August 2007

Grant Results

SUMMARY

Between 2001 and 2005, researchers from the Harvard School of Public Health and their colleagues at Teachers College Columbia University conducted a follow-up study of adolescents who, as babies, had participated in the Infant Health and Development Program (IHDP), an early intervention program for low-birthweight, premature infants funded by the Robert Wood Johnson Foundation (RWJF).

The program, which began in 1982, is the first and — as of 2006 — only multisite, randomized study of the effectiveness of a comprehensive early intervention program for low-birthweight, premature infants. It offered home visits, center-based education and family support.

This grant enabled researchers to contact 636 (64.6 percent) of the original 985 children in the study to determine whether the children (now age 18) still experienced any benefits from their participation in the early intervention services.

Key Findings

  • At age 18, youth who had been in the subgroup of heavier low-birthweight infants (whose birthweights were close to normal) and who received early intervention services scored significantly higher on tests of math and cognitive ability than similar youth who had not received the services. They were also somewhat less likely to engage in risk-taking behavior.
  • Among 18-year olds who had been in the lighter low-birthweight subgroup as infants, there were no differences on any cognitive or behavioral measures between those who had received intervention services and those who had not.

Earlier Assessments
Earlier assessments of the IHDP found that, at age 3, children who received early intervention services had significantly higher IQs and fewer behavior problems than those who had not received the services. By age 8, the advantages persisted, although at a more modest level and only among the heavier low-birthweight children.

Funding
RWJF provided $3,509,052 to support this unsolicited project. Previous RWJF grants supported the Infant Health and Development Program (close to $25.6 million) and its replication program ($1.5 million).

 See Grant Detail & Contact Information
 Back to the Table of Contents


PROBLEM

According to research compiled by Child Trends DataBank, infants born at a low birthweight are at increased risk of dying before age 1 and of long-term disability and impaired development.

  • Infants born under 2,500 grams are more likely than heavier infants to experience delayed motor and social development.
  • Children ages 4 to 17 who were born at a low birthweight are more likely to be enrolled in special education classes, to repeat a grade or to fail school than children who were born at a normal birthweight.

In a 2000 Institute of Medicine report, From Neurons to Neighborhoods: the Science of Early Child Development, a committee of child development experts concluded that early childhood intervention programs can improve cognitive and behavioral outcomes for vulnerable children by providing them with formalized education and health and social services in their preschool years.

The committee cited thousands of studies demonstrating immediate gains in IQ scores and other positive outcomes among low-income children and children with disabilities.

Only a few early childhood intervention programs have followed the children enrolled into their adolescent and adult years to determine how long these benefits persist.

Those that have, such as the Carolina Abecedarian Project and the High/Scope Perry Preschool Project, have demonstrated modest but positive lifetime advantages, including:

  • Higher IQ scores.
  • Higher math and reading achievement scores.
  • Higher rates of high school graduation.
  • Lower incidences of criminal arrests and welfare participation.

While such findings are promising, these projects served a small group of healthy, low-income children from a single site. The researchers could not draw conclusions about the likely impact of early intervention on other, more diverse populations.

In contrast to these projects, the Infant Health and Development Program, initiated in 1982 by researchers at Harvard School of Public Health and Teachers College Columbia University, and funded by RWJF, served a large group of low-birthweight, premature infants who were recruited from eight sites across the country and were diverse with respect to health, social and economic status.

An examination of these children in adolescence would add an important component to the growing body of evidence about the long-term impact of early intervention programs.

Background: Early Phases of the Infant Health and Development Program

In 1982, researchers at the Harvard School of Public Health joined with faculty from Teachers College Columbia University in designing and conducting the Infant Health and Development Program (IHDP). This program was the first and, as of 2006, only multisite, randomized study of the effectiveness of a comprehensive early intervention for preterm, low-birthweight babies.

Some 985 preterm, low-birthweight babies participated in the study. To ensure that the children were diverse with regard to health and socioeconomic status, the researchers:

  • Recruited the infants from medical institutions in eight economically diverse U.S. cities (Appendix 1 includes a list of participating institutions):
    • Bronx, N.Y.
    • Cambridge, Mass.
    • Dallas
    • Little Rock, Ark.
    • Miami
    • New Haven, Conn.
    • Philadelphia
    • Seattle
  • Sampled children from two birthweight subgroups:
    • Heavier low-birthweight infants (2,001 to 2,500 grams, or 4 pounds, 7 ounces to 5 pounds, 8 ounces) who approached normal weight.
    • Lighter low-birthweight infants (2,000 grams — 4 pounds, 6 ounces — or less) who were at higher risk for health and developmental problems.

