Established Evidence Results

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): 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 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): 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): 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): 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): 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): 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): 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): 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): 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, 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): 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): 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): 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): 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): 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, 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): 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): 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): 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): 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 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): 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): 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, 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, 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): 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): 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): 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): PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), PATIENT/CONSUMER, Educational Material, CAREGIVER, Educational Material (caregiver), Counseling (Parent/Family), Peer Counselor, Motivational Interviewing/Counseling

Intervention Description: We report on a randomized controlled trial conducted between 1996 and 2001 to evaluate a minimal contact behavioral counseling intervention to decrease household SHS exposure among children with asthma from low-income, predominantly ethnic minority families.

Intervention Results: The intervention was unsuccessful with respect to reduction of household smoking and household SHS exposure of these children. In addition, while most households that remained in the study reported full household smoking bans by the end of the study, the study team found no difference in control/intervention households citing a ban on smoking.

Conclusion: Despite these results, our study provided several important insights. The “null” results of our trial suggest that a minimal intervention with limited contact may not suffice to achieve a reduction in household tobacco exposure among low income minority families that have children with asthma. However, although no intervention/control group differences were found, our study suggests that it is possible to implement household restrictions that were not previously in place, including among low-income and minority families, since most households reported implementing full smoking bans by the end of the study (136 of the original 242 at baseline, 56%). This is significant in light of the implications of such restrictions for reduced exposure [43] and the association of bans with smoking cessation and decreased cigarette consumption. Our research also points to the need for further study of the process by which change occurs, i.e., what changes families believe they are making and actually achieve.

Study Design: RCT

Setting: Community (home)

Population of Focus: Children 2-14 years of age with asthma and a parent or guardian from each child’s household

Data Source: Parental survey (baseline data); urine cotinine; air nicotine monitor readings; and in-person follow-up.

Sample Size: 242 child/adult dyads

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), PROVIDER/PRACTICE, Patient-Centered Medical Home, Educational Material (Provider), Continuity of Care (Caseload), CAREGIVER, Education/Training (caregiver), Educational Material (caregiver), PATIENT/CONSUMER, Referrals, Other Education

Intervention Description: This study examines the effect of a provider alliance on service utilization, satisfaction , self efficacy, and attachment to a regular source of care for participating low income urban children and their families.

Intervention Results: The use of Physician Assistants and community health workers to expand community outreach, primary care services, pediatric sub-specialty care, and service coordination within and between care settings improved health services utilization, satisfaction with health services, parental self efficacy in navigating the health care system for their children, and service convenience for an at-risk population. Also, the use of Physician Assistants to provide pediatric sub-specialty services did not have a negative effect on parental satisfaction with a child's care.

Conclusion: Parents were slightly more satisfied with services received from a Physician Assistant in comparison with the physician sub- specialists in cardiology and nephrology clinics.

Study Design: Prospective quasiexperimental; Survey

Setting: South Central Los Angeles primary and specialty care clinics

Population of Focus: Children between the ages of 0-18 (“or are adolescents”) who reside within the geographic area of South Los Angeles

Data Source: A 30 item parent survey to assess parents’ perceived difficulty in accessing services and their satisfaction with the services received • Patient database was used to collect service utilization and financial data from operational and administrative tracking instruments and reports at both the primary and specialty care sites

Sample Size: Estimated 727,000 children in the service area; n=11,533 children reach during outreach events; n=80,000 (10% of children in service area) children attached to a medical home; n=8545 children enrolled in available payer sources

Age Range: Not specified

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

Intervention Description: We conducted a population-based trial to evaluate the efficacy of an intervention aimed at preventing exposure of young children to parental tobacco smoke.

Intervention Results: A strong association was found between social class and smoking behavior, in particular smoking during meals at home. The intervention itself had limited effectiveness in decreasing the number of smokers. The effect was stronger in mothers and in higher social groups. Among the "white-collar" families belonging to the intervention group, the proportion of mothers who stopped smoking was 3 times higher than in the control group (not statistically significant).

Conclusion: Educational interventions against smoking should be planned taking into account the difference in efficacy according to social class.

