BB2: Using Baby Books to Improve Maternal and Paternal Parenting and Child Outcomes

 描述(由申请人提供)：使用预期指导(AG)来教育父母关于典型的儿童发展、伤害预防和最佳育儿方式的效果好坏参半，部分原因是预期指导向父母提供的方式。一个值得注意的例外是婴儿书籍项目(BB1)，这是一个由NIH资助的随机分配的干预措施，将AG嵌入婴儿书籍中，而不是典型的讲义或医生讨论，以改善母婴健康。事实证明，BB1在增加低收入新母亲对儿童发展和育儿知识的认识、提高母亲的自我效能感、改善育儿信念和做法(阅读、安全、纪律)、减少母亲的压力和抑郁症状、提高儿童的语言技能以及减少可预防的儿童伤害的数量方面在前18个月相当有效(所有统计上显著的效果大小，0.24-.59 SD)。鉴于BB1的成功，拟议的应用程序(Baby Books 2-BB2)试图复制和扩展这些有希望的发现。虽然BB1在影响母亲及其育儿行为方面是有效的，但像大多数干预措施一样，它不包括父亲。我们的目标是测试对父亲的影响是否相同，以及当母亲和父亲都成为目标时，这种低成本干预的影响是否是相加的，或者可能是相乘的。此外，如果除了通常在访问健康儿童时提供的AG之外，还包括关于共同育儿的信息-父母共同抚养孩子的方式-除了AG，这些书籍是否会影响共同育儿关系的质量，从而使父母和他们的孩子受益？它是 有理由认为，家庭系统干预可能会比单纯关注母亲的干预对儿童的结果产生更持久的影响。此外，提供24个月的AG和跟踪30个月的儿童能够评估BB1无法衡量的对身体、认知、语言和社会发展的影响。最后，BB1是在一个地区提供的，而且只有英文。在英语和西班牙语的两个地理区域进行干预测试，允许考虑教育婴儿书籍影响中的文化差异，并增加研究结果的外部有效性。在拟议的项目中，我们将240个双亲家庭随机分配到4种情况之一：(1)仅向母亲提供教育书籍，(2)仅向父亲提供教育书籍，或(3)向父母双方提供教育书籍；以及(4)向父母双方提供非教育书籍。家庭数据收集将在6-9个月(基线)以及18、24和30个月时进行，并在孩子12、15和21个月时进行补充电话采访。使用四组随机设计，该项目(BB2)将测试教育类婴儿书籍与非教育类(即，视觉上相似但缺乏教育内容)婴儿书相比，只对母亲、只对父亲、对母亲和父亲的影响。该项目通过访谈、观察和回顾病历审计进行了7波数据收集，是第一批测试针对父母双方的不同和相乘影响的项目之一，并将为低收入儿童提供低成本和易于实施的干预措施的宝贵见解。

 DESCRIPTION (provided by applicant): The use of anticipatory guidance (AG) to educate parents about typical child development, injury prevention, and optimal parenting has had mixed effects, in part because of the way AG is delivered to parents. One notable exception is the Baby Books Project (BB1), a randomly assigned NIH-funded intervention that embedded AG into baby books, rather than the typical handouts or physician discussion, to improve maternal and child health. BB1 proved quite effective in increasing low-income, new mothers' knowledge of child development and parenting, improving maternal self-efficacy, improving parenting beliefs and practices (reading, safety, discipline), reducing maternal stress and depressive symptoms, increasing children's language skills, and reducing the number of preventable child injuries over the first 18 months (all statistically significant effect sizes, .24-.59 sd). Given te success of BB1, the proposed application (Baby Books 2 - BB2) seeks to replicate and expand on these promising findings. Although BB1 was effective in impacting mothers and their parenting behaviors, like most interventions, it did not include fathers. We aim to test whether effects are equivalent for fathers and whether the impacts of this low-cost intervention are additive or perhaps multiplicative when both mothers and fathers are targeted. Moreover, if information about co-parenting - the way parents work together to raise their children - is included in addition to the AG typically provided at well-child visits, will the books impact the quality of the co-parenting relationship and subsequently benefit parents and their children? It is reasonable to expect that a family system intervention could have more enduring effects on children's outcomes than one focused solely on mothers. Further, providing AG through 24 months and following children to 30 months enables assessment of impacts on physical, cognitive, language, and social development that BB1 could not measure. Lastly, BB1 was provided in one region and exclusively in English. Testing the intervention in two geographical regions, in English and Spanish, allows for consideration of cultural variation in the impact of th educational baby books and increases the external validity of the findings. In the proposed project we will randomly assign 240 two-parent families to one of 4 conditions: educational books provided to (1) mothers only, (2) fathers only, or (3) both parents; and (4) non-educational books provided to both parents. In-home data collection will occur at 6-9 months (baseline) and at 18, 24, and 30 months, with supplemental phone interviews when children are 12, 15, and 21 months. Using a 4-group randomized design, this project (BB2) will test the impact of educational baby books on mothers only, fathers only, and mothers and fathers together in comparison to non-educational (i.e., visually similar but lacking educational content) baby books. With 7 waves of data collection using interviews, observations, and a retrospective medical chart audit, this project is one of the first to test differential and multiplicative effecs of targeting both parents and will provide valuable insight into a low-cost and easy-to-implement intervention for low-income children.