Established Evidence Results

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

Intervention Description: The study examined the impact of two tobacco control policies implemented in the United Kingdom around 2007: smoke-free legislation and an increase in the legal age for tobacco purchase from 16 to 18 years.

Intervention Results: For both policies, smoking initiation reduced following implementation (change in legal age odds ratio [OR]: 0.67; 95% confidence interval [CI]: 0.55 to 0.81; smoke-free legislation OR: 0.68; 95% CI: 0.56 to 0.82), while inequalities in initiation narrowed over subsequent years. The legal age change was associated with annual increases in progression from initiation to occasional smoking (OR: 1.26; 95% CI: 1.07 to 1.50) and a reduction in quitting following implementation (OR: 0.57; 95% CI: 0.35 to 0.94). Similar effects were observed for smoke-free legislation but CIs overlapped the null.

Conclusion: Policies such as these may be highly effective in preventing and reducing socioeconomic inequalities in youth smoking initiation. UK implementation of smoke-free legislation and an increase in the legal age for tobacco purchase from 16 to 18 years were associated with an immediate reduction in smoking initiation and a narrowing of inequalities in initiation over subsequent years. While the policies were associated with reductions in the initiation, progression to occasional smoking increased and quitting decreased following the legislation.

Study Design: Discrete-time event history analysis

Setting: UK (Nationwide policy)

Population of Focus: Researchers, public health professionals, policymakers

Sample Size: 14992 youth

Age Range: ages 11-15

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), Organizational Changes,

Intervention Description: The intervention in this study was the national organization of preventive health services for children, particularly the difference between countries where child vaccinations are administered by general practitioners (Denmark) and those where preschool children are vaccinated in "well-baby" clinics (Finland, Iceland, and Sweden).

Intervention Results: The study found that Denmark, where child vaccinations are administered by general practitioners, presented the lowest overall coverage of MMR at 83% and the greatest difference between subpopulations of low and high socioeconomic status (SES) at 14 percentage points. In contrast, Finland, Iceland, and Sweden, where preschool children are vaccinated in "well-baby" clinics, had a higher overall coverage at 91–94%, with a more equal distribution between SES groups at 1–4 percentage points.

Conclusion: This study suggests that the organisation of preventive health care in special units, 'well-baby' clinics, facilitates vaccine uptake among children with low SES in a Nordic welfare context.

Study Design: The study utilized a comparative design to investigate the socioeconomic patterns of MMR vaccine uptake in the four Nordic countries.

Setting: Denmark, Finland, Iceland, and Sweden.

Population of Focus: The target audience of the study includes children under the age of two years and their families, particularly those from socially disadvantaged backgrounds.

Sample Size: The study analyzed register data from Denmark, Finland, Iceland, and Sweden. Specific sample sizes for each country were not provided in the text.

Age Range: The study focused on the measles, mumps, and rubella (MMR) vaccine uptake before the age of two years.

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

Intervention Description: In an effort to document state and jurisdiction activity in National Performance Measure 6 (NPM 6), AMCHP conducted an environmental scan of Title V program developmental screening activities. AMCHP obtained information through the Title V Information System (TVIS) by filtering Title V programs that chose NPM 6 and reviewing the narrative and action plans to ascertain their NPM 6 strategies, their accompanying evidence-based/informed strategy measures (ESMs), and related challenges. Information included in this issue brief does not represent an exhaustive list of each state’s and jurisdiction’s developmental screening activity, nor is every state or jurisdiction that is implementing the strategies mentioned. However, the range of strategies presented and the states and jurisdictions referenced here provide a snapshot of Title V program approaches, strategies, and techniques being used to increase developmental screening rates.

Intervention Results: The environmental scan of TVIS revealed that 41 states and jurisdictions chose NPM 6. As previously mentioned, Title V programs also have the option to select a State Performance Measure (SPM) based on results from their state’s needs assessment. Ten of the 41 states and jurisdictions that chose NPM 6 also selected an SPM related to developmental screening. The scan also found four states that did not choose NPM 6, but did select an SPM related to developmental screening. The environmental scan revealed a wide range of NPM 6 strategies and activities, under the following categories: • Policy Research, Development and Implementation • Systems Coordination 3 • Data Collection, Measurement and Existing Landscape • Technical Assistance and Training • Education, Engagement and Resource Development • Other Title V Program Strategies

Conclusion: information on Title V program activities related to NPM 6. These data provide insight into identified needs in policy, systems coordination, training, data integration, as well as strategies to address these needs. The selected examples highlighted within each category may prove useful to other Title V programs as they implement developmental screening-related strategies and measures to build or improve systems of care for children. In coming years, NPM 6 data can be analyzed more in-depth to develop resources such as reports, toolkits, or guides to assist Title V programs with developmental screening and early identification system challenges. These data will also guide AMCHP’s efforts to create meaningful technical assistance opportunities including webinars, learning modules, conference sessions, and other in-person trainings, to help states in advancing NPM 6. These resources will expand the repository of promising policies and practices featured on the State Public Health Autism Resource Center website (http://www.amchp.org/SPHARC), which is accessible to all Title V programs and their state and national partners.

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): Policy/Guideline (National), Educational Material, Screening Tool Implementation Training

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

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

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

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National)

Intervention Description: Public health agencies around the world have renewed efforts to increase the incidence and duration of breastfeeding. Maternity leave mandates present an economic policy that could help achieve these goals. We study their efficacy, focusing on a significant increase in maternity leave mandates in Canada.

Intervention Results: No significant difference in the incidence of breastfeeding before and after the policy reform

Conclusion: For most indicators we find no effect.

Study Design: QE: pretest-posttest

Setting: National

Population of Focus: Children born between 1998- 2001 or 2000-2003 who were in two-parent families and did not live in Quebec

Data Source: Canadian Community Health Survey; Mother self-report

Sample Size: N/A4

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), Medicaid, NATIONAL, PAYER

Intervention Description: To estimate the effects of Children's Health Insurance Reauthorization Act (CHIPRA), a policy that provided states the option to extend Medicaid/CHIP eligibility to immigrant children who have not been legal residents for five years or more, on insurance coverage, access, utilization, and health outcomes among immigrant children.

Intervention Results: We found that CHIPRA was associated with a significant 6.35 percentage point decrease in uninsured rates (95% CI: -11.25, -1.45) and an 8.1 percentage point increase in public insurance enrollment for immigrant children (95% CI: 1.26, 14.98). However, the effects of CHIPRA became small and statistically not significant 3 years after adoption. Effects on public insurance coverage were significant in states without state-funded programs prior to CHIPRA (15.50 percentage points; 95% CI:8.05, 22.95) and for children born in Asian countries (12.80 percentage points; 95% CI: 1.04, 24.56). We found no significant changes in health care access and utilization, and health outcomes, overall and across subgroups due to CHIPRA.