Study Design: Control trial with nonrandom assignment

Setting: Community (population based survey) and well-child health care visit

Population of Focus: Parents of newborn babies living in the town of Rivoli before 3 month compulsory vaccination

Data Source: Baseline (pre-intervention) and followup (2 and 4 years post-intervention) questionnaires

Sample Size: 1015 parents with 402 in the intervention group and 613 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, Motivational Interviewing, Other Education, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Counseling (Parent/Family), CAREGIVER, Educational Material (caregiver), Motivational Interviewing/Counseling, Education/Training (caregiver)

Intervention Description: To examine the long-term maintenance of a previously reported behavioral counseling intervention to reduce asthmatic children's exposure to environmental tobacco smoke (ETS).

Intervention Results: The originally reported analysis of baseline to 12 months was reanalyzed with a more robust restricted maximum likelihood procedure. The 2-year follow-up period was analyzed similarly. Significantly greater change occurred in the counseling group than the control groups and was sustained throughout the 2 years of follow-up. Further exploratory analyses suggested that printed counseling materials given to all participants at month 12 (conclusion of the original study) were associated with decreased exposure in the control groups.

Conclusion: Such long-term maintenance of behavior change is highly unusual in the general behavioral science literature, let alone for addictive behaviors. We conclude that ETS exposure can be reduced and that a clinician-delivered treatment may provide substantial benefit.

Study Design: Three-group RCT

Setting: Ill-child healthcare setting (pediatric allergy clinic)

Population of Focus: Families of children with asthma (6 to 17 years) including at least one parent who smoked in the home

Data Source: Interview data, pulmonary function testing, daily peak flow measures, symptom diary recordings, urinary cotinine, environmental air sampling, and permanent product (e.g., cigarette butt counts).

Sample Size: 91 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), CAREGIVER, Educational Material (caregiver), PATIENT/CONSUMER, Educational Material, Telephone Support

Intervention Description: Since most smoker parents of children with asthma are unable to quit, an alternative measure that would reduce their children's exposure to environmental tobacco smoke (ETS) is to ban smoking in the home.

Intervention Results: At 6 months, 49.2% of the intervention group reported having banned smoking in the home compared with 41.9% of controls, but the differential rate of change from baseline was not significant (P = 0.40). At follow-up, there were no significant differences between groups in the percentage reporting bans on smoking in the car, the mean reduction from baseline in total daily consumption or consumption in front of the child, children's urinary cotinine level, or parental smoking cessation.

Conclusion: The intervention did not change parents' propensity to create or maintain bans on smoking in their homes or otherwise change smoking habits to reduce their children's exposure to ETS. More intensive interventions may be required to achieve change among low-income smoker parents of children with asthma.

Study Design: Control trial with alternation by week of attendance at clinic

Setting: Ill-child healthcare setting (hospital outpatient clinics for children with asthma)

Population of Focus: Families with children between 1 and 11 years of age with doctorconfirmed asthma who attended pediatric outpatient clinics at two metropolitan hospitals

Data Source: Baseline and follow-up questionnaires; child’s urinary cotinine levels.

Sample Size: Of 378 eligible, 292 participated with 143 in the intervention group and 149 in the control group

Age Range: Not specified

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

Intervention Description: To assess counseling to caregivers and classroom health education interventions to reduce environmental tobacco smoke exposure of children aged 5–6 years in China.

Intervention Results: At the 6-month follow-up, children’s urinary cotinine was significantly lower (Z = –3.136; p = 0.002) and caregivers’ 7-day quit rate was significantly higher (34.4% versus 0%) (p < 0.001; adjusted OR = 1.13; 95% CI: 1.02–1.26) in the intervention than control group.

Conclusion: Helping caregivers quitting smoke combined with classroom-based health education was effective in reducing children’s environmental tobacco smoke exposure. Larger-scale trials are warranted.

Study Design: RCT

Setting: Community (preschools)

Population of Focus: Children ages 5-6 and their caregivers from six districts and one county in Changsha in families where one or more parent/caregiver smoked

Data Source: Caregiver interviews; child urine cotinine feedback

Sample Size: 65 smoker caregivers and their children with 33 in the intervention group and 32 in the control group

Age Range: Not specified

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

Intervention Description: To determine the effectiveness of a cotinine-feedback, behaviorally based education intervention in reducing environmental tobacco smoke (ETS) exposure and health-care utilization of children with asthma.

