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Beyond the clinic: improving child health through evidence-based community development.

Komro KA, Tobler AL, Delisle AL, O'Mara RJ, Wagenaar AC - BMC Pediatr (2013)

Bottom Line: We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health.We did not limit the review to studies conducted in the United States, but the vast majority of them were U.S.-based, and the results therefore are most applicable to the U.S. context.Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Outcomes and Policy, Institute for Child Health Policy, University of Florida, 1329 SW 16th St, Rm 5285, PO Box 100177, Gainesville, FL 32610-01, USA. komro@ufl.edu.

ABSTRACT

Background: Promoting child wellbeing necessarily goes beyond the clinic as risks to child health and development are embedded in the social and physical environmental conditions in which children live. Pediatricians play a vital role in promoting the health of children in the communities they serve and can maximize their impact by advocating for and supporting efficacious, evidence-based strategies in their communities.

Methods: To provide a succinct guide for community pediatric efforts to advance the wellbeing of all children and particularly disadvantaged children in a community, we conducted a theory-driven and structured narrative review to synthesize published systematic and meta-analytic reviews of policy-relevant, local-level strategies addressing potent and malleable influences on child health and development. An exhaustive list of policy-relevant, local-level strategies for improving child health was used to conduct a comprehensive search of recent (1990-2012), English language peer-reviewed published meta-analyses and systematic reviews in the 10 core databases of scientific literature. Our review of the literature encompassed six key conceptual domains of intervention foci, including distal influences of child health (i.e., income and resources, social cohesion, and physical environment) and proximal influences (i.e., family, school and peer). We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health.

Results: Published reviews were identified for 98 distinct policy-relevant community interventions, evaluated across 288 outcomes. We classified 46 strategies as meeting scientific criteria for efficacy by having consistent, positive outcomes from high-quality trials (e.g., tenant-based rental assistance, neighborhood watch programs, urban design and land use policies, access to quality childcare services, class size reductions, after-school programs that promote personal/social skills). Another 21 strategies were classified as having consistent evidence of positive outcomes from high-quality observational studies only, while 28 strategies had insufficient evidence available to assess their effectiveness based on published reviews. We did not limit the review to studies conducted in the United States, but the vast majority of them were U.S.-based, and the results therefore are most applicable to the U.S. context.

Conclusions: Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.

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Policy-relevant community strategies for improving child health and development. Note. aIntervention domains and outcome categories are defined by science-based framework for promoting child health and development within distressed neighborhoods (Figure 1). bStrategy meets criteria for efficacy based on a minimum of 2 high-quality trials (Level 1).
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Figure 2: Policy-relevant community strategies for improving child health and development. Note. aIntervention domains and outcome categories are defined by science-based framework for promoting child health and development within distressed neighborhoods (Figure 1). bStrategy meets criteria for efficacy based on a minimum of 2 high-quality trials (Level 1).

Mentions: Figure 2 summarizes the 46 most efficacious (Level 1) strategies and their studied outcomes. Ten of these efficacious strategies showed medium to large effect sizes in improving child physical health: access to places for physical activity, alcoholic beverage excise taxes, alcohol outlet density, bicycle helmet use, graduated driver licensing, prenatal micronutrient supplementation, quality preschool/early childhood education, sexual health education and contraceptive interventions, street lighting, and water fluoridation. An additional 14 strategies showed medium to large effect sizes in improving primary child outcomes other than physical health (i.e., cognitive development, social/emotional competence, and absence of psychological and behavioral problems): access to affordable (or free) child health care, after school programs that include academic support, after-school programs that promote personal/social skills, booster seat use, kinship care when taken from home, mentoring programs, parent involvement in child’s education, safety belt laws and enforcement, school nutrition standards for school lunch programs, school-based efforts to reduce bullying, school-based physical activity programs, smoke-free policies, urban design and land use, and volunteer tutoring programs. Two promising strategies (i.e., after school programs that promote personal/social skills, quality preschool/early childhood education) showed small to large effect sizes across a wide range of distal, proximal, and primary child health outcomes.


