American journal of preventive medicine
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Pragmatic Clinical Trial
Perspectives in Implementing a Pragmatic Pediatric Primary Care-Based Intervention Trial.
The 2013 U. S. Preventive Services Task Force (USPSTF) concluded that behavioral interventions are effective in reducing initiation of smoking in youth, recommending primary care clinicians provide education or brief counseling to prevent initiation, and that there are promising trends toward behavioral interventions improving cessation in this population. ⋯ Such an assessment assists researchers by providing a framework to guide decisions regarding study design and implementation. We then share a few principles and lessons learned in developing and implementing the primary care-based intervention trial, focusing on study setting selection, engaging providers who will be delivering the intervention and the target population who will be receiving it in designing the trial and interventions to be tested, and the need to carefully plan recruitment and retention procedures. The hope is to increase the number of well-designed studies that can be included in the evidence reviews to guide future USPSTF recommendation statements.
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The importance of behavioral counseling as a clinical preventive service derives from the social and economic burden of preventable disease in the U. S., the central role behavioral risk factors play as leading causes of premature morbidity and mortality, and the promise of the healthcare visit as a teachable moment for behavioral counseling support. In November 2013, the U. ⋯ Special focus is on the development and evaluation of evidence from systematic reviews. Assessment of the net benefit of a behavioral counseling intervention, based on the evidence review, determines the recommendation statement and accompanying letter grade. A recent Task Force recommendation on screening and behavioral counseling interventions in primary care to reduce alcohol misuse provides a brief example.
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Exposure to adult intimate partner violence (IPV) places youth at risk for a range of outcomes, including perpetration of adolescent dating violence (ADV). However, there is variability in the effect of IPV exposure, as many youth who are exposed to IPV do not go on to exhibit problems. Thus, research is needed to examine contextual factors, such as parenting practices, to more fully explain heterogeneity in outcomes and better predict ADV perpetration. The current research draws from a multisite study to investigate the predictive power of IPV exposure and parenting practices on subsequent ADV perpetration. ⋯ Results fill a critical gap in understanding of important targets to prevent ADV in middle school and highlight the important role that parents may play in ADV prevention.
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Educational interventions can help increase knowledge of available contraceptive methods, enabling individuals to make informed decisions and use contraception more effectively. This systematic review evaluated contraceptive education interventions to guide national recommendations on quality family planning services. ⋯ Results from this systematic review are consistent with evidence from the broader healthcare field suggesting that a range of educational interventions can increase knowledge. Future studies should assess what aspects of educational interventions are most effective, the extent to which it is necessary to include a healthcare provider or educator, and the extent to which educational interventions can impact behaviors.