Effects of NBP for Children of Divorce 15 Years Later

描述（由申请人提供）：拟议的项目是对240名年轻人的15年随访，他们的家庭参加了新开始计划（NBP）的实验性评估，这是一项针对离婚家庭的预防性干预。在儿童晚期提供NBP；随访将在青年期进行。家庭被随机分配到三个条件之一：母亲计划（MP），双组分母亲和儿童计划（MPCP），或文献对照（LC）条件。该项目旨在使用经验支持的改变策略来改变几个假定的离婚后儿童心理健康问题的中介。该计划以非常高的保真度和多方法实施，多报告者评估使用。意向治疗分析显示，在测试后和6个月的随访中，项目对外化问题有影响。MPCP没有累加效应。在为期6年的随访中，91%的家庭被分配到这种情况下，发现参与项目有多种好处，包括一年内诊断出精神障碍的患病率降低53%；降低外化和内化问题、酒精使用和大麻使用的水平；性伴侣较少；提高能力和平均绩点。没有出现MPCP的加性效应。适度分析表明，进入NBP的儿童出现后期问题的风险较高，其项目收益更大。项目对青少年结果的影响是通过改善父母教养和儿童期内化和外化问题来调节的。本应用程序有四个具体目的：(1)检查NBP对青少年（YA）心理健康和物质使用问题和障碍、关键发展任务的成功、与父母的关系、身体健康结果和能力以及青少年母亲的心理健康问题的功效；(2)研究青年期的节目效应是否由青少年期节目诱导的变化介导；(3)检验项目效果是否受基线风险水平、父母教育程度和职业的调节；(4)对NBP进行经济分析。将使用协方差分析、混合模型方差分析、逻辑回归和潜在增长曲线模型来检验目标。拟议的研究具有重要的公共卫生意义，并且与NIMH支持长期后续预防计划的优先事项一致（NIMH, 1998）。

DESCRIPTION (provided by applicant): The proposed project is a 15-year follow-up of 240 young adults whose families participated in an experimental evaluation of the New Beginnings Program (NBP), a preventive intervention for divorced families. The NBP was provided in late childhood; the follow-up will occur in young adulthood. Families were randomly assigned to one of three conditions: mother program (MP), dual-component mother and child program (MPCP), or literature-control (LC) condition. Programs were designed to change several putative mediators of children's post-divorce mental health problems using empirically-supported change strategies. The program was implemented with very high fidelity and multi-method, multi-reporter assessments were used. Intent-to-treat analyses showed program effects on externalizing problems at posttest and 6-month follow-up. The MPCP did not have additive effects. The 6-year follow-up, which included 91% of families assigned to condition, found multiple benefits of program participation, including a 53% reduction in one-year prevalence of diagnosed mental disorder; reduced levels of externalizing and internalizing problems, alcohol use, and marijuana use; fewer sexual partners; and increased competence and grade point average. Additive effects of the MPCP did not occur. Moderational analyses showed that children who entered NBP with higher levels of risk for later problems showed greater program benefits. Program effects on adolescent outcomes were mediated by improvements in parenting and internalizing and externalizing problems in childhood. This application has four specific aims: (1) Examine the efficacy of NBP on young adults' (YA) mental health and substance use problems and disorders, success in key developmental tasks, relationships with their parents, physical health outcomes and competencies, as well as on the mental health problems of YAs' mothers; (2) Examine whether the program effects in young adulthood are mediated by program- induced changes in adolescence; (3) Examine whether the program effects are moderated by baseline level of risk and parental education and occupation; and (4) Conduct an economic analysis of NBP. Analysis of covariance, mixed-model analysis of variance, logistic regression and latent growth curve modeling will be used to test the aims. The proposed research has important public health significance and is consistent with NIMH priorities to support long-term follow-up of prevention programs (NIMH, 1998).