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Acad Pediatr. 2018 May - Jun;18(4):460-467. doi: 10.1016/j.acap.2018.01.008. Epub 2018 Jan 31.

Screening for Behavioral Risk Factors Is Not Enough to Improve Preventive Services Delivery.

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Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Mass; Harvard-wide Pediatric Health Services Research Fellowship, Boston, Mass. Electronic address:
Division of General Academic Pediatrics, Massachusetts General Hospital, Boston, Mass; Julius B. Richmond Center of Excellence, American Academy of Pediatrics, Elk Grove Village, Ill.



Unhealthy behaviors are a major cause of chronic disease. Preappointment screening has been suggested as one way to improve preventive care delivery related to these behaviors by specifying risks to be addressed. We aimed to determine whether screening for health-related behaviors before the clinical encounter will lead to higher counseling rate and service delivery by clinicians.


We used a pre/post design in one practice with a control practice to evaluate the effects of preappointment screening for 3 behavioral risk factors (tobacco smoke exposure, no recent dental care visit, and consumption of sugar-sweetened beverages). After their clinic visit, we asked English-speaking parents whose child had one or more risk factor whether they had received counseling or services from their pediatrician to address them.


We recruited 264 parents in the pre phase and 242 in the post phase. Among 215 parents whose child had one or more risk factors, parents in the post phase were as likely to report receiving counseling than parents in the pre phase for each of the risk factors: smoking odds ratio 6.75 (95% confidence interval, 0.51, 88.88), dental health odds ratio 1.44 (95% confidence interval, 0.47, 4.41), and sugar-sweetened beverage consumption odds ratio 0.34 (95% confidence interval, 0.23, 5.18). Service delivery and reported behavior change were also similar in both phases.


Counseling rates for tobacco, dental health, or sugar-sweetened beverage consumption were low in pediatric primary care, and preappointment screening did not significantly affect clinician counseling. Future efforts will require a more robust approach to effect change in counseling, provision of service, and family behavior.


counseling; dental health services; preventive health services; sugar-sweetened beverages; tobacco


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