advisors—to work directly with parents of children in the Early Intervention Program to facilitate enrollment and renewal. The model overcomes enrollment barriers by using consumer friendly enrollment materials and one-on-one assistance, and shows the benefits of a comprehensive and collaborative approach to assisting families with enrollment into public health insurance.

Intervention Results: Since 2008, more than 5,000 children in the Early Intervention Program have been successfully enrolled and coverage renewed in Medicaid through the Service Integration Model. In 2008, the study team found that children in the Early Intervention Program had a 34% churning rate for Medicaid because of enrollment barriers and misconception of the Early Intervention Program as a replacement for Medicaid. By 2010, the churning rate for clients assisted through Office of Health Insurance Services was reduced from 34% to 8%. The Office of Health Insurance Services will modify the Service Integration Model to respond to New York State’s implementation of the Health Insurance Exchange required by the 2010 ACA. Partnerships across government programs and agencies offer opportunities to enroll hard-to-reach populations into public health insurance. The model reflects how government programs can work together to improve rates of enrollment and retention in public health insurance. The key elements of integration of program messages, data matching, and staff involvement allow for the model to be tailored to the specific needs of other government programs.

Conclusion: The model overcomes enrollment barriers by using consumer-friendly enrollment materials and one-on-one assistance, and shows the benefits of a comprehensive and collaborative approach to assisting families with enrollment into public health insurance.

Study Design: Program evaluation

Setting: Community (New York City Department of Health and Mental Hygiene's Office of Health Insurance Services and the Early Intervention Program)

Population of Focus: Uninsured and underinsured young children with special health care needs in New York City participating in the Early Intervention Program

Data Source: Evaluation data

Sample Size: 6,500 children in early intervention with a Medicaid number

Age Range: 0-3 years

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, Assessment (Provider), HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, CAREGIVER, Education/Training (caregiver), Assessment (caregiver), Educational Material (caregiver)

Intervention Description: The aims of this project were to increase the percentage of infants following safe sleep practices in the NICU before discharge and to determine if improving compliance with these practices would influence parent behavior at home.

Intervention Results: Audit data showed that there was a significant increase in the rate of supine positioning from 39% at baseline to 83% at follow-up (p<0.001). Parental surveys showed that there was a significant increase in the rate of supine position from 73% at baseline to 93% at follow-up (p<0.05).

Conclusion: Multifactorial interventions improved compliance with safe sleep practices in the NICU and at home.

Study Design: QE: pretest-posttest

Setting: Children’s Memorial Hermann Hospital NICU in Houston, TX

Population of Focus: Infants in open cribs eligible for safe sleep practices; Parents of infants after discharge

Data Source: Crib audit/infant observation; Parent report

Sample Size: Baseline (n=62) Follow-up (n=79); Baseline (n=66) Follow-up (n=98)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider)

Intervention Description: The aims of this project were to increase the percentage of infants following safe sleep practices in the NICU before discharge and to determine if improving compliance with these practices would influence parent behavior at home. An algorithm detailing when to start safe sleep practices, a "Back to Sleep" crib card, educational programs for nurses and parents, a crib audit tool, and postdischarge telephone reminders were developed as quality improvement intervention strategies.

Intervention Results: NICU compliance with supine positioning increased from 39% to 83% (P < .001), provision of a firm sleeping surface increased from 5% to 96% (P < .001), and the removal of soft objects from the bed improved from 45% to 75% (P = .001). Through the use of a postdischarge telephone survey, parental compliance with safe sleep practices was noted to improve from 23% to 82% (P < .001).

Conclusion: Multifactorial interventions improved compliance with safe sleep practices in the NICU and at home.

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, Sleep Environment Modification, Promotional Event, POPULATION-BASED SYSTEMS, COMMUNITY, Social Media, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Visual Display (Community)

Intervention Description: To improve sleep environment safety for inpatient infants.

Intervention Results: The proportion of infant cribs without loose objects in them increased (32-72%, p = .025), and safe sleep positioning remained stable (82% vs. 95%, p = .183).

Conclusion: Staff education, swaddle sleep sacks, and bedside storage containers were associated with improved sleep safety among pediatric inpatients at our institution and may help at other institutions.

Study Design: QE: pretest-posttest

Setting: University of Iowa Children’s Hospital

Population of Focus: Infants less than 1 year of age developmentally ready for a crib and asleep

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=22) Follow-up 1 (not reported) Follow-up 2 (n=37) Follow-up 3 (n=18)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Lactation Consultant, Educational Material

Intervention Description: The aim of this study was to evaluate the effect of a breastfeeding support Internet intervention on breastfeeding outcomes on women living in regional Western Australia.

Intervention Results: Women enrolled in the intervention were significantly more likely to be exclusively breastfeeding at 6 months postpartum compared with control group participants. Those women experiencing breastfeeding problems were more likely to access the Internet.

Conclusion: This breastfeeding support intervention study demonstrated a positive effect on longer-term exclusive breastfeeding for those enrolled in the intervention group. Together with more traditional methods of support, the Internet provides another possible method for promoting positive long-term breastfeeding outcomes.

Study Design: QE: non-equivalent control group

Setting: Western Australia

Population of Focus: Women who delivered an infant without serious illness, could read and understand English, and lived in a regional area in western Australia6

Data Source: Mother self-report

Sample Size: Intervention (n=207) Control (n=207)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Home Visits, Lactation Consultants, Peer Counselor, Professional Support,

Intervention Description: Breastfeeding education and support are core services provided by WIC, and numerous policies and initiatives ensure breastfeeding support is provided throughout the prenatal period and first year postpartum. Site-level characteristics related to staffing, policies, and practices that support breastfeeding were collected for the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITEPS-2). Study data included interviews with 27 WIC state agency representatives affiliated with study sites, site visits to all 80 sites to collect data on facilities and staffing and a one hour interview with a site supervisor or coordinator, and surveys with staff (n=802) working in each of the 80 sites during the period when participants were enrolled in the study.

Intervention Results: Five WIC site-level supports were significantly and independently associated with any and fully breastfeeding: access to breastfeeding peer counselors, access to International Board Certified Lactation Consultants, postnatal home visits, allowing any WIC staff member to provide breast pump education, and having a policy not to provide formula during the first 30 days postpartum. Likelihood of any and fully breastfeeding increased with each additional site-level support present (odds ratio = 1.09, 95% confidence interval, 1.06–1.12; and odds ratio = 1.26, 95% confidence interval, 1.21–1.31, respectively).

Conclusion: Positive associations between site-level supports and breastfeeding at 2, 6, and 12 months were observed. Additional research is needed to understand how site-level supports interrelate and whether specific combinations are more effective, and to identify variations in implementation of breastfeeding supports.

Study Design: Secondary analysis

Setting: WIC programs in 27 states

Population of Focus: Women enrolled in WIC for the first time for that pregnancy prenatally or before their infant was 2.5 months old in 80 WIC sites across 27 states and territories during the 20 week recruitment period

Sample Size: 1,235 mothers and their infants (80 WIC sites; 802 staff surveys)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation Systems (Inter-Hospital Systems), Educational Material (Provider),

Intervention Description: The DC Mental Health Access in Pediatrics (DC MAP) program is a child psychiatry access program (CPAP) that provides telephonic consultation services to primary care providers (PCPs) in Washington, DC. The program aims to increase access to mental health services for children and adolescents by providing PCPs with real-time access to child psychiatry experts who can offer guidance on diagnosis, treatment, and care coordination. The program also provides PCPs with information about community resources and referral options available to their patients. The program is staffed by a team of child psychiatrists, psychologists, and social workers who provide consultation services to PCPs on a range of mental health concerns, including depression, anxiety, ADHD, and behavioral problems,.

Intervention Results: DC MAP consult volume increased 349.3% over the first 5 years. Services requested included care coordination (85.8%), psychiatric consultation (21.4%), and psychology/social work consultation (9.9%). Of psychiatry-involved consultations, PCPs managed patient medication care with DC MAP support 50.5% of the time. Most (94.1%) PCPs said they would recommend colleagues use DC MAP, and 29.6% reported diverting patients from the emergency departments using DC MAP.

Conclusion: Yes, the study reported statistically significant findings, including a significant increase in consultation volume over the first 5 years of the program, as well as a significant difference between baseline and 1 year of participation in PCPs' ability to receive more timely care coordination services for their patients with mental health needs,,. Additionally, paired t-tests were conducted to analyze self-report data about PCP beliefs related to mental health services collected at baseline and again 1 year later, indicating statistically significant changes in PCP beliefs over time.

Study Design: The study design is a retrospective analysis of data collected from the DC Mental Health Access in Pediatrics program between May 2015 and May 2020. The study used a mixed-methods approach, including descriptive statistics and paired t-tests to analyze self-report data about PCP beliefs related to mental health services collected at baseline and again 1 year later.

Setting: The study was conducted in the primary care setting, specifically in pediatric primary care practices in Washington, D.C.. The DC Mental Health Access in Pediatrics program was designed to provide consultation services to primary care providers in order to enhance their ability to meet the mental health needs of their pediatric patients.

Population of Focus: The target audience for the study includes primary care providers (PCPs) who care for pediatric patients, as well as professionals involved in pediatric mental health care, such as child psychiatrists, psychologists, and other mental health specialists. The study aims to evaluate the effectiveness of the Child Psychiatry Access Program (CPAP) in supporting PCPs in addressing the mental health needs of children and adolescents in the primary care setting.

Sample Size: The study received 3,389 consultation requests from primary care providers (PCPs) between May 2015 and May 2020. This indicates a substantial sample size for evaluating the effectiveness of the Child Psychiatry Access Program (CPAP) in Washington, D.C.

Age Range: According to the PDF file, the DC Mental Health Access in Pediatrics program provides mental health consultation services for youth aged 0-21 years.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Enabling Services, Educational Material, Community-Based Group Education, Designated Clinic/Extended Hours, PROVIDER/PRACTICE

Intervention Description: This paper summarizes impacts of a breast and cervical cancer screening intervention spearheaded by a Native Hawaiian community.

Intervention Results: Women in intervention community significantly more likely to be compliant with Pap smear guidelines than women in control community (X2=5.73. p=.02)

Conclusion: Positive changes in screening activities among women aware of the intervention support the importance of information diffusion by community consumers. Diffusion may occur beyond the boundaries of the community as defined.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Oahu, HI

Population of Focus: Native Hawaiian women

Data Source: Telephone survey

Sample Size: Total (N=1,260) Analysis (n=678) Intervention (n=318); Control (n=360)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): Notification/Information Materials (Online Resources, Information Guide), Referrals, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE, PATIENT_CONSUMER

Intervention Description: To improve Early Head Start/Head Start (EHS/HS) screening, referral, and enrollment for children from diverse, low-income communities.

Intervention Results: The preintervention group included 223 patients. The postintervention group included 235 patients. EHS/HS screening improved significantly after the intervention, rising from 8% in the preintervention period to 46% in the postintervention period (odds ratio [OR] 10.5, 95% confidence interval [CI] [5.9, 19.4]). EHS/HS documented referral rates increased from 1% in the preintervention period to 20% in the postintervention period (OR 18.3, 95% CI [5.7, 93.6]). Thirty-two of the 42 patients in the postintervention group referred to EHS/HS were reached to determine enrollment status. Six children (14%) had enrolled in EHS/HS.

Conclusion: With use of existing resources, a medical home–Head Start partnership can build an integrated system that significantly improves screening and referral rates to early learning programs.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Technology-Based Support, COMMUNITY, Individual Supports

Intervention Description: We assessed whether increased use of breastfeeding smartphone applications (apps) impacts breastfeeding rates for low-income women. Women were randomized to one of two novel apps: control app containing digital breastfeeding handouts and BreastFeeding Friend (BFF), an interactive app containing on-demand breastfeeding educational and video content. The BFF app was a novel smartphone app designed based on a cross-sectional breastfeeding survey and feeback from focus group of postpartum, low-income African American women. Specifically, a multidisciplinary team of lactation consultants, perinatologists, and neonatologists designed the BFF app. The educational content included interactive advice on overcoming breastfeeding challenges, educational content on breastfeeding benefits, normal infant behavior and maternal postpartum physiology, strategies to optimize breastfeeding and pumping at work or school, hyperlinks to on-demand videos with tips and troubleshooting for successful latching, common breastfeeding positions, and using and cleaning a breast pump, as well as links to resources. All participants were given a complimentary Android smartphone with assigned breastfeeding app preloaded by a telecom provider.

Intervention Results: In the RCT, BFF and control app median uses were 15 (interquartile range [IQR] 4–24) and 9 (IQR 5–19) (p = 0.1), respectively. Breastfeeding initiation did not differ with app usage (84.1% in highest quartile versus 78.2% for lowest quartile; p = 0.5). Rates of sustained and exclusive breastfeeding through 6 months were similar between groups. Among both groups, smartphone apps were the most preferred breastfeeding resource at 6 weeks. Low quartile users also preferred alternative online breastfeeding resources: >50% of all users preferred technology-based breastfeeding resources.

Conclusion: Increased usage of breastfeeding apps did not improve breastfeeding rates among low-income women. However, technology-based resources were the most preferred breastfeeding resource after hospital discharge, indicating ongoing development of technology-based interventions has potential to increase breastfeeding in this high-needs population. clinicaltrials.gov (NCT03167073).

Study Design: Secondary analysis of an RCT

Setting: Prenatal clinic serving women with Medicaid or no health insurance at an academic medical center/Online

Population of Focus: Pregnant women at approximately 36 weeks' gestation recruited during routine obstetric appointments

Sample Size: 169 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Motivational Interviewing, Referrals, Educational Material

Intervention Description: Home visiting programs represent an important primary prevention strategy for adverse prenatal health behaviors; the various ways in which home visiting programs impact prenatal smoking cessation and reduction behaviors remain understudied.

Intervention Results: A program effect was seen for smoking cessation such that clients who smoked less than ten cigarettes per day and those who smoked 20 or more cigarettes per day during the first trimester were more likely to achieve third trimester cessation than comparison women (p <0.01 and p = 0.01, respectively). Only for heavy smokers (20 or more cigarettes during the first trimester) was there a significant reduction in number of cigarettes smoked by the third trimester versus comparison women (p = 0.01). Clients expressed the difficulty of cessation, but addressed several harm-reduction strategies including reducing smoking in the house and wearing a smoking jacket. Clients also described smoking education that empowered them to ask others to not smoke or adopt other harm reducing behaviors when around their children.

Conclusion: While a significant impact on smoking cessation was seen, this study finds a less-clear impact on smoking reduction among women in home visiting programs. As home visiting programs continue to expand, it will be important to best identify effective ways to support tobacco-related harm reduction within vulnerable families.

Study Design: Cohort - Mixed methods using a retrospective cohort of propensity score

Setting: Home visiting programs

Population of Focus: English or Spanish speaking mothers who smoked during pregnancy who currently participated in a home visiting program and received welfare benefits

Data Source: Enrollment data, in-person or telephone interviews, birth certificate data

Sample Size: 10,296 women: 2595 study participants and 7701 controls

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, CAREGIVER, Educational Material (caregiver), Motivational Interviewing/Counseling, Motivational Interviewing, Patient Reminder/Invitation, PROVIDER/PRACTICE, Nurse/Nurse Practitioner

Intervention Description: To determine if mothers receiving a smoking cessation intervention emphasizing health risks of environmental tobacco smoke (ETS) for their children have a higher quit rate than 1) mothers receiving routine smoking cessation advice or 2) a control group.

Intervention Results: Complete data (baseline and both follow-ups) were available for 166 subjects. There was no impact of group assignment on the quit rate, cigarettes/day, or stage of change. The Child Health Group intervention had a sustained effect on location where smoking reportedly occurred (usually outside) and on improved knowledge of ETS effects.

Conclusion: Further research is needed to devise more effective methods of using the pediatric health care setting to influence adult smoking behaviors.

Study Design: RCT

Setting: Primary care center in a large urban children’s hospital

Population of Focus: Female caregivers (16 years and older) who accompanied a child (under 12 years) to the Primary Care Center of Columbus Children’s Hospital for a health care visit for any chief complaint or well-child examination

Data Source: Baseline data on demographics and smoking topics collected by questionnaire; and 1- and 6-month follow-ups.

Sample Size: 479 mothers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Assessment, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: This study aimed to evaluate the effectiveness of systematic assessment of asthma-like symptoms and environmental tobacco smoke (ETS) exposure during regular preventive well-child visits between age 1 and 4 years by well-child professionals.

Intervention Results: No differences were found in asthma, wheezing and other measures between intervention and control group. Children whose parents received the intervention had a decreased risk of ETS at home ever at age 2 and 3 years, but not at age 6.

Conclusion: Systematic assessment and counselling of asthma-like symptoms and ETS exposure in early childhood by well-child care professionals using a brief assessment form was not effective in reducing the prevalence of physician-diagnosed asthma ever and wheezing, and did not improve FeNO, Rint or HRQOL at age 6 years. Our results hold some promise for interviewing parents and using information leaflets at well-child centres to reduce ETS exposure at home in preschool children.

Study Design: RCT

Setting: Well-child care centers in Rotterdam

Population of Focus: Children born between April 2002 and January 2006 attending wellcare visits at 16 well-care centers. The centers were randomized into 8 intervention and 8 control centers

Data Source: Parent self-report

Sample Size: 7775 children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Community-Based Group Education, Other Person-to-Person Education, Patient Navigation

Intervention Description: We conducted a cluster-randomized trial at 23 ethnic churches in the Baltimore, Maryland–Washington, DC, metropolitan area between 2010 and 2014. Trained CHWs enrolled 560 women. The intervention group received an individually tailored cancer-screening brochure followed by CHW-led health literacy training and monthly telephone counseling with navigation assistance. Study outcomes included receipt of an age-appropriate cancer screening test, health literacy, cancer knowledge, and perceptions about cancer screening at 6 months.

Intervention Results: The odds of having received a mammogram were 18.5 (95% confidence interval [CI] = 9.2, 37.4) times higher in the intervention than in the control group, adjusting for covariates. The odds of receiving a Papanicolaou test were 13.3 (95% CI = 7.9, 22.3) times higher; the odds of receiving both tests were 17.4 (95% CI = 7.5, 40.3) times higher. Intervention effects also included increases in health literacy and positive perceptions about cancer screening.

Conclusion: A health literacy–focused CHW intervention successfully promoted cancer-screening behaviors and related cognitive and attitudinal outcomes in Korean American women.

Setting: 23 ethnic churches in the Baltimore,MD-Washington, DC area

Population of Focus: Korean American women who had not had a pap test in 24 months and who could read and write Korean or English

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Peer Counselor, Telephone Support, Educational Material

Intervention Description: To test the efficacy of an aid to cessation/relapse prevention intervention for women postpartum.

Intervention Results: With regard to smoking cessation, 4 week point prevalence abstinent rates were higher in the treatment group at 6, 12, and 18 months (7% vs. 1%, 7% vs. 2%, and 9% vs. 1%, respectively). Sustained abstinence was higher in the treatment group at 6 months follow-up (3% vs. 0%). No difference was observed with regard to relapse prevention.

Conclusion: Regarding aid to cessation we observed small effects, regarding relapse prevention no effect. In order to capitalize on the opportunity childbirth poses with regard to smoking, theories on relapse prevention in smoking cessation that guide in designing interventions are needed.

Study Design: Two-armed randomized controlled trial

Setting: Maternity hospitals

Population of Focus: Women who gave birth in one of six hospitals In the study region, a part of Mecklenburg-West Pomerania

Data Source: Parent self-report.

Sample Size: Baseline data is available for 644 women; follow up assessments were available for 566 women after 6 months, 529 after 12, 490 after 18, and 483 after 24 months.

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Peer Counselor, Lactation Consultant, Technology-Based Support, COMMUNITY, Individual Supports,

Intervention Description: LATCH -- Lactation Advice thru Texting Can Help is a pilot, web-based texting intervention designed to improve breastfeeding rates among mothers receiving WIC. The two-way texting intervention provided both evidence-based breastfeeding education through automated texts adn a mode for mothers to freely exchange texts with breastfeeding peer counselor (PC). In addition to providing breastfeeding education, the automated texts were personalized by addressing the mother by name and signed by the PC. These automatic personalized texts were sent out regularly both prenatally and in the immediate post-partum period to increase peer counselor points of contact with mom via text. The web-based texting platform allowed all text messages to be recorded, and thus, the on-site lactation consultants and WIC supervisors were able to monitor and supervise all text-based communication regularly.

Intervention Results: Primary outcomes included early post-partum (PP) contact and exclusive breastfeeding (EBF) rates at 2 weeks PP. Feasibility outcomes included text messaging engagement and mother's satisfaction with texting platform. Fifty-eight women were enrolled, 52 of whom were available for intention-to-treat analysis (n = 30 texting, n = 22 control). Contact between mothers and PCs within 48 hr of delivery was greater in the texting group (86.6% vs. 27.3%, p < .001). EBF rates at 2 weeks PP among participants in the texting intervention was 50% versus 31.8% in the control arm (p = .197). Intervention group mothers tended to be more likely to meet their breastfeeding goals (p = .06).

Conclusion: Participants were highly satisfied with the Lactation Advice thru Texting Can Help intervention, and findings suggest that it may improve early post-delivery contact and increase EBF rates among mothers enrolled in WIC who receive PC. A large, multicentre trial is feasible and warranted.

Study Design: Pilot RCT

Setting: WIC breastfeeding programs at a hospital-based primary care center and a federally qualified community health center/Cell phone

Population of Focus: Pregnant women at 18-30 weeks gestation from local WIC breastfeeding peer counselor programs

Sample Size: 52 women (30 texting and 22 control)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), PROFESSIONAL_CAREGIVER, Educational Material (caregiver), Patient Navigation (Assistance), Outreach (Provider), Enrollment Assistance

Intervention Description: Community Health Centers (CHCs) serving low-income populations are well-positioned to support patients navigating the complexities of the public health insurance application process and prevent lapses in coverage. Specialized staff, called enrollment assistants, can help to determine insurance eligibility and/or guide patients through application processes, including assistance with completing application forms, understanding requirements, and providing appropriate documentation.

Intervention Results: Enrollment assistants are valuable resources, and CHCs are effective at helping patients with public health insurance. The enrollment assistants helped families understand the process and avoid mistakes and delays while patients valued their advice and their pragmatic, hands-on application assistance.

Conclusion: Patients’ understanding of eligibility status, reapplication schedules, and how to apply, were major barriers to insurance enrollment. Clinic staff addressed these barriers by reminding patients when applications were due, assisting with applications as needed, and tracking submitted applications to ensure approval. Families trusted clinic staff with insurance enrollment support, and appreciated it. CHCs are effective at helping patients with public health insurance. Access to insurance expiration data, tools enabling enrollment activities, and compensation are needed to support enrollment services in CHCs.

