The Prenatal/Early Infancy Project: An Adolescent Follow-up

Study Overview
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Brief Summary
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The Nurse-Family Partnership, a program of prenatal and infancy home visiting by nurses, has been examined in a series of 3 randomized trials since 1977. It has received considerable attention in the scientific and public policy communities for its replicated effects on a variety of maternal and child health outcomes across these 3 trials, including prenatal health, childhood injuries, rates of subsequent pregnancies, inter-birth intervals, as well as its long-term effects on maternal life-course, criminal behavior, and 15-year-olds' criminal and antisocial behavior in the first trial of the program conducted in Elmira, New York.

Detailed Description
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Although this program produced positive effects on maternal and child health from pregnancy through the child's fourth year of life, its long-term effects remain unexamined. The current study was conducted to determine the extent to which the beneficial effects of the program set in motion early in the life cycle altered the life-course trajectories of the mothers and the children's adaptive functioning through the first child's 15th birthday. This study examines the long-term effects of the program on two domains of maternal functioning: 1) maternal life course (subsequent children, use of welfare, employment, substance abuse, and encounters with the criminal justice system); and 2) perpetration of child abuse and neglect; and two domains of the children's behavior: 1) their functioning in schools, and 2) their criminal and antisocial behavior. The investigators hypothesized that the program effects in these domains of maternal and child functioning, as in earlier phases of the study, would be greater for families in which the mothers experienced a larger number of chronic stressors and had fewer resources to manage the challenges of living in poverty and being a parent.

Official Title
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The Prenatal/Early Infancy Project: An Adolescent Follow-up

Conditions
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Behavior, Adaptive

Intervention / Treatment
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* Behavioral: Developmental Screening
* Behavioral: Screening plus Transportation
* Behavioral: Screening, Transport, Prenatal Visits
* Behavioral: Screen, Transport, Prenatal/Inf Visits


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Must be offspring of mothers who enrolled in Elmira randomized clinical trial of the Nurse-Family Partnership (known as the Prenatal Early Infancy Project) - Exclusion Criteria: -

Ages Eligible for Study
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Minimum Age: 15 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Developmental Screening<br>Participants received sensory and developmental screening and referral for further evaluation and treatment of suspected problems at 12 and 24 months of age. | Behavioral: Developmental Screening<br>* Child participants were screened for sensory and developmental problems and referred for further evaluation and treatment of suspected problems at 12 and 24 months of age<br>|
| Active Comparator: Screening plus Transportation<br>Participants received sensory and developmental screening and referral for further evaluation and treatment of suspected problems at 12 and 24 months of age; their mothers received free transportation for regular prenatal and well-child care (through child age two). | Behavioral: Developmental Screening<br>* Child participants were screened for sensory and developmental problems and referred for further evaluation and treatment of suspected problems at 12 and 24 months of age<br>Behavioral: Screening plus Transportation<br>* Child participants were screened for sensory and developmental problems and referred for further evaluation and treatment for suspected problems at 12 and 24 months of age; their mothers were provided with free transportation for prenatal and well-child care through child age 2.<br>|
| Active Comparator: Screening, Transport, Prenatal Visits<br>Participants received sensory and developmental screening and referral for further evaluation and treatment of suspected problems at 12 and 24 months of age; their mothers received free transportation for regular prenatal and well-child care (through child age two), plus nurse home visiting during pregnancy. | Behavioral: Developmental Screening<br>* Child participants were screened for sensory and developmental problems and referred for further evaluation and treatment of suspected problems at 12 and 24 months of age<br>Behavioral: Screening plus Transportation<br>* Child participants were screened for sensory and developmental problems and referred for further evaluation and treatment for suspected problems at 12 and 24 months of age; their mothers were provided with free transportation for prenatal and well-child care through child age 2.<br>Behavioral: Screening, Transport, Prenatal Visits<br>* Child participants were screened for sensory and developmental problems and referred for further evaluation and treatment for suspected problems at 12 and 24 months of age; their mothers were provided with free transportation for prenatal and well-child care through child age 2, and were provided an average of 9 home visits by nurses during pregnancy.<br>|
| Experimental: Screen, Transport, Prenatal/Inf Visits<br>Participants received regular sensory and developmental screening and referral for further evaluation and treatment of suspected problems at 12 and 24 months of age; their mothers received free transportation for regular prenatal and well-child care (through child age two), plus nurse home visiting during pregnancy and through child age two. | Behavioral: Developmental Screening<br>* Child participants were screened for sensory and developmental problems and referred for further evaluation and treatment of suspected problems at 12 and 24 months of age<br>Behavioral: Screening plus Transportation<br>* Child participants were screened for sensory and developmental problems and referred for further evaluation and treatment for suspected problems at 12 and 24 months of age; their mothers were provided with free transportation for prenatal and well-child care through child age 2.<br>Behavioral: Screening, Transport, Prenatal Visits<br>* Child participants were screened for sensory and developmental problems and referred for further evaluation and treatment for suspected problems at 12 and 24 months of age; their mothers were provided with free transportation for prenatal and well-child care through child age 2, and were provided an average of 9 home visits by nurses during pregnancy.<br>Behavioral: Screen, Transport, Prenatal/Inf Visits<br>* Child participants were screened for sensory and developmental problems and referred for further evaluation and treatment for suspected problems at 12 and 24 months of age; their mothers were provided with free transportation for prenatal and well-child care through child age 2, and were provided an average of 9 home visits by nurses during pregnancy and 23 during the child's first two years of life.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Timing of Subsequent Births - Mothers | Interval in days between birth date of first child and first subsequent child (self-reported) | 15 years following birth of first child | 
| Months Received Aid to Families with Dependent Children (AFDC) - Mothers | Number of months mother received AFDC (self-reported) | 15-year interval following birth of first child | 
| Number of Months Employed - Mothers | Number of months employed (self-reported) | 15-year interval following birth of first child | 
| Substance Abuse - Mothers | Count of behavioral impairments due to use of substances (self-reported) | 15-year period following birth of first child | 
| Arrests - Mothers | Count of arrests (self-reported) | 15-year interval following birth of first child | 
| Child Maltreatment Reports - Mothers | Count of substantiated reports of child abuse and neglect in which mother was perpetrator (review of records) | 15-year interval following birth of first child | 
| Running Away from Home - Children | Count of times ran away from home - self-report | 15-year interval following birth of first child | 
| Person in Need of Supervision (PIN) - Children | Self report of ever having been adjudicated as a PIN | 15-year period following their birth | 
| Arrests - Children | Count of Arrests - self-report | 15-year period following birth |