Doyle Orla, Fitzpatrick Nick, Lovett Judy, Rawdon Caroline
UCD School of Economics, Dublin, Ireland; UCD Geary Institute for Public Policy, University College Dublin, Dublin, Ireland.
UCD Geary Institute for Public Policy, University College Dublin, Dublin, Ireland.
Econ Hum Biol. 2015 Dec;19:224-45. doi: 10.1016/j.ehb.2015.09.004. Epub 2015 Sep 14.
This article investigates the impact of an early intervention program, which experimentally modifies the parenting and home environment of disadvantaged families, on child physical health in the first 3 years of life. We recruited and randomized 233 (115 intervention, 118 control) pregnant women from a socioeconomically disadvantaged community in Dublin, Ireland into an intervention or control group. The treatment includes regular home visits commencing antenatally and an additional parenting course commencing at 2 years. Maternal reports of child health are assessed at 6, 12, 18, 24, and 36 months. Treatment effects are estimated using permutation testing to account for small sample size, inverse probability weighting to account for differential attrition, and both the stepdown procedure and an indices approach to account for multiple hypothesis testing. Following adjustment for multiple testing and attrition, we observe a positive and statistically significant main treatment effect for wheezing/asthma. The intervention group are 15.5 percentage points (pp) less likely to require medical attention for wheezing/asthma compared to the control group. Subgroup analysis reveals more statistically significant adjusted treatment effects for boys than girls regarding fewer health problems (d=0.63), accidents (23.9pp), and chest infections (22.8-37.9pp). Our results suggest that a community-based home visiting program may have favorable impacts on early health conditions.
本文研究了一项早期干预项目对儿童出生后前3年身体健康的影响,该项目通过实验性地改变弱势家庭的养育方式和家庭环境。我们从爱尔兰都柏林一个社会经济地位不利的社区招募了233名孕妇(115名干预组,118名对照组),并将她们随机分为干预组或对照组。治疗措施包括从产前开始定期家访,以及从2岁开始额外增加一个育儿课程。在孩子6、12、18、24和36个月时评估母亲报告的孩子健康状况。使用排列检验来估计治疗效果,以考虑小样本量;使用逆概率加权来考虑差异损耗;同时使用逐步检验程序和指数方法来考虑多重假设检验。在对多重检验和损耗进行调整后,我们观察到喘息/哮喘的主要治疗效果呈正向且具有统计学意义。与对照组相比,干预组因喘息/哮喘需要医疗护理的可能性低15.5个百分点。亚组分析显示,在健康问题较少(d=0.63)、事故(23.9个百分点)和胸部感染(22.8 - 37.9个百分点)方面,男孩的调整后治疗效果比女孩在统计学上更显著。我们的结果表明,基于社区的家访项目可能对早期健康状况产生有利影响。