All participating infants received high-risk follow-up pediatric care with frequent clinical assessments and annual developmental testing. The researchers randomly assigned the children to either the intervention or follow-up only group.

Between 1985 and 1988, the 377 children in the intervention group also received:

Home visits on a weekly basis for the first year and biweekly until age 3. The home visitors, who were at least college graduates, were specially trained and guided by intervention-specific materials.

  • Daily center-based education beginning at 12 months and continuing until 36 months.
  • Bimonthly support groups for their parents, beginning when the children were 12 months old.

The 608 children randomly assigned to the follow-up only group received the same intensive pediatric services as children in the intervention group but did not receive the additional early education services.

To evaluate the impact of the IHDP, researchers assessed children's cognitive and behavioral functioning at the conclusion of the intervention (age 3) and then again at ages 5 and 8. (See Appendix 1 for details on methodology for early project phases.)

Funding of Early Phases
In addition to support from RWJF, the early phases of the project received support from the Pew Charitable Trusts; National Institute of Child Health & Human Development of the National Institutes of Health; and the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services.

Findings at 36 Months and at 5 and 8 Years
The research team produced numerous articles on the early phases of the project (see Appendix 2 for a list of representative articles). The following key findings appear in a 1998 article by McCormick et al. "The Infant Health and Development Program: Interim Summary," in Developmental and Behavioral Pediatrics.

  • At 36 months of age, children who received the educational intervention had substantially higher IQ scores than children who received follow-up only services.
    • The group of heavier low-birthweight children scored 13.2 points higher on a test of IQ than children who had not received the intervention.
    • Lighter low-birthweight children in the study group scored 6.6 points higher than their counterparts in the follow-up-only group.
  • At ages 5 and 8, the children in the intervention group continued to have higher IQ scores, but differences between the intervention and follow-up-only group had diminished.
    • The heavier low-birthweight children had IQ scores that were four points higher than follow-up-only children, and their scores on a mathematics achievement test were also four points higher.
    • There were no differences between the two groups of lighter low-birthweight children.
  • At 36 months, the intervention group had fewer behavioral problems than the follow-up only group.
  • There were no differences in behavioral outcomes between the two groups at ages 5 or 8.

The Web site of the Promising Practices Network includes Key Evaluation Findings from the IHDP. The network, operated by RAND Corporation, profiles programs that its staff has screened for quality and evidence of positive effects.

 Back to the Table of Contents


RWJF STRATEGY

RWJF also funded over the long term the work of David Olds, Ph.D., to provide nurses to home visit young women both before and after the birth of their babies. See the Grant Results on the Nurse-Family Partnership program. Also, see the special report on Olds' work, The Story of David Olds and the Nurse Home Visiting Program.

In addition, although RWJF has never focused on children's health issues per se, a lot of its funding has benefited children. Programs include:

 Back to the Table of Contents


THE PROJECT

The Follow-Up Study

Between 2001 and 2005, the IHDP research team conducted a follow-up study to determine whether adolescents who had received intervention services as infants still experienced benefits at age 18. The research team investigated the following questions:

  • Does the IHDP intervention for low-birthweight premature infants result in persistent benefits for children who participated in the intervention compared to those who did not?
  • Do differences appear over time in the cognitive functioning, behavior and health status of children in the intervention group compared to those in the follow-up only group?
  • How does the intervention affect maternal behaviors and parenting styles?
  • Does participation in an early childhood intervention program affect the cognitive and behavioral development and achievement in siblings who are born in the five years after the study child?

Methodology

In 1995, when the children in the IHDP turned 10, RWJF provided a grant (ID# 028127) to test the feasibility of tracking the children in their adolescent years.

Staffs at the eight study sites were able to contact between 61 and 74 percent of the 878 eligible participants (i.e., those who had not died or withdrawn from the study by age 8).

