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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., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Mark Feinberg created the Family Foundations program and is the owner of a private company, Family Gold, which disseminates the Family Foundations program. His financial interest has been reviewed by the Institutional Review Board and the Conflict of Interest Committee at The Pennsylvania State University. The other authors declare no conflicts of interest. Research presented here was supported via funding from the National Heart, Lung, and Blood Institute (R01 HL137809 (Schreier)) and Eunice Kennedy Shriver National Institute of Child Health & Human Development (R01s HD058529 and HD084476 (Feinberg); T32HD101390 (Ganguli))., (Copyright © 2024 Elsevier Inc. All rights reserved.)

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., (© 2023 The Authors. Child Development published by Wiley Periodicals LLC on behalf of Society for Research in Child Development.)

Background: Across several sites in the United States, we examined whether kindergarten conduct problems among mostly population-representative samples of children were associated with increased criminal and related (criminal + lost offender productivity + victim; described as criminal + victim hereafter) costs across adolescence and adulthood, as well as government and medical services costs in adulthood., Methods: Participants (N = 1,339) were from two multisite longitudinal studies: Fast Track (n = 754) and the Child Development Project (n = 585). Parents and teachers reported on kindergarten conduct problems, administrative and national database records yielded indexes of criminal offending, and participants self-reported their government and medical service use. Outcomes were assigned costs, and significant associations were adjusted for inflation to determine USD 2020 costs., Results: A 1SD increase in kindergarten conduct problems was associated with a $21,934 increase in adolescent criminal + victim costs, a $63,998 increase in adult criminal + victim costs, a $12,753 increase in medical services costs, and a $146,279 increase in total costs. In the male sample, a 1SD increase in kindergarten conduct problems was associated with a $28,530 increase in adolescent criminal + victim costs, a $58,872 increase in adult criminal + victim costs, and a $144,140 increase in total costs. In the female sample, a 1SD increase in kindergarten conduct problems was associated with a $15,481 increase in adolescent criminal + victim costs, a $62,916 increase in adult criminal + victim costs, a $24,105 increase in medical services costs, and a $144,823 increase in total costs., Conclusions: This investigation provides evidence of the long-term costs associated with early-starting conduct problems, which is important information that can be used by policymakers to support research and programs investing in a strong start for children., (© 2023 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.)

Objective: To evaluate the benefits of the Fast Track Friendship Group program implemented as a stand-alone school-based intervention on the social cognitions, social behavior, peer and teacher relationships of peer-rejected students., Method: Over four successive years, 224 peer-rejected elementary students (57% White, 17% Black, 20% Latinx, 5% multiracial; 68% male; grades 1-4; M age  = 8.1 years old) were identified using peer sociometric nominations and randomly assigned to the intervention (n = 110) or a treatment-as-usual control group (n = 114). Four school districts serving economically-disadvantaged urban and rural communities participated. Intervention involved weekly small group social skills training with classmate partners, with sessions tailored to address individual child needs. Consultation meetings held at the start and mid-point of intervention were designed to help teachers and parents support the generalization of targeted skills., Results: Multi-level linear models, with children nested within schools (controlling for demographics and baseline scores) documented improvements in social-cognitive skills (direct assessments of emotion recognition and competent social problem-solving), social behavior (teacher ratings of social skills and externalizing behavior), and interpersonal relationships (peer sociometric nominations of peer acceptance and friendships, teacher-rated student-teacher closeness). Significant effects were generally small ( d s = .19-.36) but consistent across child sex, grade level, and behavioral characteristics., Conclusions: The intervention proved feasible for high-fidelity implementation in school settings and produced significant improvements in the social adjustment of peer-rejected children, validating the approach as a school-based Tier 2 intervention.

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., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Feinberg, who created the Family Foundations program, is the owner of a private company, Family Gold, which disseminates the Family Foundations program. His financial interest has been reviewed by the Institutional Review Board and the Conflict of Interest Committee at The Pennsylvania State University. The remaining authors have no potential conflicts of interest to declare., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Background: Parent-child relationship quality (PCRQ) and parental monitoring (PM) are associated with adolescent behavior problems following child maltreatment (CM). Whether these associations are best characterized as between (trait) or within-person (state) differences is unknown., Objective: Disaggregate between and within-person effects for PCRQ and PM on adolescent behavior problems and test whether these effects vary as a function of prior CM., Participants and Setting: Participants (n = 941) are from the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN)., Methods: Multi-level modeling was employed using PCRQ, PM, and adolescent behaviors assessed at ages 12, 14, and 16 and confirmed CM prior to age 12., Results: At the between-person level, adolescents with higher average levels of PCRQ and PM had significantly lower initial levels of externalizing (b = -9.47 and -5.54, respectively, p's < 0.05; possible range 0-66) and internalizing behaviors (b = -4.45 and -6.41, respectively, p's < 0.001; possible range 0-62). At the within-person level, greater declines in externalizing and internalizing behaviors were found when individuals reported higher-than-usual levels of PCRQ (b = -4.99 and -2.59, respectively, for externalizing and internalizing, p's < 0.001) and PM (b = -3.58 and -1.69, respectively, for externalizing and internalizing, p's < 0.001). There was an interaction between PM and CM on internalizing behaviors over time (b = -1.15, p = 0.026)., Conclusions: There are between and within-person effects of PCRQ and PM on adolescent behavior problems. Adolescents with CM histories and low levels of PM may be at risk for sustained internalizing behaviors., (Copyright © 2022. Published by Elsevier Ltd.)