Study Design: Observational cross-case comparison

Setting: Community (Community-health centers in Oregon)

Population of Focus: Practice members (e.g., managers, clinical and non-clinical staff, enrollment assistants) and families using community health centers

Data Source: Observations and interviews

Sample Size: 4 Community Health Centers (CHCs) in Oregon; 26 practice members; 18 adult family members who had at least one pediatric patient

Age Range: Parents and children; specific ages not stated

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Intensive Therapy, Peer Counselor, Motivational Interviewing, Telephone Support, CAREGIVER, Educational Material (caregiver), Motivational Interviewing/Counseling

Intervention Description: To develop and test an intervention to reduce children’s exposure to secondhand smoke (SHS) at homes in Yerevan, Armenia.

Intervention Results: Hair nicotine concentration in the child was 17% lower in the intervention group. The follow-up survey revealed an increased proportion of households with smoking restrictions and decreased exposure of children to SHS in both groups. The adjusted odds of children’s less-than-daily exposure to SHS was 1.87 times higher in the intervention group and the geometric mean of mothers’ knowledge scores at follow-up was 10% higher in that group.

Conclusion: Intensive intervention is effective in decreasing children’s exposure to SHS through educating mothers and promoting smoking restrictions at home. However, superiority over minimal intervention to decrease children’s exposure was not statistically significant.

Study Design: RCT

Setting: Home visits

Population of Focus: Households with a nonsmoking mother and at least 1 child 2-6 years of age residing with at least 1 daily smoker

Data Source: Measures of air quality and child hair nicotine; parent self-report.

Sample Size: 250 households

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Provision of Safe Sleep Item, Education/Training (caregiver), Educational Material (caregiver), PARENT/FAMILY, Training (Parent/Family), NATIONAL, Campaign, Mass Media

Intervention Description: The objective of this study was to describe parental knowledge and practices regarding infant sleep position, bedsharing, pacifier use, and feeding practices before and after receipt of a free crib and safe sleep education.

Intervention Results: Ninety percent reported that the baby slept in a crib after the intervention, compared with 51 % postnatally (p < 0.01). BBB was successful in changing knowledge and practices in the majority of high-risk participants with regards to placing the infant supine in a crib for sleep.

Conclusion: Crib distribution and safe sleep education positively influence knowledge and practices about safe sleep.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Community-Based Group Education, Group Education, Telephone Support, Educational Material, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), PARENT/FAMILY, Presentation/Meeting/Information Session/Event, Notification/Information Materials (Online Resources, Information Guide)

Intervention Description: The objective of this trial was to test if parents’ participation in an intervention based on an empowerment ideology and participatory experiences decreased the number of cigarettes smoked in homes.

Intervention Results: The median number of cigarettes smoked in the home daily decreased from 18 to 4 in the total sample (both groups about equally), however no statistically significant difference was detected between groups at 6 months follow-up.

Conclusion: Participation in the study, independent of group, may have resulted in parents decreasing the number of cigarettes smoked in the home. Valuable lessons were learned about recruiting and working with this group of parents, all of whom faced the challenges of tobacco and almost half of whom lived in poverty

Study Design: RCT

Setting: Community (home)

Population of Focus: Families connected with public health nursing offices, family resource centers, daycare centers, and kindergartens in Prince Edward Island, with at least one cigarette smoked daily in the home, children up to 5 years of age residing there, and one parent (smoker or not) willing to participate

Data Source: Data were collected in two intervieweradministered questionnaires competed in participants’ homes at baseline and 6-months follow-up.

Sample Size: 60 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, POPULATION-BASED SYSTEMS, NATIONAL, Campaign, Mass Media, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: To assess parental risk behaviour before and after a sudden infant death syndrome (SIDS) information campaign with special emphasis on associations with maternal age, education, marital status and birth order.

Intervention Results: The prevalence of non-supine sleep position decreased significantly from 33.7% before the campaign to 13.6% after (RR=0.40, 95% CI: 0.37-0.44). The decrease was significant by maternal education, cohabitation, birth order, and maternal age.

Conclusion: Non-supine sleeping decreased to a level that has never been reported before. In future campaigns, subgroup-specific measures may be needed.

Study Design: QE: pretest-posttest

Setting: N/A

Population of Focus: All mothers registered with the Medical Birth Registry of Norway as having given birth between Oct and Nov 1998 and Oct and Nov 1999 without a pathological condition

Data Source: Mother report

Sample Size: Baseline (n=5539) Follow-up (n=4143)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material

Intervention Description: This longitudinal study reports on the development and evaluation of a narrative intervention aimed at increasing human papillomavirus (HPV) vaccination among college women.

Intervention Results: The combined peer-expert narrative intervention nearly doubled vaccination compared to controls (22% vs. 12%). The pragmatic goal of increasing HPV vaccination and the theoretical predictions about message source were supported.

Conclusion: As predicted, the inclusion of peer and medical expert sources plays a critical role in promoting HPV vaccination among college women. Furthermore, the intervention increased HPV vaccination by increasing vaccine self-efficacy and intent. Theoretical and practical implications for designing effective HPV vaccine messages are discussed.

Study Design: RCT

Setting: Computer laboratory at a university

Population of Focus: Female university students who had not been seen at the campus university health center, had not been vaccinated against HPV, and were invited via email to participate

Data Source: Online pre-intervention survey administered in a computer lab and post-intervention survey distributed via email

Sample Size: Total (n=404)  Intervention Group 1 (n=101)  Intervention Group 2 (n=101)  Intervention Group 3 (n=50)  Control (n=152)

Age Range: 18-26

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Presentation/Meeting/Information Session/Event, Training (Parent/Family), CAREGIVER, Home Visit (caregiver), Education/Training (caregiver), Educational Material (caregiver), Motivational Interviewing/Counseling, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Pharmacotherapy (Nicotine), Home Visits, Educational Material, Motivational Interviewing, Peer Counselor, Telephone Support

Intervention Description: We tested a combined intervention to reduce children's secondhand smoke exposure (SHSe) and help parents quit smoking.

Intervention Results: Parents’ reports of their smoking and children’s exposure showed moderate and significant correlation with children’s urine cotinine levels and home air nicotine. 13 intervention group mothers and 4 controls reported quitting smoking for 7 days prior to 1 or more study measurements without biochemical contradiction. Results of generalized estimating equations showed significantly greater decrease in reported SHSe and mothers’ smoking in the counseled group compared with controls. Reported indoor smoking and children’s urine cotinine decreased, yet group differences for changes were not significant.

Conclusion: Nicotine contamination of the home and resulting thirdhand exposure may have contributed to the failure to obtain a differential decrease in cotinine concentration. Partial exposure to counseling due to dropouts and lack of full participation from all family members and measurement reactivity in both conditions may have constrained intervention effects. Secondhand smoke exposure counseling may have been less powerful when combined with smoking cessation.

Study Design: Two-group, repeated measures RCT

Setting: Community (home)

Population of Focus: WIC clients in San Diego, California

Data Source: 3 weekly baseline child urine cotinine measures collected before trial randomization then reported and urine cotinine measures at 3 (midintervention), 6 (post-intervention), 12, and 18 months

Sample Size: 150 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Other Education, Telephone Support

Intervention Description: The purpose of this study was to compare breastfeeding duration in mothers after delivery who were assigned randomly to a behavioral educational intervention vs enhanced usual care.

Intervention Results: Mothers in the intervention arm breastfed for a longer duration than did the control subjects (median, 12.0 vs 6.5 weeks, respectively; P = .02) Mothers in the intervention arm were less likely to quit breastfeeding over the first 6 months after delivery (hazard ratio, 0.79; 95% confidence interval, 0.65-0.97).

Conclusion: A behavioral educational intervention increased breastfeeding duration among low-income, self-identified black and Latina mothers during the 6-month postpartum period.

Study Design: RCT

Setting: Large tertiary hospital in New York City, NY

Population of Focus: Black and Latina women ≥18 years old, who had infants with birthweights ≥ 2500 gm and 5- minute Apgar scores ≥ 7

Data Source: Mother self-report

Sample Size: Randomized • Intervention (n=270) • Control (n=270) 6-Month Follow-Up • Intervention (n=214) • Control (n=209)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Professional Support,

Intervention Description: The aim of this study is to investigate the effectiveness of indivdualized intervention compared with routine care in improving rates of exclusive breastfeeding. We provided individual antenatal breastfeeding education and postnatal lactation support to intervention group. Control group received routine care. More specifically, the intervention consisted of individual antenatal breastfeeding education and postnatal lactation support. Participants were visited by a researcher at hospital admission. At the time of admission, the researcher used the breastfeeding attrition prediction scale and individualized the intervention based on the results. After delivery, researchers provided professional guidance for mothers. After discharge, researchers asked for monthly details of the breastfeeding situation and gave guidance by telephone follow-up after maternal hospital discharge to postpartum 4 months. They also received the same routine antenatal and postnatal obstretric care.

Intervention Results: We recruited 352 women of whom 176 were randomized to intervention group, 176 to control group. In total, 293 (83.2%) completed 4 months of follow-up. At discharge from hospital, 43.2% of women randomized to intervention group were exclusively breastfeeding compared with 30.0% of women in control group (relative risk 1.78; 95% confidence interval [CI] 1.12–2.82). At 4 months, 70.9% of women in the intervention group were exclusively breastfeeding compared with 46.2% of the women in the control group (2.84; 1.76–4.60). At discharge from hospital, 95.1% of women in the intervention group were breastfeeding on demand compared with 68.1% of women receiving routine care (9.00; 4.09–19.74). At 4 months, 94.6% of women in intervention group were breastfeeding on demand compared with 75.9% of women in the control group (5.57; 2.48–12.49).

Conclusion: The regular ongoing individualized antenatal education and postnatal support can effective increase the rates of exclusive breastfeeding from delivery to postpartum 4 months and change the breastfeeding behavior.

Study Design: RCT

Setting: Hospital in China

Population of Focus: Women > 34 weeks gestation recruited from from the obstetric admission office

Sample Size: 352 women (176 intervention group and 176 control group)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Nurse/Nurse Practitioner, YOUTH, Adult-led Support/Counseling/Remediation, PARENT/FAMILY, Training (Parent/Family), Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Home Visit (caregiver)

Intervention Description: A 2-year randomized, controlled trial involving 95 children measured the impact of a comprehensive home and ambulatory program for pediatric asthma management using objective outcome measures.

Intervention Results: There were no significant differences in medical visits, theophylline levels, or records of asthma symptomsOne year after discontinuing the intervention, a marked "washout" effect was observed.

Conclusion: Comprehensive ambulatory programs of childhood asthma management can improve objective measures of illness severity but must be sustained.

Study Design: RCT

Setting: Homes and well-child clinics

Population of Focus: Patients admitted to the Izaak Walton Killam Children’s Hospital with a diagnosis of asthma in the preceding 5 years

Data Source: Medical personnel

Sample Size: 95 children

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Other Education, PATIENT_CONSUMER, Provision of Breastfeeding Item, Educational Material

Intervention Description: Community forum participants voted for an education and resource distribution program (using a baby box) to help reduce local infant mortality.

Intervention Results: The proportion of participants at the follow-up survey who reported bed-sharing most or all of the time (5.7%) was lower than those participants who had said they were likely or very likely to bed-share in the post-education survey (11.3%). Although nearly all participants (98.6%) in the post-education survey reported that they were likely to use the baby box, at the postpartum follow-up, 39.1% reported actual use of the baby box.

Conclusion: The program positively impacted self-reported likelihood of several health behaviors. A community-driven approach to maternal education and resource distribution may be beneficial in other cities.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational material, HEALTH_CARE_PROVIDER_PRACTICE, Quality Improvement/Practice-Wide Intervention, Hospital Policies, Provider Training/Education,

Intervention Description: The purpose of this system-wide quality improvement project was to create a breastfeeding-friendly pediatric practice. This breastfeeding support initiative was implemented at a multisite rural Illinois pediatric practice. The policy included: (a) breastfeeding promotion recommendations; (b) provider, nurse, and staff roles; (c) patient education and resources; and (d) breastfeeding-friendly atmosphere guidelines. An evidence-based breastfeeding policy was developed, staff education sessions were conducted, private lactation rooms were created, and breastfeeding photographs/posters were displayed throughout the offices. Lactation support services were publicized throughout the offices. Lactation support services were publicized via signs and social media postings.

Intervention Results: Overall breastfeeding rates were higher at each time point after implementation. Statistically significant increases occurred at the newborn and 1-month visits, with a modest improvement at 2 and 4 months.

Conclusion: This project demonstrated an improvement in breastfeeding duration rates. It is anticipated that this practice-wide standard of care change will promote breastfeeding throughout the first 12 months of life.

Study Design: Pre-post intervention

Setting: Multisite rural IL pediatric practice

Population of Focus: Mothers with breastfeeding infants from newborn to 4 months seen for well-child visits at a pediatric practice

Sample Size: 71 infants preintervention and 18 infants postintervention

Age Range: Newborn to infants 4 months old

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Educational Material (caregiver), Education/Training (caregiver), Home Visit (caregiver)

Intervention Description: To investigate whether parents of asthmatic children would stop smoking or alter their smoking habits to protect their children from environmental tobacco smoke.

Intervention Results: Salivary cotinine concentrations in children, and changes in reported smoking habits of the parents 1 year after the intervention. At the second visit, about 1 year after the baseline visit, a small decrease in salivary cotinine concentrations was found in both groups of children: the mean decrease in the intervention group (0.70 ng/ml) was slightly smaller than that of the control group (0.88 ng/ml), but the net difference of 0.19 ng/ml had a wide 95% confidence interval (−0.86 to 0.48). Overall, 98% of parents in both groups still smoked at follow up. However, there was a non-significant tendency for parents in the intervention group to report smoking more at follow up and to having a reduced desire to stop smoking.

Conclusion: A brief intervention to advise parents of asthmatic children about the risks from passive smoking was ineffective in reducing their children’s exposure to environmental tobacco smoke. The intervention may have made some parents less inclined to stop smoking. If a clinician believes that a child’s health is being affected by parental smoking, the parent’s smoking needs to be addressed as a separate issue from the child’s health.

Study Design: RCT

Setting: Community (home)

Population of Focus: Families with an asthmatic child aged 2-12 years living with a parent who smoked

Data Source: Salivary cotinine concentrations in children, and parent self-report.

Sample Size: 501 families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: The aim of this study was to evaluate the effect on mothers of an individual educational intervention in the maternity ward about infant sleep position.

Intervention Results: Among mothers in the intervention group, 42.9 percent put their infants to sleep in a supine position at the 3-month visit, compared with 24 percent of mothers in the control group (p = 0.009). In a multivariate analysis, the intervention at the hospital was the only variable that influenced maternal practices with respect to infant sleep positioning (OR 2.22; 95% CI 1.17-4.19).

Conclusion: An individual educational session in the maternity ward about infant sleep position significantly increased the prevalence of supine position for sleeping in the infant's third month. Nevertheless, the intervention was not sufficient to guarantee that most mothers would put their infants to sleep in the recommended position.

Study Design: RCT

Setting: Maternity ward of the Hospital de Clínicas in Porto Alegre

Population of Focus: Mothers of infants in an area of Porto Alegre born between Sep 2005 and Sep 2006

Data Source: Mother/doll observation

Sample Size: Intervention (n=112/91) Control (n=116/100)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Referrals, PATIENT_CONSUMER, Incentives

Intervention Description: The primary aim was to evaluate the efficacy of financial incentives for reducing paediatric tobacco smoke exposures (TSEs) through motivating cigarette usage reduction among low-income maternal caregivers and members of their social network.

Intervention Results: The mean change in monthly child cotinine values was not significantly different in the intervention cohort over the 6-month follow-up period, compared with the control group (p=0.098, CI −0.16 to 1.89). Trends in child cotinine could not be ascribed to caregivers or social network members. Despite decreasing mean monthly cotinine values, neither the intervention cohort’s caregivers (difference in slope (control–intervention)=3.30 ng/mL/month, CI −7.72 to 1.13, p=0.144) or paired social network members (difference in slope (control–intervention)=−1.59 ng/mL/month, CI −3.57 to 6.74, p=0.546) had significantly different cotinine levels than counterparts in the control group.

Conclusion: Financial incentives directed at adult contributors to paediatric TSE did not decrease child cotinine levels.

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Assessment, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Educational Material (caregiver), Counseling (Parent/Family)

Intervention Description: To investigate whether a biomarker screening approach for tobacco smoke exposure (TSE) conducted concurrently with lead screening at well-child visits would increase parental smoking cessation and implementation of home smoking restrictions.

Intervention Results: Eighty-four percent of eligible parents agreed to have their child tested for TSE along with lead testing. Measurable cotinine was identified in 93% of children. More parents in the intervention group received tobacco treatment than in the comparison group (74% vs. 0%) and more parents reported 7-day point-prevalent abstinence from smoking at 8 weeks (29% vs. 3%).

Conclusion: These data demonstrate the feasibility of adding cotinine measurement to routine well-child lead screening to document TSE in small children. Data suggest providing this information to parents increases engagement in tobacco treatment and prompts smoking cessation.

Study Design: Observational, quasiexperimental

Setting: Pediatric clinic in Minneapolis, Minnesota

Population of Focus: Parents who smoked and their children presenting for well-child visits

Data Source: Parental self-report and child cotinine level.

Sample Size: 80 parents

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Financial Incentives, Nurse/Nurse Practitioner

Intervention Description: Before-and-after comparisons of the time-appropriate delivery rates of cervical and breast cancer screening using the automated and NP-augmented strategies of the P-PROMPT reminder and recall system.

Intervention Results: Before-and-after comparisons of time-appropriate delivery rates (< 30 months) of cancer screening showed the rates of Pap tests and mammograms for eligible women significantly increased over a 1-year period by 6.3% (P < .001) and 5.3% (P < .001), respectively. The NP-augmented strategy achieved comparable rate increases to the automated strategy alone in the delivery rates of both services.

Conclusion: The use of provider and patient reminders and pay-for-performance incentives resulted in increases in the uptake of Pap tests and mammograms among eligible primary care patients over a 1-year period in family practices in Ontario.

Setting: Eight primary care network practices and 16 family health network practices in southwestern Ontario

Population of Focus: Practicing physicians from the participating primary care network and family health network groups

Data Source: CytoBase (consortium of main laboratories in Ontario), combined with rosters of eligible patients

Sample Size: Total (N=246) Analysis (n=232) N=physicians

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): YOUTH, Adult-led Support/Counseling/Remediation, PARENT/FAMILY, CAREGIVER, Educational Material (caregiver), Motivational Interviewing/Counseling, Consultation/Counseling (Parent/Family), Counseling (Parent/Family)

Intervention Description: To determine whether repeated infancy-onset lifestyle counselling alters parental smoking and children's exposure to tobacco smoke.

Intervention Results: Parents' smoking decreased during the study similarly in the intervention and control groups. Of the 8-y-old children, 46% had detectable serum cotinine concentration, suggesting exposure to tobacco smoke during the past few days. All children were non-smokers. Serum cotinine concentrations did not differ between the intervention and control children. Children's cotinine values were highest in the families where either father or both parents were smokers.

Conclusion: Participation in the atherosclerosis prevention trial slightly decreased smoking among the intervention and control parents. However, counselling led to no differences in parental smoking between the two groups, or in exposure of the intervention and control children to tobacco smoke. This study suggests that more detailed and targeted intervention is required to achieve a significant effect on children's tobacco smoke exposure.

Study Design: Randomized prospective intervention trial

Setting: Pediatric well-child visits

Population of Focus: Families presenting at a well-baby clinic with a child 5 months old.

Data Source: Cotinine measurements of mothers, fathers, and children; Reported smoking of parents during annual office visit to pediatrician (via questionnaires and interviews)

Sample Size: 1062 families (Intervention= 540; Control = 522)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Media Campaign (Print Materials, Public Address System, Social Media), Social Supports

Intervention Description: The Youth Risk Behavior Surveillance System (YRBSS) monitors six categories of priority health behaviors among youth and young adults: 1) behaviors that contribute to unintentional injuries and violence; 2) tobacco use; 3) alcohol and other drug use; 4) sexual behaviors related to unintended pregnancy and sexually transmitted infections (STIs), including human immunodeficiency virus (HIV) infection; 5) unhealthy dietary behaviors; and 6) physical inactivity. In addition, YRBSS monitors the prevalence of obesity and asthma and other priority health behaviors. YRBSS includes a national school-based Youth Risk Behavior Survey (YRBS) conducted by CDC and state and large urban school district school-based YRBSs conducted by state and local education and health agencies. This report summarizes results for 118 health behaviors plus obesity, overweight, and asthma from the 2015 national survey, 37 state surveys, and 19 large urban schoo l district surveys conducted among students in grades 9–12.

Intervention Results: Results from the 2015 national YRBS indicated that many high school students are engaged in priority health-risk behaviors associated with the leading causes of death among persons aged 10–24 years in the United States. During the 30 days before the survey, 41.5% of high school students nationwide among the 61.3% who drove a car or other vehicle during the 30 days before the survey had texted or e-mailed while driving, 32.8% had drunk alcohol, and 21.7% had used marijuana. During the 12 months before the survey, 15.5% had been electronically bullied, 20.2% had been bullied on school property, and 8.6% had attempted suicide. Many high school students are engaged in sexual risk behaviors that relate to unintended pregnancies and STIs, including HIV infection. Nationwide, 41.2% of students had ever had sexual intercourse, 30.1% had had sexual intercourse during the 3 months before the survey (i.e., currently sexually active), and 11.5% had ha d sexual intercourse with four or more persons during their life. Among currently sexually active students, 56.9% had used a condom during their last sexual intercourse. Results from the 2015 national YRBS also indicated many high school students are engaged in behaviors associated with chronic diseases, such as cardiovascular disease, cancer, and diabetes. During the 30 days before the survey, 10.8% of high school students had smoked cigarettes and 7.3% had used smokeless tobacco. During the 7 days before the survey, 5.2% of high school students had not eaten fruit or drunk 100% fruit juices and 6.7% had not eaten vegetables. More than one third (41.7%) had played video or computer games or used a computer for something that was not school work for 3 or more hours per day on an average school day and 14.3% had not participated in at least 60 minutes of any kind of physical activity that increased their heart rate and made them breathe hard on at least 1 day during the 7 day s before the survey. Further, 13.9% had obesity and 16.0% were overweight.

Conclusion: Many high school students engage in behaviors that place them at risk for the leading causes of morbidity and mortality. The prevalence of most health behaviors varies by sex, race/ethnicity, and grade and across states and large urban school districts. Long-term temporal changes also have occurred. Since the earliest year of data collection, the prevalence of most health-risk behaviors has decreased (e.g., riding with a driver who had been drinking alcohol, physical fighting, current cigarette use, current alcohol use, and current sexual activity), but the prevalence of other behaviors and health outcomes has not changed (e.g., suicide attempts treated by a doctor or nurse, smokeless tobacco use, having ever used marijuana, and attending physical education classes) or has increased (e.g., having not gone to school because of safety concerns, obesity, overweight, not eating vegetables, and not drinking milk). Monitoring emerging risk behav iors (e.g., texting and driving, bullying, and electronic vapor product use) is important to understand how they might vary over time.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Comprehensive School-Based PA Program,

Intervention Description: - Intervention description: The intervention included onsite school-based HPV vaccination events, community-based education, and distribution of educational materials. The comparison schools received community-based education only.