Since staff had achieved these contacts with limited resources, researchers concluded that, with further recruitment efforts, they could recontact a high percentage of participants for their adolescent follow-up study.

When the researchers began the follow-up study in 2001, they reconnected with the research teams at the eight study sites. These teams helped the researchers locate the families who had participated in the early intervention program.

Researchers were able to locate and reassess 636 (64.6 percent) of the 985 original participants at age 18. This represented 72 percent of the eligible participants but was lower than the anticipated response rate. (See Limitations.)

Researchers obtained information from adolescents and their caregivers related to academic achievement, behavior, cognitive abilities and physical health.

To provide continuity, researchers used the same instruments they had used in the earlier assessments to the extent possible (some instruments were not applicable to adolescents).

For the follow-up study, researchers added questions from the Youth Risk Behavior Surveillance System, a biannual survey of high school students conducted by the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention. Questions addressed risk behaviors and related problems, including suicidal ideation/attempts, smoking, alcohol and marijuana use, and risky sexual activity. Researchers also questioned both the youth and their caregivers about general behavior problems and about youth involvement with the justice system.

At age 18, the youth were able to respond directly to questions about their academic progress and risk behaviors. Questioning youth directly on sensitive topics, however, raised issues of safety related to a participant's report of risk behaviors and problems. Researchers developed a backup safety plan to deal with this issue. (See Lessons Learned.)

See Appendix 3 for list of assessment instruments.

Communications

To communicate findings from the 18-year follow-up study, the research team:

  • Reported findings in an article published in 2006 in Pediatrics entitled "Early Intervention in Low Birth Weight Premature Infants: Results at Age 18 for The Infant Health and Development Program." (The article is available online.)
  • Prepared and submitted for publication additional articles on the effects of the IHDP intervention on maternal behaviors.
  • Made presentations at national conferences, including annual meetings of the Pediatric Academic Societies and AcademyHealth.

See the Bibliography for details on publications related to the follow-up study findings. During the project period, the researchers also reported findings related to earlier phases of the project in published articles and abstracts. These are also cited in the Bibliography.

 Back to the Table of Contents


FINDINGS

Researchers reported findings on the follow-up study in an article in Pediatrics, "Early intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program." (This article is available online.) Key findings as reported in the article:

  • Among the heavier low-birthweight youth (with birthweights between 2,001 and 2,500 grams), those who had received early intervention services scored significantly higher at age 18 on tests of math achievement and cognitive development than youth in the follow-up-only group. They were also somewhat less likely to engage in risk-taking behavior.
  • For youth in the lighter low-birthweight group (2,000 grams and less), there was no difference at age 18 between those who had received intervention services and those who had not. Researchers found no differences with regard to cognitive, behavioral, academic or physical health outcomes. These results were consistent with earlier results (at ages 36 months and 5 and 8 years) for the lighter low-birthweight group.
  • Rates of juvenile arrests and incarceration were somewhat higher in the follow-up-only group than in the intervention group, but the difference was not statistically significant.

In a presentation at the May 2006 Pediatric Academic Societies Meeting, "Self-Perception of Education Performance and Future Expectations in Very Low Birth Weight Infants at 18 Years of Age" (abstract available online), researchers reported additional findings.

  • Former very low-birthweight infants (less than 1,500 grams) scored five to eight points lower on cognitive and academic achievement tests compared to the heavier low-birthweight group.
  • Despite their lower performance, the former very low-birthweight infants were equally self-confident in their overall abilities and future expectations. When interviewed, these adolescents reported a degree of confidence in their reading ability, attitudes toward school, and self-efficacy that was similar to the confidence expressed by adolescents who had been in the heavier low-birthweight group.

In an unpublished article ("Long-Term Maternal Effects of Early Childhood Intervention: Findings from the Infant Health and Development Program"), researchers reported on the impact of IHDP on mothers.

  • The intervention had a long-term effect only on mothers' employment, and not on mothers' mental health or home environment. The effect varied by the children's birthweight:
    • When their children reached age 18, mothers of the lighter low-birthweight babies who had been in the intervention group were more likely to be employed than mothers of such children in the follow-up-only group.
    • Among mothers of the heavier low-birthweight infants, those in the intervention group were less likely to work when their children were ages 5 and 8. By the time their children were 18 years of age, mothers of the heavier low-birthweight infants were slightly more likely to work than mothers whose children had received follow-up care only.
  • Mothers' employment status did not influence how the intervention affected their children. The long-term effects on the children were not related to mothers' being employed or not.