Firstborn children have higher prevalence of obesity than secondborn siblings. The birth of a sibling typically results in resource dilution when mothers begin to divide their time and attention between two children. This mixed-methods analysis applies the family systems process of resource dilution to test the hypothesis that characteristics of the secondborn impact how parents feed the firstborn. Participants (n = 76) were mothers of consecutively born firstborn and secondborn siblings who participated in the INSIGHT trial and an observational cohort. Quantitative analyses involved multilevel models to test if characteristics of secondborns (temperament at 16 weeks, appetite at 28 weeks) were associated with maternal feeding practices of firstborns (structure and control-based feeding) at 1, 2, and 3 years, adjusting for firstborn child characteristics. A purposive subsample (n = 30) of mothers participated in semi-structured interviews to contextualize potential sibling influences on maternal feeding practices during infancy and toddlerhood. Quantitative data showed secondborn temperament and appetite were associated with how mothers fed their firstborn. Qualitative data explained maternal feeding practices in three primary ways: 1) Mothers explained shifting predictable meal and snack routines after birth of the secondborn, but did not perceive sibling characteristics as the source; 2) Family chaos following the secondborn's birth led to "survival mode" in feeding; and 3) Social support was protective against feeding resource dilution. The family systems process of resource dilution is a focus for future research and support for families during key transitions and a direction for efforts to reduce risk for child obesity., Competing Interests: Declarations of competing interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Objective: This study used a randomized clinical trial design to evaluate the success with which The Building a Strong Identity and Coping Skills intervention (BaSICS) engaged the proximal mechanisms of poverty-related stress's impact on the psychosocial functioning and mental health of young adolescents living in high poverty contexts., Method: 129 youth from very low-income families were randomized to receive the 32-hour group-based intervention or no-treatment control - 16 of these families withdrew before the intervention groups began. The remaining 113 youth aged 11-12 (53% assigned to intervention; 54% female; 40% Hispanic, 63% Black, 20% White) participated in the study, which included four assessment waves: pretest, posttest, 6-month follow-up and 12-month follow-up assessments. Primary control, secondary control, and disengagement coping were assessed via a combination of parent and youth reports as well as via interviews and questionnaires. Hypothalamic-pituitary-adrenal axis (HPA) reactivity was assessed via salivary cortisol responses occurring during a lab-based stress induction (Trier Social Stress Test)., Results: Multilevel regression models with repeated measures nested within subjects revealed that in comparison to controls, intervention youth had sustained significant increases in their knowledge about primary control coping (e.g., problem solving, emotion modulation), knowledge and utilization of secondary control (e.g., cognitive restructuring) coping, as well as decreased reliance on disengagement coping. These were accompanied by decreased cortisol reactivity in intervention versus control youth., Conclusions: These findings support that BaSICS engages several proximal mechanisms of poverty-related stress' impact on early adolescent mental health - coping skills and HPA reactivity - during the neurodevelopmentally plastic pubertal period.

This randomized trial tested the impact of an established prevention program for first-time parents, Family Foundations, adapted for low-income mothers and fathers as a series of sessions provided to couples in their homes. To assess program impact, we recruited and randomly assigned a sample of 150 low-income adult mother-father dyads (not necessarily still romantically involved, cohabiting, or married) during pregnancy or shortly after birth. The randomly assigned intervention families participated in Family Foundations Home Visiting (FFHV), consisting of 11 in-home sessions focusing on parental cooperation, collaboration, and conflict management to support children's development. Complier average causal effect (CACE) analysis was used to examine program impact on parental adjustment and parenting for families completing nine or more program sessions. Results indicated significant positive complier effects for mothers' and fathers' reports of depression, Posttraumatic Stress Disorder (PTSD) symptoms, coping with stress, and psychological aggression by fathers toward mothers at post-intervention, controlling for pre-intervention scores. Intervention parents also demonstrated higher levels of affection, engagement, and sensitivity with the infant based on observer coding of videotaped parent-child interactions. These findings indicate that the focus of Family Foundations on enhancing coparenting offers similar benefits for low-income parents and children who are compliers as has the group-format Family Foundations (FF) version in trials with universal samples of cohabiting or married parents. Results are discussed in terms of implications for home visiting, engaging fathers, and optimizing child outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

As the COVID-19 pandemic has been highly stressful for parents and children, it is clear that strategies that promote long-term family resilience are needed to protect families in future crises. One such strategy, the Family Foundations program, is focused on promoting supportive coparenting at the transition to parenthood. In a randomized trial, we tested the long-term intervention effects of Family Foundations on parent, child, and family well-being one to two months after the imposition of a national shelter-in-place public health intervention in 2020. We used regression models to test intervention impact on outcomes reported on by parents in a standard questionnaire format and a series of 8 days of daily reports. We also tested moderation of intervention impact by parent depression and coparenting relationship quality. Relative to control families, intervention families demonstrated significantly lower levels of individual and family problems (general parent hostility, harsh and aggressive parenting, coparenting conflict, sibling relationship conflict, and children's negative mood and behavior problems), and higher levels of positive family relationship quality (positive parenting, couple relationship quality, sibling relations, and family cohesion). For some outcomes, including coparenting conflict, harsh parenting, and child behavior problems, intervention effects were larger for more vulnerable families-that is, families with higher pre-pandemic levels of parent depression or lower levels of coparenting relationship quality. We conclude that targeted family prevention programming is able to promote healthy parent and child functioning during unforeseen future periods of acute stress. The long-term benefits of a universal approach to family support at the transition to parenthood indicate the need for greater investment in the dissemination of effective approaches., (© 2021 Family Process Institute.)

Background: Over 5000 community anti-drug coalitions operating in the USA serve as a cornerstone of federal drug prevention. These coalitions, however, have demonstrated effectiveness in preventing substance use only when they use technical assistance (TA) and implement evidence-based programs (EBPs). The absence of TA and EBP implementation by coalitions is a key research-to-practice gap. The Coalition Check-Up TA system is designed to fill this gap by supporting community coalition implementation of EBPs. Existing TA models for evidence-based coalition approaches are resource intensive and coalition model specific. The Coalition Check-Up is a lower cost strategy that works with a variety of types of coalitions to support sustainable implementation of EBPs. This study protocol describes a hybrid type 3 effectiveness-implementation trial applying Wandersman's Interactive Systems Framework to test the effects of the Coalition Check-Up on coalition EBP implementation capacity and outcomes. The Interactive Systems Framework outlines how the prevention support system-especially TA-bolsters EBP dissemination and implementation., Methods: Using a cluster randomized controlled design, this trial will test the overall effectiveness of the Coalition Check-Up, including how it contributes to EBP implementation and prevention of youth substance use. The first aim is to estimate the impact of the Coalition Check-Up on coalitions' capacity to do their work. We will recruit 68 anti-drug coalitions for random assignment to the Coalition Check-Up or "TA as usual" condition. We will evaluate whether the Coalition Check-Up improves coalition capacity using measures of coalition member responses about team processes, coalition network composition, and collaborative structure. Our second aim is to estimate the impact of the Coalition Check-Up on implementation of EBPs, and our third aim is to estimate the impact of the Coalition Check-Up on youth substance use., Discussion: This project will clarify how the Coalition Check-Up, a scalable approach to TA due to its low cost, affects coalition capacity to support EBP implementation. Analyses also provide insight into causal pathways from the prevention support system to the prevention delivery system outlined by the Interactive Systems Framework. Results will build the evidence-base for how to support community coalitions' sustainable implementation of evidence-based prevention programs and policies., Trial Registration: Clinicaltrials.gov registration number NCT04592120 . Registered on October 19, 2020.

