title: Home visiting for adolescent mothers: effects on parenting, maternal life course, and primary care linkage.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Family Medicine, University of Maryland School of Medicine, Baltimore, Md 21201, USA. bbarnet@som.umaryland.edu
authors.forename: Beth
authors.initials: B
authors.lastname: Barnet
authors.forename: Jiexin
authors.initials: J
authors.lastname: Liu
authors.forename: Margo
authors.initials: M
authors.lastname: DeVoe
authors.forename: Kari
authors.initials: K
authors.lastname: Alperovitz-Bichell
authors.forename: Anne K
authors.initials: AK
authors.lastname: Duggan
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D001741:Black or African American / Q000523:psychology; D001290:Attitude; D002648:Child; D003153:Community Health Services; D003866:Depressive Disorder / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006792:House Calls; D006801:Humans; D016487:Parenting; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000208:ethnology / Q000523:psychology*; D011320:Primary Health Care; D015397:Program Evaluation; D012959:Socioeconomic Factors