Conclusion: CHIPRA's eligibility expansion was associated with increases in public insurance coverage for low-income children, especially in states where CHIPRA represented a new source of coverage versus a substitute for state-funded coverage. However, we found evidence of crowd-out in certain subgroups and no effect of CHIPRA on access to care and health. Our results suggest that public coverage may be an important tool for promoting the well-being of immigrant children but other investments are still needed.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), Counseling (Parent/Family), Access,

Intervention Description: homeless health needs audit adapted to include questions about family health.

Intervention Results: The small population sample surveyed showed high levels of poor mental health in addition to behaviours that increase the risk of physical ill health (such as smoking) and a high use of secondary healthcare services. Engagement with practitioners showed awareness of poor health amongst this population group and challenges with regard to providing appropriate support.

Conclusion: There needs to be a sustainable and representative way of understanding the health needs of this population group including a comparison of the health needs of people placed in temporary accommodation in and out of their resident area.

Study Design: cross-sectional study

Setting: Bromley area in the UK

Population of Focus: public health professionals, policymakers, housing support services, health practitioners, community care providers

Sample Size: n=33

Age Range: 20-50 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): NATIONAL, Policy/Guideline (National),

Intervention Description: There is a relative paucity of literature in which breastfeeding within the military population is evaluated. In 2016, the Department of Defense extended maternity leave from 6 to 12 weeks for active duty mothers to support breastfeeding initiation and duration. The study objective was to evaluate the prolongation of maternity leave on the initiation and duration of breastfeeding in active duty mothers. No major changes related to breastfeeding support or breastfeeding policy occurred at the Brooke Army Medical Center, a large academic hospital with >1500 deliveries per year, during the study period.

Intervention Results: No changes in breastfeeding initiation occurred between the 2 cohorts (n = 423 and 434). However, an increase in breastfeeding establishment was identified at the 2- (81.5% vs 72.4%; P = .002), 4- (70.5% vs 56.7%; P < .001), 6- (60.3% vs 46.5%; P < .001), and 9-month (45.4% vs 34.9%; P = .003) visits in the 12-week leave cohort. Exclusive breastfeeding increased at 2 (56.4% vs 47.2%; P = .007), 4 (47.5% vs 36.4%; P = .001), and 6 (37.3% vs 29.3%; P = .016) months.

Conclusion: Increases in maternity leave correlated with increased breastfeeding duration and exclusivity through 9 months for active duty mothers. These data support the benefit of extended maternity leave in the military and the need for future studies to validate findings at other military treatment facilities.

Study Design: Retrospective cohort study

Setting: Policy

Population of Focus: Active duty mothers who delivered during calendar years 2014 and 2016

Sample Size: 857 mother-infant dyads (423 dyads in 2014 and 434 dyads in 2016)

Age Range: 18-43 year old women and their infants

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), NATIONALLY-BASED, ,

Intervention Description: Evaluate the impact of New York (NY)'s Paid Family Leave (PFL) law on breastfeeding, after it became effective on January 1, 2018.

Intervention Results: Before NYPFL, Black women were least likely to initiate breastfeeding and breastfed for the shortest duration. After NYPFL went into effect, breastfeeding initiation and duration to 8 weeks increased for Black women, but not for other racial/ethnic groups; these findings persisted after adjustment for sociodemographic factors. Use of paid leave after childbirth increased 15% overall, with greater increases among Black women and Hispanic women.

Conclusion: Implementation of the NYPFL law was associated with increased breastfeeding among Black women and increased use of paid leave by all. Greater increases in breastfeeding among Black women significantly reduced breastfeeding disparities by race/ethnicity. More widespread implementation of PFL programs in the United States would promote equity in the use of paid leave, which could reduce disparities in breastfeeding initiation and duration and possibly improve infant and maternal health outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): NATIONAL, Policy/Guideline (National), HOSPITAL, Development/Improvement of Services

Intervention Description: We performed a cross-sectional study and linked 2014 American Hospital Association survey and State Inpatient Database data from seven representative states. We used American Hospital Association–reported hospital characteristics and State Inpatient Database procedure codes to assign a level of maternal care to each hospital. We then assigned each patient to a minimum required level of maternal care (I–IV) based on maternal comorbidities captured in the State Inpatient Database. Our outcome was delivery at a hospital with an inappropriately low level of maternal care. Comorbidities associated with delivery at an inappropriate hospital were assessed using descriptive statistics.

Intervention Results: The analysis included 845,545 deliveries occurring at 556 hospitals. The majority of women had risk factors appropriate for delivery at level I or II hospitals (85.1% and 12.6%, respectively). A small fraction (2.4%) of women at high risk for maternal morbidity warranted delivery in level III or IV hospitals. The majority (97.6%) of women delivered at a hospital with an appropriate level of maternal care, with only 2.4% of women delivering at a hospital with an inappropriate level of maternal care. However, 43.4% of the 19,988 high-risk patients warranting delivery at level III or IV hospitals delivered at level I or II hospitals. Women with comorbidities likely to benefit from specialized care (eg, maternal cardiac disease, placenta previa with prior uterine surgery) had high rates of delivery at hospitals with an inappropriate level of maternal care (68.2% and 37.7%, respectively).

Conclusion: Though only 2.41% of deliveries occurred at hospitals with an inappropriate level of maternal care, a substantial fraction of women at risk for maternal morbidity delivered at hospitals potentially unequipped with resources to manage their needs. Promoting triage of high-risk patients to hospitals optimized to provide risk-appropriate care may improve maternal outcomes with minimal effect on most deliveries.

Setting: Seven states (Florida, Massachusetts, New Jersey, New York, North Carolina, Oregon, and Washington)

Population of Focus: Women with high-risk maternal medical conditions

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), Social Supports, Individual Supports, Housing Supports

Intervention Description: Family Unification Program

Intervention Results: Intent-to-treat analyses suggested families randomly assigned for FUP exhibited slower increases in rates of foster placement following housing intervention compared with families referred for housing advocacy alone. The program generates average savings of nearly $500 per family per year to the foster care system. Housing subsidies provide the foster care system small but significant benefits for keeping homeless families together. Findings inform the design of a coordinated child welfare response to housing insecurity.

