1. Pediatric preventive care: What determines whether patients are counseled about health behaviors and injury prevention?
Cynthia Perry and Genevieve Kenney
The Urban Institute
This research was conducted as part of the Assessing New Federalism Project, with funding through the Robert Wood Johnson Foundation.

2. Background
Child health problems (e.g. asthma, overweight) related to child/parent behavior have been increasing over time
Injuries leading cause of medical spending for children
AAP guidelines recommend physicians advise families about health behaviors during routine preventive care, though impacts of counseling demonstrated in only some areas

3. Data and Methods Project 1
Children ages 3-17 with family income <250% of FPL
Key explanatory variable is health insurance group
Examine evidence of targeting to children most in need of advice
Project 2
Children ages 3-17 with one and only visit, and it was preventive
Key explanatory variable is provider type

4. Receipt of Advice, Conditional on Preventive Visit
Among low-income families, Medicaid/SCHIP children more likely than uninsured children to receive advice during preventive visits
Receipt of Advice, Conditional on Preventive Visit %
* Indicates statistically different from Medicaid/SCHIP, p<.05 * * * * * * * * *

5. Among low-income families, eating and exercise advice is targeted to overweight children
Below 85th Percentile BMI-for-Age
Above 85th Percentile BMI-for-Age % % + + + + + * * * * * * * * * *
Medicaid/SCHIP
Private
Uninsured
PY Uninsured
* Indicates statistically different from Medicaid/SCHIP, p<.05
+ Indicates statistically different from children below 85th percentile, p<.05

6. Receipt of advice about harmful effects of smoking
Among low-income families, smoking advice targeted to those with parents who smoke %
Receipt of advice about harmful effects of smoking + + * * * * * *
* Indicates statistically different from Medicaid/SCHIP, p<.05
+ Indicates statistically different from families without smokers, p<.05

7. Pediatricians more likely than other providers to advise children
Receipt of Advice, Conditional on Preventive Visit %
* Indicates statistically different from Pediatrician, p<.10 * * * * * * * *

8. Policy Implications
Enrolling children in Medicaid/SCHIP could increase rates of preventive care and receipt of advice
Low counseling rates, even for at risk groups, among children who received preventive care suggest need for well-child reform
Pediatricians more likely to advise than non-physician providers in all areas
Suggests need for well-child reform
Change reimbursement structure?
Increased emphasis on advice?
More individualized well-child care?
Team approach using non-physicians?