Objectives: In this study, we tested whether Recipe 4 Success, a preventive intervention featuring structured food preparation lessons, was successful in improving the following 4 protective factors related to overweight and obesity among families living in poverty: toddlers' healthy eating habits, toddlers' self-regulation, parents' responsive feeding practices, and parents' sensitive scaffolding., Methods: This randomized controlled trial was open to families enrolled in Early Head Start home visits and included 73 parents and their toddlers aged 18 to 36 months. Multimethod assessments were conducted at baseline and posttreatment., Results: Compared with toddlers in usual practice Early Head Start, toddlers in Recipe 4 Success consumed healthier meals and snacks ( d = 0.57; P < .03; 95% confidence interval [CI]: 0.08-1.06) and displayed better self-regulation ( d = 0.95; P < .001; 95% CI: 0.43-1.45). Compared with parents in usual practice Early Head Start, parents in Recipe 4 Success engaged in more responsive feeding practices ( d = 0.87; P < .002; 95% CI: 0.34-1.40) and were better able to sensitively scaffold their toddlers' learning and development ( d = 0.58; P < .04; 95% CI: 0.07-1.09)., Conclusions: This randomized controlled trial revealed medium to large intervention effects on 4 important protective factors that are related to overweight and obesity but are often compromised by living in poverty., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2021 by the American Academy of Pediatrics.)

Early childhood education (ECE) interventions hold great promise for not only improving lives but also for potentially producing an economic return on investment linked to key outcomes from program effectiveness. Assessment of economic impact relies on accurate estimates of program costs that should be derived consistently to enable program comparability across the field. This is challenged by a lack of understanding of the best approach to determine program costs that represent how they will occur in the real world and how they may vary across differing circumstances. Thorough and accurate cost analyses are vital for providing important information toward future implementations and for enabling analysis of potential return on investment. In this paper, we present five key issues most relevant to cost analysis for ECE programs that interventionists should acknowledge when estimating their programs' costs. Attention to these issues more broadly can lead to comprehensive and thorough cost estimates and potentially increase consistency in cost analyses. These issues are illustrated within the cost analysis of REDI ( Re search-based, D evelopmentally I nformed), an enrichment program that seeks to extend the benefits of preschool through enhanced classroom and home visiting services. Implications for practice and policy are discussed., Competing Interests: Declarations of interest: none

Cross-sectional research has suggested that posttraumatic stress disorder (PTSD) symptom severity may be an important predictor of family violence perpetration; however, causal inference is limited by the absence of studies designed to prospectively predict family violence by PTSD symptoms. In the current study, PTSD symptoms were assessed among 250 trauma-exposed heterosexual couples 10 months after having their 1st child. The number of acts of psychological and physical intimate partner aggression (IPA) and parent-to-child aggression (PCA) that occurred during the past year was assessed at 10 and 24 months postpartum to account for stability in family violence perpetration when prospectively predicting perpetration. Longitudinal actor-partner interdependence models revealed that women's and men's PTSD symptoms positively predicted increases in the frequency of their own perpetration of psychological and physical IPA as well as psychological PCA. Additionally, partners' PTSD symptoms prospectively predicted psychological and physical IPA perpetration but not psychological or physical PCA perpetration, suggesting that partners' PTSD symptoms may directly impact dyadic processes during incidents of IPA but may not generally affect the family environment in a way that potentiates all forms of aggression. No significant gender differences were revealed. Overall, results of the current study largely support existing research and theory while clarifying inconsistencies that have emerged when examining cross-sectional associations. Further, the current results highlight the potential utility of PTSD treatment as an avenue for aggression prevention and intervention efforts during the early parenting years. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Objective: The aim of the study was to investigate prospective, longitudinal associations between maternal prenatal cortisol response to an interpersonal stressor and child health for the subsequent 3 years., Methods: One hundred twenty-three women expecting their first child provided salivary cortisol samples between 12 and 32 weeks of gestation (M (SD) = 22.4 (4.9) weeks) before and after a videotaped couple conflict discussion with their partner. Mothers reported on overall child health and several indicators of child illness (sick doctor visits, fevers, ear, and respiratory infections) when children were 6 months (n = 114), 1 (n = 116), and 3 (n = 105) years old. Associations between maternal prenatal cortisol reactivity and recovery and later child health at each of the three time points were analyzed using longitudinal regression models., Results: Greater cortisol reactivity in response to the couple conflict discussion was associated with maternal self-report of better overall child health (p = .016, 95% CI = 0.06-1.30, Cohen's f = 0.045) across the study period. Greater cortisol reactivity was also associated with lower incidence rate ratios for maternal reports of sick doctor visits (incidence rate ratio 95% CI = 0.25-0.83, p = .006), fevers (95% CI = 0.25-0.73, p = .002), ear infections (95% CI = 0.25-0.58, p < .001), and respiratory infections (95% CI = 0.08-1.11, p = .073). Cortisol recovery was unrelated to study outcomes (all p's > 0.05). Maternal prenatal depressive symptoms moderated the association between cortisol reactivity and overall child health (p = .034, 95% CI = 0.07-1.87 for interaction term) but no other health outcomes (p's > 0.05). Among women with lower depressive symptoms, cortisol reactivity was not associated with overall child health; among women with higher levels of depressive symptoms, greater cortisol reactivity was associated with better overall child health., Conclusions: This study provides longitudinal evidence that greater maternal cortisol reactivity to a salient interpersonal stressor during pregnancy is associated with fewer child health problems and better maternal report of overall child health during infancy and into early childhood., Trial Registration: Clinicaltrials.gov ID NCT01901536.

