Daniel Shaw - US grants

The specific aim of this project is to survey one possible developmental pathway leading to defiance and other early antisocial behaviors in male children from stressed low income homes. Basic information on the developmental pathway is necessary to the formation of risk groups and to the determination of the optimal mode and timing of intervention. Research on infant to parent attachment in non-clinical middle-class samples, and research on coercive cycles of interaction in antisocial children, generates hypotheses that should be tested in stressed families living at low socioeconomic levels, whose children so often become antisocial. The hypotheses are that insecure/avoidant attachments in the first year of life result from the interactions of demanding infants and unresponsive mothers who, living in limited space and under economic stress, engage in power struggles between 12 and 24 months, when the infants become mobile and more autonomous. The infants become more noncompliant and the mothers manipulative as a result, leading to coercive cycles of interaction between 2 1/2 and 3 1/2 years. A sample of 310 parent-infant male dyads from low socioeconomic backgrounds will be recruited for participation in the longitudinal project when the children are between 12-18 months of age, with formal assessments beginning when the child is 18 months old. Assessments will be conducted in the laboratory at 18, 24, and 42 months, with a home visit included as part of the 24 month assessment.

In order to complete a survey of a possible developmental pathway leading to defiance and other antisocial behavior in male children from stressed low income families, it is proposed to carry out follow-up assessments at 57 and 72 months with an initial sample of 310 males previously evaluated at 18, 24, and 42 months. The hypotheses are that insecure attachments in the first year of life result from the interactions of demanding infants and unresponsive mothers who, living in limited space and under economic stress, engage in power struggles between 12 and 24 months, when the infants become mobile and more autonomous. As a result, the infants become more noncompliant and the mothers become more manipulative, leading to coercive cycles of interaction between 2 1/2 and 3 1/2 years. It is further hypothesized that between 3 1/2 and 6 years, the coercive cycles of interaction spread to other members of the family, and the parents' discipline becomes inconsistent and ineffective. By age 6, the child is impulsive and restless, and becomes increasingly defiant with parents, aggressive and hostile with siblings and peers. The hypotheses involve tracing developmental events for the entire period from 18 to 72 months and, linking extensive research that has been carried out on attachment up to the preschool period, on the one hand, and on coercive cycles of parent-child interaction in the case of early school-age children on the other. The two latter bodies of research as yet have not been integrated empirically on low income samples despite their greater risk for developing later externalizing behavior problems. Because the follow-up covering 18, 24, and 42 months was considered too much of an undertaking given the time constraints and budgetary restrictions of a FIRST Award, the review committee recommended a separate submission for a later follow-up, provided it was logistically feasible. Now it appears both feasible and desirable to carry out a follow-up at 57 and 72 months since recruitment of the sample is complete, data collection of the first two assessments points is nearly finished, and data from a pilot study and the present investigation indicate results supporting a developmental pathway leading to early disruptive behavior from 12 to 36 months. The present application includes two 57-month home visits and a 72-month laboratory assessment so we can continue to pursue this pathway.

The overall goal of this project is to investigate selected attributes and mechanisms of emotion regulatory skills in the young offspring of mothers with childhood-onset depression that may contribute to such offspring being at high risk for eventual depressive and related disorders. We will examine the following domains: (1) emotion expression and regulatory strategies in the child, (2) adjustment and cognitive style in the mother, and (3) maternal interactive behavior related to the emotion-regulation in the child. The sample will involve a longitudinal comparison of the offspring of mothers with childhood-onset depression, the offspring of probands with childhood-onset anxiety disorder, and the offspring of probands with no childhood-onset diagnosis. Assessments of these three domains will take place annually in the laboratory. Our overall hypothesis is that there exists a characteristic confluence of child factors, maternal characteristics, and parent-child interactive factors that put the offspring of childhood-onset depressed probands at risk for depression. An accelerated longitudinal design will be utilized so that group differences can be evaluated-both cross-sectionally and longitudinally from ages 1 to 9 during the five-year span of the project.

The aim of this RSA application is to expand the candidate's ability to understand the development, prevention, and treatment of two types of childhood disorders: conduct problems and depression. The candidate proposes two programs of research and a plan for professional development. The goal of the first program (NIMH R01-50907) is to identify developmental pathways leading to antisocial behavior from infancy to middle childhood. The first hypothesis is that parent-infant interaction in the first year, characterized by infant demandingness and maternal unresponsiveness, leads to coercive cycles of interaction at preschool-age, which in turn spread to relationships the child has with siblings, peers, and teachers at school-age. It is further hypothesized that the young child who as established a pattern of conduct problems, has been rejected by caregivers, and has shown coercive patterns of interaction with adults and siblings will more likely demonstrate a persistent pattern of conduct problems from ages 6-12. This model will be tested with a sample of 310, ethnically diverse boys from low-income families followed from infancy through school-age. The goal of the second program (NIMH PO1-56193) is to investigate selected attributes and mechanisms of emotion-regulatory kills in the offspring of mothers with childhood-onset depression (COD) that may contribute to the children's own risk for depressive disorders. The offspring in the COD group will be compared with two others: (1) the offspring of probands with childhood-onset anxiety disorder (AD), and (2) the offspring of probands with no childhood-onset disorder (NCOD). It is hypothesized that in COD families, there will be greater impairment in (1) the child's regulatory strategies, (2) maternal attributes, and (3) maternal parenting, in comparison to AD and NCOD families. An accelerated longitudinal design will be utilized so that group differences can be evaluated cross-sectionally and longitudinally from ages 1 to 9 during the five-year span of the project. Participants will include 132 offspring of COD, AD, and NCOD probands. The purpose of the RSA is to permit the candidate to conduct these two programs of research, to enhance his ability to train students, and to increase his professional development by broadening his knowledge of research design and methods, psychophysiology, cultural context, and intervention research.

