Age-17 Follow-up of Home Visiting Intervention

描述（由申请人提供）：本研究对670名主要是非裔美国妇女及其17岁的头胎儿童进行了纵向随访，自1990年以来，这是一项非常重要的产前和婴儿家访护士随机对照试验。该项目的护士负责改善妊娠结局、儿童健康和发育以及产妇的经济自给自足。目前的研究旨在确定早期项目对母婴功能的影响是否会减少暴力反社会行为、精神病理、药物滥用和艾滋病毒感染风险；这些影响是否对那些同时具有遗传和环境风险的人更大；以及项目的效果是否与之前在白人身上发现的效果相同。迄今为止，该方案影响了妇女的产前保健、生育、伴侣关系和福利的使用；儿童损伤、认知、语言、成就、抑郁/焦虑和12岁前的物质使用。对建议的随访的假设是基于迄今为止发现的结果模式。与对照组相比：1)该项目将继续改善产妇的生命历程（生育间隔较短，福利使用较少，伴侣关系更稳定），特别是对心理资源较高的母亲；2)该计划将减少母亲物质使用障碍（sud）和抑郁症，对a)心理资源不足的母亲和b)登记时生活在最弱势社区的母亲的影响将更为明显；3)该计划将改善长子的健康和发展，他们将表现出：a)优越的认知、语言和学术功能，以及执行认知功能（ECF）；B)减少抑郁和焦虑；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——尤其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)使用药物和sud；B)危险的性行为；c)性传播感染（sti）和d)怀孕；5)项目对以下儿童的影响将更为明显：a)男性，b)资源匮乏的母亲所生的儿童，以及c)登记时生活在最贫困社区的儿童；6)在初步分析中，项目对母亲和儿童的影响对那些有遗传脆弱性的人将更为明显；该计划对青少年功能的影响将通过该计划在产前健康、儿童早期护理、母亲生命历程以及儿童早期学业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.