Protective Effect of Parental Monitoring on Early-to-Mid Adolescents Displaying High-Level and Increasing Aggressive Behavior.

Studies that distinguish parental monitoring (parent-driven behaviors) from parental knowledge often fail to find protective effects of monitoring on adolescent behavior problems. To answer whether parental monitoring is more strongly associated with adolescent behavior problems among adolescents who may need it most, this study applied group-based trajectory modeling to change in early- to mid-adolescent aggressive behavior problems and examined associations between parental monitoring with different subgroups. Three latent groups of adolescents were found: Low Aggression, Medium-Increasing Aggression, and High-Increasing Aggression. Results show that more maternal and paternal monitoring were associated with fewer adolescent aggressive behavior problems only for adolescents in the High-Increasing Group. This result suggests that parental monitoring is a protective factor against adolescent aggressive behavior problems for subgroups of adolescents who may need it most and less impactful for other adolescents.

Measurement invariance of the Coparenting Relationship Scale (CRS) across 10 countries.

The purpose of this study was to assess the factor structure and the measurement invariance of the Coparenting Relationship Scale (CRS) across 10 countries based on the seven-factor coparenting model (i.e., Coparenting Agreement, Coparenting Closeness, Exposure to Conflict, Coparenting Support, Endorsement of Partner's Parenting; Division of Labor) proposed by Feinberg (2003). The results of research on coparenting from numerous countries have documented its foundational importance for parent mental health, family relationship quality, child development, and psychopathology. Yet, a cross-country perspective is still lacking. Such a perspective can provide insight into which dimensions of coparenting are universally recognized and which are especially prone to variation. A unique multinational data set, comprised of 15 individual studies collected across 10 countries (Belgium, Brazil, China, Israel, Italy, Japan, Portugal, Switzerland, Turkey, USA) in nine languages was established (N = 9,292; 51.1% mothers). Measurement invariance analyses were conducted. A six-factor structure (original seven factors minus Division of Labor) of the measure was consistent across the different contexts and measurement invariance was achieved at the configural level. There was no support for metric or scalar invariance. These findings provide a basis for the CRS to be used across countries and should inspire future quantitative and qualitative research in cross-country coparenting research to understand what aspects are universal and what aspects of coparenting are linked to specific material, relational, or ideational conditions that underlie high-quality coparenting. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Couple relationship functioning and social adjustment during the transition to parenthood among fathers with a history of maltreatment.

Study of fathers has gained significant traction over recent decades. However, the experience for men over the transition to parenthood remains focused on high-socioeconomic and socially advantaged fathers. Researchers have yet to thoroughly investigate how fathers may uniquely experience this transition period with a history of childhood maltreatment, given that childhood abuse is known to impact several components of development and relationship functioning into adulthood. The current study endeavored to fill this gap by evaluating the associations between fathers' childhood experiences of physical and emotional abuse and their relationship functioning over the transition to parenthood in terms of both the couple relationship and social adjustment in relationships with others. Using data from 399 fathers who participated in a randomized control trial during pregnancy, the results from stepwise regressions indicate fathers with a history of emotional abuse experience particular declines in their external relationships (reductions in social support and increases in social stress) from prenatal (Wave 1) to postpartum (Wave 2) reports. However, no significant association emerged between fathers' history of maltreatment and their relationship functioning with their partners. These results underscore the importance of investigating the impact of different types of abuse on men in fatherhood. Moreover, we emphasize the need to study further fathers' social adjustment over the transition to parenthood beyond the couple relationship and broad social support to address the needs of men with a history of maltreatment in their new role as fathers.

Examining profiles of convergence and divergence in reports of parental warmth: Links to adolescent developmental problems.

Parental warmth during the transition from childhood to adolescence is a key protective factor against a host of adolescent problems, including substance use, maladjustment, and diminished well-being. Moreover, adolescents and parents often disagree in their perceptions of parenting quality, and these discrepancies may confer risk for problem outcomes. The current study applies latent profile analysis to a sample of 687 mother-father-6th grade adolescent triads to identify patterns of adolescent-parent convergence and divergence in perceptions of parental warmth. Five profiles were identified, and associations with adolescent positive well-being, substance use, and maladjustment outcomes in 9th grade were assessed. Patterns of divergence in which adolescents had a pronounced negative perception of parental warmth compared to parents, as well as those wherein pronounced divergence was present in only one adolescent-parent dyad, were associated with diminished positive well-being compared to adolescents who had more positive perceptions of warmth than parents. Having more negative perceptions of warmth compared to parents was also associated with elevated risk for alcohol and marijuana initiation, but only when the divergence was pronounced rather than more moderate. These findings add nuance to findings from previous between-family investigations of informant discrepancies, calling for further family-centered methods for investigating multiple perspectives.

