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Outcomes of Childhood Preventive Intervention Across 2 GenerationsA Nonrandomized Controlled Trial

Educational Objective
To examine possible intervention outcomes on the offspring of individuals (now parents) who participated in the Raising Healthy Children preventive intervention as children in the elementary grades.
1 Credit CME
Key Points

Question  Might a universal social-developmental intervention in childhood show sustained benefits across generations?

Findings  In this nonrandomized controlled trial, significant differences in the offspring of individuals (now parents) who had received the intervention in childhood were observed across 4 domains: improved early-childhood developmental functioning, lower teacher-rated behavioral problems, higher teacher-rated academic skills and performance, and lower child-reported risk behaviors.

Meaning  These findings emphasize the importance of childhood preventive intervention not only for later adult functioning but also for improved functioning in the next generation.

Abstract

Importance  Trials of preventive interventions for children that were implemented in the 1980s have reported sustained positive outcomes on behavioral and health outcomes into adulthood, years after the end of the intervention. This present study examines whether intervention in childhood may show sustained benefits across generations.

Objective  To examine possible intervention outcomes on the offspring of individuals (now parents) who participated in the Raising Healthy Children preventive intervention as children in the elementary grades.

Design, Setting, and Participants  This nonrandomized controlled trial was conducted in public elementary schools serving high-crime areas in Seattle, Washington. The panel originated in Seattle but was followed up locally and in out-of-state locations over time. Data analyzed in this study were collected from September 1980 to June 2011, with follow-up of the firstborn offspring (aged 1 through 22 years) of 182 parents who had been in the full intervention vs control conditions in childhood. Their children were assessed across 7 waves in 2 blocks (2002-2006 and 2009-2011). Data were analyzed for this article from September 2018 through January 2019.

Interventions  In grades 1 through 6, the Raising Healthy Children intervention provided elementary school teachers with methods of classroom management and instruction, first-generation (G1) parents with skills to promote opportunities for children’s active involvement in the classroom and family, and second-generation (G2) child with social and emotional skills training.

Main Outcomes and Measures  Outcomes examined in the third-generation (G3) offspring were self-regulation (emotion, attention, and behavioral regulation), cognitive capabilities, and social capabilities. Risk behaviors, including substance use and delinquency, were examined from age 6 years to study completion. Early onset of sexual activity was examined from age 13 years to study completion. Intent-to-treat analyses controlled for potential confounding factors.

Results  A total of 182 G3 children were included in this analysis (72 in the full intervention and 110 in the control condition; mean age at first wave of data collection, 7 [range, 1-13] years). Significant differences in the offspring of intervention parents were observed across 4 domains: improved early child developmental functioning (ages 1-5 years; significant standardized β range, 0.45-0.56), lower teacher-rated behavioral problems (ages 6-18 years; significant standardized β range, –0.39 to –0.46), higher teacher-rated academic skills and performance (ages 6-18 years; significant standardized β range, 0.34-0.49), and lower child-reported risk behavior (ages 6-18 years; odds ratio for any drug use [alcohol, cigarettes, or marijuana], 0.27 [95% CI, 0.10-0.73]).

Conclusions and Relevance  To our knowledge, this is the first study to report significant intervention differences in the offspring of participants in a universal childhood preventive intervention. Cost-benefit analyses have examined the benefits of childhood intervention in the target generation. The present study suggests that additional benefits can be realized in the next generation as well.

Trial Registration  ClinicalTrials.gov Identifier: NCT04075019

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Article Information

Accepted for Publication: February 28, 2020.

Corresponding Author: Karl G. Hill, PhD, Program on Problem Behavior and Positive Youth Development, Institute of Behavioral Science, University of Colorado Boulder, 483 UCB, Boulder, CO 80309-0483 (karl.hill@colorado.edu).

Published Online: June 8, 2020. doi:10.1001/jamapediatrics.2020.1310

Author Contributions: Dr Hill had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Hill, Bailey, Hawkins, Catalano, Kosterman, Epstein, Abbott.

Acquisition, analysis, or interpretation of data: Hill, Bailey, Steeger, Hawkins, Epstein, Abbott.

Drafting of the manuscript: Hill, Steeger, Abbott.

Critical revision of the manuscript for important intellectual content: Hill, Bailey, Steeger, Hawkins, Catalano, Kosterman, Epstein.

Statistical analysis: Hill, Bailey, Abbott.

Obtained funding: Hill, Hawkins, Abbott.

Administrative, technical, or material support: Hill, Bailey, Catalano, Kosterman.

Supervision: Hill, Hawkins, Catalano.

Conflict of Interest Disclosures: Dr Catalano is a former board member of Channing Bete Company, distributor of Guiding Good Choices. This program was one component tested in the study that produced the dataset used in this article. Dr Catalano also reported grants from National Institute on Drug Abuse during the conduct of the study and a patent to copyright and trademark, issued. Dr Hill reported grants from the National Institute on Drug Abuse during the conduct of the study. Dr Kosterman reported grants from National Institute on Drug Abuse during the conduct of the study. No other disclosures were reported.

Funding/Support: This study was supported by the National Institute on Drug Abuse (grants R01DA12138, R01DA023089, R01DA033956, and R01DA09679).

Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: We gratefully acknowledge the contribution of participating families, as well as the Social Development Research Group Survey Research Division for their data collection efforts.

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