This application is a revision to grant number 5R01DA021624-02 (Age-17 Follow-up of Home Visiting Intervention) extending data collection to cover not only first-born children (covered by the primary grant) but children born within 5 years of the first child. The primary grant consists of a longitudinal follow-up of 670 primarily African-American mothers and 17 year old first-born children enrolled since 1990 in a highly significant randomized controlled trial of prenatal and infancy home visits by nurses. Nurses were charged with improving pregnancy outcomes, child health and development, and maternal economic self-sufficiency. The primary grant is designed to determine whether earlier program effects on maternal and first-born child's functioning lead to less violent antisocial behavior, psychopathology, substance abuse, and risk for HIV;whether these effects are greater for those at 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 welfare use;first-born children's injuries, cognition, language achievement, depression/anxiety, and use of substances through child age 12. Despite the limited literature on the carry over effects of interventions on later born children, there are important reasons to expect effects for this intervention. This supplement (revision) takes advantage of the infrastructure developed for the parent grant and request support to gather the same data on subsequent children when they are 14-17 years of age to determine the extent to which the impact of the intervention carries over to younger siblings as they enter adolescence - a period of great risk for antisocial behavior, substance use and abuse, violence, and risk for HIV exposure. Direct assessments will be conducted to obtain valid estimates of carryover effects to younger children. The study addresses questions about the degree to which the program: 1) improves the health and development of subsequent children in terms of their a) cognitive, language, academic, and executive cognitive function (ECF);b) depression and anxiety;c) failed conduct grades, d) violent behavior and gang membership, and e) arrests, juvenile detentions, and convictions, especially for violent crimes;2) reduces subsequent children's risk for HIV infection, including a) use and abuse of substances;b) risky sexual behaviors;c) sexually transmitted infections (STIs) and d) pregnancies;3) effects on subsequent children are more pronounced for a) males, b) those born to high-resource mothers, and c) those living in the most disadvantaged neighborhoods at registration;4) effects on subsequent children's functioning is explained by its earlier impact on a) the timing and rates of subsequent births;b) families'use of welfare-related services;c) stability in partner relationships;d) improvements in neighborhood contexts;and e) antisocial behavior among first-borns.
This study examines whether the long-term effects of a program of prenatal and infancy home visiting on maternal and first-born child functioning carry over to subsequent children and lead to less violent antisocial behavior, psychopathology, substance abuse, and risk for HIV;whether these effects are greater for males and those environmentally at risk;and whether the effects are explained by the social context.
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