Intervention Results: The intervention was associated with a significantly lower odds ratio (OR) for more than one acute asthma medical visit in the follow-up year, after adjusting for baseline visits (total visits, 87; OR, 0.32; p = 0.03), and a comparably sized but nonsignificant OR for one or more hospitalization (OR, 0.34; p = 0.14). The follow-up CCR measurement and the determination of whether smoking was prohibited inside the home strongly favored the intervention group (n = 51) (mean difference in CCR adjusted for baseline, −0.38; p = 0.26; n = 51) (60; OR [for proportion of subjects prohibiting smoking], 0.24; p = 0.11; n = 60).

Conclusion: This intervention significantly reduced asthma health-care utilization in ETS-exposed, low-income, minority children. Effects sizes for urine cotinine and proportion prohibiting smoking were moderate to large but not statistically significant, possibly the result of reduced precision due to the loss of patients to active follow-up. Improving ETS reduction interventions and understanding their mechanism of action on asthma outcomes requires further controlled trials that measure ETS exposure and behavioral and disease outcomes concurrently.

Study Design: RCT

Setting: Community (pediatric pulmonary service of a pediatric hospital)

Population of Focus: Parents of children 3 to 12 years of age with asthma who were ETS exposed

Data Source: Interview data, pulmonary function, urine cotinine, asthma medications, health care utilization.

Sample Size: 87 parents

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: Many women do not have adequate and consistent social support to help them deal with breastfeeding difficulties at home after childbirth. Millennial women (those born between 1980 and 1999) have a significant presence online, making internet-based sources of breastfeeding support a potentially far-reaching, cost-effective, and convenient innovation. Social media platforms (e.g., Facebook, YouTube, Twitter, LinkedIn, Pinterest, GooglePlus+, Tumblr, and Instagram) are internet-based applications that enable the creation and exchange of user-generated content that may provide an avenue of social support. Social media breastfeeding support groups (SMBSGs) provide a cost-efficient, immediate approach to gaining social support and education from vast populations with various sociodemographics. Using 17 SMBSGs, the study team explored the variables that lead to sustained, exclusive breastfeeding to 6 months for breastfeeding millennial women who follow SMBSGs.

Intervention Results: Using structural equation modeling, I examined relationships among personal factors; competing situational demands; social support; and confidence in, knowledge of, attitude toward, and sustainability of breastfeeding. Age, education, and competing work and family demands were all predictive of social support. Breastfeeding social support had a direct effect on participants’ breastfeeding confidence, knowledge, and attitudes (F = 4.96, R2 = .07, p < .002). Furthermore, within SMBSGs, exclusive breastfeeding to 6 months was reported to be three times (66%) greater than the U.S. national average (22%).

Conclusion: Interventions aimed at providing women with resources to gain breastfeeding social support, such as SMBSGs, may be vehicles to improve women’s confidence, knowledge, and attitudes and, therefore, increase the potential for exclusive breastfeeding to 6 months.

Study Design: Repeated measures, longitudinal, mixed-methods

Setting: Online social media support groups across 21 countries

Population of Focus: Convenience sample of exclusively breastfeeding millenial women who followed at least one of 17 social media breastfeeding support groups

Sample Size: 241 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 Materials, Lactation Consultant, Other Education, Professional Support, HEALTH_CARE_PROVIDER_PRACTICE, Other (Provider Practice),

Intervention Description: A team-based, integrated lactation consultant (LC) and primary care provider (PCP) program improves breastfeeding rates in some outpatient settings, but only a limited number of studies have assessed efficacy in socioeconomically and racially diverse communities. The study intervention implemented routine LC/PCP visits for families at their first newborn visit to the FQHC following hospital discharge. A typical team-based visit was scheduled for 40 minutes with the RN/LC present for the entire visit and the PCP joining for about 10 minutes to examine the infant and coordinate the plan of care. The remaining 30 minutes was dedicated to lactation support, including addressing latch, milk supply, decreasing maternal pain, and breastfeeding anticipatory guidance.

Intervention Results: Among patients who initiated breastfeeding, those who received a LC/PCP visit were significantly more likely to be breastfeeding at 2 weeks (94% versus 80%, p = 0.004) and 4 months (68% versus 45%, p = 0.01). However, breastfeeding rates for the whole practice were not significantly different before and after implementation. Seventy-two percent of breastfeeding families saw a LC (n = 204). Median LC visit per breastfeeding patient was 1.18 (standard deviation [SD] +1.2). Patient survey reported that the three most commonly helpful aspects of the visit were “latch instruction” (60%), “breastfeeding questions answered” (80%) and “learning about massage and hand expression” (50%).

