Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): Social Supports, Care Coordination, Prenatal Care Access,

Intervention Description: The study proposed an intervention framework based on the themes and ideas generated from the qualitative analysis of participant perspectives. The proposed intervention design included three overarching thematic domains: (1) social support in the form of accompaniment and reassurance, (2) improved care delivery with greater consistency, communication, and individualization of outpatient prenatal care, and (3) improved access to outpatient prenatal care, convenient appointment availability, and uninterrupted insurance coverage during pregnancy , . The proposed intervention features included integrating CHWs into care teams and existing childbirth education, connecting pregnant individuals with social services resources, group prenatal care support, health information exchange, prenatal passport cards or applications, visit checklists, advanced access scheduling, enhanced care team visibility, drop-in pregnancy support center, insurance screening and enrollment, and CHW support for navigation and continuity . The intervention design aimed to improve trust and impact of prenatal care, advance equitably improved outcomes, and address unmet needs in those at risk for poor pregnancy outcome

Intervention Results: The study identified unique unmet needs and ideas for improving prenatal care among pregnant women with different patterns of unscheduled care utilization. Participants expressed a desire for social support interventions that address unmet psychosocial needs, care coordination, accompaniment, and navigation for at-risk pregnant women, while also addressing broader needs such as insurance eligibility, navigation to community-based resources, and access to timely prenatal care . The proposed intervention framework aimed to address these needs and improve prenatal care delivery for low-SES, Medicaid-insured, predominantly Black, pregnant women . The study also identified limitations, including a small sample size and potential social desirability bias . Overall, the study offers the opportunity to leverage qualitative narratives, tailor and adapt intervention design to meet the specific needs of a hard-to-engage population, and reduce inequitable, preventable maternal morbidity and mortality .

Conclusion: The study concluded that the use of a qualitative study design generated person-centered intervention elements that can improve trust and impact of prenatal care. The findings focused on the differential needs and ideas of pregnant women with unique patterns of utilization of unscheduled care, demonstrating a need for embedding targeted social support alongside clinical care to advance equitably improved outcomes. The study suggested that targeted interventions incorporating user ideas and addressing unique unmet needs of specific subgroups may improve perinatal outcomes. The proposed intervention elements may help maternity care systems improve health care delivery for Black, low-SES pregnant women by specifically focusing on community health worker (CHW) integration to address unmet psychosocial needs, care coordination, accompaniment, and navigation for at-risk pregnant women, while also addressing broader needs such as insurance eligibility, navigation to community-based resources, and access to timely prenatal care , .

Study Design: The study utilized a participatory action, qualitative research design to explore the perspectives and experiences of pregnant women regarding their prenatal care, barriers to care, and unscheduled care utilization in an obstetric triage unit. The qualitative analysis involved conducting in-depth, semi-structured interviews with pregnant women at the point of unscheduled hospital-based obstetric care, prompting participants regarding perspectives on group prenatal care and community health worker (CHW) interventions, and asking open-ended questions regarding ideas for improving care 2, 2. The qualitative data obtained from these interviews were then analyzed using grounded theory to identify major themes and develop an intervention framework aligned with participant perspectives

Setting: The setting for the study was an academic hospital outpatient setting, where pregnant women enrolled in a prenatal clinic were interviewed at the point of unscheduled hospital-based obstetric care in a triage unit . This setting allowed the researchers to gather insights from pregnant women who had experienced unscheduled care and to explore their perspectives on group prenatal care and community health worker (CHW) interventions, as well as their ideas for improving care

Population of Focus: The target audience for the study included pregnant women, particularly those from low socioeconomic status (SES) and Medicaid-insured, predominantly Black, pregnant women. The study aimed to capture the perspectives and experiences of this specific demographic group regarding their prenatal care, unscheduled care utilization, and ideas for improving care delivery

Sample Size: The study enrolled a total of 40 participants, who were categorized into two groups: Group 1 (n = 20) and Group 2 (n = 20) . These groups were defined based on the degree of utilization of unscheduled care during pregnancy, allowing for a comparative qualitative analysis of participant ideas for improving prenatal care. The sample size of 40 participants provided a substantial basis for capturing diverse perspectives and experiences related to prenatal care and unscheduled care utilization.

Age Range: The study did not explicitly mention the age range of the participants. However, it provided the mean age of the participants in Group 1 as 25.5 years and in Group 2 as 25.0 years . This suggests that the participants were generally in their mid-20s, but without specific details on the age range.

Intervention Components (click on component to see a list of all articles that use that intervention): Patient-Centered Medical Home, Prenatal Care Access, Social Supports,

Intervention Description: it focused on examining the factors associated with experiences of person-centered care during pregnancy and birth among Black birthing people in California using the Person-Centered Prenatal Care (PCPC) and the Person-Centered Maternity Care (PCMC-US) scales. These validated measures were used to better understand how Black women and birthing people experience their care in relation to other aspects of their identity, social status, and care-related factors . The study aimed to identify factors associated with lower PCPC and PCMC-US scores, providing insights into the contributors to the experiences of care among Black birthing people in California

Intervention Results: The study identified several factors associated with lower person-centered care scores among Black birthing people in California. Factors associated with lower PCPC scores included having foreign-born parents, having public or no insurance, part-time employment, unstable housing, late start of prenatal care (in the second or third trimester), poorer self-rated health, and lack of continuity of care with prenatal providers. On the other hand, factors associated with lower PCMC-US scores included having public insurance, late start of prenatal care, longer length of stay in the facility following birth, poorer self-rated health, lack of continuity of care between prenatal care and birth providers, and racial discordance with the birth provider . These findings highlight the contributions of intersecting identities as well as health-related and care-related factors to Black birthing people's experiences of care in California. Continuity of care and provider racial concordance were shown to improve pregnancy and birth experiences

Conclusion: The study's conclusions emphasized the significant contributions of intersecting identities, health-related factors, and care-related factors to the experiences of care among Black birthing people in California. The findings underscored the importance of continuity of care and provider racial concordance in improving pregnancy and birth experiences for this population. Additionally, the study highlighted the need to address the intersecting effects of sociodemographic factors on experiences of care and the potential interventions to decrease healthcare disparities. The authors also noted that despite the relatively homogenous sample, the analysis revealed the impact of sociodemographic factors and intersecting identities on care experiences, consistent with the existing literature on factors influencing care experiences

Study Design: The study utilized a cross-sectional design to examine the factors associated with experiences of person-centered care during pregnancy and birth among Black birthing people in California. The cross-sectional design allowed the researchers to collect data at a single point in time, providing a snapshot of the experiences and characteristics of the participants within the specified timeframe. This design is commonly used to assess associations between variables and is suitable for investigating factors related to person-centered care experiences within a specific population

Setting: The setting for the study is California, United States. The research focuses on Black women and birthing people in California and aims to examine factors associated with experiences of person-centered care during pregnancy and birth within this specific demographic and geographic context. By conducting the study in California, the researchers provide insights that are relevant to the local healthcare landscape and can potentially inform targeted interventions and policies to improve the quality of care for Black women and birthing people in the state.