With regard to effects on siblings, researchers noted, in a report to RWJF:

  • Sibling effects appear unlikely, given the lack of an effect on maternal attitudes. Preliminary examination of sibling outcomes revealed no significant differences in IQ or behavior in the siblings of the study population.

Limitations

Researchers noted limitations to the findings in their article in Pediatrics, "Early Intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program."

  • The response rate to the 18-year follow-up survey was lower than in previous rounds of assessment. Disadvantaged children and those with lower previous cognitive development were less likely to participate in the follow-up survey. After comparing nonparticipants to participants, the researchers concluded that the loss to follow-up did not affect study results although they acknowledged that unmeasured factors may have made a difference.
  • The age of assessment (18 years) does not allow for evaluation of economically important outcomes, such as higher educational attainment, employment and income.
  • Because the study sample is diverse with regard to income and education, the ability to detect significant differences in some areas is limited. In contrast to other early intervention studies, the IHDP includes a higher percentage of youth from more affluent, well-educated households who are less at risk of school failure or criminal behavior regardless of whether they receive early intervention services. A much larger sample size (about 1,500) would be more likely to result in statistically significant differences between the groups on outcomes influenced by socioeconomic status, such as education and criminal behavior.

 Back to the Table of Contents


CONCLUSIONS

In their article in Pediatrics, researchers concluded that:

  • "The results of this phase of the IHDP suggest a persistent benefit of the intervention for the subset of HLBW [heavier low-birthweight] participants and absence or even reversal of any intervention effect for the LLBW [lighter low birthweight] youth … These results parallel those seen at 8 years of age."
  • "The findings in the HBLW intervention group provide support for preschool education to make long-term changes in a diverse group of children who are at developmental risk."
  • "The lack of observable benefit in the LLBW group raises questions about the biological and educational factors that foster or inhibit sustained effects of early educational intervention."

 Back to the Table of Contents


SIGNIFICANCE TO THE FIELD

According to the researchers (in their article in Pediatrics), the modest but persistent benefits experienced by adolescents who had participated in the project intervention as infants "provides substantial reinforcement to the emerging literature on longer-term effects of early intervention."

In contrast to previous studies, which involved largely poor, healthy children, the IHDP sample of premature, low-birthweight babies from diverse cities around the country is more heterogeneous with regard to health and socioeconomic status. "[T]his phase of the IHDP provides important support for the efficacy of early educational interventions in the longer-term outcomes of children," researchers wrote. … "[T]he results provide support for extending such educational opportunities to a broader spectrum of children than included in previous studies."

 Back to the Table of Contents


LESSONS LEARNED

  1. In longitudinal studies, try to maintain contact with study subjects over the long term. Re-locating children and parents who had participated in the project was difficult after a lapse of 10 years. The major reason for the lower-than-anticipated response rate was the inability of staff at the eight sites to contact subjects. In large, multisite studies, researchers should recruit dedicated, stable staff who will maintain contact with the subject families over time. Staff should also prepare for future follow-up by obtaining backup contact information and permission for future contacts. (Project Director)
  2. Make use of the Internet and other strategies to locate subjects for follow-up. Staff had collected substantial information in previous phases to help them trace study participants for follow-up assessments. By the time they were 18, however, many of the youth were in college or had moved out of their homes. The research team used the Internet to find youth and hired "roving assessors" to collect information from youth who had moved away from the project site areas. (Project Director)
  3. Expect to spend a lot of time on legal and ethical issues related to the protection of vulnerable subjects. To evaluate the IHDP's impact on adolescent behavior, researchers had to request confidential, sensitive information about activities, such as drug use, that could put youth at legal risk. The Institutional Review Boards at the project sites carefully scrutinized the project to ensure that procedures were in place to protect youth from undue risk. Resolving these complex issues delayed data collection. (Project Director)
  4. When collecting information about mental health, substance abuse and other high-risk behaviors, be sure to have a backup plan in case a respondent discloses serious problems. Researchers used the Youth Risk Behavior Surveillance Survey, which asks questions related to mental health, substance abuse and suicidal thoughts. Researchers flagged particular questions as signals of potential problems and established a back-up safety plan if a youth responded positively to these questions. In such cases, staff called in a mental health clinician to talk with the youth. (Project Director)

 Back to the Table of Contents


AFTER THE GRANT

As of 2006, researchers are continuing a longitudinal analysis of the study data, examining long-term patterns of cognitive functioning and behavior over the 18-year period, rather than only at a single point in time. They are also seeking funding for a follow-up study of IHDP youth as they enter adulthood.