Conclusion: Team-based LC/PCP care is feasible at a FQHC. Patients found it helpful. Among families who initiated breastfeeding, receiving LC/PCP care was associated with increased breastfeeding duration through 4 months.

Study Design: Retrospective chart review

Setting: Federally Qualified Health Center in Cleveland, OH

Population of Focus: Women and infants receiving care at a Federally Qualified Health Center

Sample Size: Pre (n=197 women) and post (n=245 women)

Age Range: Women 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), PATIENT/CONSUMER, Educational Material, Telephone Support

Intervention Description: We tested a health education intervention program to reduce passive smoking in infancy. The aim was to develop an instrument for study of tobacco smoke exposure and childhood respiratory illness.

Intervention Results: There was a reduction in maternal smoking associated with contact with research staff, but this was not statistically significant (mother reported quitting: intervention 6%, control 2.2%). There were no differences between the groups in the exposure of infants to tobacco smoke.

Conclusion: There was a reduction in maternal smoking associated with contact with research staff, but this was not statistically significant. There were no differences between the groups in the exposure of infants to tobacco smoke. Reasons for this finding may include the timing of the intervention, the heterogeneity of the target group, and the manner in which information was presented on health risks caused by parental smoking.

Study Design: RCT

Setting: Well-child healthcare setting (maternity hospital, peripartum)

Population of Focus: Parents of newborn babies whose mothers smoked during pregnancy

Data Source: Questionnaires and urinary cotinine assays.

Sample Size: 184 parents

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, Other Person-to-Person Education, Peer Counselor, Motivational Interviewing, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Counseling (Parent/Family)

Intervention Description: Mobile-phone-based smoking cessation intervention has been shown to increase quitting among smokers.

Intervention Results: All findings were between intervention group B and control. No differences found between intervention group A and control or between groups A and B. Father self-reported smoking abstinence at 6 months was significantly increased in group B compared to control and even higher at 12 months. Although no reduction in self-reported exposure rates were found at 6 months, the rate as 12 months was significantly decreased in group B when compared to control group.

Conclusion: The findings suggest that adding mHealth interventions to traditional face-to-face health counseling may be an effective way to increase male smoking cessation and reduce mother and newborn SHS exposure in the home.

Study Design: Single-blind randomized control trial

Setting: Home-based (baseline, 6 months, 12 months with in person counseling); Mobile-based

Population of Focus: Parents of newborns

Data Source: Self-report survey data.

Sample Size: 342 (114 in each of the three groups)

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, PARENT/FAMILY, Notification/Information Materials (Online Resources, Information Guide), Counseling (Parent/Family), Telephone Support, Motivational Interviewing, CAREGIVER, Motivational Interviewing/Counseling, Outreach (caregiver), Home Visit (caregiver)

Intervention Description: The aim of this randomized-controlled trial was to evaluate the effectiveness of an intensive intervention to reduce children’s environmental tobacco smoke (ETS) exposure at their home compared with a minimal intervention.

Intervention Results: The levels of cotinine in the intensive intervention and minimal intervention groups in the final follow-up were significantly lower than the initial levels. The proportion of mothers reporting a complete smoking ban at home in the final follow-up was higher in the intensive intervention group than the minimal intervention group. This increase was statistically significant. The education provided during the home visits and the reporting of the urinary cotinine levels of the children were effective in lowering the children’s exposure to ETS at their home. The decrease in cotinine levels was higher in the intensive intervention group than the minimal intervention group but the difference was not statistically significant.

Conclusion: The education provided during the home visits and the reporting of the urinary cotinine levels of the children were effective in lowering the children’s exposure to ETS at their home.

Study Design: RCT

Setting: Community (home and hospital)

Population of Focus: Mothers of children aged 1-5 who lived in the Cengizhan district of Izmir in Turkey, who smoked and/or whose spouses smoked

Data Source: Urinary cotinine samples and forms

Sample Size: 80 mothers with 40 in the intensive intervention group and 40 in the minimal intervention group

Age Range: Not specified