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Author Notes:

Kelli A. Komro: komro@ufl.edu

KK, AT and AW participated in the conceptualization of the study concept and design.

AD and AT participated in the acquisition of data.

AT, RO, AD, KK and AW participated in the analysis and interpretation of data.

AT, RO, AD and KK drafted the manuscript.

KK, AW, RO and AT participated in critical revision of the manuscript for important intellectual content.

KK and AT supervised the study.

All authors read and approved the final manuscript.

The authors declare that they have no competing interests.


Research Funding:

A grant from the National Institute on Drug Abuse (DA028946; PIs: Anthony Biglan and Brian Flay) supported the authors during their work on this manuscript, as part of the Promise Neighborhoods Research Consortium (PNRC).

The PNRC (scientists from a range of disciplines, research assistants, other professionals, and neighborhood-based representatives) contributed through discussions, review and feedback.

The Institute for Child Health Policy at the University of Florida provided predoctoral fellowships for A.L. Delisle and R.J. O’Mara, which supported their work on this manuscript.


  • Science & Technology
  • Life Sciences & Biomedicine
  • Pediatrics
  • Child
  • Adolescent
  • Health promotion
  • Policy
  • Evidence-based practice
  • Review

Beyond the clinic: improving child health through evidence-based community development


Journal Title:

BMC Pediatrics


Volume 13, Number 1


, Pages 172-172

Type of Work:

Article | Final Publisher PDF


Background: Promoting child wellbeing necessarily goes beyond the clinic as risks to child health and development are embedded in the social and physical environmental conditions in which children live. Pediatricians play a vital role in promoting the health of children in the communities they serve and can maximize their impact by advocating for and supporting efficacious, evidence-based strategies in their communities.Methods: To provide a succinct guide for community pediatric efforts to advance the wellbeing of all children and particularly disadvantaged children in a community, we conducted a theory-driven and structured narrative review to synthesize published systematic and meta-analytic reviews of policy-relevant, local-level strategies addressing potent and malleable influences on child health and development. An exhaustive list of policy-relevant, local-level strategies for improving child health was used to conduct a comprehensive search of recent (1990-2012), English language peer-reviewed published meta-analyses and systematic reviews in the 10 core databases of scientific literature. Our review of the literature encompassed six key conceptual domains of intervention foci, including distal influences of child health (i.e., income and resources, social cohesion, and physical environment) and proximal influences (i.e., family, school and peer). We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health.Results: Published reviews were identified for 98 distinct policy-relevant community interventions, evaluated across 288 outcomes. We classified 46 strategies as meeting scientific criteria for efficacy by having consistent, positive outcomes from high-quality trials (e.g., tenant-based rental assistance, neighborhood watch programs, urban design and land use policies, access to quality childcare services, class size reductions, after-school programs that promote personal/social skills). Another 21 strategies were classified as having consistent evidence of positive outcomes from high-quality observational studies only, while 28 strategies had insufficient evidence available to assess their effectiveness based on published reviews. We did not limit the review to studies conducted in the United States, but the vast majority of them were U.S.-based, and the results therefore are most applicable to the U.S. context.Conclusions: Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.

Copyright information:

© 2013 Komro et al.; licensee BioMed Central Ltd.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 2.0 Generic License (https://creativecommons.org/licenses/by/2.0/).
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