Behavioral and Socioemotional Outcomes at Third Grade of the Legacy for ChildrenTM Randomized Control Trial to Promote Healthy Development of Children Living in Poverty Open Access

Abstract

Background: Approximately 20% of children in the United States live in poverty, and racial and ethnic minority groups are at especially high risk. The intersections of disadvantage due to race, ethnicity, and poverty compound the challenges that children face as they grow and develop. Although growing up in poverty is linked with heightened risk of impaired development, parents can play a pivotal role in mitigating these effects. To leverage the influence of parental self-efficacy and social support on child development, the Centers for Disease Control and Prevention (CDC) developed Legacy for Children^TM (Legacy). Legacy is a public health approach that promotes positive parenting by supporting healthy mother-child relationships, building maternal self-efficacy, and fostering social support networks in order to improve child developmental outcomes among families living in poverty.

Objective and Methods: The purpose of this study is to analyze behavioral and socioemotional outcome data from Legacy children at third grade. Results on behavioral, emotional, and social development outcomes from the intervention and control groups are compared at both sites of the randomized control trial: Miami and Los Angeles. Univariate and bivariate statistics provide descriptive data from each site and test for associations by group assignment. Multiple linear regressions and multivariable logistic regressions provide beta estimates and odds ratios controlling for baseline demographic variables.

Results: Children of Legacy mothers in Los Angeles were at lower risk for externalizing behaviors and poor adaptive skills than children whose mothers did not receive the intervention. There were no outcome differences by group assignment in Miami.

Conclusions: Group-based positive parenting interventions such as Legacy may have a sustained impact on children’s behavioral and socioemotional development several years after intervention completion. Long-term, tailored efforts are likely needed in order to maximize benefits for families and children living in poverty.

Table of Contents

Introduction….…………………………………………………………………………….....8

           Introduction....……………………………………………………………...….…....8

           Theoretical Framework...………………………………………………………....11

Literature Review...………………………………………………………………….……..13

           Impact of Early Childhood Poverty….…………………………………...…....13

           Role of Parenting…………………………………………………………..….…...17

           Legacy for Children^TM (Legacy)…………………………………………….......20

                       Intervention Development……………………………………………...20

                       Legacy Findings: Past & Present……………………………………....24

Student Contribution………………………………………………………………..…....26

           Student Contribution…………………………………………………………......26

           Ethical Considerations…………………………………………………………....27

           Legacy Intervention…………………………………………………………....….28

           Measures…………………………………………………………………………..….30

           Statistical Analyses……………………………………………………….….…....35

Journal Article…………………………………………………………………………..…..37

           Title Page for Manuscript…………………………………………………..…….37

           Abstract…………………………………………………………………………….....38

           Manuscript……………………………………………………………………….…..39

                       Introduction……………………………………………………………..….39

                       Methods……………………………………………………………….….….40

                       Results……………………………………………….……………………....46

                      Discussion……………………………………….…………...….……...…..49

                       References…………………………………………….….………….....…..55

                       Table 1. Demographics of Legacy Mothers……………….………....61

                       Table 2. Logistic Regression Models …………………………….......62

                       Table 3. Linear Regression Models…………………………...….…...63

Public Health Implications…………………………………………………………...….64

           Contextualizing Findings………………………………………………….…..…64

           Limitations & Strengths……………………………………………………...….66

           Implications, Future Directions, & Conclusion…………………..…..…...68

References……………………………………………………………………………..........70

Appendices……………………………………………………………………………...…...83

           Appendix A: IRB Determination Letter…………………………………….…83

           Appendix B: Figure 1. Legacy Curriculum Components at Each Site....84

           Appendix C: Figure 2. Assessment Measures and Scoring……………....85

           Appendix D: Table 4. Independent t-tests…………………………………...86

           Appendix E: Table 5. Chi-square Tests…………………………………....….87

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Psychology, Developmental
Keyword	public health intervention developmental psychology Legacy for ChildrenTM
Committee Chair / Thesis Advisor	Delia L. Lang, Emory University
Committee Members	Lara R. Robinson, Centers for Disease Control and Prevention Jennifer W. Kaminski, Centers for Disease Control and Prevention

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