Behavioral interventions and counseling to prevent child abuse and neglect: a systematic review to update the u.s. Preventive services task force recommendation.

Ann Intern Med. 2013 Feb 5;158(3):179-90. doi:
10.7326/0003-4819-158-3-201302050-00590.
Selph SS, Bougatsos C, Blazina I, Nelson HD.

BACKGROUND: In 2004, the U.S. Preventive Services Task Force determined that
evidence was insufficient to recommend behavioral interventions and counseling to
prevent child abuse and neglect.
PURPOSE: To review new evidence on the effectiveness of behavioral interventions 
and counseling in health care settings for reducing child abuse and neglect and
related health outcomes, as well as adverse effects of interventions.
DATA SOURCES: MEDLINE and PsycINFO (January 2002 to June 2012), Cochrane Central 
Register of Controlled Trials and Cochrane Database of Systematic Reviews
(through the second quarter of 2012), Scopus, and reference lists.
STUDY SELECTION: English-language trials of the effectiveness of behavioral
interventions and counseling and studies of any design about adverse effects.
DATA EXTRACTION: Investigators extracted data about study populations, designs,
and outcomes and rated study quality using established criteria.
DATA SYNTHESIS: Eleven fair-quality randomized trials of interventions and no
studies of adverse effects met inclusion criteria. A trial of risk assessment and
interventions for abuse and neglect in pediatric clinics for families with
children aged 5 years or younger indicated reduced physical assault, Child
Protective Services (CPS) reports, nonadherence to medical care, and immunization
delay among screened children. Ten trials of early childhood home visitation
reported reduced CPS reports, emergency department visits, hospitalizations, and 
self-reports of abuse and improved adherence to immunizations and well-child
care, although results were inconsistent.
LIMITATION: Trials were limited by heterogeneity, low adherence, high loss to
follow-up, and lack of standardized measures.
CONCLUSION: Risk assessment and behavioral interventions in pediatric clinics
reduced abuse and neglect outcomes for young children. Early childhood home
visitation also reduced abuse and neglect, but results were inconsistent.
Additional research on interventions to prevent child abuse and neglect is
needed.
PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.

Primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents: a systematic evidence review for the u.s. Preventive services task force.

Patnode CD, O`Connor E, Whitlock EP, et al.

Ann Intern Med. 2013 Feb 19;158(4):253-60. doi: 10.7326/0003-4819-158-4-201302190-00580. (Review) PMID: 23229625

BACKGROUND: Interventions to prevent smoking uptake or encourage cessation among young persons might help prevent tobacco-related illness.

PURPOSE: To review the evidence for the efficacy and harms of primary care-relevant interventions that aim to reduce tobacco use among children and adolescents.

DATA SOURCES: Three systematic reviews that collectively covered the relevant literature; MEDLINE, PsycINFO, the Cochrane Central Register of Controlled Trials, and the Database of Abstracts of Reviews of Effects through 14 September 2012; and manual searches of reference lists and gray literature.

STUDY SELECTION: Two investigators independently reviewed 2453 abstracts and 111 full-text articles. English-language trials of behavior-based or medication interventions that were relevant to primary care and reported tobacco use, health outcomes, or harms were included.

DATA EXTRACTION: One investigator abstracted data from good- and fair-quality trials into an evidence table, and a second checked these data.

DATA SYNTHESIS: 19 trials (4 good-quality and 15 fair-quality) that were designed to prevent tobacco use initiation or promote cessation (or both) and reported self-reported smoking status or harms were included. Pooled analyses from a random-effects meta-analysis suggested a 19% relative reduction (risk ratio, 0.81 [95% CI, 0.70 to 0.93]; absolute risk difference, -0.02 [CI, -0.03 to 0.00]) in smoking initiation among participants in behavior-based prevention interventions compared with control participants. Neither behavior-based nor bupropion cessation interventions improved cessation rates. Findings about the harms related to bupropion use were mixed.

LIMITATIONS: No studies reported health outcomes. Interventions and measures were heterogeneous. Most trials examined only cigarette smoking. The body of evidence was largely published 5 to 15 years ago.

CONCLUSION: Primary care-relevant interventions may prevent smoking initiation over 12 months in children and adolescents. 

PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.