Fathers are more than social accidents. Research has demonstrated that fathers matter to children's development. Despite noted progress, challenges remain on how best to conceptualize and assess fathering and father-child relationships. The current monograph is the result of an SRCD-sponsored meeting of fatherhood scholars brought together to discuss these challenges and make recommendations for best practices for incorporating fathers in studies on parenting and children's development. The first aim of this monograph was to provide a brief update on the current state of research on fathering and to lay out a developmental ecological systems perspective as a conceptual framework for understanding the different spaces fathers inhabit in their children's lives. Because there is wide variability in fathers' roles, the ecological systems perspective situates fathers, mothers, children, and other caregivers within an evolving network of interrelated social relationships in which children and their parents change over time and space (e.g., residence). The second aim was to present examples of empirical studies conducted by members of the international working group that highlighted different methods, data collection, and statistical analyses used to capture the variability in father-child relationships. The monograph ends with a commentary that elaborates on the ecological systems framework with a discussion of the broader macrosystem and social-contextual influences that impinge on fathers and their children. The collection of articles contributes to research on father-child relationships by advancing theory and presenting varied methods and analysis strategies that assist in understanding the father-child relationship and its impact on child development., (© 2019 Society for Research in Child Development.)

To understand new fathers' experiences and well-being, we examine links between fathers and their partners' replenishing and stressful daily experiences-exercise, sleep, work, chores, general stress, and parenting stress-and their own and their partners' well-being and family relations. Fathers and mothers of ten-month old infants (N=143/140 mothers/fathers) in the U.S. reported on daily experiences for eight consecutive days. Results of multilevel models indicated that more replenishing and fewer stressful daily experiences were generally linked to more parent happiness, better couple relations, and greater closeness with the infant. Several gender differences also emerged that may reflect different stress and coping processes or different social roles for mothers and fathers; most striking was that on days that fathers spent more time on chores, mothers reported greater couple closeness but fathers reported more arguments. This exploration of new parents' daily experiences demonstrates the value of the method to generate intervention-relevant insights, as well as the importance of examining fathers' (and mothers') experiences in the context of couple-level dynamics.

Trauma exposure is a consistent correlate of intimate partner aggression (IPA) and parent-to-child aggression (PCA) perpetration, and difficulties with emotions (particularly fear and anger) are hypothesized to underlie these relations. However, the absence of knowledge of the immediate, contextual influence of emotions on aggression renders existing conclusions tenuous. This study illustrates a new method for studying contextual influences on aggressive behavior. Quarterly for 1 year, 94 men and 109 women with children age 2.5 years at study commencement were interviewed to measure the sequence of behaviors during aggressive incidents as well as the intensity of their emotions immediately prior to initiation of aggression. Within aggressive incidents, the number of acts of men's PCA was predicted by men's greater fear, anger, and trauma exposure, and the positive association between men's trauma exposure and PCA perpetration was especially strong under conditions of high fear and anger. In contrast, men's IPA was predicted by greater fear and anger, but not trauma exposure. Men with low trauma exposure engaged in more IPA under conditions of high fear; among men with high trauma exposure, fear inhibited their IPA persistence. Trauma exposure and fear interacted in the same manner to predict women's IPA, but many other findings among men did not generalize to women's aggression. This study illuminates the utility of simultaneously examining aggression across genders and family dyads, and serves as a foundation for refining theories of trauma and family aggression to account for emotion as a factor that can both motivate and inhibit aggression. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

The analysis of mediational pathways in intervention trials represents the strongest method available for establishing causal links between developmental factors and child outcomes. This paper assesses mediation of the effects of Family Foundations on toddler emotional and behavioral adjustment through parent-related factors (parental stress, parental depression, coparenting negativity, parenting negativity). Data come from the second trial of Family Foundations, a universal preventive program delivered at the transition to parenthood. Mediating mechanisms were assessed at 10 months postpartum (posttest); and child outcomes were measured at two years post-birth. Results indicated that putative mediators did not significantly mediate outcomes when considered one at a time; but the set of mediators collectively mediated child outcomes. Implications for assessing mediation in future trials are discussed., Competing Interests: Dr. Mark Feinberg created the Family Foundations program and is the owner of a private company, Family Gold, which disseminates the Family Foundations program. Dr. Feinberg’s financial interest has been reviewed by the Institutional Review Board and the Conflict of Interest Committee at The Pennsylvania State University.

Over a decade ago, the Society for Prevention Research endorsed the first standards of evidence for research in preventive interventions. The growing recognition of the need to use limited resources to make sound investments in prevention led the Board of Directors to charge a new task force to set standards for research in analysis of the economic impact of preventive interventions. This article reports the findings of this group's deliberations, proposes standards for economic analyses, and identifies opportunities for future prevention science. Through examples, policymakers' need and use of economic analysis are described. Standards are proposed for framing economic analysis, estimating costs of prevention programs, estimating benefits of prevention programs, implementing summary metrics, handling uncertainty in estimates, and reporting findings. Topics for research in economic analysis are identified. The SPR Board of Directors endorses the "Standards of Evidence for Conducting and Reporting Economic Evaluations in Prevention Science."

