CoChat
Sign Up
Cited by 21Child and Adolescent HealthHealth Promotion and Cardiovascular PreventionAdolescent and Pediatric Healthcare

An ecological model to frame the delivery of pediatric preventive care

Open access
Graif, Corina, Meurer, John, Fontana, Margherita·2021·Pediatrics
DOI 10.1542/peds.2021-050693dPMC PMC8312252
Open this paper in CoChat — free account

Abstract

Screening and surveillance are integral aspects of child health promotion and disease prevention. The American Academy of Pediatrics recommends that primary care clinicians screen children and adolescents for a broad array of conditions, conduct surveillance of growth and development, identify social determinants of health, and identify protective and risk factors that might impact health over time. However, access to and outcomes of preventive services vary based on features of children’s social ecology, including family and community contexts. The proposed five-stage socio-ecological model considers multiple contextual dimensions of pediatric screening: (1) individual, (2) interpersonal, (3) organizational, (4) community/population, and (5) public policy. Incorporating this model into routine care might improve outcomes at the individual and population level. Future endeavors should focus on integration of this model with validated risk screening tools as part of a supportive electronic health record, culture, and incentive structure. Further research assessing the contributors and outcomes of differences in beliefs, resources, practices, and opportunities among individuals, families, providers, primary care organizations, communities, health systems, and policy partners will be essential in advancing knowledge and policies to improve preventive services delivery.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1542/peds.2021-050693d

Cites

5 of 5 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Improving the precision of nutritional assessment, diagnosis, and intervention requires viewing nutrition as a biological variable-a complex system resulting from interactions between internal (biology, health status, developmental stage, genetics) and external (social determinants of health, home, community, physical) environments (a nutritional ecology).

    “In this perspective, we make the case that our ability to improve the precision of assessment, diagnosis, and intervention demands a view of nutrition as a biological variable: a complex system resulting from the interactions between our internal (biology, health status, developmental stage, genetics, etc.) and external (social determinants of health, home, community, physical) environments, i.e.”

    From The Value of Integrating the Nutritional Ecology into the Nutrition Care Continuum—A Conceptual and Systems Approach (2025) · cites this paper as [10]

    Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 56

  1. [6]American Academy of Pediatrics Section of Pediatric Dentistry and Oral Health. Policy Statement: Preventive oral health intervention for pediatricians. Pediatrics. 2008; 122(6): 1387– 1394. 19015205
  2. [7]Mariana A, Graif C, Waters M, SV Subramanian. Health Selection into Neighborhoods among Moving to Opportunity Families. Am J Epidemiol. 2016; 183(2): 130– 7. 26656481 PMC4706680
  3. [8]Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2016; PMC1497553 12815076
  4. [9]Brooks-Gunn J, Duncan GJ, Klebanov PK, Sealand N. Do neighborhoods influence child and adolescent development? Am J Sociol. 1993; 99(2): 353– 395.
  5. [12]Chandra A, Miller CE, Acosta JD, Drivers of health as a shared value: mindset, expectations, sense of community, and civic engagement. Health Aff. 2016; 35(11): 1959– 1963. 27834233
  6. [13]Chou R, Cantor A, Zakher B, Preventing dental caries in children younger than 5 years: systematic review updating USPSTF recommendation. Pediatrics. 2013; 132(2): 332– 350. 23858419
  7. [14]Chou R, Cantor A, Zakher B, Prevention of Dental Caries in Children Younger Than 5 Years Old: Systematic Review to Update the U.S. Preventive Services Task Force Recommendation. Evidence Synthesis No. 104. AHRQ Publication No. 12–05170-EF-1. Rockville, MD: Agency for Healthcare Research and Quality; 2014. 24872964
  8. [15]Christakis DA, Mell L, Koepsell TD, Zimmerman J, Connell FA. Association of lower continuity of care with greater risk of emergency department use and hospitalization in children. Pediatrics. 2001; 103: 524– 529. 11230593
  9. [18]Roux Diez, Ana V. Investigating neighborhood and area effects on health. Am J Public Health. 2001; 91(11): 1783– 1789. 11684601 PMC1446876
  10. [19]Diez Roux AV, Mair C. Neighborhoods and health. Ann NY Acad Sci. 2010; 1186(1): 125– 145. 20201871
  11. [20]Bethell C, Reuland C, Schor E, “ Rates of parent-centered developmental screening: disparities and links to services access.” Pediatrics. 2011; 128(1): 146– 155. 21646266
  12. [21]Edelman MW. The cradle to prison pipeline: An American health crisis. Prev Chronic Dis. 2007; 4(3). PMC1955386 17572947
  13. [22]Edelstein BL, Manski RJ, Moeller JF. Pediatric dental visits during 1996: An analysis of the federal Medical Expenditure Panel Survey. Pediatr Dent. 2000; 22(1): 17– 20. 10730281
  14. [23]Emanuel EJ, Wachter RM. Artificial intelligence in health care: Will the value match the hype? JAMA. 2019; 321(23): 2281– 2282. 31107500
  15. [24]Evans-Whipp T, Beyers JM, Lloyd S, A review of school drug policies and their impact on youth substance use. Health Promot Int. 2004; 19(2): 227– 234. 15128714
  16. [25]Fleming E, Afful J. Prevalence of Total and Untreated Dental Caries Among Youth: United States, 2015–2016. NCHS data brief, Number 307, April 208. Accessed online at: https://www.cdc.gov/nchs/data/databriefs/db307.pdf 29717975
  17. [26]Fontana M, Eckert GJ, Keels MA, Fluoride Use in Healthcare Settings: Association with Children’s Caries Risk. Adv Dent Res 2018, 29(1) 24– 34 29355412 PMC5784481
  18. [27]Fontana M, Eckert GJ, Keels MA, Predicting Caries in Medical Settings-Risk Factors in Diverse Infant Groups. J Dent Res 2019; 98(1): 68– 76. 30205016 PMC6304713
  19. [28]Fontana M, Karimbux NY, Gonzalez Cabezas C, Dental Caries. In Pediatric Infectious Diseases: Essentials for Practice, 2019b, Shah SS, Kemper A, Ratner AJ, eds., McGraw-Hill Education. Section 5, p. 244– 252.
  20. [29]Garg A, Jack B, Zuckerman B. Addressing the Social Determinants of Health Within the Patient-Centered Medical Home. JAMA. 2013; 309(19): 2001– 2002. 23619825
  21. [30]Garg A, Boynton-Jarrett R, Dworkin PH. Avoiding the unintended consequences of screening for social determinants of health. JAMA. 2016; 316(8), 813– 814. 27367226
  22. [31]Graif C, Gladfelter AS, Matthews SA. Urban poverty and neighborhood effects on crime: Incorporating spatial and network perspectives. Sociol Compass. 2014; 8(9): 1140– 1155. 27375773 PMC4928692
  23. [32]Graif C, Matthews S. The Long Arm of Poverty: Extended Geography of Neighborhood Effects on Child Victimization. Justice Q. 2017; 34(6): 1096– 1125. 32523239 PMC7286597
  24. [33]Graif C, Lungenu A, Yetter A. Neighborhood isolation in a Rust Belt city: Violent crime effects on increasing structural isolation and homophily in inter-neighborhood commuting networks. Soc Networks. 2017; 51: 40– 59. 29104357 PMC5663310
  25. [34]Graif C, Gladfelter AS, Matthews SA. Urban Poverty and Neighborhood Effects on Crime: Incorporating Spatial and Network Perspectives. Sociol Compass. 2014; 8: 1140– 1155. 27375773 PMC4928692
  26. [35]Graif C, Arcaya M, Diez Roux A. Moving to Opportunity and Health: Exploring the Spatial Context of Neighborhood Health Effects. Soc Sci Med. 2016; 162: 50– 58. 27337349 PMC4969097
  27. [36]Graif C. Delinquency and Gender Moderation in the Moving to Opportunity Intervention: The Role of Extended Neighborhoods. Criminology. 2015; 53(3): 366– 398.
  28. [37]Griffin SO, Barker LK, Wei L, Use of dental care and effective preventive services in preventing tooth decay among US children and adolescents- Medical expenditure panel survey, United States, 2003–2009 and National Health and Nutrition Examination Survey, United States 2005–2010. MMWR 2014; 63(02): 54– 60. 25208259
  29. [38]Hambidge SJ, Bublitz Emsermann C, Federico S, Steiner JF. Disparities in pediatric preventive care in the United States, 1993–2002. Arch Pediatr Adolesc Med. 2007; 161(1): 30– 36. 17199064
  30. [39]Kassebaum NJ, Bernabe E, Dahiya M, Global burden of untreated caries: A systematic review and meta regression. J Dent Res. 2015; 1– 9. 25740856
  31. [40]Kemper AR, Krist AH, Tseng C-W, Challenges in developing US Preventive Services Task Force child health recommendations. Am J Prev Med. 2018; 54(1): S63– S69. 29254527