Intervention Results: - Results: The study found that the intervention school had a lower baseline HPV vaccine initiation and completion rate than the comparison schools. However, the initiation and completion rates increased significantly at the intervention school after the implementation of the school-based vaccination events and community-based education. The proportion of students who were vaccinated onsite at the intervention school was 30.8%.

Conclusion: - Conclusion: The study concludes that school-based HPV vaccination events and community-based education can significantly increase HPV vaccine uptake in underserved areas.

Study Design: - Study design: The study used a quasi-experimental design with an intervention school (onsite vaccination events and community-based education) and two comparison schools (community-based education only).

Setting: - Setting: The study was conducted in the Rio Grande City Consolidated Independent School District (RGCCISD) in Texas, which is an underserved area with a predominantly Hispanic population.

Population of Focus: - Target audience: The target audience was 6th-, 7th-, and 8th-grade students in the intervention and comparison schools.

Sample Size: - Sample size: The total enrollment of 6th-, 7th-, and 8th-grade students at the intervention school was n = 885, and n = 1422 at the comparison schools.

Age Range: - Age range: The mean age of students at the intervention school was 12.23 years ± 0.90, range = 9.9–14.4, and at the comparison schools was 12.18 years ± 0.91, range = 9.94–14.22.

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Adult-led Spport/Counseling/Remediation, PATIENT_CONSUMER, Educational Material (Provider), HEALTH_CARE_PROVIDER_PRACTICE

Intervention Description: The purpose of this study is to conduct moderator analyses using pooled data from three randomized controlled trials of the intervention conducted in collaboration with 2-1-1 contact centers in Atlanta, North Carolina and Houston. 2-1-1 is a strategic partner for tobacco control as it connects over 15 million clients, largely socio-economically disadvantaged, to social and health resources each year.

Intervention Results: Intervention effectiveness was not moderated by race/ethnicity, education, income, children in the home or number of smokers in the home. Smoking status of the participant, however, did moderate program effectiveness, as did time to first cigarette. Number of cigarettes per day and daily versus nondaily smoking did not moderate intervention effectiveness.

Conclusion: The intervention was effective across socio-demographic groups and was effective without respect to daily versus nondaily smoking or number of cigarettes smoked per day, although smoking status and level of nicotine dependence did influence effectiveness.

Intervention Components (click on component to see a list of all articles that use that intervention): Telephone Support, Adult-led Support/Counseling/Remediation, Educational Material (caregiver), PROFESSIONAL_CAREGIVER, PATIENT_CONSUMER, YOUTH

Intervention Description: Using data from a dissemination study in collaboration with five 2-1-1 call centers in Ohio, Florida, Oklahoma, and Alabama (n = 2,345 households), this article examines key dimensions of scalability, including effectiveness by subpopulation, secondary outcomes, identification of core elements driving effectiveness, and cost-effectiveness.

Intervention Results: Creating a smoke-free home was associated with a new smoke-free vehicle rule (odds ratio [OR] = 3.38, confidence interval [CI 2.58, 4.42]), decreased exposure to secondhand smoke among nonsmokers (b = -2.33, p < .0001), and increased cessation among smokers (OR = 5.8, CI [3.81, 8.81]). Use of each program component was significantly associated with success in creating a smoke-free home. Using an intent-to-treat effect size of 40.1%, program benefits from 5 years of health care savings exceed program costs yielding a net savings of $9,633 for delivery to 100 households.

Conclusion: Cost effectiveness, subpopulation analyses, and identification of core elements can help in assessing the scalability potential of research-tested interventions such as this smoke-free homes program.

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, PATIENT/CONSUMER

Intervention Description: To determine whether a low-cost prenatal education video improves hospital rates of breastfeeding initiation and exclusivity in a low-income population.

Intervention Results: Exposure to the intervention did not affect breastfeeding initiation rates or duration during the hospital stay. The lack of an effect on breastfeeding initiation persisted even after controlling for partner, parent, or other living at home and infant complications (adjusted odds ratio [OR] = 1.05, 95% CI, 0.70-1.56). In addition, breastfeeding exclusivity rates during the hospital stay did not differ between the groups (P = .87).

Conclusion: This study suggests that an educational breastfeeding video alone is ineffective in improving the hospital breastfeeding practices of low-income women. Increasing breastfeeding rates in this at-risk population likely requires a multipronged effort begun early in pregnancy or preconception.

Study Design: RCT

Setting: University of Virginia Health System and the Virginia Commonwealth University Health System

Population of Focus: Women 24-41 weeks GA, income ≤185% FPL, English-speaking, with a singleton pregnancy, and no known contraindication to breastfeeding

Data Source: Medical record review

Sample Size: Intervention (n=249/174)3 Control (n=248/172)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Training (Parent/Family), Education on Disease/Condition,

Intervention Description: The 5-component intervention included an HPV fact sheet library, a tailored parent education website, a set of HPV-related disease images, an HPV vaccine decision aid, and 2½ hours of communication training on using a presumptive vaccine recommendation, followed by motivational interviewing if parents were resistant to vaccination

Intervention Results: Adolescents in the intervention practices had significantly higher odds of HPV vaccine series initiation and completion than those in the control practices

Conclusion: The study concluded that there were substantial and sustained increases in HPV vaccine series initiation in intervention practices compared with controls over time

Study Design: The study was a cluster randomized clinical trial using covariate-constrained randomization to assign study arms and an intent-to-treat protocol

Setting: The study was conducted in 16 primary care practices in the Denver, Colorado, metropolitan area

Population of Focus: The target audience included 188 medical professionals and 43,132 adolescents

Sample Size: The final sample size was 16,000 adolescents (8000 per arm)

Age Range: The study included adolescents aged 11 to 17 years

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Media Campaign (Print Materials, Public Address System, Social Media)

Intervention Description: The toolkit comprised of a) continuing medical education (CME) presentation on strategies to improve HPV vaccination, b) campus-wide visual messaging regarding HPV prevalence, genital warts, cancer, and vaccine availability, and c) an electronic medical record (EMR) form prompting discussion about the HPV vaccine during visits.

Intervention Results: HPV vaccination rates at JHU SHWC improved from historical baseline 290/2,372 students/year (12.2%) to 515/2,479 students/year (20.8%), [risk ratio (RR) 1.70 (95% CI, 1.47–1.96), p < 0.001]. Additional changes included significant increases in vaccination rate per visit and vaccination rate by gender, especially among male students.

Conclusion: Methods and resources from this toolkit could be successfully adapted and deployed by college health centers.

Setting: Johns Hopkins Health and Wellness Center

Population of Focus: Students (male and female) ages 18-26

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Screening Tool Implementation Training, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: To assess the degree to which a national sample of pediatric practices could implement American Academy of Pediatrics (AAP) recommendations for developmental screening and referrals, and to identify factors that contributed to the successes and shortcomings of these efforts.

Intervention Results: At the project's conclusion, practices reported screening more than 85% of patients presenting at recommended screening ages. They achieved this by dividing responsibilities among staff and actively monitoring implementation. Despite these efforts, many practices struggled during busy periods and times of staff turnover. Most practices were unable or unwilling to adhere to 3 specific AAP recommendations: to implement a 30-month visit; to administer a screen after surveillance suggested concern; and to submit simultaneous referrals both to medical subspecialists and local early-intervention programs. Overall, practices reported referring only 61% of children with failed screens. Many practices also struggled to track their referrals. Those that did found that many families did not follow through with recommended referrals.

Conclusion: A diverse sample of practices successfully implemented developmental screening as recommended by the AAP. Practices were less successful in placing referrals and tracking those referrals. More attention needs to be paid to the referral process, and many practices may require separate implementation systems for screening and referrals.

Study Design: QE: interrupted timeseries design

Setting: Sixteen pediatric primary care practices from 15 different states

Population of Focus: Children ages 8 to 36 months at wellchild visits

Data Source: Child medical record

Sample Size: Chart audits: - Baseline and Follow-Up: (n=30) per practice in July 2006 and March 2007; total charts audited (n= 960) - Intervention period: (n=10) per practice per month for 7 months; total charts audited (n=1,120)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Patient Reminder/Invitation, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Quality Improvement/Practice-Wide Intervention, Nurse/Nurse Practitioner

Intervention Description: Improving cervical cancer screening rates was identified as a priority in a federally qualified health center when only 40% of eligible women were properly screened in 2016. Forty-five percent of the population the clinic serves is uninsured and 60% are Hispanic. The aim of this quality improvement project was to have 75% of the women 21 to 65 years of age who sought care at this clinic during the 60-day project period receive Pap test eligibility screening, enrollment in a state and federal screening program, and case management. Four rapid plan–do–study–act cycles were used. Tests of change included team engagement, patient engagement, eligibility screening, and case log management. Data were analyzed using run charts to evaluate the impact of interventions on outcomes. The interventions consisted of team meetings, a patient engagement tool, an eligibility screening tool, and case log management.

Intervention Results: Among the women who completed care at the clinic during the 60-day project period, 80% were uninsured and 86% were Hispanic. A total of 87% of women received effective care, which consisted of same-day Well Woman Health Care Program enrollment and a same-day Pap test or an appointment to return for a well-woman visit.

Conclusion: A multicomponent approach led to underserved women receiving equitable access to cervical cancer screening and timely enrollment in a cervical cancer screening program.

Setting: Federally qualified health center (FQHC) in Tucson, Arizona,

Population of Focus: Uninsured and underserved women ages 21-65

Intervention Components (click on component to see a list of all articles that use that intervention): Note-Taking (caregiver), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: A pilot randomised controlled trial was conducted with postpartum mothers to assess the feasibility and impact of note-taking during newborn teaching. Controls received standard teaching; the intervention group received pen and paper to take notes.

Intervention Results: Mothers in the intervention group were more likely than those in the control group to report placing their infant on their back for sleep (88% vs. 78%), but the difference was not statistically significant (RR=1.13, 95% CI: 0.95-1.34). However, first-time mothers were significantly more likely to report placing their infant on the back for sleep (95% vs. 65%, RR=1.46, 95% CI: 1.06-2.00).

Conclusion: Maternal note-taking is feasible and potentially efficacious in promoting desirable infant care.

Study Design: RCT

Setting: Postpartum ward of an urban safetynet hospital

Population of Focus: Mothers on the postpartum ward (infant gestational age >35 weeks, no prolonged hospitalization of the mother or the infant, expecting to retain custody of the infant)

Data Source: Mother report

Sample Size: Intervention (n=61/48) Control (n=65/58)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Educational Material

Intervention Description: To equitably increase exclusive breastfeeding at hospital discharge among obstetrician/gynecologist resident service clients by 20% over 8 weeks. Design

Intervention Results: Rates of exclusive breastfeeding at hospital discharge were 7% at baseline and 13% after implementation. Rates of exclusive breastfeeding among Black clients were 0% at baseline and 16% after implementation. Clients demonstrated Baby-Friendly knowledge (teach-back average, 89%) but continued to supplement with formula, most often related to supply concerns (65%).

Conclusion: Intentionally equitable implementation of the Baby-Friendly steps may ameliorate racial disparities in breastfeeding during the early postpartum period. Preparing families to exclusively breastfeed should begin prenatally.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Lactation Consultant, Educational Material, Home Visits

Intervention Description: This study examined the effectiveness of a breast-feeding promotion program to increase the continuation of breast-feeding.

Intervention Results: The 3-month breast-feeding rate was 32% in the intervention and 38% in the control groups (OR = 0.79, 95% CI = 0.58-1.08).

Conclusion: The program was not effective. We discuss possible explanations from the design and execution of the trial and give some points for improvement of our program, such as the categories of caregivers involved and the number and duration of contacts after parturition.

Study Design: Cluster RCT

Setting: 10 maternity and child health centers within home health care organizations in Limburg

Population of Focus: Pregnant women who applied for maternity care in one of the participating centers who gave birth to infants ≥2000 g

Data Source: Mother self-report

Sample Size: • Intervention (n=5) • Control (n=5) N=clinics • Intervention (n=371) • Control (n=330) N=women

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Support (Provider), Educational Material

Intervention Description: Sites were randomly assigned to receive an experimental intervention (n = 16) modeled on the Baby-Friendly Hospital Initiative of the World Health Organization and United Nations Children's Fund, which emphasizes health care worker assistance with initiating and maintaining breastfeeding and lactation and postnatal breastfeeding support, or a control intervention (n = 15) of continuing usual infant feeding practices and policies.

Intervention Results: Infants from the intervention sites were significantly more likely than control infants to be breastfed to any degree at 12 months (19.7% vs 11.4%; adjusted odds ratio [OR], 0.47; 95% confidence interval [CI], 0.32-0.69), were more likely to be exclusively breastfed at 3 months (43.3% vs 6.4%; P<.001) and at 6 months (7.9% vs 0.6%; P =.01), and had a significant reduction in the risk of 1 or more gastrointestinal tract infections (9.1% vs 13.2%; adjusted OR, 0.60; 95% CI, 0.40-0.91) and of atopic eczema (3.3% vs 6.3%; adjusted OR, 0.54; 95% CI, 0.31-0.95), but no significant reduction in respiratory tract infection (intervention group, 39.2%; control group, 39.4%; adjusted OR, 0.87; 95% CI, 0.59-1.28).

Conclusion: Our experimental intervention increased the duration and degree (exclusivity) of breastfeeding and decreased the risk of gastrointestinal tract infection and atopic eczema in the first year of life. These results provide a solid scientific underpinning for future interventions to promote breastfeeding.

Study Design: The Promotion of Breastfeeding Intervention Trial (PROBIT), a cluster-randomized trial conducted June 1996-December 1997 with a 1-year follow-up.

Setting: Thirty-one maternity hospitals and polyclinics in the Republic of Belarus.

Data Source: N/A

Sample Size: 17 046 mother-infant pairs 16491 (96.7%) of which completed the entire 12 months of follow-up

Age Range: mother-infant pairs consisting of full-term singleton infants weighing at least 2500 g and their healthy mothers who intended to breastfeed

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Community Health Workers (CHWs), PATIENT/CONSUMER, Home Visits, Educational Material, Other Person-to-Person Education, Peer Counselor, Motivational Interviewing, CAREGIVER, Home Visit (caregiver), Education/Training (caregiver), Educational Material (caregiver), Motivational Interviewing/Counseling

Intervention Description: We assessed the effectiveness of a community health worker intervention focused on reducing exposure to indoor asthma triggers.

Intervention Results: The high-intensity group improved significantly more than the low-intensity group in its pediatric asthma caregiver quality-of-life score (P=.005) and asthma-related urgent health services use (P=.026). Asthma symptom days declined more in the high-intensity group, although the across-group difference did not reach statistical significance (P= .138). Participant actions to reduce triggers generally increased in the high-intensity group. The projected 4-year net savings per participant among the high-intensity group relative to the low-intensity group were $189–$721.

Conclusion: Community health workers reduced asthma symptom days and urgent health services use while improving caregiver quality-of-life score. Improvement was greater with a higher-intensity intervention.

Study Design: RCT

Setting: Community (home)

Population of Focus: Families in low-income households with children with asthma

Data Source: In-home interviewing, dust sample and standardized home inspection

Sample Size: 274 randomized participants

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, HOSPITAL, Policy/Guideline (Hospital), Sleep Environment Modification, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation

Intervention Description: The purpose of this study was to improve safe sleep practices for infants in nonneonatal pediatric units with implementation of specific interventions.

Intervention Results: Safe sleep was observed for 4.9% of 264 infants at baseline and 31.2% of 234 infants postintervention (P<.001). Extra blankets, the most common of unsafe items, were present in 77% of cribs at baseline and 44% postintervention. However, the mean number of unsafe items observed in each sleeping environment was reduced by >50% (P=.001).

Conclusion: Implementation of site-specific interventions seems to improve overall safe sleep in inpatient pediatric units, although continued improvement is needed. Specifically, extra items are persistently left in the sleeping environment.

Study Design: QE: pretest-posttest

Setting: Eight children’s hospitals

Population of Focus: Infants aged 0 to 6 months admitted to the general pediatric unit (excluding infants in the NICUs, PICUs, and maternal fetal units)

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=234) Follow-up (n=210)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Data Collection Training for Staff

Intervention Description: To explore rates of screening and identification and treatment for behavioral problems using billing data from Massachusetts Medicaid immediately following the start of the state's new court-ordered screening and intervention program.

Intervention Results: Major increase from 16.6% of all Medicaid well-child visits coded for behavioral screens in the first quarter of 2008 to 53.6% in the first quarter of 2009. Additionally, the children identified as at risk increased substantially from about 1600 in the first quarter of 2008 to nearly 5000 in quarter 1 of 2009. The children with mental health evaluations increased from an average of 4543 to 5715 per month over a 1-year period.

Conclusion: The data suggest payment and a supported mandate for use of a formal screening tool can substantially increase the identification of children at behavioral health risk. Findings suggest that increased screening may have the desired effect of increasing referrals for mental health services.

Study Design: Observational pretestposttest design

Setting: Massachusetts

Population of Focus: Children enrolled in Medicaid

Data Source: Medicaid data prepared for Rosie D. v Romney (Patrick) court case

Sample Size: Well-child visits - Baseline/first quarter 2008 (n=122,494)4 - Follow-up/first quarter 2009 (n=118,573)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, POPULATION-BASED SYSTEMS, STATE, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The objectives of this study were to assess the feasibility of implementing a bundle of strategies to facilitate the use of Bright Futures recommendations and to evaluate the effectiveness of a modified learning collaborative in improving preventive and developmental care.

Intervention Results: Office system changes most frequently adopted were use of recall/reminder systems (87%), a checklist to link to community resources (80%), and systematic identification of children with special health care needs (80%). From baseline to follow-up, increases were observed in the use of recall/reminder systems, the proportion of children's charts that had a preventive services prompting system, and the families who were asked about special health care needs. Of 21 possible office system components, the median number used increased from 10 to 15. Comparing scores between baseline and follow-up for each practice site, the change was significant. Teams reported that the implementation of office systems was facilitated by the perception that a component could be applied quickly and/or easily. Barriers to implementation included costs, the time required, and lack of agreement with the recommendations.

Conclusion: This project demonstrated the feasibility of implementing specific strategies for improving preventive and developmental care for young children in a wide variety of practices. It also confirmed the usefulness of a modified learning collaborative in achieving these results. This model may be useful for disseminating office system improvements to other settings that provide care for young children.

Study Design: QE: pretest-posttest

Setting: Primary care practices (15 at baseline, 8 at follow- up) throughout the US (9 states total), with most in the Midwest

Population of Focus: Children from birth through 21 years of age

Data Source: Child medical record

Sample Size: Unknown number of chart audits from 8 practice sites completing follow-up

Age Range: Not specified

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

Intervention Description: The intervention used in the study was a screening, brief intervention, referral, and treatment/follow-up (SBIRT) model, which was used to screen eligible patients, provide treatment options, and appropriately refer for follow-up to mental health services. The study analyzed a multicomponent intervention that included PMAD screening, maternal engagement/brief intervention, referral to mental health services, and clinic follow-up to ensure mental health care uptake.

Intervention Results: The study concluded that the use of the SBIRT (screening, brief intervention, referral, and treatment/follow-up) model to implement a safety bundle may contribute to improved mental health outcomes for individuals receiving perinatal care in a private-practice outpatient health care setting. The authors emphasized that education and engagement among clinicians, staff, and patients are key to the successful implementation of a safety bundle for perinatal mental health care. The study also highlighted the importance of maternal engagement, brief intervention, shared decision-making, and closed-loop referral processes in improving help-seeking behaviors and providing evidence-based care for perinatal mood and anxiety disorders (PMAD)

Conclusion: Use of the SBIRT model to implement a safety bundle may contribute to improved mental health outcomes for individuals receiving perinatal care in a private-practice outpatient health care setting. Education and engagement among clinicians, staff, and patients are key to successful implementation of a safety bundle.

Study Design: The study design was a rapid-cycle quality improvement model using four plan-do-study-act (PDSA) cycles over the course of 90 days. The study aimed to improve screening and care for perinatal mood and anxiety disorders (PMAD) in a private-practice women's health clinic. The interventions included screening with a validated tool, brief intervention, referral, and treatment/follow-up (SBIRT) model, and team engagement via weekly meetings. The study used measurements such as pre-post maternal and team engagement survey results, biweekly chart review, and run chart analysis to evaluate the effectiveness of the interventions

Setting: The study was conducted in a suburban, private-practice women's health clinic. The setting involved health care providers, staff, and eligible patients at a private-practice women's health clinic. The study aimed to address the local problem of low rates of PMAD screening and standardized PMAD care practices among health care providers in this specific setting

Population of Focus: The target audience for the study included health care providers (n=2), staff (n=4), and eligible patients (n=78) at a private-practice women's health clinic. The initiative aimed to improve screening and care for perinatal mood and anxiety disorders (PMAD) in this specific setting, making the health care providers, staff, and eligible patients the primary target audience for the intervention

Sample Size: The sample size for the study was 78 eligible patients who were screened for perinatal mood and anxiety disorders (PMAD) using the Edinburgh Postnatal Depression Scale (EPDS)

Age Range: The age range of the study participants was not explicitly mentioned in the article. However, as the study focused on perinatal mood and anxiety disorders (PMAD), it can be inferred that the participants were women in the perinatal period, which includes pregnancy and the postpartum period. Therefore, the age range of the participants would likely be between 18 and 45 years old, which is the typical age range for women in the perinatal period

Intervention Components (click on component to see a list of all articles that use that intervention): PROFESSIONAL_CAREGIVER, Provision of Safe Sleep Item, Educational Material (caregiver), HOSPITAL, Sleep Environment Modification

Intervention Description: This was a multicenter prospective study in which exposed/unexposed mothers answered questionnaires (by telephone and online) one month after giving birth. The exposed group consisted of mothers who had given birth in a maternity hospital of the ELENA perinatal network in which an embroidered sleeping bag with a safe-sleep message was used as a preventive action; the unexposed group of mothers gave birth in a maternity hospital of the RP2S network, without this specific preventive action. Devised by the perinatal network to promote and encourage back sleeping, the embroidered “I sleep on my back” (baby) sleeping bags are systematically used in postpartum recovery rooms.

Intervention Results: A total of 540 mothers participated in the study: 245 in the exposed group and 295 in the unexposed group. In the exposed group, 87.3% of infants slept exclusively on their back versus 75.9% in the unexposed group (P<0.001); 91% of the mothers reported having actually used the sleeping bag. Except for room-sharing, compliance with the other sleeping recommendations was higher in the exposed group.