Conclusion: The present study tests the impact of the Family Unification Program – a HUD-funded housing intervention for inadequately housed families involved in the child welfare system – on foster care placement and costs among intact families whose inadequate housing threatened out of home placement of one or more children. A longitudinal randomized controlled trial embedded within the child welfare system shows FUP relates with significant declines in the rate of foster care placement

Study Design: randomized controlled trial

Setting: Chicago, IL

Population of Focus: social workers, policy makers, public health practitioners

Sample Size: n = 89 families with 257 children

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

Intervention Description: the study discusses the impact of legislative measures and public health interventions on vaccination coverage rates for the MMR vaccine in the Emilia-Romagna Region. These interventions include the implementation of national and regional laws related to mandatory vaccination strategies and public health initiatives aimed at addressing vaccine hesitancy. The study aims to analyze the effectiveness of these interventions in mitigating vaccine hesitancy and improving vaccination coverage rates for the MMR vaccine in the region.

Intervention Results: The results of the study "Vaccine Hesitancy and Mandatory Immunizations in Emilia-Romagna Region: the case of MMR vaccine" indicate a significant reduction in vaccination rates for the MMR vaccine from 2012 to 2015. However, in the following years, an increase in vaccination coverage rates was recorded, which was temporally related to the implementation of national and regional laws. The study suggests that mandatory vaccination strategies appear to be effective in the short term in the Emilia-Romagna Region in countering negative attitudes towards vaccination and mitigating vaccine hesitancy 1. Additionally, the study discusses the potential impact of public health interventions, such as information campaigns and political initiatives, on the increase in vaccination coverage rates

Conclusion: The study "Vaccine Hesitancy and Mandatory Immunizations in Emilia-Romagna Region: the case of MMR vaccine" concludes that mandatory vaccination strategies seem to be effective in the short term in the Emilia-Romagna Region for countering negative attitudes towards vaccination and mitigating vaccine hesitancy. The findings suggest that the implementation of national and regional laws temporally correlated with an increase in vaccination coverage rates for the MMR vaccine. The study also highlights the potential impact of public health interventions, information campaigns, and political initiatives on the observed increase in vaccination coverage. However, the study also raises concerns about the long-term effects of mandatory vaccination and its potential impact on public trust in vaccination

Study Design: an observational study. The researchers analyzed official aggregate data on vaccination coverage at 24 months provided by the Emilia-Romagna Region and the Italian Ministry of Health. The study aimed to correlate any significant changes in vaccination coverage rates for the MMR vaccine with index events, such as legislative measures and public health interventions, to understand the impact of these factors on vaccination coverage in the region.

Setting: Emilia-Romagna Region in Italy. This region serves as the backdrop for the study on vaccination coverage rates for the MMR vaccine and the impact of mandatory vaccination strategies.

Population of Focus: healthcare professionals, policymakers, and researchers interested in vaccination coverage rates, vaccine hesitancy, and mandatory vaccination strategies. The study provides insights into the effectiveness of mandatory vaccination strategies in the Emilia-Romagna Region and can inform public health policies and vaccination strategies in other regions and countries.

Sample Size: the study analyzes official aggregate data on vaccination coverage at 24 months provided by the Emilia-Romagna Region and the Italian Ministry of Health. The data cover the period between 2007 and 2018 and include the entire population of children in the region who were eligible for the MMR vaccine at 24 months of age.

Age Range: the vaccination coverage at 24 months of age. The study focuses on the MMR (Morbillo-Parotite-Rosolia) vaccine and analyzes the vaccination coverage rates for this vaccine among children at 24 months of age in the Emilia-Romagna Region from 2007 to 2018.

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), Housing Supports

Intervention Description: long-term rent subsidies, short-term rent subsidies, and transitional housing in supervised programs with intensive psychosocial services

Intervention Results: priority access to long-term rent subsidies reduced homelessness and food insecurity and improved other aspects of adult and child well-being relative to usual care, at a cost 9 percent higher. The other interventions had little effect.

Conclusion: The study provides support for the view that homelessness for most families is an economic problem that long-term rent subsidies resolve and does not support the view that families must address psychosocial problems to succeed in housing. It has implications for focusing government resources on this important social problem.

Setting: United States

Sample Size: 2,282 families

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), NATIONAL, Policy/Guideline (National)

Intervention Description: Numerous states have implemented policies expanding public insurance eligibility or subsidizing private insurance for parents. Under the ACA, states retain significant flexibility in terms of eligibility and program structure. This study assessed the impact of parental health insurance expansions from 1999 to 2012 on the likelihood that parents are insured; their children are insured; both the parent and child within a family unit are insured; and the type of insurance. Cross-state and within-state multivariable regression models estimated the effects of health insurance expansions targeting parents using 2-way fixed effect modeling and difference-in-difference modeling.

Intervention Results: Cross-state analyses demonstrate that public expansions without premiums and special subsidized plan expansions had the largest effects on parental coverage and increased the likelihood of jointly insuring the parent and child. Expansions increased parental coverage by 2.5 percentage points and increased the likelihood of both parent and child being insured by 2.1 percentage points. Substantial variation was observed by type of expansion. Public expansions without premiums and special subsidized plan expansions had the largest effects on parental coverage and increased the likelihood of jointly insuring both the parent and child. Higher premiums were a substantial deterrent to parents’ insurance. Our findings suggest that premiums and the type of insurance expansion can have a substantial impact on the insurance status of the family. The most effective expansions for parental insurance coverage were those for traditional Medicaid coverage without premiums and for special subsidized plans that subsidized costs for individuals to purchase state-sponsored plans. These findings can help inform states as they continue to make decisions about expanding Medicaid under the Affordable Care Act to cover all family members.

Conclusion: Our findings suggest that premiums and the type of insurance expansion can have a substantial impact on the insurance status of the family. These findings can help inform states as they continue to make decisions about expanding Medicaid under the Affordable Care Act to cover all family members.

Study Design: Cross-sectional analysis of data

Setting: Policy (States)

Population of Focus: Parents ≤ 300% FPL who were eligible for insurance expansions in selected states

Data Source: 2000–2013 March supplements to the Current Population Survey, with data from the Medical Expenditure Panel Survey—Insurance Component and the Area Resource File

Sample Size: 19 expansion states (representing 28 expansions) and 22 control states without a parental expansion during the study period

Age Range: Parents and children; specific ages not stated

Intervention Components (click on component to see a list of all articles that use that intervention): NATIONAL, Policy/Guideline (National),

Intervention Description: Several states have implemented family leave policies: CA in 2004, NJ in 2009, RI in 2014, and NY in 2018. This study examined the effects of US state-level paid family leave policies on breastfeeding, providing critically needed evidence of health effects across multiple states and among key subgroups. More specifically, the study evaluated paid family leave policies in CA and NJ, which allows up to 6 weeks of partially paid leave.