The specific aim of the project is to trace developmental pathways leading to early antisocial behaviors in male children from low socioeconomic status (SES) families. Using a model guided by a transactional perspective, and specifically by Patterson's (1982) coercion theory, our aim is to test the spread of coercive and conflictual relationships in the family that lead to antisocial outcomes for children during the later school-age years. The hypotheses are that parent-infant interaction in the first year characterized by infant demandingness and maternal unresponsiveness leads to coercive cycles of interaction at preschool-age, which in turn spread to relationships the child has with siblings, peers, and teachers at school-age. It is further hypothesized that the young child who has established a pattern of disruptive behavior, has been rejected by caregivers, and shown coercive patterns of interaction with adults and siblings, will more likely demonstrate a persistent pattern of antisocial behavior from ages 6-12. During the school-age period, we will continue to study the effects of developmental transitions, child problem behavior, and parenting on conduct problems, but also consider the influence of peer relations, neighborhood characteristics, and ethnicity. The model will be tested with a sample of 310 low-income, ethnically diverse boys who have been followed since infancy and will be between ages 10 and 12 during the study period. This age period represents the "end" of the early starter period for antisocial behavior, as children who demonstrate high rates of antisocial activity before adolescence show considerably poorer life course trajectories than those who begin antisocial activities during adolescence (Moffitt, 1990; Patterson et al., 1992). Target children will be seen with their parents and siblings at age 10 and 12 in the home, with their mother at age 11 in the lab, and observed at a day camp between ages 10-12. Additional report of child behavior will come from teachers, school, court, and police records.

In response to this RFA that requests innovative and developmentally- based intervention projects that stem from knowledge gained from studies of risk, etiology, and basic behavioral processes, this application, proposes to test a Family-based preventive intervention with two-year-old children at risk for developing significant conduct problems, providing the necessary pilot data to test the model's applied efficacy. The Investigative team's programs of research have identified specific parenting factors and family profiles that are associated with early onset and persistence of serious conduct problems from infancy to the school-age period that have yet to be tested as an intervention. Despite prior longitudinal research that has shown that early-starter children go onto show the most chronic and severe forms of antisocial behavior, a developmentally-based, ecologically sensitive intervention initiated during the toddler period has yet to be tested with extreme-risk families to examine if antisocial trajectories are preventable before the child's and family's behaviors are less malleable to change. This project will test the efficacy of Dishion's Family Check UP intervention package with a group of 120 extreme-risk families recruited from WIC sites in Pittsburgh, PA. As well as drawing on a well-established evidence base, the intervention will incorporate novel preventive strategies into the Family Check Up package from Shaw's and Gardner's developmentally based research. Extreme-risk status will be based on the presence of child, parent, and sociodemographic risk factors. It is expected that early intervention will be associated with improvement in parenting and child behavior, whereas families in the nonintervention group are likely to show decreases in parental functioning and growth in child conduct problems.