A case study in developmental discontinuity: PROSPER Interventions and adolescent substance use trajectories shape young adult substance use and mental health problems.

The loss of John Schulenberg reverberates across the developmental and prevention sciences. In honor of his many contributions, this paper applies his ideas of developmental continuity and discontinuity to understand the process by which PROSPER delivered universal prevention programs (delivered in Grades 6 and 7) affect young adult outcomes. Guided by these developmental models, we deconstructed adolescent substance use initiation trajectories into two discrete phases-early and late adolescence, demarcated by substance use initiation levels at the end of 9th grade. We evaluated the effects of PROSPER interventions on these phases, and in turn, the effects of adolescent substance use initiation on young adult antisocial behavior, alcohol and drug use consequences, and depression symptoms. This sample included 1,984 young adults who participated in the PROSPER intervention trial in Grade 6 (two cohorts, 2002 and 2003), followed over 8 adolescent measurement occasions (Fall and Spring of Grade 6; Spring of Grades 7-12). Young adult outcomes were averaged across three waves (collected at ages 20, 23, and 25). PROSPER interventions were associated with reduced substance use initiation in early adolescence, but not escalation during late adolescence. In turn, substance use in both early and late adolescence was uniquely associated with young adult antisocial behavior, depression symptoms, and substance use consequences. PROSPER interventions were associated with young adult antisocial behavior and problematic substance use via reduced risk for early initiation status. Findings are discussed in terms of developmental continuity and discontinuity.

Children's empathy moderates the association between perceived interparental conflict and child health.

Interparental conflict is known to negatively impact child well-being, including behavioral and physiological well-being. Children's empathy - that is, vicariously experiencing others' emotions - may increase children's sensitivity to and the biological repercussions of interparental conflict. Although empathy represents a valued trait and is an important part of socioemotional development, its influence on children's physical health is unknown. This study examined whether empathy moderates the association between perceived interparental conflict and both child systemic inflammation and parent-rated overall child health in a sample of children between the ages of seven to nine. Children and their parents participating in the long-term evaluation of the Family Foundations program, a randomized trial of a perinatal preventative intervention, provided data approximately eight years following enrollment into the program. We collected peripheral blood samples via dried blood spots, anthropometric measurements, and child and parent psychosocial questionnaires. Results indicated significant positive main effects of child empathy on both C-reactive protein (CRP; B = 0.26, SE = 0.11, p =.026) and Interleukin-6 (IL-6; B = 0.20, SE = 0.10, p =.045) levels. Further, child affective empathy moderated the associations between perceived interparental conflict and both CRP (B = 0.39, SE = 0.19, p =.050) and parent-reported child health (B = 0.30, SE = 0.13, p =.021), such that greater empathy strengthened the negative associations between interparental conflict and child health. Overall, findings suggests that there may be a biological cost of being more empathic in high-conflict environments and highlight the need for tools to help more empathic children appropriately manage vicarious emotions.

Parenting of siblings in Latinx families during middle childhood.

Parents' management of their children's sibling relationships, or sibling-focused parenting, has substantial theoretical and practical importance but is rarely studied. This study's goals were to describe dimensions of sibling-focused parenting and to examine sociocultural resources and challenges as potential correlates among Latinx mothers and fathers in 262 families with two children in middle childhood. Families were recruited from 11 public elementary schools, and caregivers (248 mother figures; 118 father figures) participated in a home visit and phone interviews at the onset of the study. Sibling-focused parenting included three dimensions: positive guidance (10 items), nonintervention (four items), and authoritarian control (five items). Parents rated positive guidance as their most frequent strategy, and comparisons of mothers and fathers from the same families revealed that mothers engaged in more sibling-focused parenting overall than fathers. Regarding correlates, mothers' familism values and mothers' and fathers' family cohesion reports were associated with more positive guidance and mothers' cohesion was negatively related to nonintervention in sibling conflicts. For mothers only, parenting stress was linked to all three dimensions of sibling-focused parenting-negatively to guidance and positively to authoritarian control and nonintervention; maternal depressive symptoms were positively linked to authoritarian control. Economic hardship was not a significant correlate of any dimension. Findings suggest that sibling-focused parenting is a key domain of parenting in need of further research. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Daily implementation of health-protective behaviors and family life during the early months of the COVID-19 pandemic.

