This research continuation into adolescence proposal is a request to follow a unique sample of children born at various degrees of medical risk. We have been following 188 families whose children were born at medical risk, from birth to age 8, with a continual funding from NINR. This proposal incorporates the research directions established by the National Institute of Nursing Research's initiative and Healthy People 2000 to develop practice knowledge in health promotion for older children and adolescents. The follow-up is based on a theoretical assumption that competency is influenced by risk factors that function in a cumulative fashion and are mediated or moderated by protective processes in a cumulative fashion as well. Adolescents in this sample, stratified by prematurity and medical risk, were born at the cusp of the NICU medical revolution and have unknown outcomes at adolescence. A 97% retention rate has been maintained from the 188 families and 96% families have agreed to continue. The goals in the proposed study are to (1) extend the knowledge of health trajectories of term and preterm children, and (2) examine the relationship of risk and protection in determining competency outcomes in adolescence. These goals interrelate to the extent that biological insult is believed to influence trajectories while competence is influenced by cumulative risk and protective processes. Our most striking finding has been the importance of proximal protective processes heretofore undocumented, in the prediction of competency of school age term and preterm children. Cumulative risk from multiple indexes predicted competency outcomes and were buffered by protective processes in the care taking environment. A follow-up to early adolescence will be an important and necessary addition in developing a model of development that incorporates both time specific and cumulative risks as well as protective processes for an entire period of childhood. Also, a continued investigation of protection and risk influences will be essential to understand indirections between age related experiences and the protective processes. Such studies are urgently needed to build a broader scientific foundations for nursing interventions. This proposal is very specific in identifying connections between the literature, our prior studies, the need for trajectory follow through and risk and protection in the understanding child competency outcomes. Based on the cutting edge work of our collaborators in risk contexts, we will develop models where cumulative risk and protective are highlighted.
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