SUBPROJECT ABSTRACT NOT PROVIDED

[unreadable] DESCRIPTION (provided by applicant): The aim of this RSA application is to expand the candidate's understanding of prevention science, data collection and coding methods related to children's emotion regulation, and innovative approaches in multilevel modeling. Skills acquired from the training plan should have both short- and long-term applications to the candidate's research. The candidate proposes four programs of research and a plan for professional development. Program I (NIMH R01-50907) seeks to advance our understanding of the precursors of early- and late-starting pathways of antisocial behavior (AB) by following a cohort of low-income, male youth from ages 1.5 to 18. Our first aim is to test how child, parenting, and family factors in early childhood, in conjunction with child, parent, family, peer, and neighborhood factors in middle childhood ant adolescence, lead to early-starting trajectories of antisocial outcomes during adolescence. [unreadable] [unreadable] A second goal is to examine predictors of late starting trajectories of AB, which are believed to be moderately influenced by child, parenting, and family risk factors in early and middle childhood, and potentiated by youth's life events, and peer and neighborhood factors during adolescence. Program II (NIDA R01 016110) is a multisite prevention outcome study that targets parenting practices in early childhood to reduce risk for developmental trajectories leading to early-onset conduct problems and substance abuse. The family-centered intervention is designed for implementation within the service delivery system of WIC Programs for at-risk toddlers at three sites representing urban, rural, and suburban locations (total sample - 840 families). [unreadable] [unreadable] Program III (NIMH P01-56193) investigates selected attributes and mechanisms of emotion-regulatory skills in the offspring of mothers with childhood-onset depression (COD) that may contribute to the children's own risk for depressive disorders. The offspring in the COD group will be compared with two others the offspring of probands with bipolar disorder (BD) and the offspring of probands with no childhood-onset disorder (NCOD) (total sample = 175). It is hypothesized that in COD families, there will be greater impairment in the child's regulatory strategies, maternal attributes, and maternal parenting, in comparison to BD and NCOD families. Parents and offspring ages 1-12 are assessed annually for the duration of the study. [unreadable] [unreadable] Program IV (NICHD R01 12709) is a multisite study that examines gene-environment interaction among a sample of 400 adopted infants as they develop from birth to age two. The study will examine the potential mediating and moderating effects of biological risk in relation to early caregiving practices and child externalizing and internalizing problems and competence. Psychiatric risk will be ascertained in both biological and adoptive parents longitudinal and parent-child interaction of adoptive parents and children will be assessed when infants are 9, 16, and 24 months old. The purpose of the RSA is to permit the candidate to conduct these four programs of research, enhance his ability to train students, and to broaden his knowledge of prevention' science, data collection and reduction methods, and recent advances in multilevel modeling. [unreadable] [unreadable]

DESCRIPTION (provided by applicant): This project seeks to advance our understanding of the precursors of early- and late-starting pathways of antisocial behavior (AB) by following a cohort of low-income, male youth form infancy through early adolescence. Using a model guided by a reciprocal and transactional perspective, our first aim is to test how child, parenting, and family factors in early childhood, in conjunction with child, parent, family, peer, and neighborhood factors in middle childhood and adolescence, lead to early-starting trajectories of antisocial outcomes during adolescence. We hypothesize that early child, parent, and family factors lead to coercive cycles of interaction that reinforce and coalesce patterns of child AB at school entry. During the school-age and adolescent periods, child, parent, and family factors continue to affect the course of AB; however, because of the child's increasing exposure to forces outside of the home, peer and neighborhood factors take on increasing importance in influencing trajectories toward serious forms of AB. A second goal is to examine predictors of late-starting trajectories of AB, which are believed to be moderately influenced by child, parenting, and family risk factors in early and middle childhood, and potentiated by youth's life events, and peer and neighborhood factors during adolescence. The model will be tested with a sample of 310 low-income, ethnically diverse boys who have been seen with their families on 10 occasions since infancy and will be evaluated again from ages 15 and 18 during the study period. This age period represents the apex of serious forms of antisocial behavior in the life course, when both early- and late-starting youth have been found to demonstrate high rates of delinquent activity. During the proposed funding period, target youth will be visited at their homes with their parents, siblings, best friends, and/or romantic partners at ages 15 and 17, and interviewed over the phone at ages 16 and 18. Additional reports of youth behavior will come from school, court, and police records.

DESCRIPTION (provided by applicant): The present study will examine the effects of protective factors in the family environment that are related to the prevention of risk factors associated with early substance use. Preschool family factors have been found to act as buffers or to exaggerate risk factors that lead to children's social and academic problems, both of which have been shown to be precursors of early substance use. Specifically, the quality of maternal problem-solving instruction in parent-child interactions has been identified as a correlate of both current and future academic and social success for children. For children at increased risk for poor outcomes because of socioeconomic deprivation, the acquisition of social and cognitive problem-solving skills may play a critical role in navigating the challenges of both academic and social adjustment to school as well as protect against pathways leading to early substance use. Therefore, parents who provide instruction in key problem solving skills may place their children in a strong position to succeed compared to their peers. The proposed study utilizes an existing database of 120 boys (90% retention rate) selected on the basis of sociodemographic, family, and child risk and followed from age two to six to examine the effects of maternal problem-solving instruction in relation to children's development of social and academic competence in early schooling. The current proposal will extend the existing project by investigating a specific component of parenting, problem-solving instruction, and its direct impact on academic and social outcomes, its role in buffering a child's risk factors on their school-related adjustment outcomes, and investigating how the benefits of problem-solving instruction may either be lessened or enhanced under different levels of child or maternal risk factors. In addition to extending the aims of the parent grant, the study aims to advance our understanding of the effects of maternal problem instruction on later child outcomes, which has predominantly been conducted on lower- risk populations. Observational techniques will be used to code the quality of maternal problem-solving instruction in already completed assessments that occurred when children were ages 2, 3, and 4. In addition, both mother and teacher reports and school records will be used to evaluate the child's academic and social adjustment in the early school years.