This study assessed associations between both work demands (pressure, hours) and work resources (self-direction) and marital satisfaction in a sample of 164 African American dual-earner couples who were interviewed annually across 3 years. Grounded in the work-home resources and family systems frameworks, results from longitudinal actor-partner interdependence models (APIM) revealed main effects of spouses' work experiences on their own marital satisfaction, but these effects were qualified by the interactive effects of spouses' and partners' work experiences. Some interactive effects were consistent with an amplifying pattern, for example that, beyond the main effects of actor self-direction, marital satisfaction was highest when both spouses experienced high work self-direction. Other effects were consistent with a comparative pattern, such that shorter work hours were linked to lower marital satisfaction only when partners worked longer hours. Gender moderation also was evident in findings that wives' work pressure was negatively linked to marital satisfaction only when their husbands reported high pressure, but husbands' work pressure was negatively linked to marital satisfaction only when their wives reported low pressure. This study advances understanding of work-marriage linkages in African American couples, an understudied group with a distinctive connection to the labor force. Analyses demonstrate what can be learned from investigating the couple as a unit and illustrate how family systems concepts can be addressed via APIM. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Purpose: To inform efforts to reduce costly service utilization, the present study examined longitudinal trajectories of mental health-related outpatient and residential service use among at-risk youth with a history of early externalizing problems., Methods: A cohort of 809 children in the Fast Track Project, a multisite longitudinal study of children at risk for conduct disorder, were followed prospectively from kindergarten through 12th grade. They resided in high-risk areas with high rates of poverty, crime, and violence. Their outpatient and residential service use was assessed annually between sixth and 12th grades through parent report. Growth mixture modeling was applied to model individual differences in trajectories of service use during this period. Teacher, parent, and observer-reported childhood predictors of those trajectories were also examined., Results: Most youths had minimal service use during preadolescence into adolescence. However, approximately 31% had moderate probability of using outpatient counseling services, and approximately 8% had elevated probability of seeing a family doctor for mental health needs. For residential services, approximately 6% had moderate to high probability of service use that peaked during transition to high school, whereas close to 5% had service use that dramatically increased during high school. Childhood predictors of these trajectories included earlier externalizing, internalizing, and emotion regulation problems., Conclusions: This study is the first to use person-centered analytic methods to examine longitudinal trajectories in mental health-related service use among at-risk adolescents. Timely treatment for severe externalizing problems, comorbid internalizing problems, and emotion dysregulation during childhood may be crucial for preventing chronic service use., (Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Despite substantial rates of parent to child aggression (PCA) and intimate partner aggression (IPA) co-occurrence within families, the co-occurrence of PCA and IPA within incidents of aggression has not previously been examined. To do so, we developed the Children, Intimate Relationships, and Conflictual Life Events (CIRCLE) interview to simultaneously measure incidents of psychological and physical PCA and IPA. The CIRCLE interview was administered quarterly for approximately 1 year to 109 women and 94 men from 111 couples with a first born child approximately 32 months of age at study initiation. Demonstrating the CIRCLE interview's ability to yield new knowledge about the nature of family aggression, we describe the frequency of aggressive incidents, the average number of aggressive behaviors within incidents, the daily occurrence of multiple aggressive incidents, and rates of within-incident PCA and IPA co-occurrence. With the exception of men's physical IPA, aggression scores derived from the CIRCLE interview exhibited a relatively high degree of interpartner reporting concordance, as well as structural validity and convergent validity with common aggression measures. Aggression reports via repeated testing were not influenced by social desirability or attempts to avoid aggression. Participants who perceived enhanced memory for aggression as a function of study participation reported increasing PCA and IPA frequencies over time. In the prediction of child conduct and emotional problems, the CIRCLE interview demonstrated predictive validity and incremental validity over traditional aggression measures. For the first time, within-incident co-occurrence of PCA and IPA was documented and shown to uniquely impact child outcomes. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)

The transition to parenthood is a stressful period for most parents as individuals and as couples, with variability in parent mental health and couple relationship functioning linked to children's long-term emotional, mental health, and academic outcomes. Few couple-focused prevention programs targeting this period have been shown to be effective. The purpose of this study was to test the short-term efficacy of a brief, universal, transition-to-parenthood intervention (Family Foundations) and report the results of this randomized trial at 10 months postpartum. This was a randomized controlled trial; 399 couples expecting their first child were randomly assigned to intervention or control conditions after pretest. Intervention couples received a manualized nine-session (five prenatal and four postnatal classes) psychoeducational program delivered in small groups. Intent-to-treat analyses indicated that intervention couples demonstrated better posttest levels than control couples on more than two thirds of measures of coparenting, parent mental health, parenting, child adjustment, and family violence. Program effects on family violence were particularly large. Of eight outcome variables that did not demonstrate main effects, seven showed moderated intervention impact; such that, intervention couples at higher levels of risk during pregnancy showed better outcomes than control couples at similar levels of risk. These findings replicate a prior smaller study of Family Foundations, indicating that the Family Foundations approach to supporting couples making the transition to parenthood can have broad impact for parents, family relationships, and children's adjustment. Program effects are consistent and benefit all families, with particularly notable effects for families at elevated prenatal risk.

Objective: Although maternal stress, anxiety, and depression have been linked to negative birth outcomes, few studies have investigated preventive interventions targeting maternal mental health as a means of reducing such problems. This randomized controlled study examines whether Family Foundations (FF)-a transition to parenthood program for couples focused on promoting coparenting quality, with previously documented impact on maternal stress, depression, and anxiety-can buffer the negative effects of maternal mental health problems., Methods: To assess the effects of FF, we used a randomized block design with a sample of 259 expectant mothers assigned to FF or a control condition and analyzed using propensity score models. We examine two-way interactions of condition (intervention vs. control) with maternal mental health problems (financial stress, depression, and anxiety) on birth outcomes (birth weight, days in hospital for mothers and infants). For birth weight, we assess whether intervention effects depend on length of gestation by including a third interaction term., Results: FF buffered (p < 0.05) the negative impact of maternal mental health problems on birth weight and both mother and infant length of post-partum hospital stay. For birth weight, assignment to FF was associated with higher birth weight for infants born before term., Conclusions: These results demonstrate that a psycho-educational program for couples focused on enhancing mutual coparental support, with preventive effects on maternal mental health, can reduce incidence of birth problems among women at elevated risk. Such improvements in birth outcomes could translate into substantial reductions in public and personal healthcare costs. Future work should assess mediating mechanisms of intervention impact and cost-benefit ratio of the intervention., Clinical Trials Registration: The Family Foundations follow-up intervention study is currently registered with www.clinicaltrials.gov . The study identifier is NCT01907412.