Population of Focus: The target audience for this study includes healthcare providers, policymakers, researchers, and advocates who are interested in improving the quality of care for Black women and birthing people during pregnancy and birth. The study provides valuable insights into factors associated with person-centered care during pregnancy and birth for this population, which can inform the development of targeted interventions and policies aimed at reducing disparities in birth outcomes. The findings of this study can also be of interest to individuals and organizations working to promote health equity and social justice in the United States.

Sample Size: The sample size for the study consisted of 234 Black women and birthing people who were recruited between January and September 2020 as part of a validation study for the Person-Centered Prenatal Care (PCPC) and the Person-Centered Maternity Care (PCMC-US) scales . This sample size was used for the analyses conducted to examine the factors associated with experiences of person-centered care during pregnancy and birth among Black birthing people in Californi

Age Range: The age range of the participants in the study was 15 years or older and less than 1 year postpartum . The study did not provide a specific age range for the participants. However, the study did report that the participants were predominantly aged 29-32 years

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

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

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

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

Study Design: N/A

Setting: N/A

Data Source: N/A

Sample Size: N/A

Age Range: N/A

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

Intervention Description: The current qualitative, longitudinal study examined mothers’ perceptions of how receipt of flexible funding designed to increase their housing stability may have also impacted their children’s safety, stress, mood and behavior. Forty-two mothers in the Washington, D.C. metro area were interviewed three times over a six-month period about their own safety and housing stability, as well as their children’s. Ninety-five percent of the mothers and their children were housed at the six-month interview.

Intervention Results: Ninety-five percent of the mothers and their children were housed at the six-month interview. Mothers described improvements in children’s stability and safety, decreases in children’s stress levels, and improvements to their mood and behavior. They also discussed the symbiotic relationship between their own stress and well-being, and their children’s.

Conclusion: The provision of flexible funding to assist domestic violence survivors with their housing also collaterally impacted their children’s safety, stress, mood and behavior.

Study Design: qualitative, longitudinal study

Setting: Washington, D.C. metro area

Sample Size: Forty-two mothers

Intervention Components (click on component to see a list of all articles that use that intervention): Policy/Guideline (State), Social Supports, Counseling (Parent/Family), Housing Prescriptions

Intervention Description: supportive housing program called Housing Prescriptions as Health Care

Intervention Results: the Housing Prescriptions as Health Care intervention led to improvements in child health and parental mental health over a six-month period for medically complex families in Boston who had experienced homelessness and housing instability. Specifically, there were decreases in the share of children in fair or poor health and in average anxiety and depression scores among parents in the intervention group compared to the control group

Conclusion: a population-specific model integrating health, housing, legal, and social services, such as the Housing Prescriptions as Health Care intervention, can improve health-related outcomes at the household level for medically complex families experiencing homelessness and housing instability. The findings suggest that addressing housing instability through a multifaceted supportive housing intervention can positively impact the health of both children and parents in these families

Study Design: pilot randomized controlled trial.

Setting: Boston, Massachusetts

Sample Size: seventy-eight homeless or housing-unstable families defined as "medically complex"; Sixty-seven families completed a six-month follow-up assessment

Age Range: mean age of the index child in the study was 2.8 years

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

Intervention Description: spotlights hardships and supportive factors for unhoused families led by single mothers who have successfully graduated from two transitional housing programs, one rural and one urban.

Intervention Results: Binary logistic regression results indicated education and social support as significant predictors of successful program completion. Qualitative findings further illustrate narratives surrounding supportive factors and program supports (i.e., assistance securing employment, education courses, sense of community), as well as policy implications.

Conclusion: Implications stress the need for enhancing supportive factors (i.e., education and social capital) in early prevention efforts (e.g., schools and community centers), as well as an intentional integration of addressing socio-emotional needs and resources within housing programs and services unique to rural and urban communities.

Study Design: mixed method study

Setting: Urban and Rural

Sample Size: entry and exit surveys (n = 241) as well as qualitative interviews (n = 11).

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): Individual Supports, Social Supports, Housing Supports

Intervention Description: We linked Massachusetts emergency housing assistance data with Medicaid claims between July 2008 and June 2015, constructing episodes of health care 12 months before and 12 months after families entered a shelter. We modeled emergency department visits, hospital admissions, and expenditures over the 24-month period separately for children and adults.

Intervention Results: Emergency department visits, hospital admissions, and expenditures rose steadily before shelter entry and declined gradually afterward, ending, in most cases, near the starting point. Infants, pregnant women, and individuals with depression, anxiety, or substance use disorder had significantly higher rates of all outcomes. Many children’s emergency department visits were potentially preventable.

Conclusion: Increased service utilization and expenditures begin months before families become homeless and are potentially preventable with early intervention. Infants are at greater risk.

Study Design: longitudinal study

Setting: Massachusetts

Population of Focus: social worker, medical professional, public health practitioner

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

Intervention Description: county-level Pay for Success initiative, Partnering for Family Success.

Intervention Results: explored implementation findings of treatment and control group clients participating in a randomized control trial of housing-unstable clients with children in out-of-home placement. Quantitative housing, public assistance, and child welfare administrative data findings, measured over three years were contextualized by qualitative content analyses of case management contacts, examinations of service patterns based on progress notes, and qualitative interviews

Conclusion: Determining what interventions are most effective for stabilizing housing-unstable, child welfare-involved families is a challenge that is increasingly being prioritized as society recognizes the high social and economic costs of both housing these families in emergency shelter and funding out of home placement for their children. Though our findings were mixed regarding quantitative indicators of client’s housing, public assistance receipt, and child welfare outcomes,

Study Design: convergent parallel mixed method design

Setting: County Level

Sample Size: treatment (N = 90) and control (N = 73)

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): PATIENT_CONSUMER, Peer Counselor, Assessment (PATIENT_CONSUMER), Professional Support, HEALTH_CARE_PROVIDER_PRACTICE, Other (Provider Practice), COMMUNITY, Social Supports, Individual Supports,

Intervention Description: In 2014, the New York State WIC program launched the You Can Do it (YCDI) initiative in 12 WIC clinics. This multicomponent intevention, which was originally developed by the Vermont WIC program, was designed to improve participants' knowledge, attitudes, confidence, and social support to breastfeed exclusively through a screening and tailored counseling protocol combined with peer counselor and professional support spanning the prenatal and early postpartum periods. This multicomponent intervention paired with a yearlong learning community in the 12 clinics.

