***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To evaluate the efficacy of a paraprofessional-delivered , home-visiting intervention among young , reservation-based American Indian ( AI ) mothers on parenting knowledge , involvement , and maternal and infant outcomes . METHOD From 2002 to 2004 , expectant AI women aged 12 to 22 years ( n = 167 ) were r and omized ( 1:1 ) to one of two paraprofessional-delivered , home-visiting interventions : the 25-visit " Family Spirit " intervention addressing prenatal and newborn care and maternal life skills ( treatment ) or a 23-visit breast-feeding/nutrition education intervention ( active control ) . The interventions began during pregnancy and continued to 6 months postpartum . Mothers and children were evaluated at baseline and 2 , 6 , and 12 months postpartum . Primary outcomes included changes in mothers ' parenting knowledge and involvement . Secondary outcomes included infants ' social and emotional behavior ; the home environment ; and mothers ' stress , social support , depression , and substance use . RESULTS Participants were mostly teenaged , first-time , unmarried mothers living in reservation communities . At 6 and 12 months postpartum , treatment mothers compared with control mothers had greater parenting knowledge gains , 13.5 ( p < .0001 ) and 13.9 ( p < .0001 ) points higher , respectively ( 100-point scale ) . At 12 months postpartum , treatment mothers reported their infants to have significantly lower scores on the externalizing domain ( beta = -.17 , p < .05 ) and less separation distress in the internalizing domain ( beta = -.17 , p < .05 ) . No between-group differences were found for maternal involvement , home environment , or mothers ' stress , social support , depression , or substance use . CONCLUSIONS This study supports the efficacy of the paraprofessional-delivered Family Spirit home-visiting intervention for young AI mothers on maternal knowledge and infant behavior outcomes . A longer , larger study is needed to replicate results and evaluate the durability of child behavior outcomes BACKGROUND Children of adolescent mothers may suffer because of parenting inadequacies . The use of volunteer home visitors to enhance parenting skills has not been well studied . OBJECTIVE To evaluate the effect of a volunteer model home visitation program on  adolescent parenting outcomes . DESIGN R and omized trial with assignment to home visitation or control group . SETTING Urban , African American community . PARTICIPANTS Adolescents aged 12 to 18 years at 28 or more weeks ' gestation or who had delivered a baby in the past 6 months were recruited between February 1996 and August 1999 . INTERVENTION Volunteers were recruited from the community and trained to implement a parenting curriculum during weekly home visits . Each volunteer was paired with one teenager . MAIN OUTCOME MEASURE Vali date d instruments measuring parenting stress , parenting behaviors , and mental health . RESULTS A total of 232 teenagers were successfully r and omized to home visitation and control groups . At baseline , the groups were comparable on demographic , social support , and mental health measures . Almost half the teenagers had poor mental health at baseline , and high rates persisted at follow-up in both groups . In multivariate models , the home visitation group demonstrated significantly better parenting behavior scores at follow-up than did the control group ( P = .01 ) but showed no differences in parenting stress or mental health . CONCLUSIONS The volunteer home visitation program significantly improved some parenting outcomes but not parental distress or poor mental health . Volunteers may be an effective means of providing parenting education , but interventions that include specific means of addressing poor mental health are likely to have greater effects PURPOSE To compare effects of an early intervention program ( EIP ) of intense home visitation by public health nurses ( PHNs ) with effects of traditional public health nursing care ( TPHN ) on infant health and selected maternal outcomes of adolescent mothers . METHODS EIP adolescents ( N = 102 ) received preparation-for-motherhood classes and individual home visits  ( from pregnancy through 1 year postpartum ) from PHNs employed in a county health department . Participants were predominantly Latina ( 64 % ) and African-American ( 11 % ) and from impoverished background s. Infant health outcomes were determined based on medical record data ; interviews and st and ardized question naires evaluated other program effects ( e.g. , maternal educational achievement and psychological status ) . Data were analyzed using Chi-square and repeated measures ANOVA . RESULTS Infants of EIP mothers