Objectives: We examined whether kindergarten teachers' ratings of children's prosocial skills, an indicator of noncognitive ability at school entry, predict key adolescent and adult outcomes. Our goal was to determine unique associations over and above other important child, family, and contextual characteristics., Methods: Data came from the Fast Track study of low-socioeconomic status neighborhoods in 3 cities and 1 rural setting. We assessed associations between measured outcomes in kindergarten and outcomes 13 to 19 years later (1991-2000). Models included numerous control variables representing characteristics of the child, family, and context, enabling us to explore the unique contributions among predictors., Results: We found statistically significant associations between measured social-emotional skills in kindergarten and key young adult outcomes across multiple domains of education, employment, criminal activity, substance use, and mental health., Conclusions: A kindergarten measure of social-emotional skills may be useful for assessing whether children are at risk for deficits in noncognitive skills later in life and, thus, help identify those in need of early intervention. These results demonstrate the relevance of noncognitive skills in development for personal and public health outcomes.

Although maternal stress and depression have been linked to adverse birth outcomes (ABOs), few studies have investigated preventive interventions targeting maternal mental health as a means of reducing ABOs. This randomized controlled study examines the impact of Family Foundations (FF)-a transition to parenthood program for couples focused on promoting coparenting quality, with previously documented impact on maternal stress and depression-on ABOs. We also examine whether intervention buffers birth outcomes from the negative effect of elevated salivary cortisol levels. We use intent-to-treat analyses to assess the main effects of the FF intervention on ABOs (prematurity, birth weight, pregnancy complications, Cesarean section, and days in hospital for mothers and infants) among 148 expectant mothers. We also test the interaction of cortisol with intervention condition status in predicting ABOs. FF participation was associated with reduced risk of C-section (OR .357, p < 0.05, 95 % CI 0.149, 0.862), but did not have main effects on other ABOs. FF significantly buffered (p < 0.05) the negative impact of maternal cortisol on birth weight, gestational age, and days in hospital for infants; that is, among women with relatively higher levels of prenatal cortisol, the intervention reduced ABOs. These results demonstrate that a psycho-educational program for couples reduces incidence of ABOs among higher risk women. Future work should test whether reduced maternal stress and depression mediate these intervention effects.

This study examines long-term effects of a transition to parenthood program, Family Foundations, designed to enhance child outcomes through a strategic focus on supporting the coparenting relationship. Roughly 5 to 7 years after baseline (pregnancy), parent and teacher reports of internalizing and externalizing problems and school adjustment were collected by mail for 98 children born to couples enrolled in the randomized trial. Teachers reported significantly lower levels of internalizing problems among children in the intervention group compared with children in the control group and, consistent with prior findings at age 3, lower levels of externalizing problems for boys in the intervention group. Baseline level of observed couple negative communication moderated intervention effects for parent and teacher report of child adjustment and teacher report of school adjustment and adaptation. Effect sizes ranged from 0.40 to 0.98. Results indicate that relatively brief preventive programs for couples at the transition to parenthood have the capacity to promote long-term positive benefits for children's adjustment. Although we attended to missing data issues in several ways, high levels of attrition in this long-term follow-up study is a cause for caution.

In response to growing interest in economic analyses of prevention efforts, a diverse group of prevention researchers, economists, and policy analysts convened a scientific panel, on "Research Priorities in Economic Analysis of Prevention" at the 19th annual conference of the Society for Prevention Research. The panel articulated four priorities that, if followed in future research, would make economic analyses of prevention efforts easier to compare and more relevant to policymakers and community stakeholders. These priorities are: (1) increased standardization of evaluation methods, (2) improved economic valuation of common prevention outcomes, (3) expanded efforts to maximize evaluation generalizability and impact as well as (4) enhanced transparency and communicability of economic evaluations. In this paper, we define three types of economic analyses in prevention, provide context and rationale for these four priorities as well as related sub-priorities, and discuss the challenges inherent in meeting them.

The transition to parenthood involves many stressors that can have implications for the couple relationship as well as the developmental environment of the child. Scholars and policymakers have recognized the potential for interventions that can help couples navigate these stressors to improve parenting and coparenting strategies. Such evidence-based programs are scarcely available, however, and little is known about the resources necessary to carry out these programs. This study examines the costs and resources necessary to implement Family Foundations, a program that addresses the multifaceted issues facing first-time parents through a series of pre- and post-natal classes. Costs were determined using a 6-step analytic process and are based on the first implementation of the program carried out through a five-year demonstration project. This assessment demonstrates how overall costs change across years as new cohorts of families are introduced, and how cost breakdowns differ by category as needs shift from training group leaders to sustaining program services. Information from this cost analysis helps clarify how the program could be made more efficient in subsequent implementations. We also consider how results may be used in future research examining economic benefits of participation in the program., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Purpose: Prescription drug abuse has reached epidemic proportions. Nonmedical prescription opioid use carries increasingly high costs. Despite the need to cultivate efforts that are both effective and fiscally responsible, the cost-effectiveness of universal evidence-based-preventive-interventions (EBPIs) is rarely evaluated. This study explores the performance of these programs to reduce nonmedical prescription opioid use., Methods: Sixth graders from twenty-eight rural public school districts in Iowa and Pennsylvania were blocked by size and geographic location and then randomly assigned to experimental or control conditions (2002-2010). Within the intervention communities, prevention teams selected a universal family and school program from a menu of EBPIs. All families were offered a family-based program in the 6th grade and received one of three school-based programs in 7th-grade. The effectiveness and cost-effectiveness of each school program by itself and with an additional family-based program were assessed using propensity and marginal structural models., Results: This work demonstrates that universal school-based EBPIs can efficiently reduce nonmedical prescription opioid use. Further, findings illustrate that family-based programs may be used to enhance the cost-effectiveness of school-based programs., Conclusions: Universal EBPIs can effectively and efficiently reduce nonmedical prescription opioid use. These programs should be further considered when developing comprehensive responses to this growing national crisis., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Behavioral and emotional problems are common in early childhood and put children at risk for developing more serious problems. This study tested the mediating mechanisms through which a universal coparenting intervention implemented during the transition to parenthood led to reduced child adjustment problems at age 3 and explored child gender as a potential moderator. One hundred sixty-nine heterosexual couples expecting their first child were randomly assigned to a control condition or Family Foundations, a series of eight classes that targeted the coparenting relationship. Data were collected through videotaped triadic mother-father-child interaction tasks when the child was 1 and 3 years of age. Separate longitudinal path analyses for mothers and fathers tested coparenting competition and positivity as mediators of program effects on child adjustment problems. Significant mediated effects for coparenting competition were found for fathers with both sons and daughters and for mothers with sons but not for mothers with daughters. These effects accounted for between 39 and 55% of the intervention's impact on child adjustment problems. Coparenting positivity did not mediate program effects. These results support the use of a prevention approach to reduce coparenting competition and enhance child adjustment and provide information that can be used to refine theory.