[unreadable] DESCRIPTION (provided by applicant): Parental involvement has been shown to be a robust predictor of child conduct problems (CP) and drug use risk in childhood and adolescence, but relatively little attention has been paid to the role of parental involvement in relation to child problem behavior during the transition to school-age, when children are spending more time in school, after-care settings, and in the neighborhood. Concomitantly, as children transition from preschool to school-age, there is evidence to suggest that the quality and organization of schools, after-school care, and neighborhoods play an increasingly important role in the emergence of children's CP and drug use risk. Specifically, we will address: 1) the extent to which the quality of school environments, after-school care, and neighborhoods are associated with the emergence of CP during the early school-age period; 2) how parental involvement in the toddler and preschool period may be associated with parental involvement and monitoring in extra-familial contexts in the early school-age years; 3) how parental involvement in schools, after-care, and the neighborhood, may moderate relationships between extra-familial factors and children's CP; and 4) whether a parenting intervention can increase parental involvement in school, after-care, and neighborhood contexts and decrease risk of children's subsequent CP. These issues will be tested with an existing sample of 731 ethnically-diverse children from urban, suburban, and rural sites. As all families in the study were recruited based on the presence of socio-demographic, family, and child risk factors, the cohort of children are at high risk for displaying a persistent trajectory of clinically-meaningful CP and drug use risk. Thus, the study has the potential to fill a much-needed void on associations between extra-familial contexts and risk for early-starting CP and later problem behaviors during the early school-age years. Equally critical, the study can provide data on the potential moderating influence of involved parenting, its malleability for families facing multiple adversities, and whether family-based interventions can make a difference for children facing multiple adversities. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): The revised application proposes a five-year extension of the Early Steps Multisite Project (ES-M) focused on Understanding and Preventing Early Drug Use Risk. The ES- M project is a collaboration of the Child and Family Center at the University of Oregon (Dishion), the University of Pittsburgh (Shaw), and the University of Virginia (Wilson). The first five years have been quite successful in exceeding expected recruitment rates (731), maintaining high retention rates (85%), engaging families in our family- intervention model, and producing a reduction in problem behavior and emotion distress in children from ages 2 through 4. We have found that improvements in children's adjustment were mediated by improved family management practices. In the next five years we propose to adapt the family intervention model to provide support for each child's transition into the public school system, and conduct developmental analyses to better understand early emergence of school competence, early deviant peer involvement problem behavior, and emotion distress as well as address the role of siblings in development and as an intervention outcome variable. Biannual intensive assessments are proposed that include home visits and direct observations, as well as yearly assessments of the child's problem behavior and self-regulation in the families' context. This assessment builds on an existing multiagent and multimethod assessment strategy across all three sites that have included yearly direct observations as well as measurement of child and family characteristics. We propose that the study will test the effectiveness of a feasible, cost-effective, family-centered intervention that can be initiated within WIC or similar service settings and be continued and maintained in the public school environment. In addition, the data set affords a rich opportunity to link caregiver engagement in the intervention with child and family outcomes. The net effect of this family-centered, early intervention strategy is significant reduction of risk for early- onset problem behavior, improved school competence, reduction in children's mental health disorders, and reductions in risk for drug use risk from age 2 through 10. Advancements in multivariate data analysis such as general growth mixture modeling will be used to study the environmental factors associated with the formation of health and of high-risk developmental trajectories, as well as to determine the effectiveness of the family intervention in altering those trajectories.

DESCRIPTION (provided by applicant): The proposed K05 RSA will focus on the following three areas to improve the candidate's career development: 1) learning more about genetics and brain circuitry related to the development of antisocial behavior (AB) and drug use; 2) further developing the use of the Family Check Up intervention for use with different age groups and at-risk populations; and 3) learning more about the interface among research-based intervention programs, community needs, and social policy. Skills acquired from the career development plan should have both short- and long-term applications to the candidate's research. The candidate proposes to conduct four funded programs of research. Program I (NIMH R01-50907) seeks to advance our understanding of the precursors of early- and late-starting pathways of antisocial behavior (AB) by following a cohort of low-income, male youth from ages 1.5 to 18. Program II, the Early Steps - Multisite (ES-M) Project (NIDA R01 016110), is a prevention study targeting family and extra-familial influences in early and middle childhood to reduce risk for early-onset AB, drug use, and HIV risk. Program III, the Parental Involvement and Extra-Familial Contexts Project (NIDA R01 023245), uses families from the ES-M sample to examine the contributions of neighborhood, school, and after-school care contexts in relation to drug use risk during middle childhood, and how parental involvement in these extra-familial settings may attenuate effects of extra-familial risk factors on drug use risk. Program IV represents two studies that have emerged as extensions from the Early Growth and Development Study (EGDS, NICHD R01 12709). Both studies (NICHD R01 042608 & NIDA R01 020585) use an adoption design to examine mechanisms by which genetic factors, prenatal drug exposure, and parent-child relationships influence developmental pathways leading to problem behavior and social competence in early childhood. The purpose of the K05 RSA is to permit the candidate to conduct these four programs of research and broaden his understanding basic and applied issues related to the prevention of drug use risk from early childhood through adolescence.