Intervention Results: Prevalence of exclusive BF at 7 and 30 days was significantly higher among BAPT women compared with non-BAPT or baseline cohorts. Non-Hispanic black and Hispanic women in the BAPT cohort achieved significantly higher exclusive BF rates at 30 and 60 days compared with those in non-BAPT and baseline cohorts.

Conclusion: The initiative seems to be effective at increasing exclusive BF, particularly among non-Hispanic black and Hispanic women in the New York State WIC program.

Study Design: Quasi-experimental study

Setting: 12 WIC clinics in New York State

Population of Focus: Prenatal women enrolled in WIC during the first trimester of pregnancy who intended to breastfeed or were undecided

Sample Size: Baseline cohort of 688 mother-infant dyads and two intervention cohorts: Breastfeeding Attrition Prediction Tool (BAPT) (n=362 monther-infant dyads) and non-BAPT (n=347 mother-infant dyads); 12 WIC clinics; 47 WIC staff members

Age Range: Women 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): Social Supports, Screening Tool Implementation, Family-Based Interventions,

Intervention Description: We assessed a cross-sectional sample of dyadic parent–child patients and young adult patients up to age 21 from one pediatric SCD center. Food insecurity, housing instability, and dietary quality were measured using validated US instruments and a food frequency questionnaire. Better dietary quality was defined using US dietary guidelines. Multivariate regression assessed for associations among dietary quality and food insecurity with or without (±) housing instability and housing instability alone.

Intervention Results: 70% reported less than or equal to one economic instability: 40% housing instability alone and 30% both food insecurity and housing instability. Eighty percent received more than or equal to one federal food assistance benefit. Compared to no economic instability, food insecurity ± housing instability was significantly associated with higher intake of higher dairy and pizza, while housing instability alone was significantly associated with higher dairy intake. Food insecurity ± housing instability was significantly associated with lower intake of whole grains compared to housing instability alone.

Conclusion: Our sample reported high frequencies of both food insecurity and housing instability; having more than or equal to one SDoH was associated with elements of poorer diet quality. Screening families of children with SCD for food insecurity and housing instability may identify those with potential nutrition-related social needs.

Study Design: cross-sectional

Sample Size: n=100

Age Range: mean age 10.6 ±

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 (Community), Social Supports, Family-Based Interventions, Housing Programs

Intervention Description: Rapid Rehousing Program

Intervention Results: Participants expressed feelings of insecurity in emergency shelters due to lack of privacy, theft, unsanitary conditions, and safety concerns. Families noted improvements in children's behavior and academic performance after moving into their own homes. Participants reported feeling safer and more secure once they had their own space and autonomy. Families expressed a sense of security and belonging after being housed, leading to improved relationships with family and friends and a sense of hope for the future.

Conclusion: The study highlighted the importance of the Rapid Rehousing Program in improving the security and well-being of families experiencing homelessness. Moving from emergency shelters to their own homes provided a sense of security, autonomy, and hope for the future. Recommendations included providing clear expectations about housing subsidies, offering financial education, and enhancing case management to support long-term housing security for families

Setting: Salt Lake City, UT

Population of Focus: policymakers, social service providers, researchers

Sample Size: n=31

Age Range: average age 37.5 yrs of age

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

Intervention Description: Supportive housing

Intervention Results: Consistent with findings from the larger project of which this was a part, supportive housing improved housing outcomes for families, especially those most at risk form homelessness. Its effects on child welfare outcomes varied by study site more than by risk level. Family characteristics and experiences that predicted housing and child welfare outcomes also varied by site and added limited accuracy to predictive models. Theoretical moderators did not influence supportive housing’s effects.

Conclusion: Supportive housing increases housing security and may influence child welfare outcomes in some contexts. Family characteristics and experiences marginally improve targeting of supportive housing to insecurely housed families involved with CPS.

Setting: five U.S. sites

Sample Size: 500 insecurely housed families involved in child protective services

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): 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): Prenatal Care Access, Social Supports, Targeting Interventions to Focused Groups

Intervention Description: The augmented care intervention included educationally oriented peer groups, additional appointments, extended time with clinicians, and other supports. The Mother and Family Specialty Center was created to provide augmented care, which sought to minimize risk conditions and improve pregnancy outcomes. The center provided transportation, child care, and a physical environment designed to provide welcoming, positive messages. Discussion groups were held as an integral part of each center visit to increase both social support and knowledge. Information was compiled and distributed to mothers-to-be in both video and easy-to-read print formats. The intervention also included home visits, weekend clinic hours, and direct provision of additional books and equipment

Intervention Results: Women in augmented care rated all aspects of their prenatal care significantly more favorably than did those in usual care. Participating in the Mother and Family Specialty Center was associated with highly positive appraisals of helpfulness, a belief among multiparous women that care was better this time, increased amounts of time spent with their regular nurse, and an almost universal perception that their nurse was “very helpful”. In contrast, those in usual care had more mixed evaluations of their prenatal care, although 80% judged their overall care to be “very helpful”. The number of prenatal visits was significantly greater in augmented care than in usual care. A dramatic difference between the 2 groups was self-report of participation in prenatal or childbirth classes: 79% for augmented care and 17% for usual care. Informing women about their own risk conditions and about pregnancy and delivery was an important feature of augmented care. Significantly more women in augmented care than in usual care reported that they were told they or their baby were “at risk,” although most still reported that they were not informed of their own specific risks. This self-report is at odds with the documented nurse records, which indicated that particular risks were discussed on multiple occasions. However, 69% of those aware of their risk conditions in augmented care reported positive behavior change as a result of prenatal care information, compared with 48% in usual care. Pregnancy outcomes did not differ significantly between the groups; however, among patients in augmented care, rates of preterm births were lower and cesarean deliveries and stays in neonatal intensive care units occurred in smaller proportions. Both groups had lower-than-predicted rates of low birthweight

Conclusion: High-quality prenatal care, emphasizing education, health promotion, and social support, significantly increased women’s satisfaction, knowledge of risk conditions, and perceived mastery in their lives, but it did not reduce low birthweight. The study found that augmented care did not significantly improve pregnancy outcomes, but it did improve women’s perceptions of their care and their knowledge of risk conditions. The study suggests that providing additional support and education to high-risk pregnant women can improve their satisfaction with care and their knowledge of risk conditions, which may lead to positive behavior change. The study also suggests that providing additional support and education to high-risk pregnant women may reduce rates of preterm births, cesarean deliveries, and stays in neonatal intensive care units .

