title: Implementation of the NHLBI integrated guidelines for cardiovascular health and risk reduction in children and adolescents: rationale and study design for young hearts, strong starts, a cluster-randomized trial targeting body mass index, blood pressure, and tobacco.
abstract: BACKGROUND
  Cardiovascular disease (CVD) and the underlying atherosclerosis begin in childhood, and their presence and intensity are related to known cardiovascular disease risk factors. Attention to risk factor control in childhood has the potential to reduce subsequent risk of CVD.
  
  
  OBJECTIVE
  The Young Hearts Strong Starts Study was designed to test strategies facilitating adoption of the National, Heart, Lung and Blood Institute supported Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents. This study compares guideline-based quality measures for body mass index, blood pressure, and tobacco using two strategies: a multifaceted, practice-directed intervention versus standard dissemination.
  
  
  METHODS
  Two primary care research networks recruited practices and provided support for the intervention and outcome evaluations. Individual practices were randomly assigned to the intervention or control groups using a cluster randomized design based on network affiliation, number of clinicians per practice, urban versus nonurban location, and practice type. The units of observation are individual children because measure adherence is abstracted from individual patient's medical records. The units of randomization are physician practices. This results in a multilevel design in which patients are nested within practices. The intervention practices received toolkits and supported guideline implementation including academic detailing, an ongoing e-learning group. This project is aligned with the American Board of Pediatrics Maintenance of Certification requirements including monthly physician self-abstraction, webinars, and other elements of the trial.
  
  
  CONCLUSIONS
  This trial will provide an opportunity to demonstrate tools and strategies to enhance CV prevention in children by guideline-based interventions.
authors.affiliation: RTI International, 1440 Main St Waltham, MA, 02451, USA. Electronic address: klabresh@rti.org.
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: LaBresh
authors.affiliation: Brody School of Medicine, East Carolina University, Departments of Pediatrics and Public Health, 600 Moye Blvd. 174 Life Sciences Bldg., Greenvile, NC 27834. Electronic address: lazoricks@ecu.edu.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Lazorick
authors.affiliation: Pediatric Practice Research Group, Mary Ann & J. Milburn Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital of Chicago Research Center, 225 E. Chicago Ave, Box #157, Chicago, IL, 60611, USA. Electronic address: aariza@luriechildrens.org.
authors.forename: Adolfo J
authors.initials: AJ
authors.lastname: Ariza
authors.affiliation: RTI International, 3040 Cornwallis Rd Cox 319 Research Triangle Park, NC, 27709, USA.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Furberg
authors.affiliation: Brody School of Medicine, East Carolina University, Departments of Pediatrics and Public Health, 600 Moye Blvd. 174 Life Sciences Bldg., Greenvile, NC 27834. Electronic address: lauren.whetstone@cdph.ca.gov.
authors.forename: Lauren
authors.initials: L
authors.lastname: Whetstone
authors.affiliation: RTI International, 3040 Cornwallis Rd Cox 319 Research Triangle Park, NC, 27709, USA.
authors.forename: Connie
authors.initials: C
authors.lastname: Hobbs
authors.affiliation: National Heart, Lung, and Blood Institute, 31 Center Drive, Bethesda, MD, 20892, USA. Electronic address: dejesusjm@mail.nih.gov.
authors.forename: Janet
authors.initials: J
authors.lastname: de Jesus
authors.affiliation: RTI International, 3040 Cornwallis Rd Cox 319 Research Triangle Park, NC, 27709, USA.
authors.forename: Randall H
authors.initials: RH
authors.lastname: Bender
authors.affiliation: Pediatric Practice Research Group, Mary Ann & J. Milburn Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital of Chicago Research Center, 225 E. Chicago Ave, Box #157, Chicago, IL, 60611, USA. Electronic address: ilse.salinas@northwestern.edu.
authors.forename: Ilse G
authors.initials: IG
authors.lastname: Salinas
authors.affiliation: Pediatric Practice Research Group, Mary Ann & J. Milburn Smith Child Health Research Program, Ann & Robert H. Lurie Children's Hospital of Chicago Research Center, 225 E. Chicago Ave, Box #157, Chicago, IL, 60611, USA. Electronic address: hbinns@luriechildrens.org.
authors.forename: Helen J
authors.initials: HJ
authors.lastname: Binns
mesh_terms: D001794:Blood Pressure; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002648:Child; D002675:Child, Preschool; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control* / Q000628:therapy; D008297:Male; D054555:National Heart, Lung, and Blood Institute (U.S.); D009765:Obesity / Q000517:prevention & control / Q000628:therapy; D050177:Overweight / Q000517:prevention & control* / Q000628:therapy; D010372:Pediatrics / Q000592:standards*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care; D040242:Risk Reduction Behavior; D012907:Smoking / Q000628:therapy; D000074606:Smoking Prevention; D014028:Tobacco Smoke Pollution / Q000517:prevention & control*; D014481:United States
chemical_list: D014028:Tobacco Smoke Pollution
keywords: Cardiovascular disease; Children; Cluster randomized trial; Guideline implementation; Prevention; Quality improvement