Beyond the clinic: improving child health through evidence-based community development.

Komro KA, Tobler AL, Delisle AL, O'Mara RJ, Wagenaar AC - BMC Pediatr (2013)

Policy-relevant community strategies for improving child health and development. Note. aIntervention domains and outcome categories are defined by science-based framework for promoting child health and development within distressed neighborhoods (Figure 1). bStrategy meets criteria for efficacy based on a minimum of 2 high-quality trials (Level 1).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016148&req=5

Figure 2: Policy-relevant community strategies for improving child health and development. Note. aIntervention domains and outcome categories are defined by science-based framework for promoting child health and development within distressed neighborhoods (Figure 1). bStrategy meets criteria for efficacy based on a minimum of 2 high-quality trials (Level 1).
Mentions: Figure 2 summarizes the 46 most efficacious (Level 1) strategies and their studied outcomes. Ten of these efficacious strategies showed medium to large effect sizes in improving child physical health: access to places for physical activity, alcoholic beverage excise taxes, alcohol outlet density, bicycle helmet use, graduated driver licensing, prenatal micronutrient supplementation, quality preschool/early childhood education, sexual health education and contraceptive interventions, street lighting, and water fluoridation. An additional 14 strategies showed medium to large effect sizes in improving primary child outcomes other than physical health (i.e., cognitive development, social/emotional competence, and absence of psychological and behavioral problems): access to affordable (or free) child health care, after school programs that include academic support, after-school programs that promote personal/social skills, booster seat use, kinship care when taken from home, mentoring programs, parent involvement in child’s education, safety belt laws and enforcement, school nutrition standards for school lunch programs, school-based efforts to reduce bullying, school-based physical activity programs, smoke-free policies, urban design and land use, and volunteer tutoring programs. Two promising strategies (i.e., after school programs that promote personal/social skills, quality preschool/early childhood education) showed small to large effect sizes across a wide range of distal, proximal, and primary child health outcomes.

Bottom Line: We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health.We did not limit the review to studies conducted in the United States, but the vast majority of them were U.S.-based, and the results therefore are most applicable to the U.S. context.Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Outcomes and Policy, Institute for Child Health Policy, University of Florida, 1329 SW 16th St, Rm 5285, PO Box 100177, Gainesville, FL 32610-01, USA. komro@ufl.edu.

ABSTRACT

Background: Promoting child wellbeing necessarily goes beyond the clinic as risks to child health and development are embedded in the social and physical environmental conditions in which children live. Pediatricians play a vital role in promoting the health of children in the communities they serve and can maximize their impact by advocating for and supporting efficacious, evidence-based strategies in their communities.

Methods: To provide a succinct guide for community pediatric efforts to advance the wellbeing of all children and particularly disadvantaged children in a community, we conducted a theory-driven and structured narrative review to synthesize published systematic and meta-analytic reviews of policy-relevant, local-level strategies addressing potent and malleable influences on child health and development. An exhaustive list of policy-relevant, local-level strategies for improving child health was used to conduct a comprehensive search of recent (1990-2012), English language peer-reviewed published meta-analyses and systematic reviews in the 10 core databases of scientific literature. Our review of the literature encompassed six key conceptual domains of intervention foci, including distal influences of child health (i.e., income and resources, social cohesion, and physical environment) and proximal influences (i.e., family, school and peer). We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health.

Results: Published reviews were identified for 98 distinct policy-relevant community interventions, evaluated across 288 outcomes. We classified 46 strategies as meeting scientific criteria for efficacy by having consistent, positive outcomes from high-quality trials (e.g., tenant-based rental assistance, neighborhood watch programs, urban design and land use policies, access to quality childcare services, class size reductions, after-school programs that promote personal/social skills). Another 21 strategies were classified as having consistent evidence of positive outcomes from high-quality observational studies only, while 28 strategies had insufficient evidence available to assess their effectiveness based on published reviews. We did not limit the review to studies conducted in the United States, but the vast majority of them were U.S.-based, and the results therefore are most applicable to the U.S. context.

Conclusions: Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.

Show MeSH
Related in: MedlinePlus