Study Design: The study design was a randomized controlled trial . All pregnant women who sought prenatal care from the Jefferson County (Alabama) Department of Health from March 1994 to June 1996 were screened for eligibility. Women were eligible if they met the following criteria: (1) African American, (2) eligible for Medicaid, (3) less than 26 weeks’ gestation, (4) at least 16 years old, and (5) score of 10 or higher on a risk assessment scale. The scale was based on multiple analyses of a computerized database that included all Medicaid-eligible pregnancies in the area during 1993 and 1994 and a prospective study of high-risk pregnancies . The eligible women were randomly assigned to augmented care or usual care

Setting: The study was conducted in Jefferson County, Alabama, and specifically focused on the Mother and Family Specialty Center, which provided the augmented prenatal care program for high-risk African American women . The center offered a supportive environment with culturally appropriate and individualized care, emphasizing health promotion and education . The setting included features such as transportation assistance, child care, and a welcoming physical environment designed to provide positive messages and cultural appropriateness .

Population of Focus: The target population of the study was high-risk African American women who were eligible for Medicaid, scored 10 or higher on a risk assessment scale, were 16 years or older, and had no major medical complications . The study aimed to improve pregnancy outcomes and patients’ knowledge of risks, satisfaction with care, and behavior for this specific population . The study sample included 656 African American women who enrolled in the trial, with outcome data available for 619 who delivered in area hospitals

Sample Size: The sample size for the study was 656 African American women who enrolled in the trial. Outcome data were available for 619 who delivered in area hospitals, where 318 received augmented care and 301 received usual care . The sample size of 285 women in the experimental group and a similar number of controls were considered adequate to detect a reduction in the rate of low birthweight from 20%–25% to 10%–12%

Age Range: The sample size for the study was 656 African American women who enrolled in the trial. Outcome data were available for 619 who delivered in area hospitals, where 318 received augmented care and 301 received usual care . The sample size of 285 women in the experimental group and a similar number of controls were considered adequate to detect a reduction in the rate of low birthweight from 20%–25% to 10%–12%

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

Intervention Description: using counterfactual machine learning to identify the services most likely to prevent reentry into homelessness for each household.

Intervention Results: Homelessness prevention benefited households who could access it, while differential effects exist for homeless households that partially align with community interests.Households with comorbid health conditions avoid homelessness most when provided longer-term supportive housing, and families with children fare best in short-term rentals. No additional differential effects existed for intersectional subgroups. Prioritization rules reduce community-wide homelessness in simulations. Moreover, prioritization mitigated observed reentry disparities for female and unaccompanied youth without excluding Black and families with children.

Conclusion: Community-and data-driven prioritization rules more equitably target scarce homeless resources.

Setting: St. Louis, Missouri

Population of Focus: policymakers, community stakeholders, social service providers, researchers

Sample Size: 10,043 households that accessed homeless services in St. Louis from 2009 to 2014

Age Range: 18 to 24 years for unaccompanied homeless youth, with an average age of 39.5 years (SD = 12.8) for household heads entering services

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

Intervention Description: tested relationships between three domains of housing - quality, stability, and affordability – with three types of child maltreatment – psychological abuse, physical abuse, and neglect

Intervention Results: Housing affordability was associated with reduced psychological and physical abuse (β = −1.10, p < 0.05 and β = −0.66, p < 0.05 respectively), but not with neglect. Neither housing quality nor stability had any significant association with any maltreatment type. The only significant predictor of neglect was maternal depression.

Conclusion: Housing affordability in particular may protect against maltreatment, but other domains of housing insecurity appear to have little to no effect controlling for other household factors. Findings highlight the need for increased affordable housing supply, as well as mental health supports for families cost-burdened by meeting basic needs.

Study Design: longitudinal survey

Setting: 20 U.S. Cities

Population of Focus: policy makers, social workers, public health, medical staff

Sample Size: N=1804

Age Range: Mothers with children aged 5 and 9

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

Intervention Description: Alongside increasing social media use worldwide, there is an expanding research focus on how social media use affects health behaviours, decisions and perceptions. The objective of this study was to systematically determine if and how breastfeeding is promoted and supported on the popular social media platform Instagram, which currently has over 700 million active users worldwide. To assess how Instagram is used to depict and portray breastfeeding, and how users share perspectives and information about this topic, we analysed 4,089 images and 8,331 corresponding comments posted with popular breastfeeding-related hashtags (#breastfeeding, #breastmilk, #breastisbest, and #normalizebreastfeeding).

Intervention Results: We found that Instagram is being mobilized by users to publicly display and share diverse breastfeeding-related content and to create supportive networks that allow new mothers to share experiences, build confidence, and address challenges related to breastfeeding. Discussions were overwhelmingly positive and often highly personal, with virtually no antagonistic content. Very little educational content was found, contrasted by frequent depiction and discussion of commercial products.

Conclusion: Instagram is currently used by breastfeeding mothers to create supportive networks and could potentially offer new avenues and opportunities to "normalize," protect, promote, and support breastfeeding more broadly across its large and diverse global online community.

Study Design: Qualitative study

Setting: Social media platform: Instgram

Population of Focus: Active Instagram users who shared perspectives and information about breastfeeding with popular breastfeeding-related hashtags

Sample Size: 4,089 images and 8,331 corresponding comments

Intervention Components (click on component to see a list of all articles that use that intervention): PATIENT_CONSUMER, Educational 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): COMMUNITY, Other (Communities), Social Supports

Intervention Description: The Children's Healthy Living (CHL) Program focuses on prevention of childhood obesity in the Pacific region, which is known to track into obesity and type 2 diabetes in adulthood. The CHL trial used a social ecological framework of health and wellness designed to act on multiple levels and in multiple components within behavioral, physical, social, cultural, economic, and policy environments to reduce the prevalence of overweight and obesity among children in multiple USAP communities, ultimately reducing it by 3.9% during a 2-year period. The CHL intervention was develped by a consortium of collborators at land grant colleges in the USAP region. The trial used a common template of 19 activities that were selected to address target behaviors. The intervention activities were grouped into 4 functions (or strategies): environmental change, organizational policy change, social marketing, and training that addressed the interersonal (training role of models, parents, and teachers), community (increasing access to healthy foods and environments for safe play), and organizational and policy (strengthening preschool wellness policies) levels of the social ecological model.