experienced significantly fewer total days ( n = 74 ) and actual episodes ( n = 14 ) of hospitalization during the first year of life than those receiving TPHN ( n = 154 , n = 24 , respectively ) . Similarly , positive program effects were found for immunization rates . There were no group differences in emergency room visits or repeat pregnancy rates . Alcohol , tobacco , and marijuana use significantly increased from pregnancy through 1 year postpartum in both groups but remained markedly lower than rates prior to pregnancy ( lifetime rates ) . CONCLUSIONS These findings demonstrate the positive effects of a PHN home visitation program on health outcomes for children of adolescent mothers . Days of infant hospitalization were substantially reduced and immunization rates increased during the first year of life for children of EIP mothers . Greater efforts need to be directed toward preventing repeat pregnancy and return to substance use following childbirth in at-risk adolescent mothers OBJECTIVE To assess the impact of a paraprofessional-delivered home-visiting intervention to promote child care knowledge , skills , and involvement among pregnant American Indian adolescents . DESIGN R and omized controlled trial comparing a family-strengthening intervention with a breastfeeding education program . SETTING One Apache and 3 Navajo communities . PARTICIPANTS Fifty-three pregnant American Indian adolescents were r and omly assigned to intervention ( n = 28 ) or control ( n = 25 ) groups . Follow-up data were available for 19 intervention and 22 control participants . Intervention Paraprofessionals delivered 41 prenatal and infant care lessons in participants ' homes from 28 weeks ' gestation to 6 months post partum . MAIN OUTCOME MEASURES Child care knowledge , skills , and involvement . RESULTS Mothers in the intervention compared with the control group had significantly higher parent knowledge scores at 2 months ( adjusted mean difference [ AMD ] , + 14.9 [ 95 % confidence interval ( CI ) , + 7.5 to + 22.4 ] ) and 6 months post partum ( AMD , + 15.3 [ 95 % CI , + 5.9 to + 24.7 ] ) . Intervention group mothers scored significantly higher on maternal involvement scales at 2 months post partum ( AMD , + 1.5 [ 95 % CI , -0.02 to + 3.02 ] ) , and scores approached significance at 6 months post partum ( AMD , + 1.1 [ 95 % CI , -0.06 to + 2.2 ] ) . No between-group differences were found for child care skills . CONCLUSIONS A paraprofessional-delivered , family-strengthening home-visiting program significantly increased mothers ' child care knowledge and involvement . A longer and larger trial is needed to underst and the intervention 's potential to improve adolescent parenting and related child outcomes in American Indian communities The prevalence of postnatal depression ( 10%-15 % ) renders it a major public health problem not only for the depressed mother but also for the infant , who may suffer from behavioral disturbances and cognitive delays in later years . This study aim ed at evaluating an educational intervention to alleviate postnatal depression and at generally measuring the prenatal and postnatal mood of primiparous women . A prospect i ve , r and omized controlled trial of an education intervention to reduce postnatal depression was conducted at three sites in Australia enrolling a total of 184 primiparous women . The intervention consisted of an information booklet on postnatal depression and an audiotape of one woman 's journey through clinical postnatal depression .  Mood was assessed once prenatally ( 12 - 28 weeks ) and twice postnatally ( 8 - 12 weeks and 16 - 24 weeks ) using the Scale for Assessment of Depression and Schizophrenia modified for pregnant and postnatal women ( SADS-M ) . Demographic and social support data were also collected at enrollment . Comparisons between the control group and the intervention group revealed no differences ; the educational intervention did not show any effect when women 's mood was measured by the SADS-M. Overall , a general , significant , steady decrease of depressive tendencies was observed when the two postnatal assessment s were compared to the prenatal measurements . Women were less depressed postnatally than prenatally . This overall improvement of mood was significant in most SADS-M items . The exceptions were discouragement , anxiety , anger , and irritability , which did not reach significance . Additional multivariate analyses revealed no relevant influence of social support or demographic variables on the changes in mood . The main results that the education intervention had no effect and women , overall , were more depressed prenatally than postnatally contributes further evidence to the view that the prenatal period is a separate