Poverty and InequalitySexual and Reproductive HealthFamily, Maternal & Child HealthMethodology

Home visiting for adolescent mothers: Effects on parenting, maternal life course, and primary care linkage

TitleHome visiting for adolescent mothers: Effects on parenting, maternal life course, and primary care linkage
Publication TypeJournal Article
Year of Publication2007
AuthorsBarnet, B, Liu, J, Devoe, M, Alperovitz-Bichell, K, Duggan, AK
JournalAnnals of Family Medicine
ISBN Number15441709 (ISSN)
KeywordsAdolescent, Adolescent Health Services, Adolescent mother, Adult, African American, African Americans, article, Attitude, Child, child parent relation, Community Health Services, Community services, confidence interval, contraception, controlled study, depression, Depressive Disorder, Education, Female, follow up, Follow-Up Studies, health care delivery, Health Promotion, Health Services Research, Home visits, House Calls, human, Humans, Integration, lowest income group, major clinical study, maternal care, medical personnel, Minority groups, outcome assessment, Parenting, parenting education, Pregnancy, Pregnancy in Adolescence, pregnant woman, prenatal care, primary care, Primary Health Care, primary medical care, professional practice, Program Evaluation, Randomized controlled trials, Risk Reduction Behavior, Self Report, Socioeconomic Factors, structured interview, training, urban area, Vulnerable Populations

PURPOSE: Adolescent mothers are at risk for rapidly becoming pregnant again and for depression, school dropout, and poor parenting. We evaluated the impact of a community-based home-visiting program on these outcomes and on linking the adolescents with primary care. METHODS: Pregnant adolescents aged 12 to 18 years, predominantly with low incomes and of African American race, were recruited from urban prenatal care sites and randomly assigned to home visiting or usual care. Trained home visitors, recruited from local communities, were paired with each adolescent and provided services through the child's second birthday. They delivered a parenting curriculum, encouraged contraceptive use, connected the teen with primary care, and promoted school continuation. Research assistants collected data via structured interviews at baseline and at 1 and 2 years of follow-up using validated instruments to measure parenting (Adult-Adolescent Parenting Inventory) and depression (Center for Epidemiologic Studies Depression). School status and repeat pregnancy were self-reported. We measured program impact over time with intention-to-treat analyses using generalized estimating equations (GEE). RESULTS: Of 122 eligible pregnant adolescents, 84 consented, completed baseline assessments, and were randomized to a home-visited group (n = 44) or a control group (n = 40). Eighty-three percent completed year 1 or year 2 follow-up assessments, or both. With GEE, controlling for baseline differences, follow-up parenting scores for home-visited teens were 5.5 points higher than those for control teens (95% confidence interval, 0.5-10.4 points; P = .03) and their adjusted odds of school continuation were 3.5 times greater (95% confidence interval, 1.1-11.8; P <.05). The program did not have any impact on repeat pregnancy, depression, or linkage with primary care. CONCLUSIONS: This community-based home-visiting program improved adolescent mothers' parenting attitudes and school continuation, but it did not reduce their odds of repeat pregnancy or depression or achieve coordination with primary care. Coordinated care may require explicit mechanisms to promote communication between the community program and primary care.