Conclusion: Sleeping practices when infants were 1 month old were not optimal in our study population. A simple preventive initiative in maternity hospitals, using the embroidered "I sleep on my back" sleeping bags, is relevant and effective in improving compliance with the sleeping recommendations for infants at home.

Setting: Three maternity hospitals in the ELENA perinatal network in France

Population of Focus: Mothers of newborns

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Other Person-to-Person Education, Telephone Support, Enabling Services, Educational Material, Motivational Interviewing, Peer Counselor

Intervention Description: This study evaluated a theory-guided cognitive-behavioral counseling (CBC) intervention for smoking cessation during pregnancy and postpartum. It also explored the mediating role of cognitive-affective variables on the impact of CBC.

Intervention Results: An intent-to-treat analysis found no differences between the two groups in 7-day point-prevalence abstinence. However, a respondents-only analysis revealed a significantly higher cessation rate in the CBC (37.3 %) versus the BP (19.0 %) condition at 5-months postpartum follow-up. This effect was mediated by higher quitting self-efficacy and lower cons of quitting.

Conclusion: CBC, based on the Cognitive-Social Health Information Processing model, has the potential to increase postpartum smoking abstinence by assessing and addressing cognitive-affective barriers among women who adhere to the intervention.

Study Design: RCT

Setting: University hospital prenatal care clinic

Population of Focus: Racial and ethnically diverse urban pregnant smokers

Data Source: Standard scales, self-report, urine cotinine

Sample Size: 277, 140 in the intervention group and 137 in the control group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Peer Counselor, Telephone Support, Other Education, Motivational Interviewing, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Motivational Interviewing/Counseling, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Consultation/Counseling (Parent/Family), Counseling (Parent/Family)

Intervention Description: We hypothesized that a multilevel treatment model integrating pediatric clinic-level AAR with individual-level, telephone counseling would promote greater long-term (12-month) child TSE reduction and parent smoking cessation than clinic-level AAR alone.

Intervention Results: Child TSE (urine cotinine) declined significantly in both intervention and control groups from baseline to 12-months with no between-group differences. There was s statistically significant effect on 12-month bioverified quit status-intervention group participants were 2.47 times more likely to quit smoking than those in the control group.

Conclusion: Pediatrician advice alone may be sufficient to increase parent protections of children from TSE. Integrating clinic-level intervention with more intensive individual-level smoking intervention is necessary to promote parent cessation.

Study Design: RCT

Setting: Telephone counseling

Population of Focus: Parents/caregivers

Data Source: Self-reported interview data

Sample Size: 327 were randomized (164-control and 163-intervention)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Professional Support, HEALTH_CARE_PROVIDER_PRACTICE, Baby Friendly Hospital Initiative, COMMUNITY, Individual Supports,

Intervention Description: The Westside Healthy Start Program (WHS), located in Chicago, Illinois, developed an ongoing multilevel approach to breastfeeding promotion. Key elements of the WHS breastfeeding model include individual education and counseling from pregnancy to 6 months postpartum and partnership with a local safety-net hospital to implement the Baby Friendly Hospital Initiative and provide lactation support to delivering patients. All WHS participants receive general breastfeeding education from case managers throughout pregnancy (such as information about breastfeeding benefits) and one face-to-face visit from a BFC in the third trimester for more personalized and comprehensive support. WHS collaborates with the largest delivering hospital in the service area, a safety-net provider, to improve the breastfeeding environment and systems of care.

Intervention Results: In the year our model was implemented, 44.6% (49/110) of prenatal WHS participants reported that they planned to breastfeed, and 67.0% (183/273) of delivered partici- pants initiated. Among participants reaching 6 months postpartum, 10.5% (9/86) were breastfeeding. WHS also had 2667 encounters with women delivering at our partner hospital during breastfeeding rounds, with 65.1% of contacts initiating. Community data was not available to assess the efficacy of our model at the local level. However, WHS participants fared better than all delivering patients at our partner hospital, where 65.0% initiated in 2015.

Conclusion: Healthy Start programs are a promising vehicle to improve breastfeeding initiation at the individual and community level. Additional evaluation is necessary to understand barriers to duration and services needed for this population.

Study Design: Evaluation data

Setting: Westside Healthy Start program located in Chicago, IL

Population of Focus: Low-income, African-American women who are pregnant

Sample Size: 652 women

Age Range: Women <17 to 45 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Education/Training (caregiver),

Intervention Description: The intervention included a high-quality vaccine recommendation and a brochure about HPV.

Intervention Results: The study found no statistically significant difference in HPV vaccination rates between the standard recommendation group and the combined intervention group.

Conclusion: The study suggests that a combined intervention that includes a high-quality vaccine recommendation and a brochure about HPV may not be more effective than a standard vaccine recommendation in increasing HPV vaccination rates among adolescents.

Study Design: The study used a randomized controlled trial design

Setting: The study was conducted in a pediatric primary care clinic in the United States.

Population of Focus: Parents of adolescents aged 11-17 years who were eligible for the human papillomavirus (HPV) vaccine.

Sample Size: The study included 300 parents who were randomized to receive either a standard vaccine recommendation or a combined intervention that included a high-quality vaccine recommendation and a brochure about HPV.

Age Range: The study included parents of adolescents aged 11-17 years.

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Screening Tool Implementation,

Intervention Description: The specific intervention described in the study was the screening and education of new mothers about postpartum depression by hospital-based perinatal nurses prior to hospital discharge. The intervention aligns with a discernable strategy of promoting screening, teaching, and referral of women for postpartum depression by hospital-based perinatal nurses.

Intervention Results: The study found that the majority of new mothers found it acceptable to be screened for postpartum depression and educated about community resources by hospital-based perinatal nurses. However, many new mothers were not asked about depressive symptoms by community providers. There was no significant correlation between demographics and depression risk. The study also found that group affiliation (high vs. low risk for depression) only affected the odds of experiencing postpartum depression symptoms after discharge. Less than half of the women were asked about postpartum depression after discharge, with the largest number being asked by both an obstetrician and pediatrician. The study suggests that communication between inpatient and community caregivers should be improved so that new mothers can benefit from seamless depression assessment, evaluation, and treatment

Conclusion: New mothers viewed depression screening and receiving information on community resources as a positive part of their care. Communication between inpatient and community caregivers should be improved so that new mothers can benefit from seamless depression assessment, evaluation, and treatment.

Study Design: The study design was descriptive. The study described in the article is a descriptive study. The study design involved the collection and analysis of quantitative data to describe or summarize a phenomenon, specifically the acceptability of postpartum depression screening and education by hospital-based perinatal nurses, and the further screening for postpartum depression that women received by community providers in the first few weeks after birth

Setting: The study was conducted in an academic health sciences center. New mothers were recruited from the mother-baby unit of this center.

Population of Focus: The target audience for the study includes healthcare professionals, particularly hospital-based perinatal nurses, as well as researchers and policymakers interested in postpartum depression screening and education for new mothers. Additionally, the findings may be relevant to organizations involved in maternal and child health care.

Sample Size: The study included a total of 101 new mothers, with 75 identified as high risk for depression and 26 in the comparison group at low risk for depression.

Age Range: The age group of the participants included new mothers aged 18 years and above. The study did not specify an upper age limit for the participants.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Nurse/Nurse Practitioner, Educational Material (Provider),

Intervention Description: The intervention was an online educational program that included information on PD screening and treatment, interviewing skills, screening tools, and treatment options. The intervention was designed based on the Theory of Planned Behavior (TPB) constructs, which include attitudes toward behavior, perceived behavioral control, subjective norms, perceived behavioral intention, and behavioral outcome. The study analyzed the impact of this specific intervention on participants' PD-related perceptions and intentions. Therefore, the intervention described aligns with a discernable strategy based on the TPB constructs.

Intervention Results: The results of the study showed positive gains in several key areas related to perinatal depression (PD) screening and treatment. Specifically, the intervention resulted in positive gains in PD-related perceived behavioral control (PBC), attitudes, subjective norms, knowledge, intention to screen and treat PD, and perceived importance of screening and treating PD from pre- to post-intervention . The findings indicated improvements in PD-related attitudes, knowledge, and the perceived importance of PD screening and treatment after the intervention . Additionally, the Theory of Planned Behavior Scale (TPBS) scores showed significant improvements from pre- to post-intervention, indicating a positive impact of the educational intervention on participants' perceptions and intentions related to PD screening and treatment . Overall, the results suggested that the PD online educational intervention was effective in improving participants’ PD-related PBC, attitudes, subjective norms, knowledge, and intention to screen and treat PD

Conclusion: PBC demonstrated a small-to-moderate positive association with perceived importance of screening and treating PD at post-intervention. Results from the current study suggest that the PD online educational intervention is effective in improving participants’ PD-related PBC, attitudes, subjective norms, knowledge, and intention to screen and treat PD.

Study Design: The study utilized a quasi-experimental, repeated-measures design. The study included a single group of participants, and data were collected at two time points: pre-intervention and post-intervention. The pre-intervention assessments occurred online directly prior to the participants engaging in the training, while the post-intervention assessments occurred online directly after the participants engaged in the training . This design allowed for the evaluation of changes in participants' perceptions and intentions related to perinatal depression (PD) screening and treatment before and after the educational intervention. The use of pre-post measures enabled the researchers to assess the impact of the intervention on participants' PD-related knowledge, attitudes, and intention to screen and treat PD, as well as their perceived importance of screening and treating PD. While the study did not include a control group, the use of a repeated-measures design allowed for the evaluation of changes within the same group of participants, which can provide valuable information about the impact of the intervention on participants' perceptions and intentions related to PD screening and treatment.

Setting: The study setting was not explicitly mentioned in the provided excerpts. However, the study was conducted with graduate nursing students, and the intervention was implemented and assessed online via Qualtrics . Therefore, it can be inferred that the study setting for the educational intervention and data collection was an online platform, likely associated with the academic institution where the graduate nursing program was located.

Population of Focus: The target audience of the study was graduate nursing students. The researchers chose nursing students as the participant population for several reasons. First, educational interventions for healthcare profession students have been well received and effective in improving student comfort with addressing postpartum depression. Second, nursing is the largest of the healthcare professions, with almost 3 million nurses practicing in the United States, indicating their potential impact on patient care. Third, the nursing profession has shifted to providing evidence-based care to patients; as such, this study aimed to improve perinatal depression-related evidence-based care

Sample Size: The study included a sample of 59 graduate nursing students

Age Range: The study did not provide a specific age range for the participants. However, the study included graduate nursing students, and the average age of the participants was 33.83 years (SD = 7.35)

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Community-Based Group Education, PATIENT/CONSUMER

Intervention Description: This study examined the feasibility and efficacy of Salud Es Vida – a promotora-led, Spanish-language educational group session on cervical cancer screening (Pap tests), self-efficacy (belief in ability to schedule and complete a Pap test), and knowledge among immigrant Hispanic/Latina women from farmworker backgrounds.

Intervention Results: While there was no statistically significant difference in cervical cancer screening self-efficacy scores between the group participants, both groups scored higher at follow-up, adjusting for the baseline scores.

Conclusion: The group intervention approach was associated with increased cervical cancer knowledge, but not uptake of Pap test. More intensive interventions using patient navigation approaches or promotoras who actively follow participants or conducting one-on-one rather than group sessions may be needed to achieve improved screening outcomes with this population.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: 4 rural counties in Southeast GA

Population of Focus: Hispanic/Latino immigrant women ages 21-65 who had not had a Pap test in 2 years or more

Data Source: Written survey; cervical cancer screening questions were derived from the Health Information National Trends Survey

Sample Size: Baseline (n=176) Intervention (n=86); Control (n=90) Follow-up/Analysis (n=90) Intervention (n=38); Control (n=52)

Age Range: 21-65

Intervention Components (click on component to see a list of all articles that use that intervention): PROFESSIONAL_CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Provider Training/Education, Home Visit (caregiver), Audit/Attestation

Intervention Description: The Maternal Infant Health Outreach Worker (MIHOW) program is an early-childhood home visiting program that uses community health workers (CHWs) to improve health outcomes in underserved communities. To be a MIHOW home visitor, women must be from the target community, be of the same culture and/or language group of families served, have completed all MIHOW training, and use the MIHOW curriculum. This randomized clinical trial evaluated the impact of MIHOW’s use of CHWs on selected maternal/infant outcomes up to 15 months postpartum. All study participants received the minimal education intervention (MEI), which consisted of printed educational materials about health and child development, compared to the intervention group that also received MIHOW home visitation services. Data was collected during interviews conducted by trained data collectors who were fluent in Spanish, also spoke English, and were from the same community.

Intervention Results: Enrolled women (N = 132) were randomly assigned, with 110 women completing the study (MEI = 53; MIHOW = 57). Positive and statistically significant (p < .01) effects of MIHOW were observed on breastfeeding duration, safe sleep practices, stress levels, depressive symptoms, emotional support, referral follow through, parental confidence, and infant stimulation in the home.

Conclusion: Findings provided strong evidence of the effectiveness of MIHOW for improving health outcomes in this sample. Using trained CHWs makes programs such as MIHOW a viable option for providing services to immigrant and underserved families.

Population of Focus: Pregnant Hispanic women living in middle Tennessee

Intervention Components (click on component to see a list of all articles that use that intervention): Consultation (Parent/Family), Educational Material,

Intervention Description: Team discussions and staff training, reminder mailings to parents and guardians of patients aged 9 through 12 years, pictures and information provided for utilization in patient rooms

Intervention Results: There was slight improvement in all age ranges and genders in HPV vaccination rates after the intervention, but there is a need for more tightly controlled methods to determine the effectiveness of intervention and of specific measures.

Conclusion: Sustainable methods for vaccine promotion and clinical intervention must be implemented for long-term benefit, and missed opportunities to vaccinate must be addressed.

Study Design: Retrospective assessment of HPV vaccination data before and after intervention - Intervention description: Team discussions and staff training, reminder mailings to parents and guardians of patients aged 9 through 12 years, pictures and information provided for utilization in patient rooms

Setting: Outpatient pediatric clinic in Omaha, Nebraska metropolitan area

Population of Focus: Adolescents aged 9 through 18 years old

Sample Size: N = 3393 subjects at baseline between 9 and 17 years of age

Age Range: 9 through 18 years old

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material (caregiver), Educational Material, Text Messaging,

Intervention Description: The intervention included a multilevel and trauma-informed approach, interventional videos, bilingual HPV printed educational materials, interactive discussions, and text message reminders to participants

Intervention Results: The study found no significant differences between intervention and control groups for most sociodemographic factors. However, the intervention group was younger on average. Only about one-third of the parents or guardians reported receiving HPV vaccine recommendations from their children’s pediatrician

Conclusion: there was an increase in HPV vaccine uptake among the intervention group. At the 6-month follow-up, 65.45% of participants in the intervention group reported that at least one child aged between 11 and 18 had initiated and completed the vaccine schedule, compared to only 2.9% in the control group. The initiation rate was significantly higher in the intervention group than in the control group (p < 0.001)

Study Design: The study utilized a longitudinal pilot study design to evaluate the efficacy of an HPV vaccination intervention among Chinese American parents and guardians of teenagers

Setting: The setting of the study was within the Chinese American community, involving community health centers and participants' homes

Population of Focus: The target audience was Chinese American parents and guardians of teenagers aged 11 to 18

Sample Size: The study recruited a total of 180 participants, with 110 in the intervention group and 70 in the control group

Age Range: The study focused on children aged 11 to 18, and the parents or guardians of these children were the participants

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Seven pediatric primary care practices participated in New Mexico's Developmental Screening Initiative in a year-long quality improvement project with the goal of implementing standardized developmental screening tools.

Intervention Results: At baseline, there were dramatic differences among the practices, with some not engaged in screening at all.

Conclusion: Overall, the use of standardized developmental screening increased from 27% at baseline to 92% at the end of the project.

Study Design: QE: pretest-posttest

Setting: Seven primary care practices in a large urban area and small regional community in New Mexico

Population of Focus: Children ages 1 through 60 months

Data Source: Child medical record

Sample Size: Total medical records reviewed at baseline and follow-up (n=1139)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material (Provider), Educational Material, Media Campaign (Print Materials, Public Address System, Social Media)

Intervention Description: HBWW is a multi-dimensional, community-based approach to preventing preventable preterm births. In HBWW sites, community health leaders, including hospitals, health departments and local March of Dimes staff partner to work together to implement multiple (bundled) interventions known to impact preterm birth; to improve systems of care in their community so that these interventions reach the patients who need them; and to promote awareness of preterm birth across all the community, including providers, patients and the public. The pilot/demonstration project was built on an innovative, ecological model designed to work in real world settings, where a multitude of factors—not a single intervention— influence outcomes. Like other public health problems, prematurity must be addressed in communities with broader approaches than just medical care. Working with providers, the goal of the project was to move research to practice quickly and effectively. With patients, the teams worked to improve networks of support services that addressed patient needs. For the public, the goal was that everyone, whether grandmothers, friends or business leaders, understood the impact of prematurity on families and the community.

Intervention Results: (In the pilot study in Kentucky) Real world implementation of HBWW in Kentucky provided potential for “contamination” due to a high likelihood that comparison sites were exposed to HBWW and other prematurity prevention messages due to overall state and national publicity regarding the HBWW program. Such contamination is an important consideration when interpreting HBWW evaluation results. Additionally, comparison site knowledge that its performance was being scrutinized (the Hawthorne Effect [Landsberger, 1958]) may have influenced its activities and outcomes. Population Objective Patients Create positive changes in knowledge, attitudes and behavior regarding preterm birth circumstances and modifiable risk factors, with a focus on late preterm birth. Perinatal providers Bring the latest research to everyday practice, particularly regarding late preterm infants; create positive changes in knowledge, attitudes and behaviors regarding adherence to professional guidelines on preterm birth prevention (especially late preterm birth) and elective inductions and cesareans. Public (community) Increase awareness of the importance of preventing preterm birth and the risks associated with late preterm birth. Chapter 3: The HBWW Initiative marchofdimes.com 21 The HBWW evaluation used an ecological design. This design means that the unit of analysis was the aggregated results of the intervention and comparison groups rather than individual hospitals, patients or providers. The HBWW Evaluation Team (including an independent program evaluator hired for the project and March of Dimes and Kentucky Department for Public Health staff) used data collected from the state vital records system prior to project implementation and at follow-up. They compared data over time and between intervention and comparison sites. March of Dimes staff tracked process data, and the program evaluator gathered additional data via surveys and interviews. Outcome data was collected through two methods: 1) consumer and perinatal provider surveys on knowledge, attitudes and behaviors related to preterm birth, and 2) analyses of extant vital records and birth certificate data (on preterm birth rates and other outcomes) provided by the Kentucky Department for Public Health. The HBWW logic model in Figure 3.4 has more information on inputs (resources), principle strategies, outputs, and intended behavioral, policy, health status and cost outcomes of the project. Before the HBWW initiative, Kentucky had increasing preterm birth rates. A year after HBWW implementation, Kentucky had the largest drop in preterm birth rates of any of its contiguous states. There were no other major, new initiatives addressing preterm birth in the state during this time. Both survey and birth outcome data provide exciting evidence about the success of the HBWW Kentucky pilot. Some of the most compelling outcomes are anecdotes from women and perinatal providers. HBWW successfully built relationships, partnerships and collaborations that resulted in enhancement of services and patient care. Many of these anecdotes are shared throughout this manual.

Conclusion: A lesson learned through the HBWW Kentucky pilot is that data has the power to influence behavior and, therefore, directly affect program success. For example, KDMC staff recognized a problem—a substantial number of pregnant women had substance abuse problems, illustrated by the number of newborns with positive toxicology screens. To address this issue, KDMC staff developed a “plan” to appoint a perinatal social worker to address prenatal substance abuse. The site applied for a March of Dimes community chapter grant and received funding for the perinatal social worker position. The social worker’s objectives (the “do” step) included screening women for tobacco, alcohol and drug use during pregnancy; providing appropriate referrals; and providing continuity of care for high-risk prenatal patients by improving communication between the social services department and private physician practices at the hospital. Staff examined toxicology screens at a woman’s entry into prenatal care and at delivery. Once the social worker was established at the site, women with positive toxicology screens at prenatal care enrollment were less likely to deliver infants with positive toxicology screens than prior to the social worker being available. These findings (“study”) and supporting anecdotal evidence encouraged the hospital system to continue funding the social work position beyond the grant funding period. In addition, the social worker was validated and felt empowered to continue work to reduce substance use during pregnancy. Both of these results are part of the “act” stage in PDSA. As new HBWW programs move forward, program staff should share stories and data with partners to celebrate program success. Outcome measurement and process tracking provide program staff with information on accomplishments. Defining measurable objectives for each HBWW core component in a project’s implementation workplan offers opportunities to track success. Although barriers and roadblocks may exist, small and large wins along the way provide reasons to acknowledge and celebrate project successes. Program staff can share these successes with partners, collaborators and the community and thank them for their support through media efforts and during community outreach activities. Each person working on prematurity prevention makes life better for children, their families and the communities in which they live.

Study Design: Ecological Design Study

Setting: Pilot Study based in Kentucky.

Data Source: data collected from the state vital records system prior to project implementation and at follow-up

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: Alongside increasing social media use worldwide, there is an expanding research focus on how social media use affects health behaviours, decisions and perceptions. The objective of this study was to systematically determine if and how breastfeeding is promoted and supported on the popular social media platform Instagram, which currently has over 700 million active users worldwide. To assess how Instagram is used to depict and portray breastfeeding, and how users share perspectives and information about this topic, we analysed 4,089 images and 8,331 corresponding comments posted with popular breastfeeding-related hashtags (#breastfeeding, #breastmilk, #breastisbest, and #normalizebreastfeeding).

Intervention Results: We found that Instagram is being mobilized by users to publicly display and share diverse breastfeeding-related content and to create supportive networks that allow new mothers to share experiences, build confidence, and address challenges related to breastfeeding. Discussions were overwhelmingly positive and often highly personal, with virtually no antagonistic content. Very little educational content was found, contrasted by frequent depiction and discussion of commercial products.

Conclusion: Instagram is currently used by breastfeeding mothers to create supportive networks and could potentially offer new avenues and opportunities to "normalize," protect, promote, and support breastfeeding more broadly across its large and diverse global online community.

Study Design: Qualitative study

Setting: Social media platform: Instgram

Population of Focus: Active Instagram users who shared perspectives and information about breastfeeding with popular breastfeeding-related hashtags

Sample Size: 4,089 images and 8,331 corresponding comments

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material,

Intervention Description: To evaluate the the impact of a standardized bundle of educational videos delivered via the bedside television to postpartum mothers on exclusive breastfeeding rates. The University of Minnesota Masonic Children's Hospital uses an interactive patient care tool called the GetWellNetwork, which is viewable through a patient's inroom television. The hospital's information technology team created a bidirectional interface to integrate the Epic electronic health record (EHR) with the interactive patient care tool; this allowed providers to place medical orders for educational videos to be viewed directly in patient's television screens. Once the order is placed, the patient receives a notification on their screen to view the video(s), and when they use their television remote to activate the video, it is documented in the EHR. The standard postpartum order set was updated to include orders assigning 4 breastfeeding discharge education videos to all mothers for viewing on their in-room televisions. These videos augmented existing breastfeeding support by providing education to mothers on topics including hand massage and manual expression, hands-on pumping, latch holds, and maximizing milk production.

