title: Caregiver Health Promotion in Pediatric Primary Care Settings: Results of a National Survey.
abstract: To assess practice patterns, barriers, and facilitators related to caregiver health promotion in pediatric primary care settings.
  
  
  
  We conducted a mail-based survey of a nationally representative sample of 1000 children's primary care physicians (trained in pediatrics, family medicine, or medicine-pediatrics). We assessed engagement in 6 caregiver health issues (maternal depression, tobacco use, intimate partner violence, family planning, health insurance, and tetanus, diphtheria, and acellular pertussis immunization status) along with barriers and facilitators related to engagement. We used multivariable logistic regression to identify physician and practice correlates of engagement.
  
  
  
  The response rate was 30%. The majority of respondents (79.3%) regularly addressed at least 3 caregiver health issues during well infant/child visits, most commonly maternal depression, tobacco use, and tetanus, diphtheria, and acellular pertussis immunization immunization status. Screening was the most common activity. In adjusted analyses, pediatricians were less likely to screen for intimate partner violence and family planning compared with other providers. There were no other differences in engagement by physician specialty. Lack of time was the most commonly endorsed barrier (by 85.2% of respondents). Co-location of auxiliary services was the most frequently cited facilitator for the majority of issues.
  
  
  
  Children's primary care physicians and their care teams routinely engage in a variety of activities promoting caregiver health, largely independent of training background and despite multiple practice-related barriers. Co-location of auxiliary services could support the efforts of pediatric care teams. Future efforts that investigate care models which address these barriers and facilitators will help to realize the potential of pediatric settings to impact adult health.
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: mvenkat2@jhmi.edu.
authors.forename: Maya
authors.initials: M
authors.lastname: Venkataramani
authors.affiliation: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Tina L
authors.initials: TL
authors.lastname: Cheng
authors.affiliation: Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Barry S
authors.initials: BS
authors.lastname: Solomon
authors.affiliation: Division of General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Craig Evan
authors.initials: CE
authors.lastname: Pollack
mesh_terms: D000328:Adult; D017028:Caregivers / Q000706:statistics & numerical data*; D002648:Child; D005260:Female; D006293:Health Promotion / Q000706:statistics & numerical data*; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D010372:Pediatrics; D058007:Physicians, Primary Care; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*
keywords: intimate partner violence; maternal depression; parental/guardian health; tobacco use