Age-17 Follow-up of Home Visiting Intervention

描述(由申请人提供)：这项研究是对670名主要是非裔美国人的妇女及其17岁的第一个孩子的纵向随访，自1990年以来，在一项非常重要的随机对照试验中，护士进行了产前和婴儿期家访。该项目的护士负责改善妊娠结局、儿童健康和发育，以及母亲的经济自给自足。目前的研究旨在确定早期计划对母婴功能的影响是否会减少暴力反社会行为、精神病理学、药物滥用和艾滋病毒风险；这些影响是否对那些同时具有遗传和环境风险的人更大；以及计划效果是否复制了早期对白人的试验中发现的影响。到目前为止，该计划影响了妇女的产前健康、生育力、伴侣关系和福利的使用；儿童的伤害、认知、语言、成就、抑郁/焦虑和12岁儿童使用药物。拟议的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)该计划将继续改善母亲的生命过程(较短的出生间隔，更少使用福利，更稳定的伴侣关系)，特别是对于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(SODS)和抑郁，这对a)心理资源较低的母亲，以及b)那些在登记时生活在最不利社区的母亲，将更加明显；3)该计划将改善第一个出生的孩子的健康和发育，他们将表现出：a)更好的认知、语言和学习功能，以及执行认知功能(ECF)；B)减少抑郁和焦虑；c)减少不及格的行为评分和学校纪律处分；d)减少暴力行为和帮派成员，减少逮捕、青少年拘留和定罪--特别是涉及人际暴力的犯罪；4)该方案将降低儿童感染艾滋病毒的风险，包括a)使用物质和肥皂；b)危险的性行为；c)性传播感染(STI)和d)怀孕；5)方案对儿童的影响将对a)男性、b)低资源母亲所生的儿童和c)那些在登记时生活在最不利社区的儿童更为明显；6)在初步分析中，计划对母亲和儿童的影响将对那些具有遗传脆弱性的人更加明显；以及7)计划对青少年功能的影响将通过计划在产前健康、儿童早期护理、母亲的生命过程以及儿童更早的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.