Intervention Results: Our data set included 3115 newborns (1467 pre- and 1648 postintervention). In the postintervention year, the exclusive breastfeeding rate at discharge was 69.5% vs 68.4% preintervention (P value: .80). Most mothers (81.3%; 1339) watched all 4 videos, and 308 mothers (18.7%) watched none. The mothers who watched all 4 videos were more likely to breastfeed exclusively (72.7% vs 55.3%) and less likely to exclusively formula feed than the mothers who watched none (1.1% vs 19.8%; P < .0001).

Conclusion: There was no change in exclusive breastfeeding rates pre– versus post–video education intervention. However, most mothers watched all 4 videos, and those who did were significantly more likely to engage in any breastfeeding (98.9%) compared with those who watched none (80.2%) during the postpartum hospitalization.

Study Design: Retrospective chart review

Setting: University of Minnesota Masonic Children's Hospital

Population of Focus: Mothers with gave birth in the MN hospital pre- and post-intervention

Sample Size: 3115 live births (1467 pre- and 1648 post-intervention)

Age Range: Women ages 24-36 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Peer Counselor, Technology-Based Support, COMMUNITY, Individual Supports,

Intervention Description: The LATCH study was a multisite study designed to test the effectiveness of a 2-way text messaging intervention encouraging exclusive breastfeeding among women enrolled in WIC, combining in-person prenatal and postpartum breastfeeding education and support (breastfeeding peer counseling) with mobile health technology (text messaging). Four WIC BFPC sites in Connecticut participated in the study. The effectiveness of BFPCs was clearly established in the literature; thus, the text messaging intervention was designed to faciliate the BFPCs' work, not replace it.

Intervention Results: Lactation Advice Through Texting Can Help had a significant impact on early contact between participants and BFPCs (odds ratio = 2.93; 95% confidence interval, 1.35–6.37) but did not have a significant impact on EBF (odds ratio = 1.26; 95% confidence interval, 0.54–2.66).

Conclusion: Lactation Advice Through Texting Can Help has the potential to facilitate the work of BFPCs by shortening the time-to-first-contact with clients after giving birth. Research is needed to identify the level of breastfeeding support staff coverage that WIC clinics must have to meet the demand for services created by Lactation Advice Through Texting Can Help.

Study Design: Multisite, single-blind RCT

Setting: WIC breastfeeding peer counselor program/Cell phone

Population of Focus: Low-income women participating in the WIC BFPC program

Sample Size: 174 women

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Lactation Consultant, Provision of Breastfeeding Item, Group Education, NATIONAL, Policy/Guideline (National),

Intervention Description: Workplace breastfeeding resources (e.g., break times and private spaces) help working mothers exclusively breastfeed for 6 months. This study is one of the few studies to include and measure access to breastfeeding support such as breast pumps, worksite programs, educational materials, support groups, lactation consultants, and workplace policies. To meet the 6 month recommendation, employers can provide additional resources (i.e. lactation consultants and support groups) to help mothers transition back to work and continue breastfeeding. The ACA was an important first step for establishing minimum resources to support breastfeeding mothers; however, it needs to be expanded to cover all employer and workers.

Intervention Results: Fifty-two participants met the inclusion criteria for the study and completed the survey. Most of the participants in the study were White, college-educated women who worked in clerical or administration support and education occupations. Approximately 78.8% of the participants reported access to private spaces and 65.4% reported access to break times for breastfeeding. Fewer participants reported access to breast pumps, lactation consultants, and support groups.

Conclusion: There are gaps in access to workplace breastfeeding resources, but occupational health nurses can inform and help employers implement lactation resources to reduce breastfeeding disparities.

Study Design: Online, cross sectional survey

Setting: Policy

Population of Focus: Working mothers between the ages of 18 and 50 years old who gave birth in the previous two years

Sample Size: 52 women

Age Range: 18-50 year old women

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Midwife, Educational Material, Home Visits, Telephone Support

Intervention Description: To evaluate the effects of an extended midwifery support (EMS) programme on the proportion of women who breast feed fully to six months.

Intervention Results: Findings: there was no difference between the groups at six months postpartum for either full breast feeding [EMS 43.3% versus SMS 42.5%, relative risk (RR) 1.02, 95% confidence interval (CI) 0.87-1.19] or any breast feeding (EMS 63.9% versus SMS 67.9%, RR 0.94, 95%CI 0.85-1.04).

Conclusion: The EMS programme did not succeed in improving breast-feeding rates in a setting where there was high initiation of breast feeding. Breast-feeding rates were high but still fell short of national goals.

Study Design: RCT

Setting: King Edward Memorial Hospital (KEMH), Perth, Western Australia

Population of Focus: Women who gave birth at KEMH who intended to breastfeed

Data Source: Mother self-report

Sample Size: Randomized • Intervention (n=425) • Control (n=424) 6-Month Follow-Up • Intervention (n=393) Control (n=389)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Motivational Interviewing/Counseling, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Consultation/Counseling (Parent/Family), Counseling (Parent/Family), Educational Material (caregiver)

Intervention Description: Children with asthma who are exposed to environmental tobacco smoke are at increased risk for adverse health consequences. An experimental design was used to evaluate a minimal-contact intervention aimed at modifying parents' smoking behavior in their homes.

Intervention Results: More treatment (35%) than control (17%) subjects reported smoking outside their homes at posttest (and their children’s cotinine levels were lower), but this difference was not statistically significant.

Conclusion: difference was not statistically significant.

Study Design: Experimental design

Setting: Pediatric pulmonary clinics in U of MI

Population of Focus: Parents of children with asthma

Data Source: Parent questionnaire on smoking status and child urine sample.

Sample Size: 92 families randomly assigned

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Professional Support, Educational Material (caregiver),

Intervention Description: The Following Baby Back Home (FBBH) home visiting program supports families of high-risk low birth weight preterm infants after discharge from a hospital NICU. This study compares the health care use, immunization, and infant mortality rate of low birth weight preterm infants enrolled in FBBH with similar infants not in the program.

Intervention Results: In the first year after discharge and compared with a propensity-score matched cohort of control infants, those enrolled in FBBH were significantly more likely to have higher numbers of medical appointments and more compliant immunization history. The odds of dying in the first year of life for control infants was 4.4 times (95% confidence interval: 1.2-20.7) higher than those managed in the program.

Conclusion: A goal of the FBBH home visiting program is to work with parents to educate and support them as they care for their medically fragile infants. We conclude that education and support was instrumental in the infant health care use and outcome differences we observed during the first year of life.

Study Design: Cross-sectional prospective quasi-experimental study

Setting: Following Baby Back Home program in Arkansas

Population of Focus: Children enrolled in the Following Baby Back Home program in Arkansas from January 2013 to December 2017

Sample Size: 498 children

Age Range: Infants in the first year of life

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Provision of Safe Sleep Item, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Crib Card, Visual Display (Hospital), Sleep Environment Modification, Promotional Event, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Attestation (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation

Intervention Description: The purpose of this quality improvement project was to promote the AAP safe sleep recommendations and provide appropriate role modeling of these recommendations for hemodynamically stable infants throughout their hospital stay.

Intervention Results: Observations noted an improvement from 70% to 90% (p< 0.01) of infants in a safe sleep position when comparing pre- and postintervention results. There were some improvements in knowledge of and agreement with the AAP guidelines after the educational intervention, but not as much as expected.

Conclusion: There was inconsistency between nursing knowledge and practice about safe infant sleep. Nurses were aware of the AAP recommendations, but it took time to achieve close to full compliance in changing clinical practice. Observation was an important part of this initiative to reinforce knowledge and role model best practice for parents.

Study Design: QE: pretest-posttest

Setting: Golisano Children’s Hospital at the University of Rochester in NY

Population of Focus: Hemodynamically stable infants less than 1 year of age in the mother-baby unit and nine pediatric units

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=65) Follow-up (n=60)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Lactation Consultant, Educational Material, Group Education, Telephone Support

Intervention Description: The aim of this study was to evaluate the effectiveness of a multiphased midwifery intervention called the 'Milky Way' on any breastfeeding rates until six months.

Intervention Results: There were no significant differences in the antenatal baseline data between the groups. Compared to standard care, women in the Milky Way group had higher rates of breast feeding at one (83.7%, n=144 versus 61.3%, n=119, p<0.001), four (64.5%, n=111 versus 37.1%, n=72, p<0.001) and six months (54.3%, n=94 versus 31.4%, n=61 p<0.001).

Conclusion: Assignment to the Milky Way intervention was associated with significantly higher rates of breastfeeding compared with assignment to standard care only.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Tertiary hospital in South Western Sydney Area Health Services

Population of Focus: Nulliparous women ≥19 years old with basic English literacy

Data Source: Mother self-report

Sample Size: Enrolled • Intervention (n=172) • Control (n=194) 6-Month Follow-Up • Intervention (n=149) • Control (n=189)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, PROVIDER/PRACTICE, Educational Material (Provider), Online Material/Education/Blogging

Intervention Description: This study examined the degree to which the pregnant or postpartum women, in the process of quitting smoking, felt that writing in a blog about their smoking cessation journeys helped them in their efforts to become or remain smoke free.

Intervention Results: Participants were asked to complete an online survey, which had closed-ended questions regarding their sociodemographic and smoking characteristics. Once they completed the survey, semistructured qualitative interviews were conducted over the phone. Findings suggest that blogging might combine several evidence-based behavioral strategies for tobacco cessation, such as journaling and getting support from others who use tobacco.

Conclusion: Being part of a blogging community of women who have experienced or are experiencing similar challenges can be therapeutic and help women gain confidence in their ability to quit smoking. In conclusion, blogging may help pregnant and postpartum women quit smoking by increasing their social support and promoting self-reflection.

Study Design: Quasi experimental cross sectional - survey

Setting: Online forum for pregnant women

Population of Focus: Pregnant women in an online forum

Data Source: Survey, phone interview

Sample Size: 5

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Data Collection Training for Staff

Intervention Description: To determine the impact of the Healthy Steps for Young Children Program on quality of early childhood health care and parenting practices.

Intervention Results: Percentage of children with developmental assessments was 83.1% for intervention and 41.4% for control group (OR=8.00; 95% CI=6.69, 9.56; P<.001)

Conclusion: Universal, practice-based interventions can enhance quality of care for families of young children and can improve selected parenting practices.

Study Design: RCT and QE: nonequivalent control group

Setting: Pediatric practices in 14 states (6 randomization sites: San Diego, CA; Iowa City, IA; Allentown, PA; Pittsburgh, PA; Florence, SC; Amarillo, TX. 9 QE sites: Birmingham, AL/Chapel Hill, NC; Grand Junction, CO/Montrose, CO; Chicago, IL; Kansas City, KS; Boston, MA; Detroit, MI; Kansas City, MO; New York, NY; Houston, TX/Richmond, TX)

Population of Focus: Children ages 0-36 months

Data Source: Child medical record

Sample Size: Randomization Sites: - Intervention (n=832) - Control (n=761) - Total (n=1593) Quasi-Experimental Sites: - Intervention (n=1189) - Control (n=955) - Total (n=2144) Total: - All families (n=3737) - Intervention: (n=2021) - Control (n=1716)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Parent Engagement, Educational Material (caregiver), Provider Reminder/Recall Systems,

Intervention Description: - Intervention description: Culturally tailored evidence-based HPV vaccine educational intervention, including community outreach, education sessions, and personalized reminders

Intervention Results: - Results: HPV vaccine initiation and completion rates increased significantly after the intervention, with higher completion rates among children compared to adults. Psychosocial factors such as knowledge, awareness, and intention to vaccinate also improved significantly after the intervention.

Conclusion: - Conclusion: The Tiempo de Vacunarte program was successful in improving HPV vaccination rates and psychosocial factors in a predominantly Hispanic community. Culturally tailored educational interventions and community outreach can be effective in increasing vaccination rates in underserved populations.

Study Design: - Study design: Prospective community-based intervention utilizing a pre-post design

Setting: - Setting: El Paso County, Texas, located on the US-Mexico border

Population of Focus: - Target audience: Individuals aged 18-26 years or parents/guardians of children aged 9-17 years who had not completed the HPV vaccine series

Sample Size: - Sample size: 2,380 participants were eligible and recruited into the program, with 1,796 unique surveys included in the analysis

Age Range: - Age range: 9-26 years

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Home Visits, Midwife, Feedback

Intervention Description: Maternal smoking can cause health complications in pregnancy. Particulate matter (PM2.5) metrics applied to second hand smoke (SHS) concentrations provide indoor air quality (IAQ) measurements and have been used to promote smoking behaviour change among parents of young children. Here, we present the qualitative results from a study designed to use IAQ measurements to help pregnant women who smoke to quit smoking.

Intervention Results: There were 39 women recruited (18 in Aberdeen and 21 in Coventry) and qualitative interviews were undertaken with nine of those women. Diverse accounts of smoking behaviours and experiences of participation were given. Many women reported changes to their smoking behaviours during pregnancy. Most women wanted to make further changes to their own behaviour, but could not commit or felt constrained by living with a partner or family members who smoked. Others could not envisage quitting. Using themes emerging from the interviews, we constructed a typology where women were classified as follows: 'champions for change'; 'keen, but not committed'; and 'can't quit, won't quit'. Three women reported quitting smoking alongside participation in our study.

Conclusion: Pregnant women who smoke remain hard to engage,. Although providing IAQ measurements does not obviously improve quit rates, it can support changes in smoking behaviour in/around the home for some individuals. Our typology might offer a useful assessment tool for midwives.

Study Design: Mixed methods case series

Setting: UK National Health Services (NHS) antenatal clinics

Population of Focus: Pregnant women who smoked receiving NHS antenatal services

Data Source: Indoor air quality measurements (IAQ), interviews

Sample Size: 39

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: The importance of support to breastfeeding success is well established, as are the difficulties many mothers face in accessing the support they need. With the majority of UK mothers now accessing social media for support, Breastfeeding Support Facebook (BSF) groups have increased exponentially. BSF groups vary in type (local or national/international) and in moderation—overseen by breastfeeding mothers and by midwives or trained lactation specialists. Some groups aimed at supporting mothers in a specific geographical area also have associated face-to-face groups, facilitated as either professional or peer support. Little is currently known about these specific local groups, their prevalence, impact or value to mothers. This paper examines mothers' experiences of using local BSF groups and why they value them as part of a larger study exploring the impact of midwife moderation on these groups. An online survey consisting of open and closed questions was completed by 2028 mothers.

Intervention Results: Findings identified that local BSF groups are widely used and highly valued for their connection with local face-to-face services and other mothers. They offer access to expertise and shared experience in a format mothers find convenient and timely, improving confidence and self-efficacy. Local BSF groups enable the formation of support networks and development of breastfeeding knowledge that mothers credit with increased well-being, motivation and breastfeeding duration. As such, they have the potential to add value to local face-to-face services and improve breastfeeding experiences and knowledge in communities.

Conclusion: The findings have important implications to support the development of integrated online interventions to improve public health.

Study Design: Qualitative study

Setting: Social media platform: Breastfeeding Support Facebook groups

Population of Focus: Mothers in the UK using local Breastfeeding Support Facebook groups

Sample Size: 2028 mothers

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education, Enabling Services, Other Media, COMMUNITY, POPULATION-BASED SYSTEMS

Intervention Description: A 48-month community intervention was conducted to improve breast and cervical cancer (BCC) screening among Korean American (KA) women in Alameda County (AL), California. KA women in Santa Clara (SC) County, California served as a comparison group.

Intervention Results: After adjusting for all covariates, no significant difference in Pap smear rates between intervention and comparison counties.

Conclusion: Although our overall intervention did not appear to enhance screening practices at the community-level, attendance at a women's health workshop appears to have increased cervical cancer screening.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Alameda County and Santa Clara County, CA

Population of Focus: Korean American women

Data Source: Telephone survey

Sample Size: Total (N=2,176) Baseline (n=1,093); Follow-up (n=1,083) Analysis (participated in baseline or follow-up) (n=1,902) Baseline (n=818) Intervention (n=404); Control (n=414) Follow-up (n=1,084) Intervention (n=418); Control (n=458)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: To date, most breastfeeding research on social media only focuses on content analysis, and there remains limited knowledge about the social networks of online communities (who interacts with whom), influencers in the breastfeeding space and the diffusion of evidence-based knowledge. This study, grounded in social network theory, aims to better understand the breastfeeding communication landscape on Twitter including determining the presence of a breastfeeding network, communities and key influencers. Further, we characterize influencer interactions, roles and the content being shared.

Intervention Results: The study revealed an overall breastfeeding social network of 3,798 unique individuals (users) and 3,972 tweets with commonly used hashtags (e.g., #breastfeeding and #normalizebreastfeeding). Around one third of users (n = 1,324, 34%) exchanged pornographic content (PC) that sexualized breastfeeding. The non-PC network (n = 2,474 users) formed 144 unique communities, and content flowing within the network was disproportionately influenced by 59 key influencers. However, these influencers had mostly inward-oriented interaction (% composition, E-I index: 47% professionals, -0.18; 41% interested citizens, -0.67; 12% companies, -0.18), limiting opportunities for evidence-based dissemination to the lay public.

Conclusion: Although more tweets about peer-reviewed research findings were sent compared with tweets about nonevidence-based lay recommendations, our findings suggest that it is the lay public who often communicated findings, which may be overcome through a targeted social network-based intervention.

Study Design: Outcome evaluation

Setting: Social media platform: Twitter

Population of Focus: Influencers in the breastfeeding space on Twitter

Sample Size: 3,798 unique individuals (users), 3,962 tweets

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: As recently highlighted by the National Academy of Sciences, there is a need for the scientific community (SC) to diffuse its findings to the public more effectively online, as means to counteract the spread of misinformation. In response to this call, we gathered data from Twitter for one month from major breastfeeding hashtags resulting in an interconnected social network (n = 3,798 users). We then identified 59 influencers who disproportionately influenced information flow using social network analysis. These influencers were from the SC (e.g. academics, researchers, health care practitioners), as well as interested citizens (IC) and companies. We then conducted an ego-network analysis of influencer networks, developed ego maps, and compared diffusion metrics across the SC, IC and company influencers. We also qualitatively analyzed their tweets (n = 711) to understand the type of information being diffused.

Intervention Results: Content analysis of tweets suggest IC are more active than the SC in diffusing evidence-based breastfeeding knowledge, with 35% of their tweets around recent research findings compared to only 12% by the SC. Nonetheless, in terms of outreach to the general public, the two-step networks of SC influences were more heterogenous than ICs (55.7 ± 5.07, 50.9 ± 12.0, respectively, P<0.001).

Conclusion: Collectively, these findings suggest SC influencers may possess latent potential to diffuse research and evidence- based practices. However, the research suggests specific ways to enhance diffusion.

Study Design: Outcome evaluation

Setting: Social media platform: Twitter

Population of Focus: Influencers from the scientific community using major breastfeeding hashtags on Twitter for a month

Sample Size: 59 influencers, 711 tweets

Intervention Components (click on component to see a list of all articles that use that intervention): Group Education, Educational Material, PATIENT_CONSUMER

Intervention Description: We aimed at exploring the role of teenagers as facilitators of change in enforcing a home no-smoking rule following school-based anti-tobacco programs and examining the effect of home no-smoking rule on teenagers’ intention to smoke.

Intervention Results: In all, 351 students participated. At baseline, 47.5% in the intervention group reported a home no-smoking rule and 86% indicated being unlikely to smoke, these increased to 61.3% (p=0.016) and 98.2% (p<0.001) at followup, respectively. Cohen’s d value was calculated to estimate the effect size of intervention. A large effect size of intervention was found in the intervention group (d=1.24), whilst d=0.19 in the control group.

Conclusion: Our study showed that our intervention led to the increase of no-smoking rules at home and to a negative intention towards smoking of adolescents. Consequently, we provide evidence that students are effective vehicles for carrying anti-smoking messages to their home environment including the no-smoking rule. Additionally, we confirmed previous reports that home no-smoking rule is associated with a negative intention to smoke and risk of smoking.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, Educational Material, Motivational Interviewing, PATIENT_CONSUMER, Feedback

Intervention Description: This study aimed to change parents’ perceptions of exposure by providing information on second- and third-hand exposure and personalised information on children’s exposure [NIH.

Intervention Results: Parental perceptions of exposure (PPE) were significantly higher at the study end (94.6 ± 17.6) compared to study beginning (86.5 ± 19.3) in intervention and enhanced control groups (t(72) = −3.950; p < 0.001). PPE at study end were significantly higher in the intervention group compared to the regular control group (p = 0.020). There was no significant interaction between time and group. Parallel changes in parental smoking behaviour were found. Parental perceptions of exposure were increased significantly post intervention, indicating that they can be altered.

Conclusion: By making parents more aware of exposure and the circumstances in which it occurs, we can help parents change their smoking behaviour and better protect their children.

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Referrals, Educational Material, YOUTH, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE, Screening Tool Implementation

Intervention Description: The obective of this study was to describe innovations added to the CEASE intervention and to track 2 year post-intervention implementation data on families who were screened for tobacco use.

Intervention Results: Electronic screening was used to routinely identify tobacco users, leading to increased potential for offering cessation assistance to all household members who smoke.

Conclusion: Improved delivery of smoking cessation services to families may be achieved by integrating technological innovations into routine pediatric practice.

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Educational Material (caregiver), PATIENT/CONSUMER, Telephone Support

Intervention Description: To determine whether informing families about their children’s urinary cotinine levels curtailed the exposure of children to ETS. Material and methods

Intervention Results: The intervention group contained 65 children of average age of 24.4 ±8.9 months, of whom 46 (70.8%) were male. The non-intervention group contained 69 children of average age of 25.3 ±9.8 months (p > 0.05), of whom 52 (75.4%) were male. The urinary cotinine levels at the time of the second interview were lower in both groups. The number of cigarettes that fathers smoked at home decreased in the intervention group (p = 0.037).

Conclusion: Presenting objective evidence on ETS exposure to families draws attention to their smoking habits. Measurement of cotinine levels is cheap, practical, and noninvasive. Combined with education, creating awareness by measuring cotinine levels may be beneficial.

Study Design: RCT

Setting: Allergy and Immunology Department of Dr. Behcet Uz Children’s Hospital

Population of Focus: Children younger than 3 years with episodic wheezing whose parents did not smoke in space shared by children but did have a smoker in the home

Data Source: Questionnaire data and urinary cotinine levels

Sample Size: 193 randomized into intervention and control groups

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, Motivational Interviewing, Educational Material

Intervention Description: To estimate the effectiveness of pregnancy smoking cessation support delivered by short message service (SMS) text message and key parameters needed to plan a definitive trial.