Intervention Results: Paid family leave policies resulted in a modestly greater likelihood of exclusively breastfeeding at 6 months. Subgroup analyses were mixed, although several breastfeeding outcomes were consistently improved among married, White, higher-income, and older mothers.

Conclusion: Exclusive breastfeeding improved after implementation of paid family leave policies in the overall sample, and additional benefits were noted for more advantaged mothers. This contributes critical evidence to an ongoing policy discussion, suggesting that subsequent paid family leave policies should be designed to target more vulnerable mothers.

Study Design: Quasi-experimental study

Setting: Policy

Population of Focus: Children born during 2001 to 2013 drawn from the 2003 to 2015 National Immunization Survey waves

Sample Size: 306,266 women and their children

Age Range: Mothers older than 18 years of age and their children

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), NATIONAL

Intervention Description: The aim was to estimate the impact of these policies on mental health treatment utilization in a nationally representative longitudinal sample of youth followed through adulthood.

Intervention Results: We found that the number of mental health treatment visits declined as cumulative exposure to mental health insurance legislation increased; a 10 unit (or 10.3%) increase in the law exposure strength resulted in a 4% decline in the number of mental health visits. We also found that state mental health insurance laws are associated with reducing mental health treatments and disparities within at-risk subgroups.

Conclusion: Prolonged exposure to comprehensive mental health laws across a person's childhood and adolescence may reduce the demand for mental health visitations in adulthood, hence, reducing the burden on the payors and consumers. Further, as the exposure to the mental health law strengthened, the gap between at-risk subgroups was narrowed or eliminated at the highest policy exposure levels.

Intervention Components (click on component to see a list of all articles that use that intervention): POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National)

Intervention Description: To examine the changes in breastfeeding practices in California relative to other states before and after the implementation of PFL.

Intervention Results: An increase of 3-5 percentage points for exclusive breastfeeding and an increase of 10-20 percentage points for breastfeeding at several important markers of early infancy.

Conclusion: Our study supports the recommendation of the Surgeon General to establish paid leave policies as a strategy for promoting breastfeeding.

Study Design: QE: pretest-posttest

Setting: National

Population of Focus: Healthy women ≥ 18 years old at prenatal questionnaire administration, with full or nearly full-term singleton birth weighing ≥ 5lbs

Data Source: Mother self-report from the Infant Feeding Practices Study

Sample Size: Wave 1, 1993 (n=704) Wave 2, 2005-2006 (n=1324)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): NATIONAL, Policy/Guideline (National)

Intervention Description: Most children in low-income families were already eligible for public insurance through Medicaid or the Children's Health Insurance Program before the implementation of the Affordable Care Act (ACA). Increased coverage observed for these children since the ACA's implementation suggest that the legislation potentially had important spillover or "welcome mat" effects on the number of eligible children enrolled. This study used data from the 2013–15 American Community Survey to provide the first national-level (analytical) estimates of welcome-mat effects on children’s coverage post ACA.

Intervention Results: There is a link between parents' eligibility for Medicaid and welcome-mat effects for their children under the ACA. Welcome-mat effects were largest among children whose parents gained Medicaid eligibility under the ACA expansion to adults. Public coverage for these children increased by 5.7 percentage points-more than double the 2.7-percentage-point increase observed among children whose parents were ineligible for Medicaid both pre and post ACA.

Conclusion: We estimated that if all states had adopted the Medicaid expansion, an additional 200,000 low-income children would have gained coverage.

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Guideline Change and Implementation, Organizational Changes, Quality Improvement, POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National)

Intervention Description: To determine the success of a program designed to reduce the cesarean section rate in a rural community hospital, to identify reasons for any reduction in the rate and to identify any accompanying increases in the maternal and neonatal morbidity and mortality rates.

Intervention Results: The overall cesarean section rate decreased from 23% in 1985 to 13% in 1989 (p = 0.001). Among the nulliparous women the rate decreased from 23% to 12%, but the difference was insignificant (p = 0.069); this decrease was due to a drop in the number of dystocia-related cesarean sections. The rate among vaginal birth after cesarean section (VBAC) -eligible multiparous women decreased from 93% to 36% (p less than 0.001) because of an increased acceptance of VBAC by the patients and the physicians. The rate among multiparous women ineligible for VBAC was virtually unchanged.

Conclusion: The program was accompanied by a significant decrease in the cesarean section rate. Rural hospitals with facilities and personnel for emergency cesarean sections should consider the introduction of a similar program.

Study Design: Time trend analysis

Setting: 1 small, rural hospital

Population of Focus: Nulliparous women who gave birth between January 1985 and December 19892

Data Source: Not specified

Sample Size: n=456

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): Family-Based Interventions, Policy/Guideline (National), Social Supports,

Intervention Description: Sector Wheel for Under-Resourced Populations

Intervention Results: Interviews revealed parenting stress and worsening family mental health during homelessness. Participants described barriers to navigating housing, social, and health services with children, including not knowing where to seek help, difficulty connecting to health and social services in the community, and a lack of family-focused services. Parents encountered discrimination by landlords and lack of access to permanent housing in safe neighborhoods.

Conclusion: Findings demonstrate a need for delivering family-centered and comprehensive services to homeless-experienced veteran families that recognize the multifaceted needs of this population. Advocacy initiatives are needed to address discrimination against veterans experiencing family homelessness and increase access to affordable permanent housing in safe neighborhoods for families.

Study Design: qualitative study

Setting: L.A. County, CA

Population of Focus: policy makers, social workers, public health specialists

Sample Size: n=18 veteran parents

Intervention Components (click on component to see a list of all articles that use that intervention): WIC Food Package Change, STATE-BASED, Policy/Guideline (National), NATIONALLY-BASED,

Intervention Description: The 2009 WIC food package revisions were intended to incentivize breastfeeding among the WIC population. To examine the effectiveness of this policy change, we estimated an intent-to-treat regression-adjusted difference-in-difference model with propensity score weighting, an approach that allowed us to control for both secular trends in breastfeeding and selection bias.

Intervention Results: We observed significant increases in infants that were ever breastfed in both the treatment group (10 percentage points; p < 0.01) and the control group (15 percentage points; p < 0.05); however, we did not find evidence that the difference between the two groups was statistically significant, suggesting that the 2009 revisions may not have had an effect on any of these breastfeeding outcomes.

Conclusion: Our study did not find evidence that the 2009 WIC food package revisions had an effect on ever breastfeeding, breastfeeding through 6 months, or exclusively breastfeeding through 6 months among a sample of infants eligible for WIC based on household income. Any positive effects observed in this study and prior studies that assessed this relationship may be reflections of the upward trends in breastfeeding rates that occurred in the U.S. before and after the implementation of the revisions.