Intervention Results: Among the 9840 children included in the analysis (4866 girls [49.5%] and 4974 boys [50.5%]; 6334 [64.4%] aged 2-5 years), the intervention group showed significant improvements compared with the control group from times 1 to 3 in prevalence of overweight plus obesity (d = −12.60% [95% CI, −20.92% to −4.28%]), waist circumference (d = −1.64 [95% CI, −2.87 to −0.41] cm), and acanthosis nigricans prevalence (d = −3.55% [95% CI, −6.17% to −0.92%]). Significant improvements were also observed from times 2 to 3 in prevalence of overweight plus obesity (d = −8.73% [95% CI, −15.86% to −1.60%]) but not in waist circumference (d = −0.81 [95% CI, −1.85 to 0.23] cm).

Conclusion: This randomized clinical trial found that the outcomes of the Children’s Healthy Living intervention were maintained and enhanced 6 years after the intervention among young children in the US-affiliated Pacific region. The prevalence of overweight, obesity, and acanthosis nigricans was further reduced in communities, suggesting that multilevel multicomponent interventions may help reduce child overweight and obesity in this region.

Study Design: Randomized clinical trial

Setting: Communities in 5 jurisdictions (Hawaii, Alaska, Commonwealth of the Northern Mariana Islands, American Samoa, and Guam) of the US-affiliated Pacific Region

Population of Focus: Children aged 2-8 yrs of age in the 27 selected communities

Sample Size: 9,840 children

Age Range: Children ages 2-8 years

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

Intervention Description: Through a series of logistic regressions and generalized estimating equations, we tested the temporal associations of emergency/transitional housing and child protection involvement as well as how both experiences affected school attendance and mobility.

Intervention Results: Experiences of emergency or transitional housing often proceeded or occurred concurrently with child protection involvement and increased the likelihood of child protection services. Emergency or transitional housing and child protection involvement posed risks for lower school attendance and greater school mobility.

Conclusion: A multisystem approach to assist families across social services may be important for stabilizing children's housing and bolstering their success at school. A two-generation approach focused on residential and school stability and enhancing family resources could boost adaptive success of family members across contexts.

Study Design: logistic regression

Setting: Hennepin and Ramsey County of Minnesota

Sample Size: 3278 children (ages 4 to 15) whose families used emergency or transitional housing; comparison group of 2613 children who did not use emergency or transitional housing.

Age Range: children aged 4-15 yrs old

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

Intervention Description: We used exact propensity score matching without replacement to select a reference population to compare with the sample of women with unstable housing using a one-to-one ratio, matching for maternal age, race/ethnicity, parity, prior preterm birth, body mass index, tobacco use during pregnancy, drug/alcohol abuse during pregnancy, hypertension, diabetes, mental health condition during pregnancy, adequacy of prenatal care, education, and type of hospital. Odds of an adverse obstetric outcome were estimated using logistic regression.

Intervention Results: Of 2794 women with unstable housing identified, 83.0% (n = 2318) had an exact propensity score–matched control. Women with an unstable housing code had higher odds of preterm birth (odds ratio, 1.2, 95% confidence interval, 1.0–1.4, P < .05), preterm labor (odds ratio, 1.4, 95% confidence interval, 1.2–1.6, P < .001), long length of stay (odds ratio, 1.6, 95% confidence interval, 1.4–1.8, P < .001), emergency department visits within 3 months (odds ratio, 2.4, 95% confidence interval, 2.1–2.8, P < .001) and 1 year after birth (odds ratio, 2.7, 95% confidence interval, 2.4–3.0, P < .001), and readmission within 3 months (odds ratio, 2.7, 95% confidence interval, 2.2–3.4, P < .0014) and 1 year after birth (odds ratio, 2.6, 95% confidence interval, 2.2–3.0, P < .001).

Conclusion: Unstable housing documentation is associated with adverse obstetric outcomes and high health care utilization. Housing and supplemental income for pregnant women should be explored as a potential intervention to prevent preterm birth and prevent increased health care utilization.

Setting: California

Population of Focus: Pregnant women experiencing housing instability

Sample Size: 2794 women with a live singleton birth in unstable housing

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

Intervention Description: Schools often struggle to build partnerships with homeless and highly mobile (HHM) families. These families are not homogeneous; they live in and engage with schools from diverse residential contexts. Using Epstein’s theory and framework and drawing from 132 interviews with HHM parents, school personnel, and community stakeholders in an urban district,

Intervention Results: results suggest that (a) interviewees had divergent experiences with family, school, and community partnerships; (b) some school actors were better positioned to engage HHM families than others; and (c) the diverse residential context of HHM families molded partnership building in unique ways.

Conclusion: Although partnerships were not always shaped by the residential context, in a number of ways, living in shelter, doubling up, or residing in housing first molded the opportunities to engage in their children’s education (Table 2). In this section, findings are connected to the literature and tied back to Epstein’s concept of “family-like schools” and “school-like families.” I also suggest some theoretical implications and recommendations for practice and policy

Setting: urban school distric

Sample Size: 132 parents

Intervention Components (click on component to see a list of all articles that use that intervention): Care Coordination, Social Supports, Prenatal Care Access,

Intervention Description: The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations focused on the appropriateness of key aspects of prenatal care delivery for average-risk pregnant individuals. The interventions and components of prenatal care delivery addressed in the recommendations included: 1. Prenatal Visit Schedules: This involved determining the appropriate timing and frequency of prenatal visits, including care initiation, visit timing and frequency, and routine pregnancy assessments. 2. Integration of Telemedicine: The recommendations provided guidance on the integration of telemedicine, including virtual visits and home devices, into prenatal care delivery for average-risk pregnant individuals.

Intervention Results: The results of the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations included the development of more flexible prenatal care delivery for average-risk individuals. The expert panel, consisting of 19 clinicians and researchers, provided recommendations for key aspects of prenatal care delivery, including prenatal visit schedules, integration of telemedicine, and care individualization. The panelists agreed that a risk assessment for medical, social, and structural determinants of health should be completed as soon as individuals present for care. Additionally, the panel provided recommendations for prenatal visit schedules, integration of telemedicine, and care individualization. The recommendations aimed to ensure that individuals are connected to needed services as early as possible and to match individuals' needs to services delivered.