Intervention Results: Using the validated, continuous abstinence outcome, 5.4% (11 of 203) of MiQuit participants were abstinent versus 2.0% (four of 204) of usual care participants [odds ratio (OR) = 2.7, 95% confidence interval (CI) = 0.93-9.35]. The Bayes factor for this outcome was 2.23. Completeness of follow-up at 36 weeks gestation was similar in both groups; provision of self-report smoking data was 64% (MiQuit) and 65% (usual care) and abstinence validation rates were 56% (MiQuit) and 61% (usual care). The incremental cost-per-quitter was £133.53 (95% CI = -£395.78 to 843.62).

Conclusion: There was some evidence, although not conclusive, that a text-messaging programme may increase cessation rates in pregnant smokers when provided alongside routine NHS cessation care.

Study Design: RCT

Setting: Women, Infants and Children clinics in Ohio

Population of Focus: Women 16 years and over, less than 25 weeks pregnant, who had smoked at least five cigarettes daily before pregnancy and at least one per day at enrolment, able to understand written English and owned a mobile phone with text messaging functionality

Data Source: Surveys, data from mobile text system, exhaled breath CO, saliva cotinine

Sample Size: 407 -203 to MQUIT, 204 to usual care

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Provider Education

Intervention Description: A three‐year intervention targeting Vietnamese physicians in solo practice in California.

Intervention Results: After the intervention, performance rates increased significantly for smoking cessation counseling (p = 0.02), Pap testing (p = 0.004), and pelvic examinations (p = 0.01).

Conclusion: The results demonstrate the efficacy of an intervention targeting Vietnamese primary care physicians in promoting smoking cessation counseling, Pap testing, and pelvic examinations, but not other cancer prevention activities.

Study Design: RCT

Setting: Private practices with physicians who were members of the Vietnamese Physicians’ Associations in Northern and Southern CA

Population of Focus: Physicians in solo practice who had received their medical training in Vietnam

Data Source: Physicians’ medical records

Sample Size: Total (N=48) Analysis (n=20) Intervention (n=9); Control (n=11) N=physicians

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education, Patient Navigation, Enabling Services, PROVIDER/PRACTICE, Provider Reminder/Recall Systems, Provider Education, Designated Clinic/Extended Hours, Female Provider, COMMUNITY, Television Media, Other Media, POPULATION-BASED SYSTEMS

Intervention Description: Development and implementation of a multifaceted intervention using community-based participatory research (CBPR) methodology and evaluated with a quasi-experimental controlled design with cross-sectional pre-intervention (2000) and post-intervention (2004) telephone surveys. Data were analyzed in 2005.

Intervention Results: Significantly greater odds of Pap smear for women in intervention county than in control county (OR=2.02, 95% CI: 1.37-2.99)

Conclusion: A multifaceted community-based participatory research (CBPR) intervention was associated with increased Pap test receipt among Vietnamese-American women in one community.

Study Design: QE: pretest-posttest non-equivalent control group

Setting: Santa Clara County, CA and Harris County, TX

Population of Focus: Vietnamese women living in either county

Data Source: Computer-assisted telephone interviewing system

Sample Size: Baseline(n=1,566) Intervention (n=798); Control (n=768) Follow-up (n=2,009) Intervention (n=1,004); Control (n=1,005)

Age Range: ≥18

Intervention Components (click on component to see a list of all articles that use that intervention): STATE, Policy/Guideline (State), Funding Support, POPULATION-BASED SYSTEMS, PATIENT/CONSUMER, Educational Material

Intervention Description: The goal of this study was to examine state measurements and improvements in risk-appropriate care for very low birth weight (VLBW) infants.

Intervention Results: Regulation of regionalization programs, data surveillance, review of adverse events, and consideration of geography and demographics were identified as mechanisms facilitating better measurement of risk-appropriate care. Antenatal or neonatal transfer arrangements, telemedicine networks, acquisition of funding, provision of financial incentives, and patient education comprised state actions for improving risk-appropriate care.

Conclusion: Guidelines should be collaboratively developed by healthcare providers and public health officials for consistent and suitable measures of perinatal risk-appropriate care.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Community-Based Group Education

Intervention Description: The current study is a randomized trial of a promotora-led educational intervention focused on cervical cancer in a local Hispanic community.

Intervention Results: Follow-up data revealed significant improvements in all outcome measures.

Conclusion: The observed association between cervical cancer knowledge and Pap smear receipt underscores the importance of educating vulnerable populations about the diseases that disproportionately affect them.

Study Design: RCT: pretest-posttest

Setting: South Philadelphia, PA

Population of Focus: Hispanic women

Data Source: In-person interview administered in Spanish by the promotoras

Sample Size: Total (N=120) Intervention (n=60); Wait-List Control (n=60) Analysis (n=70) Intervention (n=34); Wait-List Control (n=36)

Age Range: 18-65

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Community-Based Group Education, COMMUNITY, Other Media

Intervention Description: The objective of this study was to determine the feasibility and effectiveness of translating films, and whether the use of narrative is an effective vehicle for producing changes in knowledge, attitudes, and behaviors regarding cervical cancer compared with a nonnarrative film. A randomized controlled telephone trial surveyed the effectiveness of two films our team produced among a sample of 300 monolingual Spanish-speaking women, ages 25 to 45, who were of Mexican origin. Participants were recruited using random digit dialing (RDD) procedures from 2013 to 2014 in Los Angeles County and were randomly selected to view either a narrative or nonnarrative film. Data were collected by phone at baseline, 2 weeks, and 6 months after viewing. On average, participants arrived in the USA 25 years ago. The majority reported having less than high school education and limited English proficiency.

Intervention Results: Compared with their nonnarrative counterparts, women who received the cervical cancer–related information in the narrative film showed a significantly greater increase in new knowledge (p = 0.01) and in supportive attitudes about Pap tests expense (p = 0.05). Importantly, at 6 months, although not statistically significant, women who viewed the narrative film were also more likely to have had or scheduled a Pap test (62% vs 42%).

Conclusion: Narratives are a useful and underutilized tool to communicate information about cancer prevention. These findings have important implications for the delivery of health education among Spanish-speaking, low-literacy immigrant women, and for the reduction of cancer-related disparities.

Setting: Los Angeles county, CA

Population of Focus: monolingual Spanish-speaking women, ages 25 to 45, who were of Mexican origin.

Intervention Components (click on component to see a list of all articles that use that intervention): Home Visits, PATIENT_CONSUMER, Educational Material,

Intervention Description: In this pilot study, the breastfeed care plus intervention program was implemented to support women and their families in breastfeeding success.

Intervention Results: Both interventions proved to be effective in improving the ‘perception of breastfeeding self-efficacy,' with higher scores being found in the experimental group (p < 0.001). The proportion of exclusive breastfeeding was also higher in the experimental group

Conclusion: The BCP intervention program, during the first 120 days postpartum, showed promissory results in improving ‘perception of breastfeeding self-efficacy’ compared to conventional care, favoring breastfeeding duration and exclusivity, and cumulative breastfeeding competence of women/families.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Technology-Based Support, COMMUNITY, Individual Supports

Intervention Description: To test the effects of weekly SMS for improving infant feeding practices and infant weight. SMS were sent automatically using a web-based SMS messaging platform from the time the participant enrolled in the study until the end (4 months later). Participants were randomized to receive SMS about infant's general health issues (control) or SMS for improving feeding practices (intervention) for 4 months. Intervention SMS were created with a focus on reinforcing WIC messages on breastfeeding, preventing overfeeding, delaying introduction of solid foods, and delaying and reducing baby juice comsumption. A total of 18 messages (1 per week for 4 months) were sent. All messages were written at a grade 5 level in Spanish for PR or English for HI.

Intervention Results: A total of 170 participants completed the study (n = 86 control and n = 84 intervention). Baseline characteristics were similar between groups. At the end, exclusive breastfeeding rates were similar between groups (67.4% control and 59.1% intervention). Introduction of other foods and beverages, addition of foods to the bottle, placing infants to sleep with milk bottles, caregiver's method and response to feeding infants and distractions while feeding infants were similar between groups. Also, weight status or rate of weight gain was similar between groups.

Conclusion: There were no significant improvements in feeding practices or in weight with the intervention. The timeline of the messages in relation to the targeted behavior may have affected the effectiveness of the intervention. Earlier dissemination of messages, higher level of intensity, longer intervention, additional contacts and inclusion of other caregivers may be needed to achieve the desired effects.

Study Design: Multisite RCT

Setting: WIC programs in Puerto Rico and Hawaii/Cell phone

Population of Focus: Caregivers of infants 0-2 months old participating in the WIC program

Sample Size: 170 participants (86 control and 84 intervention)

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Adult-led Support/Counseling/Remediation, Educational Material, PATIENT_CONSUMER, YOUTH

Intervention Description: This pilot project aimed to assess implementation feasibility and impact of an intervention designed to increase smoke-free rules among socioeconomically disadvantaged households with children.

Intervention Results: Results showed 83% of participants were recruited through DM. OR had a high recruitment rate, and DM recruited more participants with a low response rate but higher retention rate. Among recruited participants with data (n = 47), smoke-free home rules increased by 50.4 percentage points during the study period (p < 0.001). Among recruited participants who had a vehicle (n = 38), smoke-free car rules increased by 37.6 percentage points (p < 0.01) and comprehensive smoke-free rules rose 40.9 percentage points (p < 0.01). Home SHS exposure declined, and within-person increase in smoke-free home rules was significantly related to less home SHS exposure (p < 0.05). It is feasible to adapt and implement the evidence-based SFHP intervention through a national cancer program, but the current pilot demonstrated recruitment is a challenge. DM produced a low response rate and therefore OR is the recommended recruitment route.

Conclusion: Despite low recruitment rates, we conclude that the SFHP can successfully increase comprehensive smoke-free rules and reduce SHS exposure among socioeconomically disadvantaged households with children recruited through a NBCCEDP.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Incentives, Educational Material, Peer Counselor, Motivational Interviewing, Pharmacotherapy (Nicotine), Other Person-to-Person Education, Group Education, Community-Based Group Education

Intervention Description: To assess the feasibility and acceptability of implementing a culturally tailored, intensive smoking cessation program, including contingency-based financial rewards (CBFR), for pregnant Aboriginal women.

Intervention Results: Twenty-two of 38 eligible women (58%) enrolled in the program, with 19 (86% remaining at the end of their pregnancy. The program was highly acceptable to both women and providers. Feasibility issues included challenges providing twice-weekly visits for 3 weeks and running fortnightly support groups. Of the 19 women who completed the program, 15 (79%) reported a quit attempt lasting >=24 hours, and 8 (42%) were CO-confirmed as not smoking in late pregnancy. The rewards were perceived to help motivate women, but the key to successful quitting was considered to be the intensive support provided.

Conclusion: 'Stop Smoking in its Tracks' was acceptable and is likely to be feasible to implement with some modifications. The program should be tested in a larger study.

Study Design: Single group pre-post test

Setting: Aboriginal Maternal and Infant Health Services clinics

Population of Focus: Pregnant aboriginal women seeking prenatal care at health services sites who were smoking and older than 16 years and less than 20 weeks gestation who were local residents

Data Source: Self-reported smoking levels, breath CO

Sample Size: 38, 19 completed the program

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Patient Reminder/Invitation, Educational Material, Other Person-to-Person Education

Intervention Description: To examine human papillomavirus (HPV) vaccine intent and the effect of an educational intervention on vaccine uptake among female college students.

Intervention Results: At baseline, 41% intended to undergo HPV vaccination. Participants who were currently sexually active and lacked supplemental health insurance had decreased intent. Perceived parental approval regarding HPV vaccination, perceived vulnerability to HPV infection, and belief in health benefits of HPV vaccine were associated with increased intent. HPV vaccine uptake was low (5.5%) and did not differ by study group. However, baseline intent was significantly associated with HPV vaccine uptake.

Conclusion: Interventions to increase HPV vaccine uptake in college students should address HPV-related beliefs and broader barriers to vaccination.

Study Design: RCT

Setting: University Health Service Gynecology Clinic at the University of Michigan

Population of Focus: Full- or part-time female students visiting the clinic for a routine physical and had not received the first dose of the HPV vaccine series

Data Source: University of Michigan University Health Services medical records; self-report via a mailed survey, telephone interview, or email (if dates of vaccination were unavailable)

Sample Size: Total (n=256)4  Intervention (n=128)  Control (n=128)

Age Range: 18-26

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Training (Parent/Family)

Intervention Description: The purpose of this project was to determine the impact of brief THS intervention on smoking behaviors of caregivers of children seen in an urban pediatric ED. A convenience sample of children < 36 months with caregivers who smoke brought to a pediatric ED was recruited. Consented caregivers were randomized to a control group who received routine education or intervention group who received brief THS education.

Intervention Results: Results revealed the treatment group was more likely to change smoking policies (OR 2.0, 95% CI 0.166–24.069), reduce the number of cigarettes (OR 4.88, 95% CI 0.785–30.286), or quit smoking (OR 1.12, 95% CI 0.346–3.590). This study demonstrated that a brief THS intervention in our sample influenced smokers to change smoking behaviors. These changes would ultimately decrease ETS exposure to children and its adverse health effects.

Conclusion: These changes would ultimately decrease ETS exposure to children and its adverse health effects. With the limitations of small sample size and high loss to follow-up, the study does not show statistical significance for generalizability.

Study Design: RCT; pilot study. This was a prospective 6-month follow-up pilot study of a convenience sample

Setting: Urban pediatric Emergency Department

Population of Focus: Children under 36 months with caregivers who smoke brought to a pediatric ED

Data Source: Parent self-report.

Sample Size: 40 randomized families

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Peer Counselor, Motivational Interviewing, Educational Material, Other Person-to-Person Education

Intervention Description: This randomized controlled pilot study evaluated feasibility and potential efficacy of a social-cognitive theory (SCT)-based biomarker feedback intervention among pregnant Alaska Native (AN) smokers.

Intervention Results: High rates of treatment compliance, study retention, and treatment acceptability were observed in both groups. 7-day point prevalence smoking abstinence rates at delivery verified with urinary cotinine were the same in both study groups (20% intent-to-treat analysis, 26% per-protocol). SCT-based measures did not change differentially from baseline by study group.

Conclusion: This trial supports the feasibility and acceptability of providing biomarker feedback within the clinical care delivery system, but the intervention did not promote increased smoking cessation during pregnancy compared to usual care.

Study Design: RCT- pilot

Setting: Primary care center

Population of Focus: Pregnant Alaskan native women who smoked receiving prenatal care at a primary care center in Anchorage, AK

Data Source: Urine cotinine levels, phone interviews

Sample Size: 60 -30 intervention, 30 control

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Technology-Based Support, Educational Material, PATIENT_CONSUMER

Intervention Description: To examine the effectiveness of a mobile phone-based nutrition education intervention targeting pregnant and nursing mothers in six Sri Lankan divisional secretariat areas.

Intervention Results: A total of 996 pregnant and nursing mothers participated in the pre-assessment survey, of which 720 completed the post-assessment. Most were nursing mothers (84.2% pre- and 78.9% post-assessment). Participants provided positive feedback on the intervention. Knowledge/awareness (t = −18.70, p < 0.01) and attitudes (t = −2.00, p < 0.05) increased when exposed to the intervention. Favourable improvements in the practices were also observed. Mothers’ practices related to breastfeeding and 24-h dietary diversity showed a statistically significant improvement. However, social norms and behaviour intentions did not significantly improve. The qualitative component also revealed favourable responses.

Conclusion: The mobile intervention improved participants’ knowledge, awareness, attitude, and practices, but not social norms or behaviour intentions. This approach is recommended to be used on a larger scale in community settings. In addition, mobile technology could drive intervention in pandemic-related situations.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Materials, Other Education, Technology-Based Support, COMMUNITY, Social Media, Social Supports,

Intervention Description: Social media crosses socioeconomic and geographic lines and can inform and empower people, increase communication speed, and mobilize partnerships. Through the dissemination of standardized messages and graphics, social media can be optimized for the delivery of evidence-based nutrition information. In 2014, the USDA launched a mobile-responsive Web site to assist WIC staff in engaging participants and community partners. Resources included posters, brochures, videos, widgets, graphics, and BF peer counseling training. Recognizing the opportunity for spreading messages via social media, the Web site was enhanced with the addition of a social media toolkit for World Breastfeeding Week/National Breastfeeding Month (August, 2016). The goal of the project was to create sample graphics and messages based on the campaign that could be used by WIC agencies and partners to reach participants, eligible participants, and the public. Messages were developed using content from the Loving Support campaign materials and Loving Support Peer Counseling Training. Agencies were encouraged to link to the Loving Support Web site and use the hashtag #WICLovingSupport in their posts. Agencies could also customize the messages and graphics as needed to promote their own activities and events. The toolkit included Facebook covers and posts, Twitter headers and posts, a Twibbon, an Instagram post, and an e-card. A guide to using the toolkit with sample messages was created as well. The Figure shows sample images and messages.

Intervention Results: The toolkit was launched on July 12, 2016 and received 4,319 page views by the end of August. Overall there were 9,432 downloads of all Loving Support materials and 29,745 page views to the Loving Support Web site. This was a 50% increase in page views and a 17% increase in downloads over the previous month, before the launch of the toolkit. Use of the toolkit continued since August with 1,507 page views between August, 2016 and February, 2017. The number of users for that same period was 5,007 (new and returning users). There were 2,342 downloads of social media graphics, with Facebook covers and posts, the e-card, and Instagram posts as the most downloaded items. The Twibbon campaign had 36 supporters. A TweetReach snapshot report from August 2 to August 6 (during World Breastfeeding Week) showed that the hashtag #WICLovingSupport had 60 tweets from 40 contributors, 287,820 accounts reached (the number of people who likely saw content), and 362,607 impressions (the number of times people likely reached).

Conclusion: Translating policy and guidance into action-oriented messages that WIC agencies can easily use and disseminate can increase the exposure of evidence-based nutrition messages. Although it is a relatively low-cost communication strategy, social media involves a high cost in time and attention needed to maintain an active presence.8 By providing a ready-to-go social media toolkit, the Food and Nutrition Service was able to offer consistent messaging, but it also reduced WIC staff workload and reached many people with information about BF promotion and support.

Study Design: Program evaluation

Setting: Social media platforms: Facebook, Twitter, and Instagram

Population of Focus: WIC staff

Sample Size: 5,007 new and returning users

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Educational Material

Intervention Description: The objective of this study was to reduce postpartum smoking relapse and prolong breastfeeding duration during the first 8 weeks postpartum in mothers who quit smoking just before or during pregnancy and have newborns admitted to the Neonatal Intensive Care Unit (NICU).

Intervention Results: More mothers were smoke free (81 vs 46%, P<0.001) and breastfeeding (86 vs 21%, P<0.001) in the intervention than in the control group at 8 weeks postpartum.

Conclusion: Interventions to support mother–infant bonding during a newborn's hospitalization in the NICU are associated with reduced rates of smoking relapse and prolonged duration of breastfeeding during the first 8 weeks postpartum.

Study Design: Prospective randomized clinical trial; RCT

Setting: NICU

Population of Focus: Mothers of infants admitted to the NICU at Loma Linda University Children’s Hospital, who had a history of tobacco use during or within 1 year before pregnancy but who were not currently smoking

Data Source: Smoking status was evaluated by three methods: (1) mother’s report (2) CO-oximetry and (3) salivary cotinine levels

Sample Size: 54 enrolled in study and randomized

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Pharmacotherapy (Nicotine), PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Counseling (Parent/Family), CAREGIVER, Motivational Interviewing/Counseling, Motivational Interviewing

Intervention Description: Although many Latinos in the US smoke, they receive assistance to quit less often than non-Latinos. To address this disparity, we recruited Latino couples into a randomized controlled trial and provided a smoking cessation program during a teachable moment, when men’s partners were pregnant.

Intervention Results: We found high rates of cessation but no arm differences in smoking rates at the end of pregnancy (0.31 vs. 0.30, materials only vs. counseling, respectively) and 12 months after randomization (postpartum: 0.39 vs. 0.38). We found high quit rates among nondaily smokers but no arm differences (0.43 vs. 0.46 in pregnancy and 0.52 vs. 0.48 postpartum). Among daily smokers, we found lower quit rates with no arm differences but effects favoring the intervention arm (0.13 vs. 0.16 in pregnancy and 0.17 vs. 0.24 postpartum).

Conclusion: A less intensive intervention promoted cessation equal to more intensive counseling. Postpartum might be a more powerful time to promote cessation among Latino men. Impact Less intensive interventions when delivered during teachable moments for Latino men could result in a high smoking cessation rate and could reduce disparities.

Study Design: RCT

Setting: Community (home)

Population of Focus: Pregnant Latinas and their partners who smoked from 10 county health departments

Data Source: Surveys at end of pregnancy, 3-mo postpartum and 12-mo postpartum; also saliva samples for cotinine analysis.

Sample Size: 348 randomized couples

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Educational Material, CAREGIVER, Educational Material (caregiver)

Intervention Description: Exposure to second-hand smoke (SHS) is a major public health problem and a risk factor for morbidity and mortality. The objective of this randomized trial was to estimate the impact of a culturally-sensitive intervention to reduce SHS exposure in Mexican-American households.

Intervention Results: Ambient nicotine levels significantly decreased over the 12 study months (F=13.6, DF=147; p<0.001); with a significantly greater decrease in the EI households compared to the SC households (F=4.1, DF=72; p<0.05). At 12 months, 73% of EI households had banned smoking vs. 56% of SC households. Ambient nicotine levels, measured using nicotine air sampling monitors, were significantly associated with self-reported SHS exposure at the 12-month follow-up. Knowledge of the health effects of SHS increased from baseline to 6 and 12 months in the EI condition but not in the SC condition (F=6.0, DF=238; p<0.01), and smokers and quitters in the EI group reported an increased perception of health vulnerability compared to those in the SC group.

Conclusion: Our low-cost intervention impacted SHS-related knowledge and exposure among Mexican Americans. This culturally-appropriate intervention has the potential to decrease SHS-related health problems in the target population substantially.

Study Design: RCT

Setting: Home-based intervention

Population of Focus: 91 households (with a child under 18 years of age and two adults, one of whom was a smoker)

Data Source: 74 households (83%) provided baseline, 6-month, and 12-month survey and nicotine monitor data. An ambient air monitor, for assessing levels of nicotine due to secondhand smoke, was installed in each participating residence at baseline.

Sample Size: 91 households randomized

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Educational Material (caregiver), Education/Training (caregiver), PATIENT/CONSUMER, Educational Material, Other Education

Intervention Description: The purpose of this longitudinal, five-week, quasi-experimental pilot study was to determine whether “smoking hygiene,” an educational intervention, reduces the frequency of respiratory symptoms experienced by infants whose mothers both smoke and breastfeed.