DESCRIPTION (provided by applicant): The goal of this project is to examine biological and early developmental factors in patterns of substance use in young men from early adolescence to the transition to adulthood. The project builds on an ongoing prospective, longitudinal study of 310 high-risk young men who have been followed since infancy using multiple methods (e.g., observation, interview) and informants (e.g., parents, teachers, peers) and spanning child, family, and extra-familial risk factors. As participants undergo the transition to adulthood and face challenges in interpersonal and instrumental domains, the project will incorporate data on genetics and brain function to understand how these individual differences in underlying, emerging biology factors, separately and in combination, influence patterns of use for drugs, alcohol, and nicotine. Assessments of brain function will examine the contribution of function in mesolimbic and corticolimbic neural circuits at two time points by conducting functional MRI of participants' striatal reactivity to reward stimuli, amygdala reactivity to threat stimuli, resting cerebral blood flow, and resting functional connectivity. The inclusion of fMRI at this point in the longitudinal study will provide detailed information on the association between brain function and genetic factors, early development, social context, and substance use. The guiding hypothesis of the project is that stable characteristics such as a history of antisocial behavior and impulsivity; family and extra- familial contextual risk; brain function; and genetic variants associated with substance use- related brain function will contribute to longitudinal patterns of substance use. In addition, it is expected that the success participants have in establishing stable romantic relationships and employment/educational training during the transition to adulthood will attenuate associations between risk factors and patterns of substance use in early adulthood. The project provides an unprecedented opportunity to examine factors spanning from early childhood through early adulthood that are related to substance use and to link such data with data on genes and brain function during the transition from adolescence to adulthood using a low-income sample of ethnically diverse males at high risk for maladaptive adult functioning. Thus, the study offers the potential to advance our understanding of pathways to substance use problems and guide developmentally informed prevention and intervention efforts.

DESCRIPTION (provided by applicant): The primary goal of this project is to examine the short and long-term effects of a preventive intervention focusing on three interrelated dimensions of health: improving sleep, increasing physical activity, and improving skills in emotion regulation. This intervention targets high-risk youth at a key neuromaturational period-early adolescence-when many individuals are experiencing new challenges to regulatory systems involved in sleep, activity, and emotion regulation. This maturational period is also a crucial time in the normal development of habits, skills, and proclivities in each of these domains. Thus, early adolescence presents unique opportunities for a preventive intervention targeting these three interrelated regulatory systems. Participants will include 160 10-13 year-old children whose families are identified on the basis of sociodemographic, child, and/or family risk. Children will be selected as having difficulties in at least one of these domains (sleep, sedentary behavior, or emotion regulation) and then randomly assigned to either a control or intervention group. All families will receive baseline, one- and two-year follow-up assessments of child sleep, physical activity, and emotion regulation. Families in the preventive intervention group will be offered feedback and intervention services on these three child domains and other parenting and family issues (e.g., parent involvement, parent self-care, school problems) following the initial assessment and the one-year follow up. We hypothesize that the intervention will be associated with improvements in sleep, physical activity, and emotion regulation among those in the intervention group, as well as improvements in measures of social, behavioral, and affective function. Finally, we will explore the possibility that increases in parental involvement mediate some of the changes found in child sleep, physical activity, and emotion regulation. PUBLIC HEALTH RELEVANCE: This project addresses a set of issues with enormous relevance to public health and policy, targeting early intervention to improve sleep, physical activity, and affect regulation, at a sensitive period in development. Evidence supporting the effectiveness of these interventions, and demonstrating enduring effects from the optimal developmental timing of the intervention in early adolescence would have major public health implications relevant to a broad range of behavioral, emotional, and physical health outcomes.

DESCRIPTION (provided by applicant): The goal of this project is to examine biological and early developmental factors in patterns of substance use in young men from early adolescence to the transition to adulthood. The project builds on an ongoing prospective, longitudinal study of 310 high-risk young men who have been followed since infancy using multiple methods (e.g., observation, interview) and informants (e.g., parents, teachers, peers) and spanning child, family, and extra-familial risk factors. As participants undergo the transition to adulthood and face challenges in interpersonal and instrumental domains, the project will incorporate data on genetics and brain function to understand how these individual differences in underlying, emerging biology factors, separately and in combination, influence patterns of use for drugs, alcohol, and nicotine. Assessments of brain function will examine the contribution of function in mesolimbic and corticolimbic neural circuits at two time points by conducting functional MRI of participants' striatal reactivity to reward stimuli, amygdala reactivity to threat stimuli, resting cerebral blood flow, and resting functional connectivity. The inclusion of fMRI at this point in the longitudinal study will provide detailed information on the association between brain function and genetic factors, early development, social context, and substance use. The guiding hypothesis of the project is that stable characteristics such as a history of antisocial behavior and impulsivity; family and extra- familial contextual risk; brain function; and genetic variants associated with substance use- related brain function will contribute to longitudinal patterns of substance use. In addition, it is expected that the success participants have in establishing stable romantic relationships and employment/educational training during the transition to adulthood will attenuate associations between risk factors and patterns of substance use in early adulthood. The project provides an unprecedented opportunity to examine factors spanning from early childhood through early adulthood that are related to substance use and to link such data with data on genes and brain function during the transition from adolescence to adulthood using a low-income sample of ethnically diverse males at high risk for maladaptive adult functioning. Thus, the study offers the potential to advance our understanding of pathways to substance use problems and guide developmentally informed prevention and intervention efforts. PUBLIC HEALTH RELEVANCE: The goal of this project is to examine biological and early developmental factors in patterns of substance use in young men from early adolescence to the transition to adulthood. The project builds on an ongoing prospective, longitudinal study of 310 high-risk young men who have been followed since infancy using multiple methods and informants, and spanning child, family, and extra-familial risk factors. These data will be linked with data on genes and brain function during the transition from adolescence to adulthood. Thus, the study offers the potential to advance our understanding of pathways to substance use problems and guide developmentally informed prevention and intervention efforts.