Conclusion: The conclusions of the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations highlighted the need for more flexible and individualized prenatal care delivery for average-risk pregnant individuals. The study emphasized the importance of individualizing care, incorporating telemedicine, and considering both medical conditions and social and structural determinants of health in routine care delivery. The MiPATH recommendations were developed to address the limitations of the existing prenatal care guidelines, which have remained largely unchanged since 1930. By providing more flexible prenatal care choices, including options for visit frequency, monitoring plans, and the inclusion of telemedicine, the recommendations aimed to tailor care based on patient preference and needs in consultation with practitioner recommendations. The study also acknowledged the limitations of the recommendations, including the reliance on expert consensus due to the lack of robust evidence in certain areas. Additionally, the panel considered prenatal care delivery in an ideal setting, and the real-world considerations, such as late presentation to care and lack of supporting resources, were recognized as important areas for future research and policy recommendations. The MiPATH recommendations were described as the initial step in an ongoing process, with plans to obtain input from various stakeholders, including patients, professional societies, public health representatives, and payers, to garner diverse perspectives on the new recommendations. Furthermore, ongoing efforts, such as a systematic review by the Agency for Healthcare Research and Quality, were planned to capture additional supporting evidence for key aspects of prenatal care delivery. In conclusion, the MiPATH recommendations aimed to redesign prenatal care to be more effective, efficient, and equitable for pregnant individuals nationwide, taking into account the evolving landscape of prenatal care delivery and the individualized needs of pregnant individuals. ,

Study Design: The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations were developed using an appropriateness study design, specifically the RAND Corporation and University of California Los Angeles Appropriateness Method (RAM), which is a modified Delphi process. The appropriateness study involved six phases: 1. Definition and scope of key terms 2. Literature review and data synthesis 3. Case scenario development 4. Expert panel selection, engagement, and scenario revision 5. Expert panel introduction and appropriateness rating (round 1) 6. Expert panel meeting and appropriateness rating (round 2) 7. Expert panel review of findings The goal of the study was to generate recommendations for components of prenatal care delivery across common average-risk pregnancy conditions. The RAM method was selected for this panel because of its rigor, evidence-based methodology, and ability to incorporate existing evidence and expert opinion to arrive at clinical recommendations. The study received institutional review board exemption from the University of Michigan (HUM00188505). The MiPATH recommendations offer more flexible prenatal care delivery for average-risk individuals.

Setting: The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations were developed through a panel process using the RAND Corporation and University of California Los Angeles Appropriateness Method. The panel consisted of 19 clinicians and researchers who represented expertise across maternity care, pediatrics, telemedicine, and social and structural determinants of health. The panelists were selected based on their expertise and were not limited to a specific setting. The recommendations were developed for average-risk pregnant individuals (i.e., individuals not requiring care by maternal-fetal medicine specialists) and were not limited to a specific geographic or healthcare setting. The recommendations were developed to be applicable to a wide range of settings and circumstances.

Population of Focus: The target audience for the Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) recommendations includes a diverse group of stakeholders involved in prenatal care delivery, such as: 1. Maternity Care Clinicians: The recommendations provide important guidance for maternity care clinicians, including obstetricians, midwives, and other healthcare professionals involved in prenatal care delivery. 2. Patients: MiPATH plans to obtain input from patients to ensure that their perspectives are considered in the development and implementation of the recommendations. 3. Professional Societies: Input from professional societies is sought to ensure that the recommendations align with established standards and best practices in prenatal care. 4. Public Health Representatives: Involvement of public health representatives is important to ensure that the recommendations address broader public health goals and priorities related to prenatal care. 5. Payers: Input from payers, such as insurance companies and healthcare payers, is sought to ensure that the recommendations align with payment models and reimbursement structures. The goal is to garner diverse perspectives on the new recommendations from a wide range of stakeholders, including patients, professional societies, public health representatives, and payers, to ensure that the recommendations are well-informed and aligned with the needs of various stakeholders involved in prenatal care delivery.

Sample Size: The Michigan Plan for Appropriate Tailored Healthcare in Pregnancy (MiPATH) panel consisted of 19 clinicians and researchers who participated in the development of the recommendations. This panel was selected based on their expertise in maternity care, pediatrics, telemedicine, and social and structural determinants of health. The panelists were involved in a rigorous process using the RAND Corporation and University of California Los Angeles Appropriateness Method to develop the recommendations for prenatal care delivery. The sample size of 19 panelists reflects the expertise and diversity of perspectives involved in the development of the MiPATH recommendations.

Age Range: The panelists involved in the development of the recommendations were clinicians and researchers with expertise in maternity care, pediatrics, telemedicine, and social and structural determinants of health, and their age range is not specified in the published literature.

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): Social Supports, Individual Supports,

Intervention Description: Our goal was to examine the impact of maternal homelessness (mothers ever homeless or who lived in shelters during pregnancy) and participation in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) during pregnancy in conjunction with air pollution exposure on birthweight in the Boston-based Children’s HealthWatch cohort from 2007 through 2015 (n = 3366).

Intervention Results: We included 3366 participants in our analysis (Figure 1). The median birthweight was 3272 g (Table 1). The majority of mothers in the cohort were non-Hispanic Black (50%), followed by Hispanic (33%). Nearly 40% of mothers were immigrants, and 84% participated in WIC during pregnancy. Most mothers did not smoke in the past 5 years (74%), and nearly half of the mothers attained more than a high school education (47%). Half of the study subjects reported that their household incomes were below $20,000 (data not shown). The majority of children had public health insurance (86%). The median PM2.5 concentrations across each trimester were similar (1st: 9.1 µg/m3, 2nd: 9.2 µg/m3, 3rd: 8.9 µg/m3).

Conclusion: Our study emphasizes the independent and combined effects of maternal social and environmental stressors on birthweight, including homelessness and exposure to PM2.5, as well as the potential protective effect of participating in WIC during pregnancy. Importantly, even within a predominantly low-income population, the association of prenatal PM2.5 with birthweight was stronger among non-Hispanic Black mothers and marginally significant among immigrants and single mothers, which indicates the need for special attention to the circumstances of these groups of mothers. These findings can be used to better target health interventions and support policy change for pregnant mothers at high risk to maximize a healthy start for newborns.

Study Design: cohort study

Setting: Boston, MA

Population of Focus: researchers, public health professionals

Sample Size: n = 3366

Age Range: infants up to 48 months of age

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

Intervention Description: The primary exposure variable was homelessness. The primary outcome of interest was a binary variable indicating postpartum readmission within 6weeks after the discharge date of the delivery hospitalisation. The secondary outcome of interest examined women who had a postpartum ED visit.

Intervention Results: Homeless women had lower rates of both postpartum readmissions (risk-adjusted rates: 1.4% vs 1.6%; adjusted OR (aOR) 0.87, 95% CI 0.75 to 1.00, p=0.048) and ED visits than non-homeless women (risk-adjusted rates: 8.1% vs 9.5%; aOR 0.83, 95% CI 0.77 to 0.90, p<0.001). A sensitivity analysis stratifying the non-homeless population by income quartile revealed significantly lower hospitalisation rates of homeless women compared with housed women in the lowest income quartile. These results were surprising due to the trend of postpartum hospitalisation rates increasing as income levels decreased.