Subsequently, the results have been presented to several professional groups:

  • The New England Association of Neonatologists (Marlborough, Mass., September 15, 2006).
  • The Division of General Pediatrics at the Massachusetts General Hospital (Boston, October 11, 2006).
  • The Western Perinatal Research Meeting (Banff, Alberta, Canada, February 16, 2007).
  • MCH professionals in Barcelona, Spain (June 13, 2007). This resulted in a story in El Pais, a national newspaper.

 Back to the Table of Contents


GRANT DETAILS & CONTACT INFORMATION

Project

Follow-up Study of Adolescents Who Participated in the Infant Health and Development Program

Grantee

Harvard University School of Public Health (Boston,  MA)

  • Amount: $ 3,509,052
    Dates: August 2001 to September 2005
    ID#:  039543

Contact

Marie C. McCormick, M.D., Sc.D.
(617) 432-3759
mmccormi@hsph.harvard.edu

 Back to the Table of Contents


APPENDICES


Appendix 1

The Infant Health and Development Program: Methodology and Intervention Components of Early Phases

A description of the Infant Health and Development Program appears on the Web site of the Promising Practices Network. The network, operated by RAND Corporation, profiles programs that its staff has screened for quality and evidence of positive effects. The following is a summary of the project methodology.

Methodology
Site Selection and Sample
Researchers recruited the sample of low-birthweight preterm infants from eight geographically and economically diverse sites around the country. RWJF selected the sites through a national solicitation in 1984. The major criteria for participation were as follows:

  • A medical school or affiliated hospital with an obstetric service and a sufficient number of births to enroll 135 infants and their families within six months.
  • A pediatric component able to recruit and retain the subjects, provide pediatric surveillance at specified intervals and provide pediatric support to the educational centers.
  • A facility for providing the educational component.

The eight sites were:

  • University of Arkansas for Medical Science College of Medicine.
  • Children's Hospital Corporation, Boston.
  • Medical Associates Research and Education Foundation (University of Pennsylvania).
  • University of Miami School of Medicine.
  • University of Texas Southwest Medical School at Dallas.
  • University of Washington School of Medicine.
  • Yale University School of Medicine.
  • Yeshiva University, Albert Einstein College of Medicine.

Infants eligible for the study:

  • Had been born in one of the participating hospitals at each of the eight sites.
  • Had a birthweight of 2,500 grams or less and a gestational age of 37 weeks or less.
  • Resided in an area that was 45 minutes or less from the early educational center.

A total of 4,551 infants were screened for eligibility. The primary analysis group consisted of 985 infants who met the eligibility criteria and whose families gave consent to participate. Infants were enrolled between October 1984 and August 1985 in two birthweight subgroups (or strata):

  • Heavier low-birthweight infants (2,001 to 2,500 grams).
  • Lighter low-birthweight infants (2,000 grams or less).

Within each subgroup, researchers randomly assigned infants to either the intervention group (N=377) or follow-up-only group (N=608).

Intervention Components
Infants assigned to the intervention group received an educational program adapted for low-birthweight infants from the Carolina Abecedarian Project, an early intervention for socially disadvantaged normal birthweight children.

The intervention had three components:

  • Home Visits: The IHDP protocol specified weekly home visits for the first year after birth and biweekly visits thereafter. The home visitors, who were at least college graduates, were specially trained and guided by intervention-specific materials. They provided parents with health and developmental information, along with family support. In addition, the home visitors implemented two specific curricula:
    • The first emphasized cognitive, linguistic and social development through games and activities for the parent to use with the child.
    • The second involved a systematic approach to help parents manage self-identified problems.
  • Child Development Centers: Beginning at 12 months and continuing until 36 months, the IHDP intervention children attended a Child Development Center five days a week for at least four hours a day. The teaching staff continued to implement the curriculum learning activities used by the home visitors and tailored the program to each child's needs and developmental levels.
  • Parent Groups: Beginning at 12 months, bimonthly parent group meetings provided parents with information on child rearing, health and safety and other parenting concerns, along with social support.