Intervention Results: Of the 21 mother-infant pairs who completed the study, 66% of the nine infants in the control group experienced respiratory illness, compared to 42% of the 12 infants in the intervention group (x2 .814; p > .05). Thus, the difference was statistically nonsignificant in this small sample, but the trend worsened the anticipated direction. The study demonstrates some of the difficulties of intervening with this group of mothers. The findings of this study suggest that, with modification, smoking hygiene may become a valuable educational tool that can be used by health care professionals to help women who smoke and breastfeed decrease the health risks to their infants.

Conclusion: The study demonstrates some of the difficulties of intervening with this group of mothers.

Study Design: Longitudinal quasiexperimental pilot study

Setting: Maternity patients

Population of Focus: Mothers who smoked >5 cigarettes a day prenatally, planned to breastfeed, planned to be discharged with the baby, and had no significant health problems

Data Source: Questionnaire to determine mother’s smoking habits at week 5. The infant respiratory signs and symptoms that were queried at each of the three home visits (Weeks 2, 3, and 5) included wheezing, cough, upper respiratory infection (cold), ear infection, pneumonia, bronchitis, and hospitalization.

Sample Size: 29 mother-infant pairs

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Referrals, CAREGIVER, Educational Material (caregiver), Educational Material, Telephone Support

Intervention Description: We sought to evaluate the efficacy of a brief intervention with smoking parents on smoking cessation rates after child hospitalization with a randomized, controlled trial.

Intervention Results: Sixty smoking parents participated in the study. The majority of study participants were uninsured women under age 30 who smoked approximately half of a pack per day. There were no statistically significant differences between control and intervention groups for our outcomes. However, 45% (CI: 33–57%) of all participants reported at least one quit attempt during the 2-month study period and 18% (CI: 10–30%) of participants were quit at study conclusion.

Conclusion: Willingness to quit smoking was much higher than expected in this population of parenting smokers.

Study Design: RCT

Setting: Community (hospital)

Population of Focus: Parents who smoke of a hospitalized children

Data Source: Telephone interview at 2 months and self-report of quit status

Sample Size: 62 parents randomized; 41 completed study

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Counseling (Parent/Family), CAREGIVER, Educational Material (caregiver), Motivational Interviewing/Counseling

Intervention Description: Smoking caregivers of children hospitalized for respiratory illness at the University of New Mexico were offered a smoking cessation intervention during the child's hospitalization.

Intervention Results: Fourteen percent of participants in the counseling group and 5% in the brief message group were self-reported quitters at 6 months. A significant percentage of smoking parents of children hospitalized for respiratory illness are willing to receive smoking cessation counseling while their child is in the hospital. Abstinence rates appear similar to other pediatric office-based interventions. Child hospitalization should be considered an important opportunity to provide parents with smoking cessation services, particularly since many smoking parents will not have access to these services elsewhere.

Conclusion: Child hospitalization should be considered an important opportunity to provide parents with smoking cessation services, particularly since many smoking parents will not have access to these services elsewhere.

Study Design: RCT

Setting: Community (hospitalization for Respiratory Illness)

Population of Focus: Parents of children hospitalized for respiratory illness

Data Source: Validated questionnaires and Fagerstrom test for nicotine dependence (self-report) All participants were followed by phone at 3 and 6 months posthospitalization for quit attempts.

Sample Size: 42 randomly assigned parents

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Educational Material, Other Education, Other Person-to-Person Education

Intervention Description: Nurse-delivered telephone support, relapse prevention training, and information about the adverse effects of smoking and ETS.

Intervention Results: At 6 months postpartum, 36% remained abstinent; 26% smoking; and 38% smoking daily. At 12 months postpartum, 78.5% reported no difficulties in making homes smoke- free. By 12 months this % increased to 86.9%.

Conclusion: While regional legislative activity has been effective in reducing ETS in many public places,12 private homes cannot be easily regulated. Public health education remains the most effective means to protect children from ETS in their homes. While there is growing appreciation for the importance of smoke-free homes,133 there remain significant misperceptions about effective ways to enact this protection.

Study Design: RCT

Setting: Hospital (time of birth) and Community (telephone)

Population of Focus: Mothers who had quit smoking during pregnancy

Data Source: Interview data collection at birth and at 6 and 12 months postpartum.

Sample Size: 251 mothers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Pharmacotherapy (Nicotine), Peer Counselor, Educational Material, Other Person-to-Person Education

Intervention Description: Exposing children to secondhand tobacco smoke (SHS) causes significant harm and occurs predominantly through smoking by caregivers in the family home. We report a trial of a complex intervention designed to reduce secondhand smoke exposure of children whose primary caregiver feels unable or unwilling to quit smoking.

Intervention Results: Outcomes were the change in average home air quality, significant reduction in number of cigarettes smoked in the home and HIS, threefold increase in the odds of making an attempt to quit during the 12 weeks of the study. Significant behavior change, improvement in indoor air quality and consequent reductions in exposure of young children to SHS as measured by salivary cotinine.

Conclusion: By reducing exposure to SHS in the homes of children who live with smokers unable or unwilling to quit, this intervention offers huge potential to reduce children’s’ tobacco-related harm.

Study Design: Open label, parallel, RCT

Setting: Home-based (educational home visits and feedback air quality) and telephone counseling

Population of Focus: Caregivers resident in Nottingham City and County, England who were at least 18 years old, the main caregiver of a child aged under 5 years living in their household, and reported that they were smoking tobacco inside their home

Data Source: Participant questionnaires, indoor air, saliva samples to measure child’s cotinine.

Sample Size: 205; 103 to intervention and 102 to usual care

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material (Provider), Consultation (Parent/Family), Education on Disease/Condition,

Intervention Description: The intervention consisted of a five-component toolkit aimed at improving healthcare providers' communication skills about HPV vaccination. The components included: (1) making presumptive and strong recommendations, (2) using motivational interviewing techniques, (3) providing a fact sheet, (4) showing disease images, and (5) using a website.

Intervention Results: - Providers in the intervention group reported higher use of the intervention components, including making presumptive and strong recommendations and using motivational interviewing techniques. - Use of the fact sheet was significantly correlated with high parental acceptance of the HPV vaccine. - Providers in the intervention group did not report spending more time discussing the vaccine with hesitant parents than control providers. - Providers in the intervention group reported greater improvement in parental HPV vaccine acceptance than control providers. The study found that the intervention resulted in substantial improved HPV vaccine series initiation and completion among adolescents in the intervention arm compared to controls. Providers in the intervention group reported greater improvement in parental HPV vaccine acceptance than control providers. However, the change in parental vaccine acceptance over time was not statistically significant between groups.

Conclusion: Communication-based interventions, such as the five-component toolkit used in this study, have the potential to increase HPV vaccination rates among adolescents. - Future research should examine the effectiveness of a streamlined version of the intervention, focusing on communication skills training and fact sheets.

Study Design: The study used a randomized controlled trial design.

Setting: The study was conducted in a central Colorado practice-based research network.

Population of Focus: Healthcare providers who work with adolescent patients.

Sample Size: The study included 187 providers from 16 practices (8 intervention, 8 control).

Age Range: The study focused on adolescent patients who were eligible for HPV vaccination.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Online Material/Education/Blogging, Peer Counselor

Intervention Description: The aim of this randomized controlled trial was to determine whether a behavioural intervention in pregnancy supported by online information would improve smoking cessation rates However, due to a number of challenges, recruitment to this trial was reluctantly halted.

Intervention Results: We aimed to recruit 220 maternal smokers within 2 years and after screening 1995 women, just 22 enrolled over a 8-month period. Only three women accessed the online element of the intervention and, at follow up, no women reported quitting.

Conclusion: We report our findings as they may inform the design and powering of future smoking cessation interventions in pregnancy.

Study Design: RCT

Setting: Antenatal clinics

Population of Focus: Self-reported smokers who were aged over 18 years, less than 17 weeks gestation, understood English, had access to the Internet, and had capacity to give consent

Data Source: Breath CO, website statistics, survey, medical records

Sample Size: 22- 13 intervention group, 9 control group

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, Educational Material, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), CAREGIVER, Education/Training (caregiver), Home Visit (caregiver), Educational Material (caregiver)

Intervention Description: Secondhand smoke (SHS) and other air pollutants adversely affect the health of pregnant women and infants. A feasibility study aimed at reducing air pollution in homes of pregnant women or infants living with a smoker was completed.

Intervention Results: Post-intervention, 70% of participants reported smokers were less likely to smoke indoors, and 77% had at least one air purifier turned on at the final visit. Participant satisfaction was high (91%) and 98% would recommend air purifiers. Indoor PM2.5 was significantly decreased (P < 0.001). Salivary cotinine was significantly decreased for non-smoking women (P < 0.01) but not infants, and no significant change in air nicotine occurred (P = 0.6).

Conclusion: Air purifiers with SHS education is a feasible intervention in homes of women and infants. These data demonstrate reduction in indoor PM2.5 and salivary cotinine in non-smoking adults. Air purifiers are not an alternative for smoking cessation and a home/car smoking ban. Smoking cessation should be strongly encouraged for all pregnant women, and nonsmoking mothers with infants should be counseled to completely avoid SHS exposure. This study provides support for a future intervention evaluating clinical endpoints.

Study Design: A single arm, unmasked clinical trial

Setting: Home-based (4 home-visits during the 5 week study)

Population of Focus: Women > 18 years of age and either pregnant nonsmokers or post-partum (any smoking status) with an infant age 0-12 months

Data Source: Air quality assessment, salivary cotinine

Sample Size: 50 women, 32 had infants and 18 were pregnant at time of enrollment

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): CAREGIVER, Educational Material (caregiver), Motivational Interviewing/Counseling, Education/Training (caregiver)

Intervention Description: This study tested a behavioral intervention to increase dental attendance among rural Oregonian low-income women and their children.

Intervention Results: Compared to statewide PRAMS, attendance was higher during pregnancy for study mothers (45% statewide; 95% CI = 40-50%) and for their children by 24 months (36% statewide; 95% CI = 27-44%).

Conclusion: Prenatal or postpartum motivational interviewing/counseling (MI) did not lead to greater attendance when compared to HE alone and cost more to implement. High attendance may be attributable to the counselors' patient navigator function.

Study Design: RCT

Setting: Four rural counties in OR

Population of Focus: Children of pregnant women aged ≥15 years in their first or second trimester eligible for Medicaid

Data Source: Medicaid claims; maternal self-report

Sample Size: Prenatal MI/Postpartum MI (n=121) Prenatal MI/Postpartum HE (n=50) Prenatal HE/Postpartum MI (n=134) Prenatal HE/Postpartum HE (n=44)

Age Range: not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Community Health Workers (CHWs), Educational Material, Training, Screening in Nontraditional Settings

Intervention Description: The intervention described in the article to increase postpartum depression (PPD) screening is the implementation of a community health worker (CHW) program . The CHWs were trained to assist providers with PPD screening and behavioral health referrals by addressing patient barriers to care. The CHWs also provided education to patients and families about PPD and the importance of screening. The CHWs were available to assist patients during their well-child visits and provided follow-up phone calls to patients who screened positive for PPD.

Intervention Results: The study found that the implementation of a community health worker (CHW) program was effective in increasing postpartum depression (PPD) screening rates in a pediatric patient-centered medical home (PCMH) that primarily serves a Latinx immigrant population. The study found that the overall screening rate increased from 45% to 66% after the implementation of the CHW program . The study also found that the rate of patients referred after positive screenings increased from 9% to 22% following project implementation . The study concludes that CHWs can assist providers with PPD screening and behavioral health referrals by addressing patient barriers to care and that future studies focusing on the referral process for PPD treatment and resources for minority populations are needed to assess the impact of screening on maternal and infant clinical outcomes

Conclusion: Postpartum depression is a serious problem that affects many new mothers and often goes unrecognized, with even higher prevalence among minority populations, specifically immigrant mothers. Pediatric providers caring for infants and mothers must prioritize screening for PPD to improve diagnostic rates and ensure effective referrals and treatment protocols are in place. This project demonstrates how CHWs can assist providers with PPD screening and behavioral health referrals by addressing patient barriers to care. Future studies focusing on the referral process for PPD treatment and resources for minority populations, are needed to assess the impact of screening on maternal and infant clinical outcomes.

Study Design: The study design is a pre- and post-intervention study . The study evaluated the effectiveness of implementing a community health worker (CHW) intervention to improve postpartum depression (PPD) screening and referral rates in two South Carolina patient-centered medical homes that primarily provide care to low-income Latinx populations . The study collected pre- and post-implementation data by reviewing current procedural terminology (CPT) billing codes and examining patient charts

Setting: Pediatric clinic that serves a diverse population of patients, including Latinx and immigrant mothers two South Carolina patient-centered medical homes that primarily provide care to low-income Latinx populations

Population of Focus: However, it is likely that the target audience includes healthcare providers, policymakers, and researchers who are interested in improving postpartum depression screening and referral rates in diverse populations, particularly Latinx and immigrant mothers. The study provides insights into the effectiveness of utilizing community health workers (CHWs) to improve PPD screening and referral rates in low-income Latinx populations

Sample Size: he sample size for the study is 552 patients . This sample size was used to evaluate the effectiveness of the interventions implemented in two South Carolina patient-centered medical homes that primarily provide care to low-income Latinx populations

Age Range: The study does not focus on a specific age group. However, the sample population includes newborns and children up to 6 months of age who were seen at 1 month and 6-month well-child visit

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), HOSPITAL, Crib Card, Visual Display (Hospital), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver)

Intervention Description: To determine the impact, at 60 days of life, of an educational intervention conducted in maternity centers aimed at improving adherence to the recommendations on safe infant sleep.

Intervention Results: After the intervention, a 35% increase in the supine sleeping position (p < 0.0001) was observed; exclusive breastfeeding increased by 11% (p= 0.01); and co-sleeping decreased from 31% to 18% (p< 0.0005).

Conclusion: The educational intervention was useful to improve adherence to the recommendations on safe sleep at 60 days of life: using the supine position and breastfeeding improved, and the rate of co-sleeping decreased. No changes were observed in the number of household members who smoke, bedroom sharing, and pacifier use.

Study Design: QE: pretest-posttest

Setting: Hospital Municipal Comodoro Meisner and Hospital Universitario Austral

Population of Focus: Live newborns with >36 gestation weeks born in two hospitals whose mothers lived in the District of Pilar without major congenital malformations and/or hospitalization in the NICU for more than 10 days

Data Source: Caregiver report

Sample Size: Baseline (n=251) Follow-up (n=248)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, PATIENT_CONSUMER, ,

Intervention Description: Project Dads in Nutrition Education will strengthen the capacity of the Georgia Healthy Start program to integrate an evidence-based nutrition education program, breastfeeding education, and father engagement into its routine services.

Intervention Results: Changes in prepost survey assessment of participants’ nutrition literacy and eating behaviors; changes in prepost survey assessment of participants’ breastfeeding knowledge, attitudes, intent, initiation, and duration; and health and food diary collected 3 times (ie, at baseline, 3 months, and 6 months after enrollment).

Conclusion: Process evaluation throughout the study to document implementation. Generalized linear mixed modeling will be used to determine the impact of the intervention.

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Referrals, Educational Material,

Intervention Description: To identify the diverse services required by families of children with special health care needs (CSHCN) and identify the specific care coordination (CC) efforts associated with the most common types of observed diagnoses. Requested services were categorized into specific sectors, and CC efforts were quantified by observed diagnoses and defined sectors. CC service data were extracted and analyzed from patient encounters over 4 years (2009-2013) in a department database. This included descriptive information about referrals and linkages to medical, dental, and behavioral health providers and to state, private, and community agencies. Diagnostic classifications and CC sectors were defined to enable categorization.

Intervention Results: A total of 2682 CSHCN records were reviewed. The majority (59%) required services/resources in 1 to 2 sectors, 24% required services/resources in 3 to 5 sectors, and 17% required services/resources in 6 or more sectors. Including informational service, the most frequently required sectors across the study population were education, financial, medical/dental, social connections, and advocacy. Children diagnosed with autism spectrum disorder had the highest needs across all sectors.

Conclusion: Most CSHCN and their families use a substantial amount of CC time and effort to secure services from diverse sectors. High-quality and efficient CC requires an understanding of the specific needs of these CSHCN and their families and how to link them to a diverse array of services and resources.

Study Design: Retrospective observational study

Setting: Center for Care Coordination at Connecticut Children's Medical Center in Hartford, Connecticut

Population of Focus: Children and youth aged 0 to 21 years who were identified as having special health care needs and were served by the MHI program at the Center

Sample Size: 2682 CYSHCN

Age Range: CYSHCN aged 0 to 21 years

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Educational Material, Technology-Based Support,

Intervention Description: Partners For Kids (PFK) is an accountable care organization caring for pediatric Medicaid beneficiaries in Ohio. PFK QI specialists recruited practices to develop QI projects around increasing well care visit rates (proportion of eligible children with well care visits during calendar year) for children aged 3-6 years and adolescents. The QI specialists supported practice teams in implementing interventions and collecting data through monthly or bimonthly practice visits.

Intervention Results: Ten practices, serving more than 26 000 children, participated in QI projects for a median of 8.5 months (IQR 5.3-17.6). Well care visit rates in the QI-engaged practices significantly improved from 2016 to 2018 (P < .001 for both age groups). Over time, well care visit rates for 3- to 6-year-old children increased by 11.8% (95% CI 5.4%-18.2%) in QI-engaged practices, compared with 4.1% (95% CI 0.1%-7.4%) in non-engaged practices (P = .233). For adolescents, well care visit rates increased 14.3% (95% CI -2.6% to 31.2%) compared with 5.4% (95% CI 1.8%-9.0%) in QI-engaged vs non-engaged practices over the same period (P = .215). Although not statistically significant, QI-engaged practices had greater magnitudes of rate increases for both age groups.

Conclusion: Through practice facilitation, PFK helped a diverse group of community practices substantially improve preventive visit uptake over time. QI programs in primary care can reach patients early to promote preventive services that potentially avoid costly downstream care.

Study Design: Prospective cohort study

Setting: Community-based primary care practices serving pediatric Medicaid beneficiaries. These practices were geographically distributed throughout central and southeast Ohio, with a mix of urban and rural locations.

Population of Focus: Community-based primary care practices in Ohio, specifically those providing care to pediatric Medicaid recipients. These practices were actively engaged with Partners For Kids (PFK) and were involved in the Healthy Children Initiative, a quality improvement effort aimed at increasing well care visit rates for pediatric Medicaid patients.

Sample Size: 10 community-based primary care practices that were actively engaged in the Healthy Children Initiative. These practices served more than 26,000 pediatric Medicaid beneficiaries.

Age Range: The patient population served by these practices included pediatric Medicaid beneficiaries, with a focus on children aged 3-6 years and adolescents.

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, PATIENT_CONSUMER, HEALTH_CARE_PROVIDER_PRACTICE, Educational Material (Provider), Peer Counselor

Intervention Description: To evaluate changes in referrals to Women, Infants, and Children’s Supplemental Nutrition Program peer counselors, reported prenatal provider education and support, and breastfeeding outcomes (intention, initiation, 1-month duration of any and exclusive breastfeeding) after a prenatal breastfeeding promotion intervention.

Intervention Results: Pre-intervention (n = 71) and post-intervention (n = 70) participants were 49% Black, 61% publicly insured, and 16% uninsured. More post-intervention participants had > 1 Toolkit use (76%), peer counselor program referrals (60.0% post vs. 36.6% pre, p < .01), reported any breastfeeding intention (89% vs. 72%, p = .013), and intended to breastfeed for > 1 year (31% vs. 14%, p = .014). Post-intervention breastfeeding initiation and exclusivity were higher, but not significantly different. Post-intervention participants reported better prenatal breastfeeding supp

Conclusion: Implementing a prenatal Breastfeeding Toolkit, including facilitating peer counselor referral, was associated with increases in provider counseling, participants’ breastfeeding intentions, and uptake of peer counselors. Replicating this approach may reinforce efforts to support breastfeeding in similar practices serving women with lower incomes.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Educational Material, Group Education

Intervention Description: The rate of breastfeeding among immigrant Vietnamese women in Western countries is low compared to those in Vietnam. To counteract this trend, a language and culture specific education program was developed.

Intervention Results: Results suggested that the education program had significant effects on knowledge, attitudes, planned and actual behaviour towards breastfeeding. However, the effect did not sustain until 6 months postpartum.

Conclusion: Implications for nursing practice and further research are discussed.

Study Design: QE: non-equivalent control group

Setting: Western and South Western Sydney, New South Wales

Population of Focus: Vietnamese women who were at least 12 weeks pregnant

Data Source: Mother self-report

Sample Size: Intervention (n=108) Control (n=86)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), Sleep Environment Modification, CAREGIVER, Educational Material (caregiver), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation

Intervention Description: A quality improvement project for implementing safe sleep practices (SSP) was conducted at a large, U.S children's hospital.

Intervention Results: Audit data showed that 72% and 77% of infants were asleep supine at baseline and follow-up respectively (p=0.07).

Conclusion: Infant safe sleep practices have the potential to reduce infant mortality.

Study Design: QE: pretest-posttest

Setting: A tertiary care children’s hospital in AR

Population of Focus: Infants 0-12 months in intensive care and medical-surgical units caring asleep at the time of the audit

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=398) Follow-up (n=498)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Assessment, Educational Material (Provider), Screening Tool Implementation Training

Intervention Description: Prevention programs serve those at high risk by removing external risk factors, providing enriching environments, training parents on responsiveness and positive redirection to build skills for optimal development. Remediation programs are for children diagnosed with developmental disturbances, attempting to maximize competence and minimize delays. Compensation services target established disorders like cerebral palsy or Down syndrome, aiming to maximize overall functioning through aids and behavioral techniques. This article states that intervention programs tend to have a positive moderate effect on developmental attainment, with structured, intense programs providing family support being more effective. Earlier intervention in infancy may lead to better outcomes, though evidence is unclear. Appropriate early intervention services can help optimize development for delayed children.

Intervention Results: The resource presents several key results related to intervention programs for children with developmental delays. It states that intervention programs have been shown to have a positive moderate effect on eventual developmental attainment, improving intellectual, academic achievement, and scores on developmental outcomes measures. Prevention services specifically have been found to have significant lasting effects into adulthood, with children who participated being less likely to fail grades, be assigned to special programs, have higher achievement scores, be more likely to graduate high school and seek higher education, and have higher earning wages as adults. The Ypsilanti Perry Preschool Project calculated savings to society of $100,000 per child who participated. For biologically at-risk populations, intervention facilitated short-term gains in growth, development, and improved parenting skills.

Conclusion: This resource concludes that while more methodologically sound longitudinal studies are needed, the available evidence suggests that early intervention programs can benefit children with or at risk of developmental delays. It proposes that for intervention to be effective, programs should be structured, intense, involve family support services, and begin as early as possible in a child's life. The passage endorses developmental screening as a crucial step to identify delayed children early so they can receive appropriate intervention services to maximize their developmental potential.