Conclusion: Two factors likely led to lower rates of hospital readmissions among homeless women. First, barriers including lack of transportation, payment or childcare could have impeded access to postpartum inpatient and emergency care. Second, given New York State’s extensive safety net, discharge planning such as respite and sober living housing may have provided access to outpatient care and quality of life, preventing adverse health events. Additional research using outpatient data and patient perspectives is needed to recognise how the factors affect postpartum health among homeless women. These findings could aid in lowering readmissions of the housed postpartum population.

Study Design: Cross-sectional secondary analysis

Setting: New York statewide inpatient and emergency department databases

Population of Focus: healthcare professionals

Sample Size: 82 820 and 1 026 965 postpartum homeless and non-homeless women, respectively.

Age Range: 15-44 yrs of age

Intervention Components (click on component to see a list of all articles that use that intervention): Social Supports, Access,

Intervention Description: Caregivers of children 0 to 48 months of age were interviewed in 5 urban medical centers from May 2009 to December 2015. Caregivers reported on the following: caregiver health, maternal depressive symptoms, child’s health, lifetime hospitalizations, developmental risk, and 3 housing circumstances, which were categorized as being behind on rent in the past 12 months, multiple moves (≥ 2 in past 12 months), and child’s lifetime history of homelessness. Associations with caregiver and child health outcomes were examined through multivariable logistic regression.

Intervention Results: 34% had at least 1 of the following adverse housing circumstances: 27% had been behind on rent, 8% had made multiple moves, and 12% had a history of being homeless. Overlap between these was limited; 86% experienced only 1 adverse housing circumstance. Each circumstance was individually associated with increased adjusted odds of adverse health and material hardship compared with stable housing. Households behind on rent had increased adjusted odds of fair and/or poor caregiver health (adjusted odds ratio [aOR]: 1.91; 95% confidence interval [CI]: 1.77–2.05), maternal depressive symptoms (aOR: 2.71; 95% CI: 2.51–2.93), child lifetime hospitalizations (aOR: 1.19; 95% CI: 1.10–1.27), fair and/or poor child health (aOR: 1.41; 95% CI: 1.28–1.56), and household material hardships. Families with multiple moves and history of homelessness had similar adverse caregiver, child, health, and hardship outcomes.

Conclusion: Three forms of housing instability were associated with adverse caregiver and child health among low-income renter households. The American Academy of Pediatrics recommends social screening within health care; providers could consider assessing for behind on rent, multiple moves, and homelessness in high-risk practices.

Setting: 5 urban medical centers from

Sample Size: 22 324 families

Age Range: Caregivers of children 0 to 48 months of age

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

Intervention Description: We interviewed 20571 low-income caregivers of children <4 years old in urban pediatric clinics and/or emergency departments in 5 US cities. Categories of homelessness timing were prenatal, postnatal, both, or never; postnatal duration was >6 months or <6 months.

Intervention Results: After controlling for birth outcomes and other potential confounders, compared with never-homeless children, children who were homeless both pre- and postnatally were at the highest risk of the following: postneonatal hospitalizations (adjusted odds ratio [aOR] 1.41; confidence interval [CI] 1.18–1.69), fair or poor child health (aOR 1.97; CI 1.58–2.47), and developmental delays (aOR 1.48; CI 1.16–1.89). There was no significant association with risk of underweight (aOR 0.95; CI 0.76–1.18) or overweight status (aOR 1.07; CI 0.84–1.37). Children <1 year old with >6 months of homelessness versus those who were never homeless had high risks of fair or poor health (aOR 3.13; CI 2.05–4.79); children 1 to 4 years old who were homeless for >6 months were at risk for fair or poor health (aOR 1.89; CI 1.38–2.58).

Conclusion: After controlling for birth outcomes, the stress of prenatal and postnatal homelessness was found to be associated with an increased risk of adverse pediatric health outcomes relative to those who were never homeless. Interventions to stabilize young families as quickly as possible in adequate and affordable housing may result in improved pediatric health outcomes.

Study Design: cross-sectional study

Setting: 5 US cities

Population of Focus: healthcare professionals & policymakers

Sample Size: 20 571 low-income caregivers of children <4 years old

Age Range: N/A

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

Intervention Description: Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding. Mobile health (mHealth) interventions employing digital technologies provide a rapidly evolving means of engaging fathers and providing them with information and support to address their needs related to both breastfeeding and transitioning to fatherhood. The Parent Infant Feeding Initiative (PIFI) was a 4-arm, randomized controlled trial conducted in Perth, Australia. The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes. The primary outcomes were duration of exclusive and any breastfeeding. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions.

Intervention Results: A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers.

Conclusion: This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports.

Study Design: RCT

Setting: Antenatal breastfeeding class/Online

Population of Focus: Couples from public and private hospitals in Perth, Australia

Sample Size: 1426 couples

Age Range: Adults 18 years and older

Intervention Components (click on component to see a list of all articles that use that intervention): COMMUNITY, Social Supports

Intervention Description: Year 8 girls nominated other girls in their year who are likely to be influential (e.g. who they look up to, are good listeners); the 18% most nominated were invited to be peer supporters (PSs). PSs attended 2 consecutive days of training (plus a top-up day 5 weeks later) outside the school site, led by pairs of PS trainers, to increase their knowledge about PA and their capabilities and confidence to promote PA in their friendship group.

Intervention Results: Six schools were recruited: four PLAN-A (n = 269) and two control (n = 158). In total, 94.7% of Year 8 girls participated. A total of 55 (17–24% of Year 8 girls) PSs were trained (attendance rate 91–100%). Five girls were trained as PS trainers. Questionnaire data provision exceeded 92% at all time points. Accelerometer return rates were > 85% and wear-time criteria were met by 83%, 71% and 62% of participants at T0, T1 and T2, respectively. Mean weekday MVPA did not differ between intervention arms at T1 (1.1 minutes, 95% CI –4.3 to 6.5 minutes) but did at T2 (6.1 minutes, 95% CI 1.4 to 10.8 minutes), favouring PLAN-A. The mean cost of intervention delivery was £2685 per school or £37 per Year 8 girl. Process evaluation identified good fidelity, engagement and enjoyment of the PS training and peer-support strategies. PSs needed more guidance on how to start conversations.

Conclusion: Informal peer-led intervention approaches, such as PLAN-A, hold promise as a means of promoting PA to adolescent girls.