  32. [41]Kogan MD, Alexander GR, Teitelbaum MA, The effect of gaps in health insurance on continuity of a regular source of care among pre-school aged children in the United States. JAMA. 1995; 274: 1429– 1435. 7474188
  33. [42]Krieger N, Waterman PD, Chen JT, Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures—the public health disparities geocoding project (US). Public Health Reports. 2016. PMC1497538 12766219
  34. [43]Kristjansson E, Hogg W, Dahrouge S, Predictors of relational continuity in primary care: patient, provider and practice factors. BMC Fam Pract. 2013; 14(72). 23725212 PMC3688290
  35. [44]Lechuga J, Swain GR, Weinhardt LS. The cross-cultural variation of predictors of human papillomavirus vaccination intentions. J Women’s Health. 2011; 20(2): 225– 230. PMC3064873 21314448
  36. [45]Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995; 80– 94. 7560851
  37. [46]Link BG, Northridge ME, Phelan JC, Ganz ML. Social epidemiology and the fundamental cause concept: on the structuring of effective cancer screens by socioeconomic status. Milbank Q. 1998; 76(3): 375– 402. 9738168 PMC2751089
  38. [48]Marinho VCC, Worthington HV, Walsh T, Clarkson JE. Fluoride varnishes for preventing dental caries in children and adolescents. Cochrane Database of Systematic Reviews. 2013; 7(CD002279). PMC10758998 23846772
  39. [49]Milgrom PM, Cunha-Cruz J. Are tooth decay prevention visits in primary care before age 2 years effective? JAMA Pediatr. 2017. 28241192
  40. [50]Moyer VA; US Preventive Services Task Force. Prevention of dental caries in children from birth through age 5 years: US Preventive Services Task Force recommendation statement. Pediatrics. 2014 6; 133(6): 1102– 11. 24799546
  41. [51]NASEM, National Academies of Sciences, Engineering, and Medicine. Parenting Matters: Supporting Parents of Children Ages 0–8. Washington, DC: The National Academies Press, 2016. 27997088
  42. [52]Okunseri C, Szabo A, Garcia RI, Provision of fluoride varnish treatment by medical and dental care providers: variation by race/ethnicity and levels of urban influence. J Public Health Dent. 2010; 70(3): 211– 219. 20459463 PMC2967666
  43. [53]Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010; 51(1): S28– S40. 20943581
  44. [54]Pitts NB, Zero DT, Marsh PD, Dental Caries. Nat Rev Dis Primers. 2017; 3(17030). 28540937
  45. [55]Poortinga W Social relations or social capital? Individual and community health effects of bonding social capital. Soc Sci Med. 2006; 63(1): 255– 270. 16427171
  46. [56]Quiñonez RB, Kranz AM, Lewis CW, Oral Health Opinions and Practices of Pediatricians: Updated Results from a National Survey. Acad Pediatr. 2014; 14(6): 616– 623. 25439160 PMC4254652
  47. [57]Ramey DM. The social structure of criminalized and medicalized school discipline. Sociol Educ. 2015; 88(3): 181– 201.
  48. [58]Robinson LR, Bitsko RH, Thompson RA, CDC Grand Rounds: Addressing Health Disparities in Early Childhood. MMWR. 2017; 66(29): 769– 772. 28749927 PMC5657810
  49. [59]Saultz JW, Lochner J. Interpersonal continuity of care and care outcomes: a critical review. Ann Fam Med. 2005; 3: 159– 166. 15798043 PMC1466859
  50. [60]Sampson RJ, Graif C. Neighborhood social capital as differential social organization: Resident and leadership dimensions. Am Behav Sci. 2009; 52(11): 1579– 1605.
  51. [61]Schinasi LH, Auchincloss AH, Forrest CB, Diez Roux AV. Using electronic health record data for environmental and place based population health research: a systematic review. Ann Epidemiol. 2018; 28(7): 493– 502. 29628285
  52. [62]Tellez M, Gomez J, Pretty I, Evidence on existing caries risk assessment systems: are they predictive of future caries? Comm Dent Oral Epidemiol. 2013; 41: 67– 78. 22978796
  53. [65]Urquhart O, Tampi MP, Pilcher L, Nonrestorative Treatments for Caries: Systematic Review and Network Meta-analysis. J Dent Res. 2019; 98(1): 14– 26. 30290130 PMC6304695
  54. [66]Weyant RJ, Tracy SL, Anselmo TT, Topical fluoride for caries prevention: executive summary of the updated clinical recommendations and supporting systematic review. J Am Dent Assoc. 2013; 144(11): 1279– 91. 24177407 PMC4581720
  55. Schwendicke F, Splieth CH, Thomson WM, Reda S, Stolpe M, Foster Page L. Cost-effectiveness of caries-preventive fluoride varnish applications in clinic settings among patients of low, moderate and high risk. Community Dent Oral Epidemiol. 2018 2; 46(1): 8– 16. doi: 10.1111/cdoe.12320. Epub 2017 Jul 6. 28682498 · DOI · Paper page
  56. [68]Workentine S, Rohloff R, Meurer JR. Review of how to improve childhood developmental screening processes in primary care. 2020. Under review for publication.

Cited by

Sorted by citations

Authors
Graif, C., Meurer, J., & Fontana, M.
Affiliations
  • Pennsylvania State University (US)
  • Medical College of Wisconsin (US)
  • University of Michigan (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2021-07-01
Volume
148
Issue
Supplement 1
Pages
s13-s20
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2021-050693d
PMC
PMC8312252
OpenAlex
W3176439187
Cited by
21
References
5
Citations by year
2026: 3 · 2025: 7 · 2024: 4 · 2023: 4 · 2022: 1 · 2021: 2
FWCI
0.57
Type
journal article
Language
en
Open access
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute of Dental and Craniofacial Research (U01DE021412)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24HD041025, K01HD093863, P2CHD041025)
Topics
  • Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
  • Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
Keywords
pediatric preventive care, socio-ecological model, child health screening, child health monitoring, social determinants of health, risk screening tool, electronic health records, primary care organization, health policy, family and community context, health promotion
MeSH terms
Adolescent, Child, Delivery of Health Care, Education, Humans, Pediatrics, Preventive Medicine, Social Environment

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review