Adolescent pregnancy and birth rates continue to be increasingly high in this country. National health priorities focus on expanding community- based intervention programs and research directed towards preventing the adverse social, health, and maternal behavior problems that can accompany early childbearing and childrearing. These problems are of concern because of their potential negative effect on infant health and development and the mother's life course. The purpose of this study is to determine if an early intervention program (EIP) improves social and health outcomes and mother-infant interaction of adolescent mothers and their children. An experimental design with repeated measures will be employed. The sample will be composed of a minimum of 100 adolescent subjects (50 in each group) from ethnically diverse backgrounds. Over 50% of the subjects are expected to be Hispanic or Black and from socioeconomically disadvantaged homes. Subjects in the experimental group will receive the EIP, whereas those in the comparison group will receive traditional public health nursing care. The EIP will begin during the second trimester of pregnancy and continue through the first year of motherhood. This comprehensive nursing care program will include a unique combination of """"""""Preparation for Motherhood"""""""" classes, maternal- fetal interactive activities, and prenatal/postal home visits by public health nurses for counseling, social support, and facilitation of mother- infant interactions. Mothers will participate in NBAS exams, observe role modeling, receive videotape instruction and feedback and undergo life planning and counseling. These activities are structured to build the social competence of mothers so that they may more effectively manage their lives and provide appropriate caregiving. The social outcomes to be examined are education, job training, and employment--status and duration. The health outcomes to be evaluated are: use of preventive health care services (measured by the number of prenatal, postnatal, and well baby visits attended or missed); repeat pregnancy rates; presence vs absence of maternal health-related behaviors, such as smoking, alcohol and drug use; infant birthweight and gestational age; and infant morbidity rates (measured by number of pediatric/emergency room visits and hospitalizations). The quality of mother-infant interactions will be evaluated using the NCATS and NCAFS. The supportive characteristics of the home environment will be assessed with the HOME. Social competence will be determined by assessments of adolescents' social and communication skills (external competencies) and internal perceptions (social support, stress and depression). These variables will be evaluated at regular intervals during the 24-months following birth. Data analysis will include repeated measures ANOVAs, canonical correlations and multiple regressions. The mediating effects of social competence on social, health and maternal behavior outcomes and the overall theoretical model will be examined by causal modeling procedures. A costs and benefits analysis of the EIP and traditional public health nursing care will be performed. If the data indicate positive effects of the EIP, the program may be easily replicated in other public health care nursing agencies and in school settings.