Infants in both the intervention and follow-up-only groups received periodic medical, developmental and social service assessments with referral for community services as needed. At the end of the intervention period (age 36 months), the children received whatever community educational programs were available at the site.

The assessment completion rates were 92 percent at age 36 months, 82 percent at age 5 years and 89 percent at age 8 years.


Appendix 2

(Current as of the time of the grant; provided by the grantee organization; not verified by RWJF.)

The Infant Health and Development Program: A Selection of Articles on the Early Phases of the Program

Blair C, Ramey CT and Hardin JM. "Early Intervention for Low Birthweight, Premature Infants: Participation and Intellectual Development," American Journal on Mental Retardation, 99(5): 542–554, 1995.

Bradley RH, Whiteside L, Mundfrom DJ, Casey PH, Kelleher KJ and Pope SK. "Contribution of Early Intervention and Early Caregiving Experiences to Resilience in Low-Birthweight, Premature Children Living in Poverty," Journal of Clinical Child Psychology, 23: 425–434, 1994.

Bradley RH, Burchinal MR and Casey PH, "Early Intervention: The Moderating Role of the Home Environment," Applied Developmental Science, 5(1): 2–8, 2001.

Brooks-Gunn Jeanne, McCarton CM, Casey PH, McCormick MC, Bauer CR, Bernbaum JC, Tyson J, Swanson M, Bennett FC, Scott DT, Tonascia J and Meinert CL. "Early Intervention in Low-Birth-Weight Premature Infants: Results Through Age 5 Years from the Infant Health and Development Program," Journal of the American Medical Association, 272(16): 1257–1262, 1994.

Brooks-Gunn Jeanne, Liaw F-r and Klebanov PK. "Effects of Early Intervention on Cognitive Function of Low Birth Weight Preterm Infants," Journal of Pediatrics, 120(3): 350–359, 1992.

Brooks-Gunn J, Klebanov PK, Liaw F-r and Spiker D. "Enhancing the Development of Low-Birthweight, Premature Infants: Changes in Cognition and Behavior over the First Three Years," Child Development, 64: 736–753, 1993.

Fewell RR and Scott KG. "Cost Analysis Decisions for IHDP," in Helping Low Birth Weight, Premature Babies: The Infant Health and Development Program (Ruth T. Gross, Donna Spiker, and Christine W. Haynes (eds). Palo Alto, Calif.: Stanford University Press, 1997.

"Enhancing the Outcomes of Low-Birth-Weight, Premature Infants: A Multisite, Randomized Trial. Infant Health and Development Program," Journal of the American Medical Association, 263(22): 3035–3042, 1990.

Hollomon HA and Scott KG. "Influences of Birthweight on Educational Outcomes at Age Nine: The Miami Site of the Infant Health and Development Program," Journal of Developmental & Behavioral Pediatrics, 19(6): 404–410, 1998.

Liaw F-r and Brooks-Gunn J. "Cumulative Familial Risks and Low-Birthweight Children's Cognitive and Behavioral Development," Journal of Clinical Child Psychology, 23(4): 360–372, 1994.

McCarton CM, Brooks-Gunn J, Wallace IF, Bauer CR, Bennett FC, Bernbaum JC, Broyles S, Casey PH, McCormick MC, Scott DT, Tyson J, Tonascia J and Meinert CL. "Results at Age 8 Years of Early Intervention for Low-Birth-Weight Premature Infants," Journal of the American Medical Association, 277(2): 126–132, 1997.

McCormick MC, McCarton C, Tonascia J and Brooks-Gunn J. "Early Educational Intervention for Very Low Birth Weight Infants: Results from the Infant Health and Development Program," Journal of Pediatrics, 123(4): 527–533, 1993.

McCormick MC, McCarton C, Brooks-Gunn J, Belt P and Gross RT. The Infant Health and Development Program: Interim Summary," Developmental and Behavioral Pediatrics, 19(5): 359–370, 1998.