The coronavirus disease (COVID-19) pandemic has necessitated the use of health-protective behaviors (HPB), such as social distancing, staying at home, frequent handwashing, and wearing facemasks to mitigate the transmission of disease. An investigation of interpersonal costs associated with the use of HPB can help inform strategies to promote their sustained implementation. This study examined the daily associations between the implementation of HPB and family functioning and assessed moderation by coparenting quality, economic strain, and the number of days that state-level stay-at-home policies had been in effect, during the early days of the pandemic. Mothers and fathers from 155 families with children who were 9 years old, on average, completed daily reports of HPB, parental stress, and family relationship quality over eight consecutive days in April or May of 2020. Hierarchal linear models showed that HPB was associated with increased levels of parental stress and interparental conflict. Negative coparenting relations exacerbated the next-day association between HPB and interparental conflict. HPB was also associated with increased levels of parent-child and interparental closeness, but these linkages dissipated for families who had spent more days under state-level stay-at-home policies. Although crucial for public health, the implementation of HPB may have detrimental short-term effects on daily family life. Family support and interventions are necessary to minimize the psychosocial burden of these important public health measures and increase their sustained adherence.

Promoting toddlers' self-regulation and healthy eating habits among families living in poverty: A randomized controlled trial of Recipe 4 Success.

The Recipe 4 Success preventive intervention targeted multiple factors critical to the health and well-being of toddlers living in poverty. This randomized controlled trial, which was embedded within Early Head Start home visits for 12 weeks, included 242 racially and ethnically diverse families (51% girls; toddler mean age = 2.58 years; data collected 2016-2019). Compared to parents in usual practice home visits, parents in Recipe 4 Success displayed greater sensitive scaffolding of toddlers' learning and more responsive food parenting practices (Cohen's d = .21-.30). Toddlers in Recipe 4 Success exhibited greater self-regulation and had healthier eating habits (Cohen's d = |.16-.35|). Results highlight the value of Recipe 4 Success in promoting parent and toddler behavior change that could have life-long benefits.

Modeling Long-Term Budgetary Impacts of Prevention: An Overview of Meta-analyses of Relationships Between Key Health Outcomes Across the Life-Course.

Budget analysis entities often cannot capture the full downstream impacts of investments in prevention services, programs, and interventions. This study describes and applies an approach to synthesizing existing literature to more fully account for these effects. This study reviewed meta-analyses in PubMed published between Jan 1, 2010 and Dec 31, 2019. The initial search included meta-analyses on the association between health risk factors, including maternal behavioral health, intimate partner violence, child maltreatment, depression, and obesity, with a later health condition. Through a snowball sampling-type approach, the endpoints of the meta-analyses identified became search terms for a subsequent search, until each health risk was connected to one of the ten costliest health conditions. These results were synthesized to create a path model connecting the health risks to the high-cost health conditions in a cascade. Thirty-seven meta-analyses were included. They connected early-life health risk factors with six high-cost health conditions: hypertension, diabetes, asthma and chronic obstructive pulmonary disorder, mental disorders, heart conditions, and trauma-related disorders. If confounders could be controlled for and causality inferred, the cascading associations could be used to more fully account for downstream impacts of preventive interventions. This would support budget analysis entities to better include potential savings from investments in chronic disease prevention and promote greater implementation at scale.

Parental warmth and young adult depression: A comparison of enduring effects and revisionist models.

Guided by a novel analytic framework, this study investigates the developmental mechanism through which parental warmth is related to young adult depression. Data were from a large sample of participants followed from early adolescence to young adulthood (N = 1,988; 54% female). Using structural equation modeling, we estimated and compared competing developmental models - enduring effects vs. revisionist models - to assess whether parental warmth during adolescence had enduring or transient effects on depression in young adulthood. We also examined whether contemporaneous experiences of parental warmth in young adulthood were more salient than parental warmth in adolescence. Results supported the revisionist model: early intergenerational experiences in adolescence predicted psychopathology early in young adulthood, but their unique effects gradually diminished; whereas parental warmth in young adulthood continued to be protective of young adult depression. Effects of mother and father warmth on young adult depression were similar in pattern and magnitude. Results were held when accounting for covariates such as adolescent sex, family income status, and family structure. Young adult mental health interventions may consider targeting maintenance or improvement in parental warmth to help offset the long-term impact of adversity early in life.