The study examines whether anxiety or chronic relationship stress alter the way that couple conflict affects cortisol levels for women and men during the transition to parenthood. Saliva samples, assayed for cortisol, were collected before and after couple interaction from 128 heterosexual couples expecting their first child. Confirming prior research, expectant mothers had higher cortisol levels than their spouses, and gestational age was linked to women's cortisol level. Negativity during couple interaction was associated with greater cortisol reactivity for men, but not women. Tests of moderation indicated little relation between negativity and cortisol recovery for individuals with a low level of anxiety or little history of chronic arguing with the partner. However, among individuals with elevated levels of either of these two factors, negativity was linked to less cortisol recovery for men, but more cortisol recovery for women. Consistent results were also found for the relation between low warmth in the couple interaction and both reactivity and recovery for men and women high in anxiety. Future research should examine whether pregnancy is responsible for these different gender patterns, or whether the inhibition of negativity is stressful for women with high levels of risk., (© 2012 The British Psychological Society.)

The current study examined developmental changes in the relative influence of risk and protective factors (RPFs) across individual, family, peer, school, and community domains on adolescent alcohol use. Using longitudinal data from two independent samples, multivariate cross-lagged models were used to estimate the unique influence of each RPF on subsequent changes in recent alcohol use between early to late adolescence. The results supported the hypothesis that the influence of Individual Risk would increase during this developmental period. However, less consistent evidence was found concerning developmental changes among the other domains. Whereas the influence arising from Family Protection diminished during adolescence, the influence of Family Risk, School Protection, and Community Protection did not vary. The influence of Peer Risk showed a nonlinear pattern across adolescence, peaking during the middle adolescent years. The results of this study support a developmental approach to adolescent alcohol use and emphasize the need for prevention strategies that account for these developmental changes., (2013 APA, all rights reserved)

To test the assumption embedded in state-of-the-art, community assessment and decision-making regarding prevention of underage drinking: that there is minimal variation in the way that risk and protective factors (RPF) are associated with underage drinking across communities. Three large datasets provided the same measures of adolescent alcohol use and RPFs. Multilevel ordered-logistic regression models were carried out separately for each dataset and separately for males and females in 8th and 10th grades, testing random slopes for each RPF index. Predicted school-level coefficients were derived from these models, representing the association between RPFs and alcohol use. The variation in associations between RPFs and alcohol use across schools was greatest for antisocial peer risk and community protection; the lowest variation across schools was found for family cohesion and individual antisocial behavior. Ranges in predicted coefficients indicate large differences across schools for many RPFs. Bivariate correlations indicated that school-level associations vary across RPFs in expected directions. Policy makers should recognize that the magnitude of associations between RPFs and adolescent alcohol use vary considerably across communities, and that such variability is greater for certain RPFs than others. These findings have implications for policies regarding how prevention resources are targeted within and across communities.

Objectives: We examined the independent and combined influence of major risk and protective factors on youths' alcohol use., Methods: Five large data sets provided similar measures of alcohol use and risk or protective factors. We carried out analyses within each data set, separately for boys and girls in 8th and 10th grades. We included interaction and curvilinear predictive terms in final models if results were robust across data sets. We combined results using meta-analytic techniques., Results: Individual, family, and peer risk factors and a community protective factor moderately predicted youths' alcohol use. Family and school protective factors did not predict alcohol use when combined with other factors. Youths' antisocial attitudes were more strongly associated with alcohol use for those also reporting higher levels of peer or community risk. For certain risk factors, the association with alcohol use varied across different risk levels., Conclusions: Efforts toward reducing youths' alcohol use should be based on robust estimates of the relative influence of risk and protective factors across adolescent environment domains. Public health advocates should focus on context (e.g., community factors) as a strategy for curbing underage alcohol use.

Purpose: To prepare public systems to implement evidence-based prevention programs for adolescents, it is necessary to have accurate estimates of programs' resource consumption. When evidence-based programs are implemented through a specialized prevention delivery system, additional costs may be incurred during cultivation of the delivery infrastructure. Currently, there is limited research on the resource consumption of such delivery systems and programs. In this article, we describe the resource consumption of implementing the PROSPER (PROmoting School-Community-University Partnerships to Enhance Resilience) delivery system for a period of 5 years in one state, and how the financial and economic costs of its implementation affect local communities as well as the Cooperative Extension and University systems., Methods: We used a six-step framework for conducting cost analysis, using a Cost-Procedure-Process-Outcome Analysis model (Yates, Analyzing costs, procedures, processes, and outcomes in human services: An introduction, 1996; Yates, 2009). This method entails defining the delivery System; bounding cost parameters; identifying, quantifying, and valuing systemic resource Consumption, and conducting sensitivity analysis of the cost estimates., Results: Our analyses estimated both the financial and economic costs of the PROSPER delivery system. Evaluation of PROSPER illustrated how costs vary over time depending on the primacy of certain activities (e.g., team development, facilitator training, program implementation). Additionally, this work describes how the PROSPER model cultivates a complex resource infrastructure and provides preliminary evidence of systemic efficiencies., Conclusions: This work highlights the need to study the costs of diffusion across time and broadens definitions of what is essential for successful implementation. In particular, cost analyses offer innovative methodologies for analyzing the resource needs of prevention systems., (Copyright © 2012 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

Despite advances in understanding the role that several physiological systems play in the occurrence of general violence, little progress has been made toward understanding biological correlates of intimate partner violence (IPV). We explored involvement of one physiological system, the hypothalamic-pituitary-adrenal (HPA) axis. Among 137 heterosexual couples expecting a first child, baseline level of HPA activity-assessed via salivary cortisol collected before a couple conflict discussion-was linked to both men's and women's violence perpetration. HPA reactivity to the conflict bout did not show an independent association with IPV. However, persisting elevation in men's, and down-regulation in women's, HPA activity during a further recovery period was linked to men's violence perpetration., (© 2011 Wiley Periodicals, Inc.)