Intervention Components (click on component to see a list of all articles that use that intervention): HOSPITAL, Elective Induction Policy, Guideline Change and Implementation, Quality Improvement, POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National)

Intervention Description: Estimate the frequency of failure to follow the French consensus guidelines for elective induction, and assess how failure affects the rate of cesarean delivery.

Intervention Results: Women with electively induced and spontaneous labor had identical cesarean rates (4.1%). The guidelines were not followed in 23.2% of elective inductions. The risk of cesarean was higher after induction with a Bishop score <5, than after spontaneous labor (adjusted OR = 4.1, 95% CI [1.3–12.9]), while elective induction with a favourable cervix did not increase the cesarean risk. In nulliparas, failure to follow the guidelines tripled the risk of cesarean (adjusted OR = 3.2 [1.0–10.2]). On the other hand, elective induction of labor for women with a favourable cervix did not increase the risk of cesarean over the risk with spontaneous labor.

Conclusion: Elective induction does not appear to increase the cesarean rate when the guidelines are met. Electively inducing labor with a low Bishop score increased the risk of cesarean, especially in nulliparas.

Study Design: Retrospective cohort

Setting: 138 maternity units

Population of Focus: Nulliparous women who gave birth between June 2001 and May 20022

Data Source: Not specified

Sample Size: Total (n=2,052) Intervention (n=69) Control (n=1,983)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational Material, Lactation Consultant, Provision of Breastfeeding Item, Group Education, NATIONAL, Policy/Guideline (National),

Intervention Description: Workplace breastfeeding resources (e.g., break times and private spaces) help working mothers exclusively breastfeed for 6 months. This study is one of the few studies to include and measure access to breastfeeding support such as breast pumps, worksite programs, educational materials, support groups, lactation consultants, and workplace policies. To meet the 6 month recommendation, employers can provide additional resources (i.e. lactation consultants and support groups) to help mothers transition back to work and continue breastfeeding. The ACA was an important first step for establishing minimum resources to support breastfeeding mothers; however, it needs to be expanded to cover all employer and workers.

Intervention Results: Fifty-two participants met the inclusion criteria for the study and completed the survey. Most of the participants in the study were White, college-educated women who worked in clerical or administration support and education occupations. Approximately 78.8% of the participants reported access to private spaces and 65.4% reported access to break times for breastfeeding. Fewer participants reported access to breast pumps, lactation consultants, and support groups.

Conclusion: There are gaps in access to workplace breastfeeding resources, but occupational health nurses can inform and help employers implement lactation resources to reduce breastfeeding disparities.

Study Design: Online, cross sectional survey

Setting: Policy

Population of Focus: Working mothers between the ages of 18 and 50 years old who gave birth in the previous two years

Sample Size: 52 women

Age Range: 18-50 year old women

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), Access, Notification/Information Materials (Online Resources, Information Guide),

Intervention Description: does not provide a specific intervention

Intervention Results: Of 1 004 000 mothers (mean [SD] age at birth, 29.8 [5.9] years; 44.7% White), 20 022 (2.0%) experienced SMM. Higher municipal rental housing costs were associated with greater odds of SMM (odds ratio [OR], 1.27; 95% CI, 1.01-1.60), particularly among mothers with less than a high school education (OR, 1.81; 95% CI, 1.06-3.10), and the positive associations decreased at higher levels of affordable housing availability. Among mothers with less than a high school education, the risk of SMM was 8.0% lower (risk ratio, 0.92; 95% CI, 0.85-1.00) for each additional $1000 annual municipal-level housing subsidy per person with an income lower than poverty level after controlling for rental costs and other characteristics, which translated to a 20.7% lower educational disparity in SMM.

Conclusion: In this cross-sectional study, living in a municipality with higher rental housing costs was associated with higher odds of SMM, except when there was high availability of publicly supported affordable housing. These results suggest that greater availability of publicly supported affordable housing has the potential to mitigate the association between rental housing costs and SMM and reduce socioeconomic disparities in SMM.

Study Design: cross-sectional study

Setting: New Jersey

Population of Focus: Women who experienced SMM

Sample Size: 1,004,000 live births

Age Range: 29.8

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National)

Intervention Description: The authors reviewed state perinatal regionalization models and levels of care to compare varying definitions between states and assess mechanisms of measurement and areas for improvement.

Intervention Results: Review of state models revealed variability in the models themselves, as well as the various mechanisms for measuring and improving risk-appropriate care. Regulation of regionalization programs, data surveillance, review of adverse events, and consideration of geography and demographics were identified as mechanisms facilitating better measurement of risk-appropriate care. Antenatal or neonatal transfer arrangements, telemedicine networks, acquisition of funding, provision of financial incentives, and patient education comprised state actions for improving risk-appropriate care. The void of explicit and updated national standards led to the current variations in definitions and models among states. State regionalization models and measures of risk-appropriate care varied greatly. These variations arose from inconsistent definitions and models of perinatal regionalization. Guidelines should be collaboratively developed by healthcare providers and public health officials for consistent and suitable measures of perinatal risk-appropriate care.

Conclusion: State models of regionalized risk-appropriate care vary. Due to these discrepancies, national attempts to compare access to risk-appropriate perinatal care, and establish the evidence base for effectiveness, have been difficult to achieve. This impacts efforts to optimize VLBW infant access to appropriate facilities, a worthwhile endeavor as this population comprises a majority of neonatal deaths [7, 8]. State legislatures, regulatory institutions, public health officials, and hospitals themselves must recognize and commit to the need for national standards and definitions, determine what these standards will be, and disseminate this information to healthcare providers, clinicians, and patients.

Study Design: N/A

Setting: 7 states

Data Source: Information was gathered from meeting presentations, presenters, state representatives, and state websites.

Sample Size: 7 state models

Age Range: N/A

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), NATIONALLY-BASED, ,

Intervention Description: The purpose of this cross-sectional, mixed-methods study was to describe infant and young child feeding intentions, practices, decision-making, and experiences during the first wave of the COVID-19 pandemic in the U.S.

Intervention Results: There were immediate positive effects of stay-at-home policies on human milk feeding practices, even during a time of considerable uncertainty about the safety of breastfeeding and the transmissibility of SARS-CoV-2 via human milk, constrained access to health care services and COVID-19 testing, and no effective COVID-19 vaccines.

Conclusion: Federally mandated paid postpartum and family leave are essential to achieving more equitable lactation outcomes.

Intervention Components (click on component to see a list of all articles that use that intervention): WIC Food Package Change, STATE-BASED, Policy/Guideline (National), NATIONALLY-BASED,

Intervention Description: To investigate the impact of the revised WIC program on maternal and child health in a large, multi-state data set.