Ramey CT, Bryant DM, Waski BH, Sparling JJ, Fendt KH and LaVange LM. "Infant Health and Development Program for Low Birth Weight, Premature Infants: Program Elements, Family Participation, and Child Intelligence," Pediatrics, 89: 454–465, 1992.

Spiker D, Ferguson J and Brooks-Gunn J. "Enhancing Maternal Interactive Behavior and Child Social Competence in Low Birth Weight, Premature Infants," Child Development, 64: 754–768, 1993.


Appendix 3

The Infant Health and Development Program: Assessment Instruments for Follow-Up Study at Age 18

The researchers used the following instruments to measure cognitive, behavioral and health outcomes of 18-year-olds in the follow-up survey.

  • Academic Achievement
    Woodcock-Johnson Test of Achievement-Revised (WJ-III): WJ-III is a test of reading and math achievement.
  • Cognitive Development
    Wechsler Abbreviated Scale of Intelligence (WAIS): WAIS is a general test of intelligence (IQ)

    Peabody Picture Book Vocabulary Test-Revised: The PPVT-R measures an individual's receptive (hearing) vocabulary for standard American English and provides at the same time, a quick estimate of verbal ability or scholastic aptitude.
  • Behavior
    Youth Risk Behavior Surveillance System (YRBSS): YRBSS was developed in 1990 to monitor priority health risk behaviors that contribute markedly to the leading causes of death, disability and social problems among youth and adults in the United States. These behaviors, often established during childhood and early adolescence, include:
    • Tobacco use.
    • Unhealthy dietary behaviors.
    • Inadequate physical activity.
    • Alcohol and other drug use.
    • Sexual behaviors that contribute to unintended pregnancy and sexually transmitted diseases, including HIV infection.
    • Behaviors that contribute to unintentional injuries and violence.
  • Physical health
    36-Physical Component Summary (SF-36) The SF-36 is a multipurpose, short-form health survey with only 36 questions.
  • Baseline Measures
    As in previous phases of the study, researchers collected a standard set of pre-randomization variables to compare participants and non-participants on selected variables prior to their randomization into either the intervention or follow-up only group. These variables included birthweight, maternal age, race/ethnicity, gender, maternal educational attainment at the time of the birth of the child and a measure of the child's neonatal health and problem status.


Appendix 4

Glossary

Institutional Review Board (IRB). A committee at academic institutions and medical facilities that monitors research studies to assure, both in advance and by periodic review, that appropriate steps are taken to protect the rights and welfare of human subjects.

Source: http://en.wikipedia.org/wiki/Institutional_Review_Board

Low-birthweight (LBW). The World Health Organization (WHO) defines low-birthweight as weight at birth of less than 2,500 grams (5.5 pounds). This is based on epidemiological observations that infants weighing less than 2,500 grams are approximately 20 times more likely to die than heavier babies.

Source: www.who.int/reproductivehealth/publications/low_birthweight/low_birthweight_estimates.pdf

Very low-birthweight (VLBW). Babies who are very low in birthweight (less than 1,500 grams, or 3 pounds, 4 ounces) have a 25 percent chance of dying before age 1.

Source: Child Trends DataBank

Prematurity or Preterm Birth. Premature birth is one that occurs before 37 weeks of gestation. It is often linked to low birthweight.

Source: www.who.int/reproductive health/publications/low_birthweight/low_birthweight_estimates.pdf

Randomized controlled trial. In a randomized controlled trial, the impact of a program is determined by randomly assigning individuals to an intervention group or control group. Random assignment refers to the assignment of individuals in the pool of all potential participants to either the experimental (treatment) group or the control group in such a manner that their assignment to a group is determined entirely by chance.

Source: www.ojp.usdoj.gov/BJA/evaluation/glossary/glossary_r.htm

Suicidal ideation. The strict definition is wanting to take one's own life or thinking about suicide without actually making plans to commit suicide, but the term is often used to refer to having the intent to commit suicide, including planning how it will be done.

Source: http://bipolar.about.com/od/suicide/g/suicidalideatio.htm

 Back to the Table of Contents


BIBLIOGRAPHY

(Current as of date of this report; as provided by grantee organization; not verified by RWJF; items not available from RWJF.)

