Home Visiting for Adolescent Mothers: Effects on Parenting, Maternal Life Course, and Primary Care Linkage

Beth Barnet; Jiexin Liu; Margo DeVoe; Kari Alperovitz-Bichell; Anne K. Duggan

doi:10.1370/afm.629

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Figure 1.
Participant flow through the study.
Note: Some participants in the home visit and control groups who did not complete a year-1 follow-up did complete a year-2 follow-up.

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Table 1.

Baseline Characteristics of Adolescents in the Third Trimester of Pregnancy, Overall and by Study Group

		Group
Characteristic	Overall (N = 84)	Home Visit (n = 44)	Control (n = 40)	P Value
TANF = Temporary Assistance to Needy Families; CTS = Conflict Tactics Scale; AAPI = Adult-Adolescent Parenting Inventory; CES-D = Center for Epidemiologic Studies Depression.
* Higher scores indicate greater household violence.
† Higher scores indicate better parenting.
‡ By the Fisher exact test.
Demographics
Age, mean (SD), y	16.9 (1.4)	16.4 (1.4)	16.6 (1.4)	.40
African American, %	91	86	94	.27
Medicaid insurance, %	77	77	78	.59
Received TANF in past month, %	27	26	27	.57
Lives with mother, %	65	59	72	.26
Continuous health insurance for past 12 months, %	64	60	68	.34
Dropped out of school, %	30	23	37	.16
Pregnancy and parenting history
Age at first pregnancy, mean (SD), y	15.6 (1.4)	15.4 (1.3)	15.8 (1.5)	.27
Prior birth, %	13	14	13	1.00
Abuse and violence exposure
Beaten or physically harmed by parent, %	18	21	15	.51
Victim of sexual abuse, %	10	9	10	.89
In a physical fight in past 12 months, %	31	30	33	.36
Household violence: total CTS score, mean (SD)*	26.5 (19.9)	25.1 (18.0)	28.0 (21.9)	.52
Mental health
Depressive symptoms (CES-D score >21), %	34.5	34.1	35.0	1.0
Substance use
Used tobacco in past 30 days, %	10	11	8	.72^‡
Used alcohol in past 30 days, %	5	5	5	1.0^‡
Used marijuana in past 30 days, %	5	7	3	.62^‡
Parenting attitudes and beliefs
Total AAPI score,^† mean (SD)	111.3 (14.5)	114.4 (13.8)	108.0 (14.5)	.04
Characteristics of baby’s father
Age, mean (SD), y	19.7 (3.6)	19.7 (4.1)	19.6 (3.1)	1.00
In jail, %	14	14	14	1.00
Married, living together, going with baby’s mother, %	63	64	63	.94

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Table 2.

Program Impact on Parenting Attitudes and Beliefs

		*Mean Score (SD) by Year of Follow-up**		Difference in Score Change^† Home Visit vs Control
Parenting Measure	Group	Year 1 (n = 62)	Year 2 (n = 63)	β^‡	95% CI	P Value
AAPI = Adult-Adolescent Parenting Inventory; CI = confidence interval.
* Higher scores indicate better parenting.
† A greater mean difference indicates greater benefit of the home-visiting program relative to the control condition.
‡ Determined by generalized estimating equation (GEE) linear regression analysis with change in parenting score from baseline to follow-up as the outcome, adjusting for age, baseline parenting score, and baseline depressive symptoms.
Total AAPI score, mean (SD)	Home visit	119.6 (14.6)	122.0 (17.2)	5.5	0.5 to 10.4	.03
	Control	110.1 (13.7)	111.8 (14.7)
AAPI subscale scores, mean (SD)
Appropriate expectations	Home visit	24.4 (2.8)	24.9 (3.3)	1.1	0.1 to 2.1	.02
	Control	23.0 (2.3)	23.3 (2.4)
Empathy	Home visit	29.2 (4.3)	30.9 (4.2)	1.7	0.3 to 3.4	<.05
	Control	27.0 (4.3)	27.5 (4.8)
Avoidance of physical punishment	Home visit	37.3 (5.2)	36.8 (6.9)	1.8	−0.4 to 4.0	.10
	Control	34.7 (6.1)	34.2 (5.7)
Avoidance of role reversal	Home visit	28.6 (6.5)	29.4 (7.7)	1.3	−1.1 to 3.7	.28
	Control	25.4 (5.4)	26.7 (6.4)

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Table 3.

