We conducted a randomized controlled trial to determine whether a home-based intervention program could reduce infant passive smoking and lower respiratory illness. The intervention consisted of four nurse home visits during the first 6 months of life, designed to assist families to reduce the infant's exposure to tobacco smoke. Among the 121 infants of smoking mothers who completed the study, there was a significant difference in trend over the year between the intervention and the control groups in the amount of exposure to tobacco smoke; infants in the intervention group were exposed to 5.9 fewer cigarettes per day at 12 months. There was no group difference in infant urine cotinine excretion. The prevalence of persistent lower respiratory symptoms was lower among intervention-group infants of smoking mothers whose head of household had no education beyond high school: intervention group, 14.6%; and controls, 34.0%.

ABSTRACT. Objective. Rates of childhood immunizations and other preventive services are lower in many practices than national goals and providers' own estimates. Office systems have been used in adult settings to improve the delivery of preventive care, but their effectiveness in pediatric practices is unknown. This study was designed to determine whether a group of primary care practices in 1 community could implement officebased quality improvement systems that would significantly improve their delivery of childhood preventive services. The study was part of a larger community-wide intervention study reported in a preceding study.Methods. All the major providers of primary care to children in 1 community were recruited and agreed to participate (N ‫؍‬ 8 practices). Project staff worked onsite with improvement teams in each practice to develop tailored systems to assess and improve the delivery of immunizations and screening for anemia, tuberculosis, and lead exposure. Office-based quality improvement systems typically involved some combination of chart prescreening, risk assessment forms, Post-it prompts, flowsheets, reminder/recall systems, and patient education materials. Office systems also often involved redistributing responsibilities among office staff.Results. All 8 participating practices created improvement teams. Project staff met with the practices 10 to 15 times over 12 months. After the period of office assistance, the overall rates for all preventive services except tuberculosis screening increased by amounts that were both clinically and statistically significant. Absolute percent improvements included: complete immunizations at 12 months, 7%; complete immunizations at 24 months, 12%; anemia screening, 30%; lead screening, 36%. The amount of improvement achieved varied considerably between practices.Conclusions. Office systems and the principles of quality improvement that underlie them seem to be effective in improving the delivery of childhood preventive services. Important predisposing factors may exist within practices that affect the likelihood that an individual practice will make significant improvements. Pediatrics 2001;108(3). URL: http://www.pediatrics.org/ cgi/content/full/108/3/e41; prevention, immunizations, improvement, office systems, primary care.ABBREVIATIONS. TB, tuberculosis; HMO, health maintenance organization; RN, registered nurse; F/U, follow-up. P reventive services are the cornerstone of pediatric primary care. The American Academy of Pediatrics, the American Academy of Family Physicians, and other national organizations recommend a complex array of anticipatory guidance, risk assessment, screening, and immunizations to prevent injury and disease in children. 1,2 However, rates of most preventive services fall below national goals, and there is wide variation in these rates between practices. Deficits in immunization delivery have received most attention, but studies have found similar performance gaps for anemia, lead, tuberculosis (TB), and vision screening. 1,3 Many i...

OBJECTIVES. Infants from families of low socioeconomic status are said to suffer higher rates of lower respiratory illness, but this assertion has not been carefully examined. METHODS. We studied the frequency and determinants of lower respiratory illness in infants of different socioeconomic status (n = 393) by analyzing data from a community-based cohort study of respiratory illness during the first year of life in central North Carolina. RESULTS. The incidence of lower respiratory illness was 1.41 in the low socioeconomic group, 1.26 in the middle group, and 0.67 in the high group. The prevalence of persistent respiratory symptoms was 39% in infants in the low socioeconomic group, 24% in infants in the middle group, and 14% in infants in the high group. The odds of persistent respiratory symptoms in infants of low and middle socioeconomic status were reduced after controlling for environmental risk factors for lower respiratory illness. Enrollment in day care was associated with an increased risk of persistent symptoms among infants of high but not low socioeconomic status. CONCLUSIONS. Infants of low socioeconomic status are at increased risk of persistent respiratory symptoms. This risk can be partly attributed to environmental exposures, most of which could be changed.

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This study employed 2 methods to assess the attitudes of 52 general early childhood teachers serving young children with disabilities in inclusive early childhood settings. The first consisted of a structured interview using an index of functional child characteristics to assess professional comfort in serving an individual child. The second consisted of a rating scale to assess global attitudes toward the benefits and drawbacks of inclusion. Findings indicated significant differences in teachers' comfort levels as a function of severity of the child's disability across all domains. Predicted comfort scores were lowest when the child was reported to have severe to profound disabilities in the areas of leg functioning, muscle tone, and appropriate behavior.Inclusive programming for young children with disabilities and their families is still considered by many to be an innovative practice. Previous research suggests that, among the many factors that determine successful implementation of innovation in the schools, teacher attitudes play a central role (Stein & Wang, 1988). Although a number of studies have documented that parents of preschoolers with and without disabilities, particularly parents of children who participated in an inclusive setting very little is known about the attitudes of general early childhood personnel toward the inclusion of young children with disabilities in general child care and preschool programs.Volk and Stalhman (1994) speculated that attitudes toward inclusion among general early childhood personnel could range from concern about self-competence in meeting individual needs to feelings of sympathy and sadness for a child or resentment about having to assume additional responsibilities and learn new skills.The majority of studies examining adult attitudes toward individuals with disabilities can be divided into two groups. Initial studies involved measures of attitudes toward disabilities or disability subgroups using broad categories (e.g., mentally retarded, deaf, physically disabled; Antonek & Livneh, 1988). This approach has been criticized because of differences in how categorical labels are used and interpreted and because of the variability that exists among individuals with the same disability label (Home, 1985; Ward & Center, 1987).