A perinatal coparenting intervention: Effects of a randomized trial on parent cardiometabolic risk and self-reported health.

BACKGROUND: The transition to parenthood is a common yet stressful experience faced by many young and midlife adults, and the risk of cardiometabolic conditions also begins to rise at this time. Consequently, parenthood represents an opportune time to intervene with adults to support their psychological and physical health. PURPOSE: We examined whether the benefits of the Family Foundations program, a perinatal preventative intervention promoting positive coparenting, extend beyond documented mental health and family relationship outcomes to better cardiometabolic risk factors among parents. METHODS: We analyzed data from 183 couples (n = 366 participants) who, eight years prior, were randomly assigned to the 9-session perinatal preventative intervention program or a control condition. We collected dried blood spots to measure C-reactive protein (CRP), interleukin-6 (IL-6), and cholesterol; parents also reported on their self-rated health. RESULTS: Randomization to the intervention condition was associated with lower cholesterol (B=-.081, p = .049). Among parents who demonstrated more negative communication styles at pretest (during pregnancy), the intervention was further associated with better self-rated health (B=.181, p = .018). Participation in the intervention program was also marginally associated with lower CRP (B=-.261, p = .077), particularly among mothers (B=-.428, p = .076). CONCLUSIONS: These findings indicate that coparenting-focused interventions, such as Family Foundations, can lead to benefits beyond psychosocial and behavioral outcomes, and suggest that Family Foundations may improve parents' longer-term physical health, with potentially more benefits among couples who demonstrated more negative communication styles during pregnancy.

COVID-19 family dynamics and health protective behavior adherence: A 16-wave longitudinal study.

OBJECTIVE: Health-protective behavior (HPB) adherence (wearing protective face masks, social distancing, and increased handwashing) plays a critical role in reducing infectious disease transmission; yet factors underlying HPB adherence are not well understood. Most research focuses on individual factors-beliefs about susceptibility, severity, and HPB efficacy; however, understanding parent and child HPB adherence may require a family conceptualization. This study evaluated whether family relations (cohesion, conflict, and chaos), as well as parent-child conflict regarding pandemic-specific circumstances (e.g., social distancing prohibitions about spending time with friends) account for parent and child HPB adherence, over and above parents' individual concerns about COVID-19 risks. METHOD: This study utilized data reported by parents in 204 families with children (Mage = 4.2; 45% girls) collected on 16 occasions between May 2020 through April 2021. The impact of within-person (WP) and between-person (BP) effects of each family-level factor on parent and child HPB adherence was evaluated in a series of two-level multilevel models. RESULTS: Over the course of the study, parent HPB adherence was generally stable and child HPB adherence declined early on but then leveled off. Results showed the protective effect of family cohesion for both parent and child HPB adherence at the WP and BP level. In addition, periods of higher COVID-19-related conflict corresponded to increases in parent and child HPB adherence. CONCLUSIONS: Intervention efforts should be directed at promoting family cohesion in order to promote sustained parent and child HPB adherence. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Interparental conflict, family climate, and threat appraisals: Early adolescent exposure and young adult psychopathology risk.

Long-term studies evaluating threat appraisals as an intervening variable linking interparental conflict (IPC) and internalizing problems are lacking, as are longitudinal studies evaluating the role of the broader family context in these models. Guided by the cognitive-contextual framework, this study followed 225 adolescents (53% females) and their families from age 11 into young adulthood (age 19.6) to evaluate the long-term implications of IPC and threat appraisals for young adult internalizing symptoms. First, a long-term mediation model revealed that increases in IPC from age 11 to 14 (but not initial levels) best accounted for adolescent threat appraisals at age 14. In turn, threat appraisals mediated the association between IPC and young adult (age 19.6) internalizing problems. Second, the family climate-defined as high levels of cohesion and organization-moderated the relation between IPC and threat appraisals. Adolescents in families that experienced declines in positive family climate and increasing IPC had the highest threat appraisals; however, families that maintained (or increased in) positive family climate were protective against increasing IPC. Interestingly, the combination of decreasing IPC and decreasing positive family climate corresponded with the lowest threat appraisals in the sample, contrary to expectations. This finding seems consistent with a family disengagement perspective which may be less threatening to adolescents but may confer risk for other problem outcomes. This study underscores the importance of IPC and threat appraisals during adolescence, and offers new insights into the role of the family climate in protecting against escalating IPC for young adult internalizing risk. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Trajectories of parent and child well-being across the pandemic year: Role of financial strain, social distancing, and COVID-19 prevalence.