Intervention Results: The main analysis included 331,946 mother-infant dyads. WIC recipients were more likely to be younger, Black or Hispanic/Latina, unmarried, and of greater parity. The revised WIC program was associated with reduced likelihood of more-than-recommended GWG (−1.29% points, 95% confidence interval [CI] −2.03, −0.56) and increased likelihood of ever breast fed (1.18% points, 95% CI 0.28, 2.08). We also identified heterogeneous effects on GWG, with more pronounced associations among women 35 and older. There were no associations with foetal growth.

Conclusion: The revised WIC program was associated with improvements in women's gestational weight gain and infant breast feeding.

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

Intervention Description: The intervention was the Medicaid expansion in 2014 under PPACA. The study compared changes in outcomes between states that expanded Medicaid (Iowa, Kentucky) and those that did not (Wisconsin, North Carolina).

Intervention Results: The results showed modest improvements in elective admissions, ambulatory surgery rates, length of stay, and discharge to home in Medicaid expansion states compared to non-expansion states. There were decreases in admission charges.

Conclusion: The conclusion was that PPACA-associated Medicaid expansion modestly improved children’s access to surgical care in the first year, with shifts towards more elective and ambulatory procedures.

Study Design: The study design was a retrospective analysis using administrative/claims data.

Setting: The setting was 4 U.S. states: Iowa, Kentucky, Wisconsin, and North Carolina.

Population of Focus: The target audience seems to be policymakers and researchers interested in the impact of PPACA and Medicaid expansion on children's health outcomes.

Sample Size: The sample size was 1,597,708 encounters across the 4 states.

Age Range: The age range was 0 to 30 years old.

Intervention Components (click on component to see a list of all articles that use that intervention): NATIONAL, Policy/Guideline (National),

Intervention Description: Active duty mothers typically work long hours and have historically gone back to work after 6 weeks of maternity leave and faced deployments as soon as 6 months postpartum. In January 2016, the US Department of Defense increased the duration of paid maternity leave for active duty service members from 6 weeks to 12 weeks. The study aims to determine the impact of maternity leave length on breastfeeding duration and postpartum depression rates in active duty service members.

Intervention Results: A total of 214 surveys were collected. Fisher exact test was used to compare rates of breastfeeding and postpartum depression between the 2 groups. A total of 87% of service members initiated breastfeeding. Among women who had 6 weeks versus 12 weeks of maternity leave, 51.64% versus 56.96% breastfed up to 6 months, p = 0.45.

Conclusion: The ideal maternity leave duration is unknown. With recent changes to the Department of Defense maternity leave policy, we aimed to evaluate the effect this had on breastfeeding and postpartum depression rates. No statistically significant difference was seen when we compared rates of breastfeeding in women who had 6 weeks versus 12 weeks of maternity leave. Further research is required to determine the ideal maternity leave duration and best practices to promote breastfeeding. When looking at postpartum depression, our study shows that postpartum depression was noted in 16% of patients who took 6 weeks versus 9% of those who took 12 weeks of maternity leave. No statistically significant difference was seen; however, this was likely because of the small sample size. Only 29 out of 214 women suffered from depression regardless of length of maternity leave. More research is needed to determine if maternity leave length does indeed impact postpartum depression rates.

Study Design: Survey

Setting: Policy

Population of Focus: Active duty mothers who were given 6 or 12 weeks of maternity leave

Sample Size: 214 women (130 women received 6 weeks of maternity leave & 84 women received 12 weeks of maternity leave)

Age Range: Mothers older than 18 years of age

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

Intervention Description: - Intervention description: Implementation of the mandatory vaccination law (MVL) in Italy in 2017, which expanded the number of mandatory vaccinations from four to ten and introduced administrative penalties for those parents or individuals who were hesitant about or refused vaccination. -

Intervention Results: Results: The MVL resulted in a significant increase in vaccination coverage for measles and rubella in Italy, with important consequences for the 95% target, and has resulted in the restriction of measles transmission. The trend for the first dose of measles or rubella vaccine increased significantly, reinforced by the Italian Decree Law, reaching 94.4% in 2019. The trend for the second dose showed a significant increase and reached 90.2% in 2019 for measles and 90.0% for rubella.

Conclusion: - Conclusion: The application of the MVL has resulted in a significant increase in vaccination coverage for measles and rubella in Italy, with important consequences for the 95% target, and has resulted in the restriction of measles transmission. Nevertheless, special attention should be paid to the further maintenance and improvement of MMR vaccination coverage. -

Study Design: - Study design: Observational study

Setting: - Setting: Italy

Population of Focus: - Target audience: Individuals under 16 years of age

Sample Size: - Sample size: Not specified

Age Range: - Age range: Individuals under 16 years of age

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), NATIONAL, Policy/Guideline (National)

Intervention Description: In 2006, Massachusetts passed major health reform legislation, including an individual mandate for adults (who were required to purchase insurance or face a penalty); Medicaid expansion (i.e., children’s eligibility for the state’s Medicaid-CHIP increased from 200 to 300% of the FPL and adult eligibility for Medicaid increased to 100% FPL), and minimum essential benefits for private insurance (e.g., coverage of basic specialty services, no co-pay or deductible for preventive care visits).

Intervention Results: Massachusetts health reform, the model for the ACA, reduced uninsurance and improved access to some types of care for children in the state. Expanding adult-oriented health access policies in MA was associated with a trend toward reduced uninsurance and improved access to specialty care for children overall at 5 years post-reform. For low-income children, health reform was associated with increased access to a personal doctor for children previously Medicaid-eligible and increased access to specialty care for children newly Medicaid-eligible.

Conclusion: Adult-oriented health reforms may have reduced uninsurance and improved access to some types of care for children in Massachusetts. Repealing the ACA may produce modest detriments for children.

Study Design: Quasi-experimental difference-in-difference

Setting: Policy (Data from 2003, 2007, and 2011-2012 waves of the National Survey of Children's Health)

Population of Focus: Families with children in Massachusetts

Data Source: National Survey of Children’s Health (NSCH

Sample Size: 5,760 children in the intervention group (MA), 28,183 children in the comparison group (other New England states)

Age Range: 0-17 years

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

Intervention Description: We examine the determinants of cigarette-smoking initiation in Poland using survival analysis techniques and data from four youth smoking surveys: the 2003, 2009, and 2016 Global Youth Tobacco Surveys (GYTS) and the 2019 PolNicoYouth survey (number of person-period observations N = 164 807). Split-population duration models are employed. The hazard of smoking initiation is modeled as a function of cigarette prices, nonprice tobacco-control measures, and socioeconomic variables.

