title: Home-visiting intervention to improve child care among American Indian adolescent mothers: a randomized trial.
abstract: OBJECTIVE
  To assess the impact of a paraprofessional-delivered home-visiting intervention to promote child care knowledge, skills, and involvement among pregnant American Indian adolescents.
  
  
  METHODS
  Randomized controlled trial comparing a family-strengthening intervention with a breastfeeding education program.
  
  
  METHODS
  One Apache and 3 Navajo communities.
  
  
  METHODS
  Fifty-three pregnant American Indian adolescents were randomly assigned to intervention (n = 28) or control (n = 25) groups. Follow-up data were available for 19 intervention and 22 control participants. Intervention Paraprofessionals delivered 41 prenatal and infant care lessons in participants' homes from 28 weeks' gestation to 6 months post partum.
  
  
  METHODS
  Child care knowledge, skills, and involvement.
  
  
  RESULTS
  Mothers in the intervention compared with the control group had significantly higher parent knowledge scores at 2 months (adjusted mean difference [AMD], +14.9 [95% confidence interval (CI), +7.5 to +22.4]) and 6 months post partum (AMD, +15.3 [95% CI, +5.9 to +24.7]). Intervention group mothers scored significantly higher on maternal involvement scales at 2 months post partum (AMD, +1.5 [95% CI, -0.02 to +3.02]), and scores approached significance at 6 months post partum (AMD, +1.1 [95% CI, -0.06 to +2.2]). No between-group differences were found for child care skills.
  
  
  CONCLUSIONS
  A paraprofessional-delivered, family-strengthening home-visiting program significantly increased mothers' child care knowledge and involvement. A longer and larger trial is needed to understand the intervention's potential to improve adolescent parenting and related child outcomes in American Indian communities.
authors.affiliation: Johns Hopkins Center for American Indian Health, 621 N. Washington Street, Baltimore, MD 21205, USA. abarlow@jhsph.edu
authors.forename: Allison
authors.initials: A
authors.lastname: Barlow
authors.forename: Elena
authors.initials: E
authors.lastname: Varipatis-Baker
authors.forename: Kristen
authors.initials: K
authors.lastname: Speakman
authors.forename: Golda
authors.initials: G
authors.lastname: Ginsburg
authors.forename: Ingrid
authors.initials: I
authors.lastname: Friberg
authors.forename: Novalene
authors.initials: N
authors.lastname: Goklish
authors.forename: Brandii
authors.initials: B
authors.lastname: Cowboy
authors.forename: Pauline
authors.initials: P
authors.lastname: Fields
authors.forename: Ranelda
authors.initials: R
authors.lastname: Hastings
authors.forename: William
authors.initials: W
authors.lastname: Pan
authors.forename: Raymond
authors.initials: R
authors.lastname: Reid
authors.forename: Mathuram
authors.initials: M
authors.lastname: Santosham
authors.forename: John
authors.initials: J
authors.lastname: Walkup
mesh_terms: D000293:Adolescent; D003150:Community Health Workers; D005260:Female; D006699:Home Care Services; D006801:Humans; D007198:Indians, North American; D007223:Infant; D007224:Infant Care / Q000379:methods*; D007231:Infant, Newborn; D009035:Mothers / Q000193:education*; D017063:Outcome Assessment, Health Care; D011247:Pregnancy