DESCRIPTION (provided by applicant): Our proposed study tests a comprehensive approach to the promotion of school readiness in low-income families, beginning shortly after the birth of the child, through enhancement of positive parenting practices (and when present, reduction of psychosocial stressors) within the pediatric primary care platform. We do so by integrating two evidence-based interventions: 1) a universal primary prevention strategy (Video Interaction Project [VIP]); 1, 2 and 2) a targeted secondary/tertiary prevention strategy (Family Check-up [FCU]) 3 for families with infants/toddlers identified as having additional risks. VIP provides parents with a developmental specialist who videotapes the parent and child and coaches the parent on effective parenting practices at each pediatric primary care visit. FCU is a home-based, family-centered intervention that utilizes an initial ecologically- focused assessment to promote motivation for parents to change child-rearing behaviors, with follow-up sessions on parenting and factors that compromise parenting quality. Two primary care settings serving low-income communities in New York City, NY and Pittsburgh, PA will be utilized to test our integrated intervention in hospital-based clinics, providing information about translation across venues where one of the two interventions has been previously used alone. Also, we will leverage the practice network developed by an initiative known as Reach Out and Read (ROR), 4 providing an infrastructure for later dissemination. We plan to test the VIP/FCU model in a randomized trial of 500 families (200 to VIP/FCU, 200 to routine care, 100 to VIP alone) utilizing parent surveys, observational data on parent-child interactions, and direct assessments of children's development, at key points during intervention follow-up. Analyses will address questions of program impact for the integrated program across all families and by key subgroups, and the added value of FCU to VIP. The largest single contribution made by this study is to test whether an integrated primary and secondary/tertiary prevention strategy implemented in pediatric primary care can produce impacts on early school readiness outcomes, including social-emotional, pre-academic, and self-regulation. As such, this study has the potential to provide the scientific and practice communities with information about an innovative approach to promoting school readiness skills among low-income children.

DESCRIPTION (provided by applicant): This proposal will test the long-term impact of the Family Check-Up (FCU) approach to preventing substance use and other high-risk problem behaviors from toddlerhood through adolescence by enhancing parenting. A critical question for a randomized prevention trial such as this is the extent to which early family support reduces adolescent alcohol and drug use (ADU), high-risk sexual behavior linked to HIV-AIDS, and serious problem behaviors in adolescence. The study also will examine how reduction in these adolescent problem behaviors is mediated by improvement in parenting and peer environments and is moderated by the family ecology and genetic risk. The proposed study will include follow-up assessments of 731 children through adolescence that include the collection of DNA; observations of family interaction; parent, youth and teacher report of adjustment; and assessments of and reports about peer environments. The Early Steps (ES) multisite sample was recruited from WIC centers in three geographically, socioeconomically, and ethnically diverse communities: Pittsburgh, PA; Charlottesville, VA; and Eugene, OR. To increase the number of sample families at risk for later ADU, eligibility was restricted to WIC families with additional socioeconomic (i.e., low parental education), family (i.e., maternal stress), and child (i.e., toddler conduct problems) risk factors. The children and families were initially assessed at child age 2 and then yearly through age 10.5, using a multi-agent and multi-method strategy that included direct observations of family interaction in most years. Families were randomly assigned to be offered a yearly FCU intervention, including adapted and tailored family management interventions. Specifically, the Family Check-Up will be evaluated as it relates to reducing adolescent substance use, high-risk sexual behavior linked to HIV, and other serious problem behavior at ages 14 and 16, how such intervention effects might be mediated by changes in parenting, and moderated by neighborhood adversity and GxE interactions.