Intervention Results: Our study finds a negative and significant relationship between cigarette prices and the hazard of smoking initiation in all models (hazard ratio from 0.86 to 0.91). Lower hazards of smoking initiation were also associated with a comprehensive advertising ban (hazard ratio from 0.69 to 0.70) and with the introduction of pictorial warnings (hazard ratio from 0.65 to 0.68).

Conclusion: This study concludes that cigarette price increases, such as from higher cigarette excise taxes, could further significantly reduce cigarette youth smoking initiation in Poland. Removing promotional and advertising elements from cigarette packs and making the health warning more noticeable through plain packaging laws would further accelerate the reduction in smoking initiation.

Study Design: Observational cross-sectional analysis

Setting: Poland (nationwide)

Population of Focus: Researchers, policymakers, and educators

Sample Size: 22541 youths

Age Range: ages 13-18

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), NATIONAL, Policy/Guideline (National), STATE, Prenatal Care Access

Intervention Description: Prenatal care is an important component of preventive health care with multigenerational consequences for women and their families. For low-income immigrant women, Emergency Medicaid, a federal safety net program for those poor enough to qualify for Medicaid but who cannot meet the citizenship requirements, covers the cost of a birth but not prenatal care or postpartum contraception. An “unborn child” option enacted in CHIP and CHIPRA gave states new options to provide prenatal care coverage with federal matching funds for extending coverage to immigrant children and pregnant women, regardless of their legal status or date of entry to the U.S. The study leveraged a natural experiment where unauthorized immigrant women eligible for Emergency Medicaid gained access to prenatal care coverage by the expansion of the Emergency Medicaid Plus program in Oregon.

Intervention Results: Expanding access to prenatal care coverage increased both utilization and quality of prenatal care, and women were more likely to receive adequate care and recommended preventive health services. After expansion of access to prenatal care, there was an increase in prenatal visits (7.2 more visits, 95% CI 6.46 to 7.98), receipt of adequate prenatal care (28% increased rate, CI 26 to 31), rates of diabetes screening (61% increased rate, CI 56 to 65) and fetal ultrasounds (74% increased rate, CI 72 to 77). Maternal access to prenatal care was also associated with an increased number of well-child visits (0.24 more visits, CI 0.07 to 0.41), increased rates of recommended screenings and vaccines, and reduced infant mortality (-1.04 per 1000, CI -1.45 to -0.62) and rates of extremely low birth weight (<1000g) (-1.5 per 1000, CI -2.58 to -0.53).

Conclusion: Our results provide evidence of increased utilization and improved health outcomes for unauthorized immigrants and their children who are United States citizens after introduction of prenatal care expansion in Oregon. This study contributes to the debate around reauthorization of the Children's Health Insurance Program in 2017.

Study Design: Quasi-experimental difference-in-difference

Setting: Policy (Oregon Health Authority)

Population of Focus: Pregnant low-income immigrant women and their infants

Data Source: Medical claims data from January 1, 2003 through October 1, 2015

Sample Size: 210,200 mothers and infants

Age Range: Pregnant women: 12-51 years; Infants: 0-1 years

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

Intervention Description: This research explored pregnant women’s experiences of homelessness through the lens of critical feminist theory, to examine pregnant homeless women’s engagement with housing and health service systems.

Intervention Results: Results showed how the resource-depleted housing context, combined with organisational restrictions that constrained care coordination and continuity, generated exclusionary outcomes for pregnant homeless women.

Conclusion: These findings, informed by a feminist critical social work framework, draw attention to: the harms of gender-blind policy and practice; the approaches to providing care that work; and a need within social work to address challenges unique to pregnant women experiencing homelessness.

Study Design: qualitative

Setting: Victoria, Australia

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), NATIONAL

Intervention Description: Immigrant restrictive policies could lead to reduced access to Medicaid and CHIP even for citizen children in immigrant families.

Intervention Results: Results suggest a significant chilling effect where the magnitude of the effect varies according to family demographics and by the types of laws being passed. Immigrant restrictive social welfare laws being adopted have a strong negative effect on U.S. citizen children in immigrant families' enrollment in Medicaid/CHIP, a 5.5 percentage point reduction in coverage. Among the subsample of only immigrant families, results point toward a global chilling effect created by an overall restrictive policy environment. All immigrant restrictive related laws, including those aimed at education, job restriction, identification access, and social welfare restrictions have a significant and negative impact on access to public insurance for U.S. citizen children with non-citizen mothers.

Conclusion: This research shows that the unintended consequence of restrictive state legislation aimed at immigrants is the reduction in access to Medicaid and CHIP by low-income U.S. citizen children living in immigrant families. Reduced access to health insurance can increase unmet medical needs for an already vulnerable group.

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

Intervention Description: An increasing number of European countries implemented a point-of-sale (PoS) display ban on tobacco products. A point-of-sale (PoS) display ban is a tobacco control policy that prohibits the display of tobacco products at the point of sale, such as in retail stores. The ban aims to reduce the visibility and promotion of tobacco products in retail environments, particularly to young people, and to de-normalize tobacco use. This study assessed the association between PoS display bans in Europe and adolescent smoking and perceived accessibility of tobacco, 2-6 years after PoS display ban implementation.

Intervention Results: The implementation of a PoS display ban was associated with a 15% larger drop in the odds of regular smoking (OR 0.85, 95% CI 0.79 to 0.91), but was not significantly associated with perceived accessibility of tobacco (OR 0.97, 95% CI 0.892 to 1.03). Associations were similar in males and females (cross-level interactions of gender with display ban were not statistically significant for either outcome).

Conclusion: The implementation of PoS display bans in Europe was associated with a stronger decrease in regular smoking among adolescents. This decrease does not appear to be driven by a decreasing accessibility of tobacco, but might be caused by further de-normalisation of tobacco as a result of PoS display bans.

Study Design: Quasi-experimental design

Setting: Data pulled from European survey (specifically Austria, Belgium, Bulgaria, Croatia, Cyprus, Czech Republic, Denmark, Estonia, Finland, Greece, Iceland, Ireland, Latvia, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, and Sweden)

Population of Focus: Policymakers, public health professionals, researchers

Sample Size: 174878 youths

Age Range: ages 15-16

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (National), NATIONAL, POPULATION-BASED SYSTEMS

Intervention Description: The goal of this study was to assess the impact of eight French perinatal guidelines on actual obstetric practices.

