Barnet Beth, Liu Jiexin, DeVoe Margo, Alperovitz-Bichell Kari, Duggan Anne K
Department of Family Medicine, University of Maryland School of Medicine, Baltimore, Md 21201, USA.
Ann Fam Med. 2007 May-Jun;5(3):224-32. doi: 10.1370/afm.629.
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.
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).
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.
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.
青少年母亲面临再次快速怀孕以及患抑郁症、辍学和育儿能力差的风险。我们评估了一项基于社区的家访项目对这些结果的影响以及对青少年与初级保健建立联系的影响。
从城市产前护理机构招募年龄在12至18岁、主要为低收入且非裔美国人的怀孕青少年，并将她们随机分配到家访组或常规护理组。从当地社区招募的经过培训的家访人员与每位青少年配对，并在孩子两岁生日前提供服务。他们提供育儿课程，鼓励使用避孕药具，帮助青少年与初级保健建立联系，并促进其继续上学。研究助理在基线以及随访1年和2年时通过结构化访谈收集数据，使用经过验证的工具来测量育儿能力（成人 - 青少年育儿量表）和抑郁症（流行病学研究中心抑郁量表）。学校状况和再次怀孕情况通过自我报告获取。我们使用广义估计方程（GEE）进行意向性分析，以衡量项目随时间的影响。
在122名符合条件的怀孕青少年中，84名同意参与、完成了基线评估并被随机分配到家访组（n = 44）或对照组（n = 40）。83%的人完成了第1年或第2年的随访评估，或两者都完成了。通过GEE分析，在控制基线差异后，家访青少年的随访育儿得分比对照青少年高5.5分（95%置信区间，0.5 - 10.4分；P = 0.03），且他们继续上学的调整后几率高出3.5倍（95%置信区间，1.1 - 11.8；P < 0.05）。该项目对再次怀孕、抑郁症或与初级保健的联系没有任何影响。
这项基于社区的家访项目改善了青少年母亲的育儿态度和继续上学情况，但并未降低她们再次怀孕或患抑郁症的几率，也未实现与初级保健的协调。协调护理可能需要明确的机制来促进社区项目与初级保健之间的沟通。