DESCRIPTION (provided by applicant): This proposal will test the long-term impact of the Family Check-Up (FCU) approach to preventing substance use and other high-risk problem behaviors from toddlerhood through adolescence by enhancing parenting. A critical question for a randomized prevention trial such as this is the extent to which early family support reduces adolescent alcohol and drug use (ADU), high-risk sexual behavior linked to HIV-AIDS, and serious problem behaviors in adolescence. The study also will examine how reduction in these adolescent problem behaviors is mediated by improvement in parenting and peer environments and is moderated by the family ecology and genetic risk. The proposed study will include follow-up assessments of 731 children through adolescence that include the collection of DNA; observations of family interaction; parent, youth and teacher report of adjustment; and assessments of and reports about peer environments. The Early Steps (ES) multisite sample was recruited from WIC centers in three geographically, socioeconomically, and ethnically diverse communities: Pittsburgh, PA; Charlottesville, VA; and Eugene, OR. To increase the number of sample families at risk for later ADU, eligibility was restricted to WIC families with additional socioeconomic (i.e., low parental education), family (i.e., maternal stress), and child (i.e., toddler conduct problems) risk factors. The children and families were initially assessed at child age 2 and then yearly through age 10.5, using a multi-agent and multi-method strategy that included direct observations of family interaction in most years. Families were randomly assigned to be offered a yearly FCU intervention, including adapted and tailored family management interventions. Specifically, the Family Check-Up will be evaluated as it relates to reducing adolescent substance use, high-risk sexual behavior linked to HIV, and other serious problem behavior at ages 14 and 16, how such intervention effects might be mediated by changes in parenting, and moderated by neighborhood adversity and GxE interactions.

ABSTRACT Despite well-documented effects on families from parenting interventions aimed at improving child school readiness for low-income families, making progress at the population level has been limited. Key barriers include identification and engagement of families, challenges of scalability and sustainability at low cost within existing service systems, and heterogeneity of risk even in high-risk populations. Vulnerability in parent-child relational health is linked to detriments in child school readiness; however, such vulnerabilities have yet to be systematically integrated into population-level strategies, contributing to limitations in population-level progress. The Smart Beginnings (SB) model (R01HD076390-05) is a birth to 3 year program that addresses each of these barriers through: 1) utilization of pediatric primary care as a universal platform to facilitate population- level engagement and scalability; 2) provision of a tiered preventive intervention through universal primary prevention (Video Interaction Project [VIP], delivered through health care) integrated with a selective, targeted secondary intervention (Family Check Up [FCU], delivered through strategic home visiting). A significant innovation of the SB approach is its use of periodic, systematic screening for early parent-child relational health risks to inform targeted delivery of support for parenting by addressing ecological and proximal stressors. Both of the interventions integrated in SB (VIP and FCU) bring an established record of sustained impact for low-income families. Our current study (including program delivery and assessment through child age 2 years) examines the impact of the integrated model in a randomized controlled trial (RCT) of 400 families in a scalable platform: pediatric primary care. Preliminary findings with initial outcomes through age 2 demonstrate substantial promise, with positive impacts on relational health (enhanced parenting of infants/toddlers) and child development (reduced toddler problem behaviors), paving the way for enhanced later school readiness. The current proposal seeks to build on this work, by completing delivery of the SB model through child age 3 and performing assessments of children in the RCT at ages 4 and 6 years to determine whether early impacts of the SB tiered intervention on relational health and early child development translate to later benefits for school readiness. In addition, the proposal will address important gaps necessary for refinement and implementation of tiered prevention models like SB including: 1) understanding mechanisms of action (i.e., mediation) of SB across all families and by intervention offer, and 2) moderation of treatment response based on baseline differences in financial/human capital and psychosocial risk. Findings from the application will provide a long-term test of program efficacy with information to support next-stage scaling. Completion of study aims will directly support NICHD priorities seeking to optimize school readiness skills in economically and socially disadvantaged children and could result in transformative changes in policy and practice.

Project Summary One of the most debilitating and pervasive high-risk ecologies children encounter in American society is poverty and its many correlates, such as compromised parenting, deprived neighborhoods and schools, deviant peer clustering, and poor nutrition and medical care. Despite the greater risk of a host of maladaptive outcomes associated with poverty, few studies have prospectively examined young adult adjustment for children born into poverty beginning at age 2. Even fewer longitudinal trials initiated in early childhood have examined the impact of a brief and repeated family intervention in preventing alcohol and drug use disorder (ADUD). The Early Steps Multisite (ESM) prevention trial was specifically designed to address the needs of children and families living in poverty, often marked by compromised parenting and parent well-being. Initiated at child age 2 and follow-ups at nine ages through age 16, the ESM sample was recruited from WIC centers in three geographically, socioeconomically, and ethnically diverse communities: Pittsburgh, PA; Charlottesville, VA; and Eugene, OR. To increase the number of sample families at risk for later ADUD, eligibility was restricted to WIC families with additional socioeconomic, family, and child risk factors. Families were randomly assigned to be offered a yearly FCU intervention, including adapted and tailored family management interventions. The children and families were initially assessed at child age 2 and then yearly through age 10.5, using a multi-agent and multi-method strategy that included direct observations of family interaction in most years, and subsequently followed at ages 14 and 16. In the current application, we are proposing to continue following this multiethnic sample (N=731) of youth who are transitioning to adulthood, at ages 19 and 21. With genotyping on an extensive contemporary array, prospective data on neighborhood risk and racial/ethnic disparities, we propose to examine direct, interactive, and cascading effects of child, genetic, family, peer, and neighborhood factors on ADUD and related outcomes; lasting effects of the Family Check-Up on ADUD and related problem and prosocial behavior; and moderating effects of the Family Check- Up?s effectiveness.

