Impact of a universal perinatal home-visiting program on reduction in race disparities in maternal and child health: Two randomised controlled trials and a field quasi-experiment.

dc.contributor.author

Dodge, Kenneth A

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Goodman, W Benjamin

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Bai, Yu

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Best, Debra L

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Rehder, Peter

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Hill, Sherika

dc.date.accessioned

2023-05-24T15:08:01Z

dc.date.available

2023-05-24T15:08:01Z

dc.date.issued

2022-11

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2023-05-24T15:08:00Z

dc.description.abstract

Background

Public health interventions must become accountable for reduction of race disparities, particularly among Black, Hispanic, and Non-Hispanic White families in the United States. Family Connects (FC) is a universal perinatal home-visiting program that assesses family-specific needs, offers support, and provides connections to community resources to address identified needs. Two previously-published randomised controlled trials and a field quasi-experiment have shown positive impact on maternal mental health, infant emergency medical care utilization, and government investigations for child maltreatment; however, these reports have not tested impact on reducing race disparities in these outcomes. The current report examined three questions in these trials: 1) the extent of race disparities in maternal and infant health and well-being, absent intervention; 2) whether intervention can be implemented with high reach and fidelity among all race groups; and 3) whether assignment to intervention reduces race disparities in important outcomes.

Methods

Data were re-examined from: 1) a randomised controlled trial of 4777 birthing families in Durham, NC, USA; 2) a replication randomised controlled trial of 923 birthing families in Durham, NC, USA; and 3) a quasi-experiment of 988 birthing families in rural NC, USA. Families were classified as Black, Hispanic, Non-Hispanic White, or Other. Disparity reduction was tested by the interaction effect between treatment assignment and race.

Findings

1) In the absence of intervention, large and statistically significant differences between Black familes and Non-Hispanic White families were found in maternal anxiety, maternal depression, father non-support, child emergency medical care, and child maltreatment investigations. Few differences were found between Non-Hispanic White familes and Hispanic families.2) High rates of participation in treatment were found for each race group.3) Across studies, assignment to FC was associated with statistically significant reductions in 7 of 12 disparities, in maternal anxiety and depression, father non-support, infant emergency medical care, and child maltreatment investigations.

Interpretation

This study provides a method, metric, and mandate to prioritise testing of whether public health interventions reduce race disparities in family outcomes.

Funding

This research was supported by grant R01HD069981 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and a grant from The Duke Endowment.
dc.identifier

S2667-193X(22)00173-9

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2667-193X

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2667-193X

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https://hdl.handle.net/10161/27406

dc.language

eng

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Elsevier BV

dc.relation.ispartof

Lancet regional health. Americas

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10.1016/j.lana.2022.100356

dc.subject

Child maltreatment

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Public health

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Race disparities

dc.title

Impact of a universal perinatal home-visiting program on reduction in race disparities in maternal and child health: Two randomised controlled trials and a field quasi-experiment.

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Journal article

duke.contributor.orcid

Dodge, Kenneth A|0000-0001-5932-215X

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Goodman, W Benjamin|0000-0002-2417-1483

duke.contributor.orcid

Hill, Sherika|0000-0001-8429-7259

pubs.begin-page

100356

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Duke

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Sanford School of Public Policy

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School of Medicine

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Trinity College of Arts & Sciences

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Staff

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Sanford

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Duke Population Research Institute

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Clinical Science Departments

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Family Medicine and Community Health

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Pediatrics

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Psychiatry & Behavioral Sciences

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Family Medicine and Community Health, Community Health

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Psychology & Neuroscience

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Institutes and Provost's Academic Units

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University Institutes and Centers

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Duke Institute for Brain Sciences

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Psychiatry, Child & Family Mental Health & Community Psychiatry

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Initiatives

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Duke Science & Society

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Duke Population Research Center

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Center for Child and Family Policy

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Pediatrics, General Pediatrics and Adolescent Health

pubs.publication-status

Published

pubs.volume

15

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