Existing research demonstrated large deteriorations in parent, child, and family well-being within 2 months after the onset of the COVID-19 pandemic. Yet, little is known about the trajectories of families' adjustment in the following months, including what risk factors are associated with changes in families' adjustment. The current study examined (1) change in the parent, child, and family well-being over time; (2) associations of pandemic-related stressors, financial and social distancing-associated stress, with well-being between and within families; and (3) the role of local COVID-19 prevalence, prior participation in family-focused prevention, and parent gender. From April 2020 to January 2021, 393 parents from 235 families reported five times on parent mental health, child behavior problems, family relationships, and pandemic-related stressors. Findings indicate that, across all domains of well-being, there was either little change across the 8 months or a small degree of recovery followed by a shift to further deterioration. On average, parents experiencing greater pandemic-related stressors also reported poorer functioning in all domains; monthly fluctuations in pandemic-related stressors were also associated with fluctuations in parent mental health and child behavior problems. In some domains, the links between pandemic-related stressors and parent and child well-being were stronger among families living in areas with overall higher COVID-19 prevalence rates. Parents' experiences during the pandemic did not differ systematically across prior intervention participation or parent gender. Taken together, findings suggest a need for supportive interventions to help families navigate extended periods of crisis.

Multivariate growth trajectories of parenting practices in adolescence predicting young adult relationships with parents.

Guided by the life course perspective, this study investigated the developmental antecedents of contact, closeness/warmth, and negativity in young adults' relationships with their parents. Taking the developmental systems approach, we considered interindividual differences in not only initial levels of parenting quality in early adolescence (Grade 6) but also developmental changes in parenting quality across adolescence (Grades 6-12) as predictors of young adult-parent relationship quality. Data were from a large sample of young adults (N = 1,631; Mage = 22.84; 57% female; 90% White; 25% received free/reduced-price school lunch in Grade 6) followed from the fall of Grades 6 to 12 at eight time points, plus a young adult assessment. Using multivariate latent growth curve modeling, we identified a nuanced pattern of predictors of the three relationship dimensions. Higher initial levels of and lower rates of decline in parental involvement across adolescence predicted more young adult contact with mothers and fathers. Higher initial levels of parental warmth and parental involvement, as well as lower rates of decline in parental warmth, predicted greater closeness/warmth with mothers and fathers in young adulthood. Higher initial levels of and lower rates of decline in effective discipline predicted less young adult negativity toward mothers and fathers. These results held even when accounting for important adolescent and young adult covariates (adolescent sex and race, adolescent family income and structure, adolescent aggressive behavior tendencies, young adult living arrangement). The study offers new insights into how parenting practices in adolescence contribute to parent-child relationship in young adulthood. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Coparenting-focused preventive intervention reduces postnatal maternal BMI and buffers impact of cortisol.

OBJECTIVE: The postpartum period is a key life stage, contributing to increased maternal obesity risk. Current lifestyle interventions do not consider the role of a woman's partner in reducing stress and supporting lifestyle change. The objective of this study was to assess the effect of an intervention that seeks to enhance coparenting relationship quality on maternal BMI from before conception to 12 months post partum and whether the intervention moderated the association of changes in cortisol and BMI. METHODS: A randomized controlled trial was used to assess an intervention (eight classes: four during and four following pregnancy) focusing on enhancing couple coparenting relationships during pregnancy and post partum (n = 57) compared with standard care (n = 53). RESULTS: The main outcome measures were changes in maternal BMI and cortisol. There was a smaller increase in BMI for mothers in intervention compared with control groups (mean [SE], -1.03 [0.42] kg/m2 , p = 0.015). There was an interaction between intervention status and cortisol change predicting BMI change (p = 0.026), such that cortisol change significantly predicted BMI change among mothers in the control (p = 0.049) but not the intervention groups (p = 0.204). CONCLUSIONS: A coparenting intervention improved maternal postpartum BMI, with this effect potentially related to ameliorating the negative effect of stress, as measured by cortisol, on BMI. The role of enhanced coparenting in improving maternal anthropometry warrants urgent attention.

Long-term Effects of Adolescent Substance Use Prevention on Participants, Partners, and their Children: Resiliency and Outcomes 15 Years Later During the COVID-19 Pandemic.