Project Summary/Abstract Cardiovascular disease (CVD) and diabetes are leading causes of death among adults in the US, with incident disease following years of accumulating risk conferred through various metabolic pathways (obesity, dyslipidemia, insulin resistance), immune factors (e.g., systemic inflammation), and rising blood pressure. The pathogenesis of CVD and cardiometabolic health begins in childhood, thus it is imperative to identify factors that contribute to emerging cardiometabolic health disparities. Like other chronic diseases, CVD and diabetes track a socioeconomic gradient, with greater lifelong health risk among individuals born into disadvantaged circumstances. However, no prospective studies have carefully characterized links between early socioeconomic disadvantage and adult health, addressing whether poverty during particular developmental stages is especially harmful and delineating developmentally salient risk factors that may link economic disadvantage to cardiometabolic disease (CMD) risk. Guided by the family stress framework, we propose that family-, school- and community-level factors during critical phases of development are pathways through which socioeconomic disadvantage in childhood shapes cardiometabolic health. We also consider the role of child- based protective factors that might buffer the effects of poverty on adult health outcomes. Finally, we explore how race and SES intersect to shape risk for CMD in adulthood and whether adult health behaviors are pathways through which economic disadvantage gives rise to greater propensity for CMD. The project will assess the cardiovascular health of a diverse sample of 248 adult men (aged 31-33 years) who participated in the Pittsburgh Mother & Child Project (PMCP). The parent project recruited a sample of 310 toddlers from low income families and has followed them closely to early adulthood, permitting a comprehensive assessment of risk and protective factors. We will consider whether these factors relate to biomarkers of cardiometabolic health risk and preclinical markers of CVD ? carotid intima media thickness and pulse wave velocity. By testing novel contextual pathways at the family, school, and neighborhood levels this investigation will help to identify contexts that can be targeted by programs and policies aimed at reducing socioeconomic disparities in adult health.

ABSTRACT Emerging empirical research and theory suggests that disparities in children?s early development and adjustment resulting from poverty and racism would be expected to be magnified in the context of the additional stressors engendered by COVID-19. However, there has been very limited study either of: 1) COVID-19 impacts on core psychosocial mechanisms likely to be shared with those of poverty and racism, including parent adjustment and parent-child relational health, or 2) the potential for increased resilience from preventive interventions delivered prior to COVID-19 that effectively target these core mechanisms. Building on extensive developmental and prevention research conducted prior to COVID-19, we developed an innovative, tiered birth to 3 year preventive model (Smart Beginnings [SB]) integrating universal, primary prevention delivered in health care (Video Interaction Project [VIP]) and targeted, secondary/tertiary prevention (Family Check-Up [FCU]) delivered through home visiting to facilitate population-level engagement and address heterogeneity in risk. SB has shown tremendous promise for both impact and scalability in an NICHD- funded (HD076390) randomized controlled trial (RCT) and ongoing competing continuation, with beneficial effects prior to COVID-19 on parent adjustment, relational health, and child psychosocial development. The proposed revision seeks to expand the scope of this ongoing RCT to address critical gaps in knowledge of impacts of COVID-19 for Latinx and Black low-income families (two groups that have been disproportionately affected by the pandemic), who were enrolled in New York City and Pittsburgh, PA, respectively. Enrollment (~200 per site, 403 total) and randomization took place shortly after birth, with follow-up assessments of parent adjustment, relational health and child development completed at 6, 18 and 24 months prior to COVID-19, and in progress at 4 and 6 years primarily following onset of the pandemic. In this revision, we will add detailed, remote assessments of COVID-19 family health and economic impacts at 2 time points following the onset of COVID-19 (quantitative at 9-12 months and qualitative/mixed methods at 18-24 months). Leveraging the SB cohort will provide a unique opportunity to critically examine: 1) the short and long-term impacts of COVID-19 on parent adjustment, parent-child relational health, and child development and adjustment across a continuum of family risk related to poverty and racism collected prior to COVID onset, and 2) potential buffering of SB on COVID-19 impacts, including in the context of race/ethnicity and family risk. Findings will provide generalizable knowledge necessary for design and scaling of interventions seeking to prevent potentially lifelong impacts of COVID-19 for highly vulnerable families of color with young children. In studying families who are among the most affected by the pandemic yet also among the most understudied, this revision is strongly aligned with NICHD?s specific interests for this NOSI as described in NOT-OD-20-097.