Sharlene Wolchik - US grants

behavioral /social science research tag; disease /disorder proneness /risk; divorce /separation; family structure /dynamics

mental disorder prevention; health care referral /consultation; training; biomedical facility; child psychology; behavioral /social science research tag;

DESCRIPTION (Adapted from applicant's abstract): The proposed project is a 6 year follow-up of 249 families who participated in an experimental evaluation of a prevention program for children of divorce. The evaluation included three randomly assigned conditions; a mother-only program, a combined program which involved separate mother and child components and a self-study, guided reading condition. The interventions targeted empirically-supported risk and protective factors (putative mediators) and were well-implemented with a high degree of fidelity. Participant retention was excellent, and multiagent, multimethod assessments were conducted. Analyses of immediate posttest and short-term follow-up data revealed positive effects on the targeted putative mediators, as well as on children's mental health outcomes. Although several studies have demonstrated similar immediate and short-term mental health gains for preventive interventions targeting children of divorce, researchers have not yet addressed whether positive program effects persist into adolescence. Long-term follow-up is particularly important for this population, given that children of divorce are at an elevated risk for developing problems that normatively increase during adolescence. The proposed project has four specific aims: to examine whether there are persistent program effects on behavioral and mental health problems during adolescence; to examine whether program effects obtained at the 6 year follow-up are mediated by improvement on the putative mediators targeted in the intervention; to examine moderators of long term intervention effects; and to test alternative theoretical models in which stressful contextual factors, mother-child relationship variables, and child characteristics assessed in childhood are prospectively linked to mental health outcomes in adolescence. Multimethod, multiagent assessments of internalizing and externalizing problems and behavioral and mental problems that are rare in childhood but more prevalent during adolescence will be conducted. Adolescents, mothers, (step)fathers, and teachers will complete questionnaire data; mothers and adolescents will engage in problem-solving videotaped interactions; archival data will be collected from school records. Analyses of covariance, latent growth curve modeling, structural equation modeling, and survival analyses will be employed to test the specific aims.

[unreadable] DESCRIPTION (provided by applicant): The proposed project is a 15-year follow-up of 240 young adults whose families participated in an experimental evaluation of the New Beginnings Program (NBP), a preventive intervention for divorced families. The NBP was provided in late childhood; the follow-up will occur in young adulthood. Families were randomly assigned to one of three conditions: mother program (MP), dual-component mother and child program (MPCP), or literature-control (LC) condition. Programs were designed to change several putative mediators of children's post-divorce mental health problems using empirically-supported change strategies. The program was implemented with very high fidelity and multi-method, multi-reporter assessments were used. Intent-to-treat analyses showed program effects on externalizing problems at posttest and 6-month follow-up. The MPCP did not have additive effects. The 6-year follow-up, which included 91% of families assigned to condition, found multiple benefits of program participation, including a 53% reduction in one-year prevalence of diagnosed mental disorder; reduced levels of externalizing and internalizing problems, alcohol use, and marijuana use; fewer sexual partners; and increased competence and grade point average. Additive effects of the MPCP did not occur. Moderational analyses showed that children who entered NBP with higher levels of risk for later problems showed greater program benefits. Program effects on adolescent outcomes were mediated by improvements in parenting and internalizing and externalizing problems in childhood. This application has four specific aims: (1) Examine the efficacy of NBP on young adults' (YA) mental health and substance use problems and disorders, success in key developmental tasks, relationships with their parents, physical health outcomes and competencies, as well as on the mental health problems of YAs' mothers; (2) Examine whether the program effects in young adulthood are mediated by program- induced changes in adolescence; (3) Examine whether the program effects are moderated by baseline level of risk and parental education and occupation; and (4) Conduct an economic analysis of NBP. Analysis of covariance, mixed-model analysis of variance, logistic regression and latent growth curve modeling will be used to test the aims. The proposed research has important public health significance and is consistent with NIMH priorities to support long-term follow-up of prevention programs (NIMH, 1998). [unreadable] [unreadable] [unreadable]

PROJECT SUMMARY/ABSTRACT: Parental divorce is experienced by about 1 million children per year in the US and it is estimated that 40% of children in the US will experience this transition in family structure. Parental divorce confers risk for problems in multiple domains of functioning across the lifespan. Compelling evidence demonstrates that this family transition confers risk for numerous problems in childhood, adolescence and adulthood that have significant individual and societal costs, including physical health problems, mental health problems, problematic substance use, cigarette smoking, and risky sexual activity. It also impairs competencies such as academic performance, peer competence and self-esteem. This proposal advances NICHD's scientific vision to ?understand how specific? behavioral, and social factors interact over time to influence health and disease? and to identify individual- and family-level factors that are most likely to promote positive outcomes, such as resiliency. The overall goal of this project is to examine the long-term effects of the New Beginnings Program (NBP), a parenting-after-divorce prevention program that was provided when the offspring were between 9 and 12 years old. The NBP has shown positive effects on multiple problem outcomes and competencies in childhood, adolescence and emerging adulthood. This application proposes a 26-year follow-up of 240 adult offspring (35-38 years old) of mothers who participated in a randomized, controlled trial (RCT) of the program. The specific aims of the project are as follows: 1) examine whether the NBP's effects on physical health, mental health, and substance use problems and competence outcomes endure into adulthood, 2) test the pathways by which the program has long-term effects in adulthood, 3) assess whether the NBP leads to benefits in the offspring (G3) of adults (G2) whose families participated in the NBP 26 years earlier and 4)  conduct a comprehensive assessment of the NBP's fiscal impact.  This project builds on data from five multi- agent, multi-method assessments with excellent retention (90%-98% of randomly assigned families). In the 6- year and 15-year follow-up assessments, program effects were found on multiple domains of functioning, including physical health and mental health outcomes and competencies. Multi-method, multi-agent assessment that includes reports from the adult offspring, their romantic partners, their children between 3 and 18 years old and the children's teacher; behavioral observation of parent-child interactions; and physiological measures of health outcomes will be conducted. Data analytic strategies, including logistic regression, analysis of covariance and survival analysis, will be used to test program effects on the functioning of the adults and their children. Multiple-path mediation models will be conducted to identify the pathways that account for the program effects.