Evidence From the USPSTF and New Approaches to Evaluate Interventions to Prevent Child Maltreatment.

Importance: The United States Preventive Services Task Force (USPSTF) has considered the topic of prevention of child maltreatment multiple times over its nearly 40-year history, each time reaching the conclusion that the evidence is insufficient to recommend for or against interventions aimed at preventing this important health problem with significant negative sequelae before it occurs. In the most recent evidence review, which was conducted from August 2021 to November 2023 and published in March 2024, the USPSTF considered contextual questions on the evidence for bias in reporting and diagnosis of maltreatment in addition to key questions regarding effectiveness of interventions to prevent child maltreatment.

Observations: A comprehensive literature review found evidence of inaccuracies in risk assessment and racial and ethnic bias in the reporting of child maltreatment and in the evaluation of injuries concerning for maltreatment, such as skull fractures.

Primary Care Clinicians in Low-Access Counties.

Advanced practice providers comprise an increasing percentage of the health care and primary care workforce. This paper evaluates the weighted contribution of advanced practice providers to the primary care workforce in well-served and underserved counties across North Carolina using age- and sex-adjusted population measures of access.

A System for Health, Not a Health Care System.

Clinical care makes a modest contribution to well-being, but adequate access to high-quality care is a necessary, if insufficient, condition for health. This issue of the focuses on the Healthy North Carolina 2030 clinical indicators, the impact of health disparities, and the COVID-19 pandemic.

Intention to Engage in Maternal and Child Health Home Visiting.

Home visiting (HV) programs have the potential to improve maternal and child health. As federal and state initiatives expand the reach of these programs, understanding what factors enhance uptake and retention of the services becomes increasingly important. This qualitative study used a Reasoned Action Model (RAM) and a cultural lens to explore factors influencing the engagement of women with low-income in HV programs.

Patterns of Risk and Protective Factors Among Alaska Children: Association With Maternal and Child Well-Being.

This study used population-representative data to examine associations of risk and protective factor patterns among Alaska Native/American Indian (AN/AI; N = 592) and non-Native (N = 1,018) children with maternal and child outcomes at age 3 years. Among AN/AI children, a high risk/moderate protection class was associated with child developmental risk and mothers being less likely to feel comfortable asking for help or knowing where to go for parenting information compared to a low socioeconomic status/high protection class. Among non-Native children, a moderate risk/high protection class was associated with child developmental risk and mothers being less likely to feel comfortable asking for help compared to a low risk/high protection class.

Child-Adult Relationship Enhancement in Primary Care: A Randomized Trial of a Skill-Based Parent Training with Parent Mentor Adaptation.

Introduction: Child-Adult Relationship Enhancement in Primary Care (PriCARE) is a 6-session group training designed to teach positive parenting skills. Parent engagement in such programs is a common implementation barrier. Our objectives were to (1) examine the impact of a peer mentor on attendance and stigma and (2) replicate a previous study by measuring PriCARE's impact on child behavior and parenting practices.

Heterogeneity in Risk and Protection Among Alaska Native/American Indian and Non-Native Children.

Currently, little is known about patterns of co-occurring risk and protective factors among young children. Understanding variations in co-occurring risk and protective factors among children in Alaska is important as experiences of collective trauma may contribute to differences in the intersection of risk and protective factors between Alaska Native/American Indian (AN/AI) and non-Native children. Using data from the Alaska Longitudinal Child Abuse and Neglect Linkage (ALCANLink) project, a linkage of the 2009-2011 Alaska Pregnancy Risk Assessment Monitoring System survey and administrative data sources, and the 2012-2014 Childhood Understanding Behaviors Survey, we conducted latent class analysis to identify classes of AN/AI (N = 593) and non-Native (N = 1018) children in terms of seven risk factors (poverty, maternal depression, maternal binge drinking, parental incarceration, intimate partner violence exposure, other violence exposure, child maltreatment) and four protective factors (father figure involvement, reading by adults, family meals, peer interactions) experienced prior to age 3 years.

Preconception and Prenatal Predictors of Early Experiences of Risk and Protection Among Alaska Children.

Objectives: Our objective was to identify preconception and prenatal predictors of early experiences of co-occurring risk and protective factors to help target prevention efforts to the highest-need families prior to the birth of the child.

Methods: Data were from the Alaska Longitudinal Child Abuse and Neglect Linkage project and the 2012-2014 Alaska Child Understanding Behaviors Survey. We used latent class analysis and Vermunt's three-step approach to examine predictors of latent classes of risk and protective factors among Alaska children.

Public Policy Approaches to Population Health.

The United States spends more per capita on health care than any other country and has worse health outcomes. Public policy can influence almost all aspects of health. Publicly funded insurance pays for health care for more than half of Americans.

Trajectories of child protective services contact among Alaska Native/American Indian and non-Native children.

Background: Contact with child protective services (CPS) functions as an independent marker of child vulnerability. Alaska children are an important population for understanding patterns of CPS contact given high rates of contact overall and among specific demographic groups.

Objective: We aimed to identify longitudinal trajectory classes of CPS contact among Alaska Native/American Indian (AN/AI) and non-Native children and examine preconception and prenatal risk factors associated with identified classes.

Primary Care Interventions to Prevent Child Maltreatment: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Importance: Child maltreatment, also referred to as child abuse and neglect, can result in lifelong negative consequences.

Objective: To update the evidence on interventions provided in or referable from primary care to prevent child maltreatment for the US Preventive Services Task Force.

Data Sources: PubMed, Cochrane Library, EMBASE, and trial registries through December 18, 2017; references; experts; literature surveillance through July 17, 2018.

Intracranial Pressure Monitoring in Infants and Young Children With Traumatic Brain Injury.

Objective: To examine the use of intracranial pressure monitors and treatment for elevated intracranial pressure in children 24 months old or younger with traumatic brain injury in North Carolina between April 2009 and March 2012 and compare this with a similar cohort recruited 2000-2001.

Design: Prospective, observational cohort study.

Setting: Twelve PICUs in North Carolina.

Effectiveness of a Statewide Abusive Head Trauma Prevention Program in North Carolina.

Importance: Abusive head trauma (AHT) is a serious condition, with an incidence of approximately 30 cases per 100,000 person-years in the first year of life.

Objective: To assess the effectiveness of a statewide universal AHT prevention program.

Design, Setting, And Participants: In total, 88.

Corporal punishment.

Corporal punishment is used for discipline in most homes in the United States. It is also associated with a long list of adverse developmental, behavioral, and health-related consequences. Primary care providers, as trusted sources for parenting information, have an opportunity to engage parents in discussions about discipline as early as infancy.

Update on prenatal care.

Many elements of routine prenatal care are based on tradition and lack a firm evidence base; however, some elements are supported by more rigorous studies. Correct dating of the pregnancy is critical to prevent unnecessary inductions and to allow for accurate treatment of preterm labor. Physicians should recommend folic acid supplementation to all women as early as possible, preferably before conception, to reduce the risk of neural tube defects.

National, regional, and state abusive head trauma: application of the CDC algorithm.

Objective: To examine national, regional, and state abusive head trauma (AHT) trends using child hospital discharge data by applying a new coding algorithm developed by the Centers for Disease Control and Prevention (CDC).

Methods: Data from 4 waves of the Kids' Inpatient Database and annual discharge data from North Carolina were used to determine trends in AHT incidence among children <1 year of age between 2000 and 2009. National, regional, and state incidence rates were calculated.