Articles

Gray RF, Indurkhya A and McCormick MC. "Prevalence, Stability and Predictors of Clinically Significant Behavior Problems in Low Birth Weight Children at 3, 5, and 8 Years." Pediatrics, 114(3): 736–743, 2004. Available online.

Gray R and McCormick MC. "Early Childhood Intervention Programs in the US: Recent Advances and Future Recommendations." Journal of Primary Prevention, 26: 259–275, 2005. Abstract available online. Full text requires subscription or fee.

Martin A, Brooks-Gunn J and Klebanov P. "Long-Term Maternal Effects of Early Childhood Intervention: Findings from the Infant Health and Development Program (IHDP)." Journal of Applied Developmental Psychology, 29(2): 101–117, 2008.

McCormick MC, Brooks-Gunn J, Buka SL, Goldman J, Yu J, Salganik M, Scott DT, Bennett FC, Kay LL, Bernbaum JC, Bauer CR, Martin C, Woods ER and Casey PH. "Early Intervention in Low Birth Weight Premature Infants: Results at 18 Years of Age for the Infant Health and Development Program." Pediatrics, 117(3): 771–780, 2006. Available online.

Roberts G, Bellinger D and McCormick MC. "A Cumulative Risk Factor Model for Early Identification of Academic Difficulties in Premature and Low Birth Weight Infants." Maternal and Child Health Journal, 11: 161–172, 2007. Abstract available online. Full text requires subscription or fee.

Yu J, Buka SL, McCormick MC, Fitzmaurice GM and Indurkhya A. "Behavioral Problems and the Effects of Early Intervention on Eight-Year-Old Children with Learning Disabilities and the Effects of Early Intervention." Maternal and Child Health Journal, 10: 329–338, 2006. Abstract available online. Full text requires subscription or fee.

Presentations and Testimony

Ron Gray, Alka Indurkhya and Marie C. McCormick, "Prenatal and Perinatal Risk Factors for Subsequent Behavior Problems in Preterm Low Birth Weight Children up to Age Eight Years," at the Pediatric Academic Societies' Annual Meeting, May 3–6, 2003, Seattle. Abstract available online.

Ron Gray, Alka Indurkhya and Marie C. McCormick, "Prevalence, Stability and Time Trends of Clinically Significant Behavior Problems in Children Born Prematurely," at the Pediatric Academic Societies' Annual Meeting, May 3–6, 2003, Seattle. Abstract available online.

Ron Gray, Alka Indurkhya and Marie C. McCormick. "Comparing the Child Health Questionnaire Behavior and Mental Health Scales with the Child Behavior Checklist in the Assessment of Outcomes for Preterm Low Birth Weight Children," at the AcademyHealth Annual Research Meeting, June 27–29, 2003, Nashville, Tenn. Abstract available online.

Gehan Roberts, David Bellinger and Marie McCormick, "Identifying Early Predictors for School Age Academic Difficulties in Former Low-Birth-Weight Infants," at the Pediatric Academic Societies' Annual Meeting, May 1, 2004, San Francisco. Abstract available online.

Jennifer Yu, Stephen Buka, Marie McCormick, Garrett Fitzmaurice and Alka Indurkhya, "Do Early Intervention Programs Alleviate Behavioral Problems in Children with Learning Disabilities?" poster presentation at the Annual AcademyHealth Conference, June 26, 2005, Boston. Proceedings available online (go to page 30 for abstract).

CR Martin, Z Zheng, SL Buka and MC McCormick, "Social Development and Physical Health Outcomes in Very Low Birth Weight (VLBW, <1500g) Infants at 18 Years of Age," at the Pediatric Academic Societies Annual Meeting, May 1, 2006, San Francisco. Abstract available online.

CR Martin, Z Zheng, Stephen L Buka and MC McCormick, "Self-Perception of Education Performance and Future Expectations in Very Low Birth Weight Infants at 18 years of Age," at the Pediatric Academic Societies Meeting, May 1, 2006, San Francisco. Abstract available online.

 Back to the Table of Contents


Report prepared by: Jayme Hannay
Reviewed by: Mary B. Geisz
Reviewed by: Molly McKaughan
Program Officer: Laura C. Leviton

Most Requested