We tested an integrative model of individual and dyadic variables contributing to intimate partner violence (IPV) perpetration. Based on the vulnerability-stress-adaptation (VSA) model, we hypothesized that three "enduring vulnerabilities" (i.e., antisocial behavior, hostility, and depressive symptoms) would be associated with a "maladaptive process" (i.e., negative relationship attributions) that would lead to difficulties in couple conflict resolution, thus leading to IPV. Among a community sample of 167 heterosexual couples who were expecting their first child, we used an actor-partner interdependence model to account for the dyadic nature of conflict and IPV, as well as a hurdle count model to improve upon prior methods for modeling IPV data. Study results provided general support for the integrative model, demonstrating the importance of considering couple conflict in the prediction of IPV and showing the relative importance of multiple predictor variables. Gender symmetry was observed for the prediction of IPV occurrence, with gender differences emerging in the prediction of IPV frequency. Relatively speaking, the prediction of IPV frequency appeared to be a function of enduring vulnerabilities among men, but a function of couple conflict among women. Results also revealed important cross-gender effects in the prediction of IPV, reflecting the inherently dyadic nature of IPV, particularly in the case of "common couple violence." Future research using longitudinal designs is necessary to verify the conclusions suggested by the current results.

This study investigated the ability of a psychosocial prevention program implemented through childbirth education programs to enhance the coparental and couple relationship, parental mental health, the parent-child relationship, and child outcomes. A sample of 169 heterosexual, adult couples expecting their first child was randomized to intervention and control conditions. The intervention families participated in Family Foundations, a series of eight classes delivered before and after birth, which was designed as a universal prevention program (i.e., applicable to all couples, not just those at high risk). Intent-to-treat analyses utilizing data collected from child age 6 months through 3 years indicated significant program effects on parental stress and self-efficacy, coparenting, harsh parenting, and children's emotional adjustment among all families, and maternal depression among cohabiting couples. Among families of boys, program effects were found for child behavior problems and couple relationship quality. These results indicate that a universal prevention approach at the transition to parenthood focused on enhancing family relationships can have a significant and substantial positive impact on parent and child well-being.

Service use patterns and costs of youth diagnosed with attention-deficit/hyperactivity disorder (ADHD) and comorbid conduct disorder (CD) were assessed across adolescence (ages 12 through 17). Featured service sectors include mental health, school services, and the juvenile justice system. Data are provided by three cohorts from the Fast Track evaluation and are based on parent report. Diagnostic groups are identified through a structured assessment. Results show that public costs for youth with ADHD exceed $40,000 per child on average over a 6-year period, more than doubling service expenditures for a non-ADHD group. Public costs for children with comorbid ADHD and CD double the costs of those with ADHD alone. Varying patterns by service sector, diagnosis, and across time indicate different needs for youth with different conditions and at different ages and can provide important information for prevention and treatment researchers.

Background: Economic analyses of programs to prevent or treat behavioral health problems among children and youth are an important component of intervention research., Aims of the Study: This study examines the cost-effectiveness of the Fast Track intervention, a multi-year, multi-component intervention designed to reduce violence in at-risk children. Analytic models estimate intervention cost-effectiveness allowing for sampling variation and considering alternative policy-maker willingness to pay levels., Methods: Costs of the intervention were estimated using program budgets. The probability of intervention effectiveness is mapped against willingness to pay using cost-effectiveness acceptability curves (CEAC). Cost-effectiveness is gauged using three outcomes measured in grade 9: diagnosis of conduct disorder; acts of interpersonal violence avoided; index criminal offense avoided., Results: Evaluation of the total sample shows that the intervention was not cost-effective at anticipated levels of policy maker's willingness to pay. For those most at-risk, however, the intervention was likely cost-effective., Discussion: Outcome measures are based on parent reports and so may be subject to respondent bias. Future costs related to conditions such as conduct disorder are speculative based on previous research., Implications for Health Care Provision and Use: Researchers must consider the population targeted for delivery of intervention services when evaluating cost-effectiveness of their intervention. This study indicates that the intervention was cost-effective only for youth most at-risk for behavioral problems. This result implies that overall cost-effectiveness would be improved by better targeting., Implications for Health Policies: The intervention is cost-effective for the highest risk children. From a policy standpoint, this finding is encouraging since such children are likely to generate high costs for taxpayers and society over their lifetimes. Nonetheless, the initial outlay required to finance the program is substantial., Implications for Further Research: Interventionists should consider program costs in designing interventions in order to better balance feasibility with efficacy.

Objectives: We explored the economic implications of conduct disorder (CD) among adolescents in 4 poor communities in the United States. We examined a range of expenditures related to this disorder across multiple public sectors, including mental health, general health, school, and juvenile justice., Methods: We used self- and parental-report data to estimate expenditures during a 7-year period in late adolescence of a sample of youths. We contrasted expenditures for youths with CD and youths with oppositional defiant disorder, elevated symptoms (no CD diagnosis), and all others. Diagnosis was determined with a structured assessment., Results: Additional public costs per child related to CD exceeded $70000 over a 7-year period., Conclusions: Public expenditures on youths with CD are substantially larger than for youths with closely related conditions, reflecting the importance of prevention and early treatment for the disorder.