Effect of Level of Exposure to the Parenting Curriculum on Adolescent Mothers’ Parenting Attitudes and Beliefs

	Level of Exposure to Parenting Curriculum
	Low Exposure (<75% of Planned Sessions)			High Exposure (≥75% of Planned Sessions)
Parenting Measure	β*	95% CI	P Value	β*	95% CI	P Value
AAPI = Adult -Adolescent Parenting Inventory; CI = confidence interval.
* β = the mean difference in score between intervention home-visited adolescents (with high or low exposure to the curriculum) and control adolescents, using the generalized estimating equation (GEE), and adjusting for age, baseline AAPI scores, baseline depressive symptoms, and household violence.
Total AAPI score	0.2	−7.0 to 7.3	.97	8.3	3.2 to 13.3	<.005
AAPI subscale scores
Inappropriate expectations	0.3	−1.3 to 1.9	.08	1.5	0.4 to 2.5	.01
Empathy	1.4	−0.7 to 3.5	.19	2.6	0.9 to 4.3	<.005
Avoidance of physical punishment	0.04	−3.2 to 3.3	.98	2.6	0.2 to 5.0	.03
Avoidance of role reversal	−0.9	−4.9 to 3.0	.63	2.1	−0.1 to 4.4	.06

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Table 4.

Program Impact on Contraceptive and Pregnancy Outcomes, Mental Health, School Completion, and Linkage With Primary Care

		Year of Follow-up		Program Impact at 2 Years
Measure	Group	Year 1 n (%)	Year 2 n (%)	AOR*	95% CI	P Value
AOR = adjusted odds ratio; CI = confidence interval; CES-D = Center for Epidemiologic Studies Depression.
* Adjusted for baseline depressive symptoms and baseline household violence.
† Excludes the 14 adolescents who had graduated at baseline.
Contraceptive use and pregnancy outcomes
Used condoms “always” in past 12 months	Home visit	18/36 (50)	17/31 (55)	3.6	0.9–14.4	.07
	Control	9/26 (35)	12/32 (38)
Used hormonal contraception in past 12 months	Home visit	18/36 (50)	18/31 (58)	0.7	0.2–1.9	.46
	Control	15/26 (58)	21/32 (66)	1.0
Repeat pregnancy	Home visit	7/36 (19)	14/31 (45)	1.2	0.4–3.5	.69
	Control	5/26 (19)	12/32 (38)	1.0
Repeat birth	Home visit	3/36 (8)	4/31 (13)	0.6	0.2–2.6	.54
	Control	2/26 (8)	6/32 (19)	1.0
Maternal mental health
Depressive symptoms (CES-D score ≥21)	Home visit	8/36 (22)	11/31(36)	2.1	0.6–7.1	.24
	Control	6/26 (23)	8/32 (25)	1.0
School status
In school or graduated at year 2^†	Home visit	–	22/31 (71)	3.5	1.1–11.8	<.05
	Control	–	14/32 (44)	1.0
Linkage with primary care
Has a regular personal doctor at year 2	Home visit	–	19/31 (61)	1.9	0.7–5.6	.23
	Control	–	15/32 (47)	1.0

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Table 5.

Selected Characteristics of Adolescent Mothers With and Without a Regular Personal Doctor

	Adolescent Has a Regular Personal Doctor
Characteristic	Yes (n = 34)	No (n = 29)	P Value
CTS = Conflict Tactics Scale; CES-D = Center for Epidemiologic Studies Depression.
* n = 19.
† n = 19.
Demographics
Age at baseline, mean (SD), y	16.2 (1.5)	16.9 (1.4)	.04
Lives with mother at year 2, %	62	46	.23
Household conflict at year 2: CTS score, mean (SD)	17.4 (14.5)	23.6 (14.5)	.13
Continuous health insurance from baseline to year 2, %	42	26	.19
Contraceptive use and pregnancy outcomes
Used condoms “always” in past 12 months at year 2, %	56	35	.09
Used hormonal contraception in past 12 months at year 2, %	62	62	.98
Repeat pregnancy by year 2, %	47	35	.48
Repeat birth by year 2, %	18	14	.68
Maternal mental health
Depressive symptoms (CES-D score >21) at baseline,* %	38	21	.13
Depressive symptoms (CES-D score >21) at year 2,^† %	41	17	<.05
Group
Home visit	61	39	.25
Control	47	53

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The Article in Brief

Home Visiting for Adolescent Mothers: Effects on Parenting, Maternal Life Course, and Primary Care Linkage

Beth Barnet, MD , and colleagues

Background Adolescent mothers have high rates of repeat pregnancy, depression, and school dropout, and less chance of being financially independent in the future. This study evaluates a program for pregnant teenagers and teenage mothers in which trained home visitors provide parenting education, encouragement to use contraception and continue school, and connection to primary medical care.

What This Study Found The home-visiting program improved teenage mothers� attitudes and beliefs about parenting and helped them stay in school. It did not reduce repeat pregnancy or depression and did not provide coordination with primary care.

Implications

Home visiting can provide important results for low-income adolescent mothers.
Community-based home-visiting programs and primary care practices may achieve greater benefits if they work together to develop and test methods to coordinate care for high-risk adolescents.