Effects of Attachment-Based Intervention on Low-Income Latino Children's Emerging Health Outcomes: A Randomized Controlled Trial

Project Summary/Abstract
Latino children have worse health than non-Latino White children across many common conditions, including
respiratory illnesses and obesity, laying a foundation for health disparities across the life course. Prior studies
demonstrate that attachment-based parenting interventions, those designed to foster sensitive parenting
behavior and secure infant-parent attachment, improve maternal sensitivity, attachment security, child
socioemotional development, and some aspects of child psychophysiological regulation. To date, there has not
been a large-scale trial testing the efficacy of an attachment-based intervention for supporting physical health
more broadly. This is a significant gap, especially with regard to Latino child health promotion, given (a) the
promise of attachment-based interventions, and (b) the early origins of health disparities that negatively impact
Latino children, the largest and fastest-growing segment of the U.S. population. The proposed RCT will test
the impacts of an attachment-based intervention on emerging health outcomes in low-income Latino
children (N = 260). We will focus on low-income Latino families as a group at exceptionally high risk for health
problems. The manualized intervention, Attachment and Biobehavioral Catch-up (ABC), consists of 10
sessions provided by a trained parent coach to primary caregivers and their infants in their homes. We will
enroll families with 9-month-old infants and follow them longitudinally until age 2. In Aim 1, we will test the
effects of ABC on child health outcomes. We hypothesize positive intervention effects on common infant
and toddler illnesses (e.g., respiratory illnesses), low-grade inflammation, BMI, and sleep. In Aim 2, we will
test mediators of intervention effects. We hypothesize (a) positive intervention effects on sensitive
parenting behaviors and child stress regulation, and (b) that these factors will mediate intervention effects
on child health outcomes. In Aim 3, we will test sociocultural context as a moderator of intervention
effects. We hypothesize stronger intervention effects in higher-risk dyads (i.e., mothers who are more
acculturated, who have fewer supports, or who experience more discrimination) than in lower-risk dyads. Our
proposal is innovative in that the RCT design provides an unprecedented opportunity to test causal impacts of
an attachment-based intervention on a comprehensive set of early health outcomes known to track across the
life course. This proposal is significant in that it aligns directly with the NICHD priority of Understanding Social
Determinants of Health and Developmentally Informed Strategies to Mitigate Health Disparities. We will (a)
examine how attachment-based intervention supports a foundation for health and (b) identify subgroups to
prioritize in future efforts to optimize health in low-income Latino children.

Grant Number: 5R01HD106997-04
NIH Institute/Center: NIH
Principal Investigator: LISA BERLIN