Age-17 Follow-up of Home Visiting Intervention

描述（由申请人提供）：本研究是对670名主要是非洲裔美国妇女及其17岁的第一个出生的孩子的纵向随访，这些孩子自1990年以来参加了一项由护士进行的产前和婴儿期家访的高度显著的随机对照试验。该方案的护士负责改善妊娠结局、儿童健康和发展以及产妇经济自给自足。目前的研究旨在确定早期项目对孕产妇和儿童功能的影响是否会导致暴力反社会行为、精神病理学、药物滥用和艾滋病毒风险减少;这些影响是否对那些同时存在遗传和环境风险的人更大;以及项目效果是否复制了早期白人试验中发现的效果。迄今为止，该方案影响到妇女的产前健康、生育、伴侣关系和福利的使用;儿童的伤害、认知、语言、成绩、抑郁/焦虑和12岁以下儿童的物质使用。拟议后续行动的假设是基于迄今发现的结果模式。与对照组相比：1）该计划将继续改善产妇的生命历程（生育间隔时间短、福利使用少、伴侣关系稳定），特别是心理资源较高的母亲; 2）该计划将减少母亲的物质使用障碍（SUD）和抑郁症，这对a）心理资源不足的母亲的影响将更加明显，和B）那些在登记时生活在最贫困社区的人; 3）该计划将改善第一个出生的孩子的健康和发展，这些孩子将表现出：a）上级的认知、语言和学术功能，以及执行认知功能（ECF）; B）较少的抑郁和焦虑; c）更少的不合格行为等级和学校纪律处分，d）更少的暴力行为和帮派成员，更少的逮捕，青少年拘留和定罪-特别是涉及人际暴力的犯罪; 4）该方案将减少儿童感染艾滋病毒的风险，包括a）使用药物和SUD; B）危险性行为; c）性传播感染和d）怀孕; 5）项目对儿童的影响将更加明显，a）男性，B）那些低资源母亲所生的孩子，（c）登记时生活在最贫困社区的人;（6）初步分析表明，计划对母亲和儿童的影响对那些有遗传脆弱性的人更为明显;（7）该方案对青少年功能的影响将通过该方案在产前健康、儿童早期护理、母亲生命过程以及儿童早期学习和行为功能方面的改善来解释。

DESCRIPTION (provided by applicant): This study is a longitudinal follow-up of 670 primarily African-American women and their 17-year-old first-born children enrolled since 1990 in a highly significant randomized controlled trial of prenatal and infancy home visiting by nurses. Nurses in this program are charged with improving pregnancy outcomes, child health and development, and maternal economic self-sufficiency. The current study is designed to determine whether earlier program effects on maternal and child functioning lead to less violent antisocial behavior, psychopathology, substance abuse, and risk for HIV; whether these effects are greater for those at both genetic and environmental risk; and whether program effects replicate those found in an earlier trial with whites. To date, the program affected women's prenatal health, fertility, partner relations, and use of welfare; children's injuries, cognition, language, achievement, depression/anxiety, and use of substances through child age 12. Hypotheses for the proposed follow-up are based upon the pattern of results found to date. Compared to control-group counterparts: 1) the program will continue to improve maternal life-course (fewer short inter-birth intervals, less use of welfare, more stable partner relations), especially for mothers with higher psychological resources; 2) the program will reduce maternal substance use disorders (SUDs) and depression, effects that will be more pronounced for a) mothers with low psychological resources, and b) those living in the most disadvantaged neighborhoods at registration; 3) the program will improve the health and development of firstborn children who will exhibit: a) superior cognitive, language, and academic functioning, and executive cognitive functioning (ECF); b) less depression and anxiety; c) fewer failed conduct grades and school disciplinary actions, d) less violent behavior and gang membership, and fewer arrests, juvenile detentions, and convictions - especially for crimes involving interpersonal violence; 4) the program will reduce children's risk for HIV infection, including a) use of substances and SUDs; b) risky sexual behaviors; c) sexually transmitted infections (STIs) and d) pregnancies; 5) program effects on children will be more pronounced for a) males, b) those born to low-resource mothers, and c) those living in the most disadvantaged neighborhoods at registration; 6) Program effects on mothers and children, in preliminary analyses, will be more pronounced for those with genetic vulnerabilities; and 7) program effects on adolescent functioning will be explained by the program's improvement in prenatal health, early care of the child, maternal life-course, and earlier child academic and behavioral functioning.