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育，伤害预防和最佳养育的效果好坏参半，部分原因是AG传递给父母的方式。一个值得注意的例外是婴儿书籍项目（BB1），这是一个随机分配的NIH资助的干预措施，将AG嵌入婴儿书籍，而不是典型的讲义或医生讨论，以改善孕产妇和儿童健康。BB1在提高低收入新妈妈对儿童发育和养育的认识、提高母亲自我效能、改善父母养育观念和行为方面效果显著（阅读、安全、纪律），减少产妇压力和抑郁症状，提高儿童的语言技能，减少头18个月内可预防的儿童伤害的数量（所有统计学显著效应量，0.24 - 0.59标准差）。鉴于BB1的成功，拟议的应用程序（婴儿书籍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，但与大多数干预措施一样，它不包括父亲。我们的目标是测试是否效果是等同的父亲，以及这种低成本的干预措施的影响是累加的，还是倍增的，当母亲和父亲都有针对性。此外，如果除了在健康儿童访问时通常提供的AG之外，还包括关于共同养育子女的信息-父母共同抚养子女的方式-这些书籍是否会影响共同养育关系的质量，从而使父母及其子女受益？是 我们有理由期望，家庭系统的干预措施可能比只关注母亲的干预措施对儿童的结果产生更持久的影响。此外，通过24个月和30个月的儿童提供AG，可以评估BB1无法测量的对身体，认知，语言和社会发展的影响。最后，BB1在一个地区提供，而且只使用英语。测试干预在两个地理区域，英语和西班牙语，允许考虑文化差异的影响th教育婴儿书籍，并增加了外部效度的调查结果。在拟议的项目中，我们将240个双亲家庭随机分配到4个条件之一：（1）只向母亲提供教育书籍，（2）只向父亲提供教育书籍，或（3）父母双方提供教育书籍;（4）向父母双方提供非教育书籍。将在6 - 9个月（基线）和18、24和30个月时进行家庭数据收集，并在儿童12、15和21个月时进行补充电话访谈。使用4组随机设计，该项目（BB2）将测试教育性婴儿书籍对仅母亲、仅父亲以及母亲和父亲一起的影响，并与非教育性（即，视觉上相似但缺乏教育内容）婴儿书籍。该项目通过访谈、观察和回顾性病历审计进行了7波数据收集，是首批测试针对父母双方的差异和倍增效应的项目之一，将为低收入儿童的低成本和易于实施的干预提供有价值的见解。

 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.