Study Design: RCT

Setting: 6 secondary schools

Population of Focus: Girls aged 12-13

Data Source: Accelerometer and questionnaire; PS training attendance; minutes of moderate to vigorous PA (MVPA)

Sample Size: 269 experimental and158 control

Age Range: Ages 12-13

Intervention Components (click on component to see a list of all articles that use that intervention): COMMUNITY, Social Supports

Intervention Description: A two-arm cluster randomised controlled feasibility study was conducted in six English secondary schools (4 intervention & 2 control). Year 8 (age 12-13) girls were eligible and randomisation was at school-level. The intervention involved training Year 8 girls (out of school for two consecutive days, plus one top-up day 5 weeks later), who were identified by their peers as influential, to provide informal support to their friends to increase their physical activity. Feasibility of the intervention and the research was examined, including: recruitment, training attendance and data provision rates, evidence of promise of the intervention to affect weekday moderate-to-vigorous physical activity (MVPA), intervention cost and estimation of the sample size for a definitive trial. Accelerometer and questionnaire data were collected at the beginning of Year 8 (Time 0), the end of Year 8 (10-weeks after peer-supporter training) and the beginning of Year 9 (Time 2).

Intervention Results: Four hundred twenty-seven girls were recruited (95% recruitment rate). 55 girls consented to be a peer-supporter and 53 peer-supporters were trained (97% of those invited). Accelerometer return rates exceeded 85% at each time point and wear time criteria was met by 83%, 71% and 62% participants at Time 0, 1 and 2 respectively. Questionnaire data were provided by >91% of participants at each time point. Complete-case adjusted linear regression analysis showed evidence of a 6.09 minute (95% CI = 1.43, 10.76) between-arms difference in weekday MVPA at Time 2 in favour of the intervention arm. On average PLAN-A cost £2685 per school to deliver (£37 per Year 8 girl). There were no adverse events. A trial involving 20 schools would be adequately powered to detect a between-arms difference in weekday MVPA of at least six minutes.

Conclusion: The PLAN-A intervention adopts a novel peer-led approach, is feasible, and shows evidence of promise to positively affect girls' physical activity levels. A definitive trial is warranted.

Study Design: Two-arm cluster RCT

Setting: Six secondary schools

Population of Focus: Secondary school girls

Data Source: Accelerometer; questionnaire

Sample Size: 427 girls

Age Range: Ages 12-13

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

Intervention Description: The Iowa Department of Public Health’s 1st Five Healthy Mental Development Initiative is bridging public and private health care systems to improve early detection of social-emotional delays and prevention of mental health problems among young children and their families. Key features of the 1st Five model include: user-friendly mental and developmental health screening and referral forms; ongoing education and support for medical office staff on healthy development and use of screening and referral tools; specially trained care coordinators to identify and address a wide range of children’s and families’ needs; relationships with community resources that provide early intervention; and timely notification of outcomes to the referring physician offices.

Intervention Results: With an evaluation under way, early 1st Five experience indicates that families identified through the program have a range of unmet needs: each physician referral results in an average of three to five follow-up referrals for services.

Conclusion: The early experience in Iowa indicates that there are substantial opportunities to improve early detection of social–emotional delays and problems and prevention of mental health problems by strengthening the connection between physicians and the public health system and providing comprehensive care coordination. This requires building relationships and changing mindsets and practices at the community and clinic level. It requires modest funding and does not happen overnight. An ongoing evaluation of the 1st Five initiative will yield important evidence about the benefits and challenges of this approach. If early indications are borne out, adoption and replication in other communities and states may be warranted. The Iowa model itself is adapted from similar programs in North Carolina and Connecticut. The model can be a “win-win-win” situation. It can provide overburdened primary care physicians and their staff with the knowledge and tools to identify at-risk patients and make easy, fast referrals, with the assurance that they will be informed of the outcomes. It can also allow the public health system to better perform its surveillance and early intervention functions. Finally, it can provide critical treatment and relief to young children and their families, alleviating or avoiding exacerbation of early developmental problems and other family crises and enhancing the likelihood of a healthy, productive future.

Study Design: N/A

Setting: Iowa

Data Source: the Child and Family Policy Center,

Sample Size: N/A

Age Range: young children ages 0 to 5 years and their families,

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

Intervention Description: Design: Participants were randomly assigned to: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline. Settings: The study recruited a community-based sample from homeless service agencies and advertisements in a large Midwestern city. Participants: The study recruited two hundred forty (N = 240) women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care. Measurements: We measured frequency of alcohol and drug use using the Form 90 semi-structured interview, and self-efficacy using Pearlin and Schooler's (1978) 7-item Mastery Scale.

Intervention Results: mothers showed significant improvement in substance use and self-efficacy over time in each condition. However, as expected, patterns of change differentiated intervention groups with more mothers showing better substance use and self-efficacy outcomes in housing + supportive services than in SAU. Unexpectedly, more mothers in SAU showed better outcomes than those in housing-only.

Conclusion: Substance use decreased and self-efficacy increased over time, but patterns of change characterized the intervention groups. In particular, findings suggest that when providing housing to this population, supportive services should also be offered.

Setting: large Midwestern city

Sample Size: (1) housing + support services (n = 80), (2) housing-only (n = 80), or (3) services as usual (SAU) (n = 80) and were re-assessed at 3-, 6-, 9- and 12-months postbaseline.

Age Range: women between the ages of 18 to 24 years, experiencing homelessness and with a substance use disorder (SUD) who also had a biological child under the age of 6 years in their care.

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

Intervention Description: We used a semistructured interview protocol with three sections that solicited participants accounts of family housing and homelessness chronologically, beginning with the circumstances that led to their current episode of homelessness (e.g., Thinking back over the past few months, what is it that brought you to the shelter?), the experiences and impacts of their current episode of homelessness (e.g., What has your stay been like here at the shelter?; How has it been for you/your children?; Since you’ve been here, has there been any change in your relationship(s) with your child(ren)?), and their expectations and concerns for the future when they obtain housing (e.g., As you think ahead to your move back to the community, what are the things you are hopeful about or looking forward to?; Are there things you are concerned or nervous about?). Interviews were conducted by trained interviewers who were graduate students in psychology or who had prior experience interviewing vulnerable people. Initial interviews were reviewed by the first author to verify the quality of the interviews and to provide guidance as needed. Interviewers also completed interview summary forms (Miles et al., 2014) to provide additional information on each interview (e.g., main issues or themes from the interview, information gained or not gained from the interview, issues or questions that could be pursued in future interviews).

Intervention Results: Findings showed that families’ experiences prior to their homelessness were characterized by vulnerability, instability, and isolation. In the emergency shelter system, families faced new challenges in environments that were restrictive, noisy, chaotic, and afforded little privacy. Participants described a further disruption of relationships and described having to change their family practices and routines.

Conclusion: Future research is needed on ways in which shelters can be more hospitable, supportive, and helpful for parents and their families to minimize negative impacts and facilitate timely rehousing of families.

Study Design: qualitative study

Setting: Canada

Sample Size: n=18

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

Intervention Description: 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