Intervention Results: The percentage of children weighing less than 1500 g at birth born in Level III hospitals increased through 1999 but dropped subsequently, without ever returning to the 1994 level (P<0.0001). The overall caesarean rate climbed slowly but regularly from 1994 through 2006 (P<0.0001). Use of antenatal corticosteroids for women hospitalised for threatened preterm labour and in children born before 33 weeks has fluctuated since the release of the guideline (P>0.05). Exclusive breastfeeding at discharge from the maternity ward has increased slowly (P<0.0001). The percentage of deliveries with active management of the third stage of labour rose notably from 1999 to 2006 (P<0.0001), and smoking cessation during pregnancy rose slightly in 2006 (P<0.0001). Since 1994, early discharges have become slowly, slightly, but regularly more frequent for all women (P<0.0001). The guideline on episiotomies has had a slight positive effect in the short term (P<0.0001).

Conclusion: Globally, the impact on actual practices of clinical practice guidelines, except the guideline concerning the active management of the third stage of labour, was low. Most of the changes observed in practices began before the pertinent guideline was published.

Study Design: Time trend analysis

Setting: French hospitals

Population of Focus: Subsample of all infants born weighing <1500 gm Data from 1994 to 1998 only included singleton pregnancies

Data Source: Data from the voluntary Audipog database in which participating hospitals send data on all deliveries covering a given period of at least a full month (chosen by hospital) each year. Authors extracted a subsample from the data.

Sample Size: Percentages given without numerator or denominator.

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): NATIONAL, Policy/Guideline (National),

Intervention Description: The ACA was revised to include a provision for lactation breaks in the workplace. Employers are required to provide locations and job-protected breaks from work for mothers to express milk. This study investigates if (a) workplace support directly influences the working mothers' breastfeeding intention, self-efficacy, and duration, and (b) workplace support indirectly influences breastfeeding duration through the mediating effect of breastfeeding intention and self-efficacy.

Intervention Results: After adjusting for confounders, there was a statistically significant direct effect between self-efficacy, breastfeeding intention, and breastfeeding duration. A statistically significant indirect effect of workplace support on breastfeeding duration through self-efficacy in attaining breastfeeding goals was also observed. The mediation ratios of the indirect effects showed that self-efficacy in attaining breastfeeding goals accounted for 40.8% (P-value=0.032) of the total effect; however, all other mediation ratios did not show statistical significance.

Conclusion: Self-efficacy is an important predictor for breastfeeding duration. Workplaces may help bolster women's self-efficacy by providing environments that are supportive to breastfeeding working mothers. Future research is needed to identify breastfeeding policies that boost self-efficacy.

Study Design: Prospective cohort study

Setting: Policy

Population of Focus: Women working outside the home who completed the Infant Feeding Practices Survey

Sample Size: 1198 women

Age Range: 23-35 year old women

Intervention Components (click on component to see a list of all articles that use that intervention): Guideline Change and Implementation, HOSPITAL, POPULATION-BASED SYSTEMS, NATIONAL, Policy/Guideline (National), PROFESSIONAL_CAREGIVER, Consensus Guideline Implementation, HEALTH_CARE_PROVIDER_PRACTICE, Active Management of Labor

Intervention Description: To evaluate the rate of primary cesarean delivery after adopting labor management guidelines.

Intervention Results: Among women delivering after induction or augmentation, the cesarean delivery rate decreased from 35.5% to 24.5% (odds ratio [OR] 0.59, 95% confidence interval [CI] 0.38-0.91). The overall cesarean delivery rate decreased from 26.9% to 18.8% (adjusted OR 0.59, CI 0.38-0.92). Composite maternal morbidity was reduced (adjusted OR 0.66, CI 0.46-0.94). The frequency of cesarean delivery documenting arrest of dilation at less than 6 cm decreased from 7.1% to 1.1% postguideline (n=182 and 176 preguideline and postguideline, respectively, P=.006) with no change in other indications.

Conclusion: Postguideline, the cesarean delivery rate among nulliparous women attempting vaginal delivery was substantially reduced in association with decreased frequency in the diagnosis of arrest of dilation at less than 6 cm.

Study Design: Retrospective cohort

Setting: 1 public university hospital in Pennsylvania

Population of Focus: Nulliparous women who gave birth between September 13, 2013 and February 28, 2014 and between May 1, 2014, to September 28, 2014

Data Source: Not specified

Sample Size: Total (n=567) Pre-intervention (n=275) Post-intervention (n=292)

Age Range: Not Specified

Intervention Components (click on component to see a list of all articles that use that intervention): PAYER, Expanded Insurance Coverage, HEALTH_CARE_PROVIDER_PRACTICE, Public Insurance (Health Care Provider/Practice), NATIONAL, Policy/Guideline (National)

Intervention Description: Dependent coverage expansion (DCE) policies on the state and federal level have been enacted to target the high rates of uninsurance and unique barriers to obtain coverage among adolescents and young adults (AYA). DCE, a component of the ACA, requires private insurance policies that cover dependents to offer coverage for policyholders’ children through age 26. Several states, including Massachusetts, New Hampshire, and Maine, adopted state DCE policies that extended dependent coverage, with the Massachusetts policy accompanied by other health reforms later incorporated into the ACA, including an individual mandate, a Medicaid expansion, creation of a health insurance exchange with subsidies, and prohibition of pre-existing condition exclusions. State and federal health reforms may modify the effects of a DCE by altering the coverage options and incentives for AYA.

Intervention Results: Findings suggest that an individual mandate and other reforms may enhance the effect of DCE in preventing loss of coverage among AYA. Implementation of DCE with other reforms was significantly associated with a 23% reduction in exit from dependent coverage among AYA compared to the reduction observed for DCE alone. Additionally, comprehensive reforms were associated with over two additional years of dependent coverage for the average AYA and a 33% increase in the odds of regaining dependent coverage after a prior loss. Findings suggest that an individual mandate and other reforms may enhance the effect of DCE in preventing loss of coverage among AYA. The joint effect of these policy levers is also associated with maintenance of dependent coverage until an older age and increased likelihood of regaining dependent coverage after an initial disenrollment. In addition to reductions in the odds of and time to dependent coverage exit, DCE was associated with further coverage gains for AYA in the form of regained dependent coverage.

Conclusion: Findings suggest that an individual mandate and other reforms may enhance the effect of DCE in preventing loss of coverage among AYA.

Study Design: Retrospective cohort with a pre- to post-comparison

Setting: Policy (Insurance consortium in 3 states: Massachusetts, Maine, and New Hampshire)

Population of Focus: Harvard Pilgrim Health Care members who were enrolled continuously as a dependent for at least 1 year between the ages of 16 and 18, from January 2000 to December 2012

Data Source: Enrollment and claims data from Harvard Pilgrim Health Care (HPHC), a large not-for-profit health plan with over 1 million members in commercial plans concentrated in Massachusetts, New Hampshire, and Maine

Sample Size: 131,542 individuals

Age Range: 16-18 years