entity from the postnatal period , with distinctive psychoneuro-endocrine pathways and , thus , suggesting different profiles of women 's experience . This evidence indicates the necessity to screen , refer , and manage prenatal maternal mood as an entity in its own right , rather than as a window on the postnatal period PURPOSE Adolescent mothers are at risk for rapidly becoming pregnant again and for depression , school dropout , and poor parenting . We evaluated the impact of a community-based home-visiting program on these outcomes and on linking the adolescents with primary care . METHODS Pregnant adolescents aged 12 to 18 years , predominantly with low incomes and of African American race , were recruited from urban prenatal care sites and r and omly assigned to home visiting or usual care .  Trained home visitors , recruited from local communities , were paired with each adolescent and provided services through the child ’s second birthday . They delivered a parenting curriculum , encouraged contraceptive use , connected the teen with primary care , and promoted school continuation . Research assistants collected data via structured interviews at baseline and at 1 and 2 years of follow-up using vali date d instruments to measure parenting ( Adult-Adolescent Parenting Inventory ) and depression ( Center for Epidemiologic Studies Depression ) . School status and repeat pregnancy were self-reported . We measured program impact over time with intention-to-treat analyses using generalized estimating equations ( GEE ) . RESULTS Of 122 eligible pregnant adolescents , 84 consented , completed baseline assessment s , and were r and omized to a home-visited group ( n = 44 ) or a control group ( n = 40 ) . Eighty-three percent completed year 1 or year 2 follow-up assessment s , or both . With GEE , controlling for baseline differences , follow-up parenting scores for home-visited teens were 5.5 points higher than those for control teens ( 95 % confidence interval , 0.5–10.4 points ; P = .03 ) and their adjusted odds of school continuation were 3.5 times greater ( 95 % confidence interval , 1.1–11.8 ; P < .05 ) . The program did not have any impact on repeat pregnancy , depression , or linkage with primary care . CONCLUSIONS This community-based home-visiting program improved  adolescent mothers ’ parenting attitudes and school continuation , but it did not reduce their odds of repeat pregnancy or depression or achieve coordination with primary care . Coordinated care may require explicit mechanisms to promote communication between the community program and primary care Background Postpartum depression is a devastating condition that affects a significant number of women and their offspring . Few preventive interventions have targeted high risk youth , such as American Indians ( AIs ) . Objective To evaluate the feasibility of a depression prevention program for AI adolescents and young adults . Methods Expectant AI women ( mean age = 18.15 ; N = 47 ) were r and omized ( 1:1 ) to either the Living in Harmony program ( LIH , an 8 lesson cognitive-behaviorally based program ) or an Educational – Support program ( ES , an 8 lesson education program ) .  Both interventions were delivered by AI paraprofessionals . Adolescents were evaluated during their pregnancy at baseline , at post-intervention , and at 4 , 12 , and 24 weeks postpartum . The primary outcome measure was the Center for Epidemiological Studies –Depression scale ( CES-D ) . Additional measures of depression included the onset of major depressive disorder ( MDD ; assessed via computerized diagnostic interview ) and the Edinburgh Postpartum Depression Scale ( EPDS ) . Secondary outcomes included changes in mothers ’ global functioning and social support . Results At all post intervention assessment s , mothers in both groups showed similar reductions in depressive symptoms and similar rates of MDD ( 0 and 6 % in LIH and ES respectively ) . Both groups of participants also showed similar improvements in global functioning . No changes in either group were found on the measure of social support . Conclusions Findings suggest that both paraprofessional-delivered interventions may reduce symptoms of depression among AIs . Replication with a larger sample , a usual care control condition , blinded evaluators , and a longer follow-up is needed OBJECTIVE The Affordable Care Act provides funding for home-visiting programs to reduce health care disparities , despite limited evidence that existing programs can overcome implementation and evaluation challenges with at-risk population s. 
    Output:
    
However , this review did not find evidence identifying the most effective intervention for preventing postpartum depression symptoms in adolescent mothers