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Home Visits, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Counseling (Parent/Family), PROVIDER/PRACTICE, Nurse/Nurse Practitioner, Educational Material

Intervention Description: As asthma is the most common chronic disease in childhood, much attention is directed towards primary prevention. Here, the clinical effectiveness of a multifaceted educational prevention was studied.

Intervention Results: The results of this study indicate that the intervention was able to reduce exposure to mite, pet and food allergens, but not to passive smoking. Despite this reduction, there was no effect on either parentally reported or GP-observed symptoms during first 2 yrs of life, nor on total and specific IgE at 2 yrs. However, asthma-like symptoms at the end of the 2nd yr were less frequently reported in the intervention group.

Conclusion: In conclusion, the intervention used in this study was not effective in reducing asthma-like symptoms in high-risk children during the first 2 yrs of life, although it was modestly effective at 2 yrs. Follow-up is necessary to confirm whether the intervention can actually prevent the development of asthma.

Study Design: RCT

Setting: Community

Population of Focus: Pregnant moms whose child would be high-risk for developing asthma

Data Source: Parental and GP report of asthma-like symptoms using questionnaires Measurement of mite, cat and dog allergen levels at baseline and 1 year.

Sample Size: 476 randomized to intervention and control groups

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Screening Tool Implementation Training

Intervention Description: The purpose of this study was to examine the feasibility and effectiveness of implementation of validated developmental screening by using the Parents' Evaluation of Developmental Status in 2 urban pediatric practices.

Intervention Results: Providers found routine screening easier than expected and feasible to conduct in a busy primary care setting. The practice change resulted in screening of 61.6% of eligible children. Compared with same-aged children before screening, after screening was implemented more behavioral concerns were detected in the 2-year-old group, and more children with developmental concerns were identified in the 3-year-old group. Referral rates for additional evaluation increased only for 3-year-olds, although the types of referrals (ie, audiology and early intervention) were consistent as those found before screening started.

Conclusion: Implementation of validated screening by using the Parents' Evaluation of Developmental Status was feasible in large, urban settings. Effectiveness was demonstrated via chart review documenting an increased rate of identification of developmental and behavioral concerns. Perceived obstacles, such as the time requirement, should not prevent widespread adoption of screening.

Study Design: QE: pretest-posttest

Setting: Boston Children’s Hospital Primary Care Center (CHPCC) and Joseph Smith Community Health Center in Massachusetts

Population of Focus: Children ages 2-3 years (20-40 months) receiving well-child visits

Data Source: Child medical record

Sample Size: Medical charts reviewed6 : - Baseline (n=338) o Children aged 2 years (n=169) o Children aged 3 years (n=169) - Follow-up (n=278) o Children aged 2 years (n=127) o Children aged 3 years (n=151) - Total charts (n=616)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, Peer Counselor, Educational Material, Motivational Interviewing, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Counseling (Parent/Family)

Intervention Description: To test the effectiveness of tailored quitline (telephone) counselling among smoking parents recruited into cessation support through their children's primary schools.

Intervention Results: Parents who received quitline counselling were more likely to report 7-day point-prevalence abstinence at 12-month assessment [34.0 versus 18.0%, odds ratio (OR) = 2.35, confidence interval (CI) = 1.56–3.54] than those who received a standard self-help brochure. Parents who received quitline counselling were more likely to use nicotine replacement therapy (P < 0.001) than those who received a standard self-help brochure. Among parents who did not achieve abstinence, those who received quitline counselling smoked fewer cigarettes at 3-month (P < 0.001) and 12-month assessment (P < 0.001), were more likely to make a quit attempt (P < 0.001), to achieve 24 hours' abstinence (P < 0.001) and to implement a complete home smoking ban (P < 0.01).

Conclusion: Intensive quitline support tailored to smoking parents is an effective method for helping parents quit smoking and promoting parenting practices that protect their children from adverse effects of smoking.

Study Design: RCT

Setting: Home-based telephone counseling

Population of Focus: Smoking parents

Data Source: Parent and child each completed a separate questionnaire. The primary outcome measure was 7-day pointprevalence abstinence at 12-month follow-up.

Sample Size: 512 parents who were smokers enrolled in RCT with children between the 9 and 12 years old

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Other Education, Telephone Support, Partner-Level Intervention, Technology-Based Support, COMMUNITY, Social Supports, Individual Supports,

Intervention Description: Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding. Mobile health (mHealth) interventions employing digital technologies provide a rapidly evolving means of engaging fathers and providing them with information and support to address their needs related to both breastfeeding and transitioning to fatherhood. The Parent Infant Feeding Initiative (PIFI) was a 4-arm, randomized controlled trial conducted in Perth, Australia. The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. The primary outcomes were duration of exclusive and any breastfeeding. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions.

Intervention Results: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers.

Conclusion: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports.

Study Design: RCT

Setting: Antenatal breastfeeding class/Online

Population of Focus: Couples from public and private hospitals in Perth, Australia

Sample Size: 1426 couples

Age Range: Adults 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Counseling (Parent/Family), PATIENT/CONSUMER, Home Visits, Other Person-to-Person Education, Educational Material

Intervention Description: To determine if low-cost air-quality monitors providing personalised feedback of household second-hand smoke (SHS) concentrations plus standard health service advice on SHS were more effective than standard advice in helping parents protect their child from SHS.

Intervention Results: 120 mothers were recruited of whom 117 were randomised. Follow up was completed after 1-month in 102 and at 6-months in 78 participants. There was no statistically significant reduction in PM2.5 concentrations by either intervention type at 1-month or 6-months, nor significant differences between the two groups at 1-month (p = 0.76) and 6-month follow-up (p = 0.16).

Conclusion: Neither standard advice nor standard advice plus personalised air-quality feedback were effective in reducing PM2.5 concentrations in deprived households where smoking occurred. Finding ways of identifying homes where air-quality feedback can be a useful tool to change household smoking behaviour is important to ensure resources are targeted successfully.

Study Design: RCT

Setting: Home-based

Population of Focus: Disadvantaged mothers who were exposed to SHS at home

Data Source: Air quality data, and caregiver selfreport

Sample Size: 117 mothers

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Educational Material, CAREGIVER, Education/Training (caregiver)

Intervention Description: Pediatric well-care visits provide a clinical opportunity to counsel new mothers about their smoking and the deleterious effects of environmental tobacco smoke (ETS) on infant health.

Intervention Results: The intervention reduced smoking (5.9% vs 2.7%) and relapse (55% vs 45%) at 6-month follow-up, but logistic regression analysis at 12 months revealed no significant treatment effect. The intervention had a positive effect on secondary outcome variables, such as readiness to quit and attitude toward and knowledge of ETS. Multiple logistic regression analysis indicated that husband/partner smoking was the strongest predictor of maternal quitting or relapse.

Conclusion: A pediatric office-based intervention can significantly affect smoking and relapse prevention for mothers of newborns, but the effect decreases with time. Consistent prompting of the provider to give brief advice and materials at well-care visits could provide a low-cost intervention to reduce infant ETS exposure.

Study Design: RCT

Setting: Pediatric well-care visits

Population of Focus: Mothers of newborns who were currently smoking or had quit for pregnancy

Data Source: Outcome data were obtained from 6- and 12-month follow-up questionnaires mailed to all participants.

Sample Size: 2,901 randomized to minimal (usual care) and Extended (received advice and materials)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, Quality Improvement, Policy/Guideline (Hospital), CAREGIVER, Educational Material (caregiver)

Intervention Description: The authors describe a 4-year demonstration project (2004-2007) to reduce infant deaths related to sleep environments by changing attitudes and practices among nurses who work with African American parents and caregivers in urban Michigan hospitals.

Intervention Results: Across all 7 sites, among infants in cribs at the time of the audits, there was a significant increase in the percentage on their backs from 80.7% to 91.9% (p<0.05).

Conclusion: Following the policy change effort, nurses changed their behavior and placed infants on the back to sleep.

Study Design: QE: pretest-posttest

Setting: Seven urban hospitals in MI

Population of Focus: Healthy newborn infants in cribs at the time of the audit B

Data Source: Crib audit/infant observation

Sample Size: Baseline (n=579) Follow-up (n=692)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Parent Engagement, Educational Material,

Intervention Description: - Intervention description: The multicomponent intervention included providing Vaccine Information Statement (VIS) forms to parents in advance, screening for needed immunizations during all visit types, and incorporating provider performance feedback.

Intervention Results: - Results: The intervention was highly effective in reducing missed opportunities for HPV vaccination, with adjusted risk ratios ranging from 0.41 to 0.51. The intervention also had a positive impact on missed opportunities for MenACWY and influenza vaccinations during nonconfidential visits. The study found that strong provider recommendations were already in place before the intervention, and that improving the immunization process workflow and incorporating provider performance feedback were key to reducing missed opportunities. Yes, the study reported a significant reduction in missed opportunities for HPV vaccination, indicating an increased uptake of the HPV vaccine among adolescents visiting the school-based health centers. The intervention was found to be highly effective in improving the delivery of HPV vaccination, as evidenced by the decrease in missed opportunities for HPV vaccination during all visit types. Additionally, the study also observed a positive impact on missed opportunities for MenACWY and influenza vaccinations during nonconfidential visits, suggesting an overall improvement in the uptake of adolescent vaccinations in the school-based health center setting ,[object Object],, ,[object Object],.

Conclusion: - Conclusion: The study supports addressing missed opportunities for HPV vaccination in school-based health centers and demonstrates that practice-level changes and performance feedback can be effective strategies for decreasing missed opportunities. The study also supports bundling adolescent immunizations as a strategy to reduce missed opportunities and improve coverage rates for other indicated vaccines.

Study Design: - Study design: The study used a mixed-methods design with a pre-post intervention comparison.

Setting: - Setting: The study was conducted in two school-based health centers located on separate public high school campuses within the same school district in the Los Angeles area.

Population of Focus: - Target audience: The target audience was adolescents between the ages of 11 and 18 who were eligible for Vaccines for Children (VFC) and had an available California Immunization Registry (CAIR) record.

Sample Size: - Sample size: The study included a total of 1,423 patient visits (892 in the baseline period and 531 in the intervention period) across both school-based health centers.

Age Range: - Age range: The study included adolescents between the ages of 11 and 18.

Intervention Components (click on component to see a list of all articles that use that intervention): PROFESSIONAL_CAREGIVER, Educational Material (caregiver), Provision of Safe Sleep Item, HOSPITAL, Quality Improvement, Crib Card, Policy/Guideline (Hospital), HEALTH_CARE_PROVIDER_PRACTICE, Educational Material (Provider), Nurse/Nurse Practitioner, Audit/Attestation, Audit/Attestation (Provider)

Intervention Description: This hospital quality improvement initiative performed a series of Plan-Do-Study-Act cycles designed to increase the proportion of infants placed in a “perfect sleep” environment that met all of the American Academy of Pediatrics’ infant safe sleep guidelines. The initiative took place while the hospital was preparing for Baby Friendly certification, with increased emphasis on rooming in and skin to skin at the same time. Initial cycles targeted nurse and parental education, while later cycles focused on providing sleep sacks/wearable blankets for the infants. The goal was to achieve 70% “perfect sleep” compliance among infants cared for in the hospital.

Intervention Results: While we did not meet our goal, the percentage of infants with 'perfect sleep' increased from a baseline of 41.9% to 67.3%, and we also saw improvement in each of the individual components that contribute to this composite measure. Improvements were sustained over 12 months later, suggesting that QI interventions targeting infant safe sleep in this inpatient setting can have long-lasting results.

Conclusion: This project also suggests that infant safe sleep QI initiatives and preparation towards Baby Friendly Hospital Certification can be complementary.

Population of Focus: Hospital healthcare providers

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Social Supports, Referrals, Screening Tool Implementation Training

Intervention Description: The Iowa Department of Public Health’s 1st Five Healthy Mental Development Initiative is bridging public and private health care systems to improve early detection of social-emotional delays and prevention of mental health problems among young children and their families. Key features of the 1st Five model include: user-friendly mental and developmental health screening and referral forms; ongoing education and support for medical office staff on healthy development and use of screening and referral tools; specially trained care coordinators to identify and address a wide range of children’s and families’ needs; relationships with community resources that provide early intervention; and timely notification of outcomes to the referring physician offices.

Intervention Results: With an evaluation under way, early 1st Five experience indicates that families identified through the program have a range of unmet needs: each physician referral results in an average of three to five follow-up referrals for services.

Conclusion: The early experience in Iowa indicates that there are substantial opportunities to improve early detection of social–emotional delays and problems and prevention of mental health problems by strengthening the connection between physicians and the public health system and providing comprehensive care coordination. This requires building relationships and changing mindsets and practices at the community and clinic level. It requires modest funding and does not happen overnight. An ongoing evaluation of the 1st Five initiative will yield important evidence about the benefits and challenges of this approach. If early indications are borne out, adoption and replication in other communities and states may be warranted. The Iowa model itself is adapted from similar programs in North Carolina and Connecticut. The model can be a “win-win-win” situation. It can provide overburdened primary care physicians and their staff with the knowledge and tools to identify at-risk patients and make easy, fast referrals, with the assurance that they will be informed of the outcomes. It can also allow the public health system to better perform its surveillance and early intervention functions. Finally, it can provide critical treatment and relief to young children and their families, alleviating or avoiding exacerbation of early developmental problems and other family crises and enhancing the likelihood of a healthy, productive future.

Study Design: N/A

Setting: Iowa

Data Source: the Child and Family Policy Center,

Sample Size: N/A

Age Range: young children ages 0 to 5 years and their families,

Intervention Components (click on component to see a list of all articles that use that intervention): Provider Training/Education, Educational Material (Provider), Nurse/Nurse Practitioner,

Intervention Description: The article describes an evidence-based educational intervention aimed at increasing the screening of immigrant mothers for postpartum depression in the Baby Well Clinic. The intervention consisted of a 2-hour educational session for Child Health Services (CHS) nurses, which included information on postpartum depression, screening tools, and cultural aspects of depression in immigrant mothers. The nurses were also provided with a screening tool and a guideline for screening and referral. The intervention was followed by a 6-month implementation period during which the nurses were expected to screen all immigrant mothers attending the Baby Well Clinic for postpartum depression.

Intervention Results: The study found that the educational intervention was feasible and acceptable to CHS nurses. The nurses reported increased knowledge and confidence in screening for postpartum depression, and the majority of them (97%) stated that the training had a positive impact on their ability to screen immigrant mothers for postpartum depression. However, the study also found that the implementation of the intervention was challenging due to factors such as language barriers, limited time, and competing demands. The study suggests that further research is needed to evaluate the effectiveness and cost-effectiveness of the intervention

Conclusion: The intervention was found feasible but require adjustment in the design of the practical training sessions. The use of the provided material, a comic strip on parental support and interpreter information needs further evaluation.

Study Design: The study design used in this research is a feasibility study with a one-group pretest-posttest experimental design

Setting: However, it is mentioned that the study was conducted by researchers from Lund University in Sweden . The study focused on screening immigrant mothers for postpartum depression in the context of the Baby Well Clinic, which is a primary healthcare center that provides care for families with children aged 0-6 years

Population of Focus: The target audience for this study is Child Health Services (CHS) nurses who work with non-native-speaking immigrant mothers in the Baby Well Clinic in Sweden . The aim of the study was to test the feasibility of an evidence-based educational intervention for CHS nurses in screening non-native-speaking immigrant mothers for postpartum depression

Sample Size: The sample size for this study was 34 Child Health Services (CHS) nurses representing 17 clinics

Age Range: However, the study focused on screening immigrant mothers for postpartum depression in the context of the Baby Well Clinic, which is a primary healthcare center that provides care for families with children aged 0-6 years . Therefore, it can be inferred that the age group of the participants is mothers with newborns and infants aged 0-6 years.

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT/CONSUMER, Telephone Support, Educational Material, Patient Reminder/Invitation

Intervention Description: This study explores the views of women who received a tailored text messaging cessation intervention (MiQuit) during pregnancy, focusing on acceptability, perceived impact, and suggestions for improvements.

Intervention Results: Three main themes were identified: "impact", "approach," and "optimization." Participants described an immediate, yet often short-lived, impact from the texts that distracted and delayed them from smoking and they perceived that texts focusing on the development of and risk to the baby generated more enduring emotional impacts. Most women found receiving support by text preferable to face-to-face cessation support, with participants citing the greater regularity, convenience, and non-judgmental style as particular advantages. Participants would have preferred a longer support program with increased tailoring, greater customization of text timings and consideration of cutting down as an alternative/precursor to quitting.

Conclusion: Pregnancy-specific cessation support by text message was well received and participants considered the support increased their motivation to stop smoking. The focus on the developing baby, the regularity of contact and the provision of gentle, encouraging messages were highlighted as particularly important elements of the program.

Study Design: Qualitative interview

Setting: Mobile based

Population of Focus: Pregnant women smokers aged 17- 37 who had received the MiQuit text messaging intervention as part of a larger RCT

Data Source: Telephone interviews

Sample Size: 15

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Provider/Patient Communication Portal, Educational Material (Provider),

Intervention Description: Although patient-provider continuity improves care delivery and satisfaction, poor continuity with primary care providers (PCP) often exists in academic centers. We aimed to increase patient empanelment from 0% to 90% and then increase the percent of well-child care (WCC) visits scheduled with the PCP from 25.6% to 50%, without decreasing timely access that might result if patients waited for PCP availability. Nationwide Children's Hospital Primary Care Network cares for >120,000 mostly Medicaid-enrolled patients across 13 offices. Before 2017, patients were empaneled to an office, not individual PCPs. We empaneled patients to PCPs, reduced provider floating, implemented continuity-promoting scheduling guidelines, scheduled future WCC visits for patients ≤15 months during check-in for their current one, and encouraged online scheduling. We tracked the percentage of all WCC visits that were scheduled with the patient's PCP and the percentage of subsequent WCC visits for patients ≤15 months that were scheduled during the current visit, and provided feedback to schedulers. We followed emergency department (ED) utilization and visit show rates. WCC visit completion rates were tracked using HEDIS metrics.

Intervention Results: Patient empanelment increased from 0% to >90% (P < .001). Patient-provider WCC continuity increased from 25.6% to 54.7% (P < .001). A 20.5% decrease in ED utilization rate was associated with continuity project initiation. Empaneled patients demonstrated higher show rates (76.9%) versus unempaneled patients (71.4%; P < .001). WCC completion rates increased from 52.6% to 60.7%.

Conclusion: WCC continuity more than doubled after interventions and was associated with decreased ED utilization, higher show rates, and increased timely WCC completion.

Study Design: Program evaluation

Setting: Nationwide Children's Hospital (NCH) Primary Care Network (PCN) with a group of 13 urban offices in Columbus, Ohio

Population of Focus: Patients of the Nationwide Children's Hospital (NCH) Primary Care Network (PCN) in Columbus, Ohio serving a diverse population of over 120,000 patients, most of whom are Medicaid-enrolled.

Sample Size: 13 primary care offices

Age Range: Pediatric practices serving children 0-17 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, HOSPITAL, CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), Visual Display (Hospital)

Intervention Description: To determine infant sleep positioning practices and SIDS awareness before and after a hospital-based Back to Sleep campaign.

Intervention Results: Comparing baseline to follow-up, there was no significant change in supine sleep position (20.4% vs. 22.4%) (p>0.05).

Conclusion: The Back to Sleep campaign was effective in our hospital setting. Our data indicate the need for special targeting of young, unmarried, and non-breast-feeding mothers. Fear of choking remains an important deterrent to proper infant sleep positioning.

Study Design: QE: pretest-posttest

Setting: Pediatric ambulatory care center of Wyckoff Heights Medical Center in NY

Population of Focus: Mothers of healthy term infants 6 months and younger born in the hospital and attending the pediatric outpatient clinics

Data Source: Mother report

Sample Size: Baseline (n=250) Follow-up (n=250)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Quality Improvement/Practice-Wide Intervention, Educational Material (Provider), Collaboration with Local Agencies (Health Care Provider/Practice),

Intervention Description: The study used quality improvement (QI) as part of a collaborative learning system approach to improve access and flow within Child and Adolescent Mental Health Services (CAMHS). Seven separate teams across five CAMHS services in the trust identified a local issue related to flow in their system and developed QI projects to tackle these. Each team developed a family of measures containing outcome, process, and balancing measures.

Intervention Results: Improvements in outcome measures were seen by three teams; City and Hackney ADHD, Tower Hamlets Triage, and Luton Emotional and Behavioural Team. Improvements in process measures were seen by two teams. One team did not see an improvement in outcome or process measures.

Conclusion: The study shows that the use of quality improvement (QI) as part of a collaborative learning system approach can lead to improvements in access and flow within Child and Adolescent Mental Health Services (CAMHS).

Study Design: Quality improvement (QI) as part of a collaborative learning system approach.

Setting: Child and Adolescent Mental Health Services (CAMHS) in East London NHS Foundation Trust (ELFT), England

Population of Focus: Mental health professionals, healthcare providers, policymakers, and researchers interested in improving access and flow within CAMHS.

Sample Size: Seven separate teams across five CAMHS services in the trust participated in the study.

Age Range: The study focused on Child and Adolescent Mental Health Services (CAMHS), which serves individuals up to the age of 18.

Intervention Components (click on component to see a list of all articles that use that intervention): Educational Material, Provider Training/Education,

Intervention Description: The intervention involved a multimodal protocol with four significant components, including a sub-protocol for patient visits. It included a one-hour online train-the-trainer module, a modified YATK PowerPoint presentation, staff education about the protocol, and distribution of scripts and vaccine eligibility algorithms to staff

Intervention Results: The staff survey showed positive responses, with 87.5% response rate and all RNs or LPNs intending to make changes to their current practice. Vaccination rates increased post-protocol implementation, with higher acceptance of the vaccine among male patients

Conclusion: The evidence-based protocol, which included staff training and education, led to increased acceptance of the HPV vaccine and positive changes in staff behavior and intention to improve vaccination rates

Study Design: The study utilized a pre-post intervention design, with the intervention implemented immediately following a training class with staff

Setting: The setting is a county immunization clinic where the evidence-based protocol was implemented to improve HPV vaccine initiation rates

Population of Focus: The target audience includes clinic staff, such as registered nurses, LPNs, ancillary staff, and management, who participated in the implementation of the protocol

Sample Size: The sample included all clinic staff (n = 8) and a convenience sample of 209 11–14 year-old patients, with 115 patients in 2018 serving as the intervention group and 94 patients in 2017 serving as the pre-intervention group for comparison purposes

Age Range: The sample included all clinic staff (n = 8) and a convenience sample of 209 11–14 year-old patients, with 115 patients in 2018 serving as the intervention group and 94 patients in 2017 serving as the pre-intervention group for comparison purposes