We examined whether participation in adolescent substance use prevention programming can enhance long-term resilience into adulthood such that individuals were better able to cope with adversities during the initial months of the COVID-19 pandemic, yielding benefits for the individuals, their partners/spouses, and children; 197 adults (28-30 years old) who entered the PROSPER randomized trial of substance use prevention programming as 6th graders and subsequently had become parents-and 128 of their partners-participated in two waves of long-term follow-up data collection. Respondents completed questionnaires on substance use, adjustment, parenting quality, and children's mood and behavior problems 15 years after baseline, and again via an online survey in the first three months of the COVID-19 pandemic. Results were mixed, with some indications of better adjustment of PROSPER intervention compared to control participants during the early phase of the pandemic (less increase in alcohol use and less decrease in parenting warmth) and their children (lower levels of externalizing and internalizing problems) but several null results as well (no differences in other substance use behaviors, other parenting measures, or parent depression). Adolescent substance use prevention programs can foster long-term individual and interpersonal resilience factors that allow participants-as well as their children-to adapt and cope with unforeseen periods of acute stress and adversity with less deterioration in health and well-being.

Comparison of Estimated Incentives for Preventing Postpartum Depression in Value-Based Payment Models Using the Net Present Value of Care vs Total Cost of Care.

Importance: Strong financial incentives are critical to promoting widespread implementation of interventions that prevent postpartum depression. Value-based payment (VBP) approaches could be adapted to capture longer-term value and offer stronger incentives for postpartum depression prevention by sharing the expected future health care savings estimated by reduced postpartum depression incidence with clinicians. Objective: To evaluate whether sharing 5-year expected savings estimated by reduced postpartum depression incidence offers stronger incentives for prevention than traditional VBP under a variety of circumstances. Design, Setting, and Participants: This decision analytic model used a simulated cohort of 1000 Medicaid-enrolled pregnant individuals. Health care costs for individuals receiving postpartum depression preventive intervention or not, over 1 or 5 years post partum, in a variety of scenarios, including varying rates of Medicaid churn (ie, transitions to a new Medicaid managed care plan, commercial insurance plan, or loss of coverage) were estimated for the period 2020 to 2025. The model was developed between March 5 and July 30, 2021. Exposure: Sharing 100% of 1-year actual health care cost saving vs 50% of 5-year estimated health care cost savings associated with reduced postpartum depression incidence. Main Outcomes and Measures: The main outcome was the amount of clinician incentive shared in a VBP model from providing preventive interventions. The likelihood of the health care payer realizing a positive return on investment if it shared 50% of 5-year expected savings with a clinician up front was also measured. Results: The simulated cohort was designed to be reflective of the demographics characteristics of pregnant individuals receiving Medicaid; however, no specific demographic features were simulated. Providing preventive interventions for postpartum depression resulted in an estimated 5-year savings of $734.12 (95% credible interval [CrI], $217.21-$1235.67) per person. Without health insurance churn, sharing 50% of 5-year expected savings could offer more than double the financial incentives for clinicians to prevent postpartum depression compared with traditional VBP ($367.06 [95% CrI, $108.61-$617.83] vs $177.74 [95% CrI, $52.66-$296.60], respectively), with a high likelihood of positive return for the health care payer (91%). As health insurance churn increased, clinician incentives from sharing estimated savings decreased (73% reduction with 50% annual churn). Conclusions and Relevance: In this decision analytic model of VBP approaches to incentivizing postpartum depression prevention, VBP based on 5-year expected savings offered stronger incentives when churn was low. Policy should support health care payers and clinicians to share estimated savings and overcome health insurance churn issues to promote wide-scale implementation of interventions to prevent perinatal mental health conditions.

Applying the PROSPER prevention delivery system with middle schools: Emerging adulthood effects on substance misuse and conduct problem behaviors through 14 years past baseline.

This study evaluated emerging adult effects of the PROmoting School-Community-University Partnerships to Enhance Resilience (PROSPER) universal prevention delivery system implemented in middle schools. Twenty-eight rural school districts were randomized to intervention and control conditions, with 1985 nineteen-year-old participants (90.6% White, 54.1% female) evaluated through age 25. Intent-to-treat, multi-level, point-in-time analyses of covariance and growth analyses were conducted. Outcomes were assessed with self-report measures of substance misuse (lifetime, current, frequency) and conduct problem behaviors. Analyses showed very limited point-in-time effects; there were growth pattern effects on measures of illicit drugs, non-prescribed drugs, cigarettes, and drug problems. When risk moderation was observed, it favored higher-risk participants. These emerging adult effects concerning slower growth of lifetime misuse combine with more robust adolescent stage findings to support PROSPER's public health value.