Minkovitz, C., Strobino, D., Hughart, N., Scharfstein, D., Guyer, B., & Healthy Steps Evaluation Team (2001). Early effects of the Healthy Steps for Young Children Program. Archives of Pediatrics & Adolescent Medicine, 155(4), 470–479.
Model(s) Reviewed:
Healthy Steps (National Evaluation 1996 Protocol)
| Screening decision | Screening conclusion | HomVEE procedures and standards version |
|---|---|---|
| Passes screens | Eligible for review | Version 1 |
| Rating | Design | Attrition | Baseline equivalence | Compromised randomization | Confounding factors | Valid, reliable measure(s) |
|---|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Not established on race/ethnicity or SES (i.e., maternal education). | None | None | Not assessed in manuscripts reviewed before 2021 |
Notes:
In 2020, HomVEE updated this review to move the measures of whether the parent gave the baby cereal or water from the Positive Parenting Practice domain to the Child Health domain because ACF determined that HomVEE should place all child feeding outcomes under the Child Health domain.
Study presents unadjusted program and comparison group means (columns 5 and 6). Tests of statistical significance apply to adjusted results in column 7 (means difference or odds ratio).
The standard errors in Minkovitz et al. (2001) are adjusted for clustering by site.
| Study participants | The sample included 1,987 mothers with children ages 2 to 4 months at assessment. All women enrolled in Healthy Steps within four weeks of the child’s birth. Study enrollment occurred between September 1996 and November 1998. Most mothers had a high school degree (~85%) and one in four also had a college degree. Most study participants were white (~62%) or African American (~24%). The most common maternal age groups were 20-29 (~51%) and over 30 (~33%). Nearly two-thirds of mothers were married. |
|---|---|
| Setting | The six sites—Allentown, PA, Amarillo, TX, Florence, SC, Iowa City, IA, Pittsburgh, PA, and San Diego, CA—were randomly assigned as part of the national evaluation. (There were nine other sites that used quasi-experimental comparisons. These comparisons received a low rating, however. See Study Ratings for details.) Sites were group practices, hospital-based clinics, or pediatric practices in health maintenance organizations. |
| Intervention services | Healthy Steps Specialists provided well-child care, home visits, a child development telephone information line, child development and family health checkups, written materials for parents that emphasize prevention, parent group meetings, and links to community resources. Home visits typically occurred at least once during the first month after birth and a total of six times by the time the children were age 3. Three in four mothers in the intervention group had received a home visit by the two- to four-month follow-up. |
| Comparison conditions | Children in the control group received routine pediatric care but had no exposure to the Healthy Steps Specialist or to Healthy Steps materials. |
| Subgroups examined |
This field lists subgroups examined in the manuscript (even if they were not replicated in other samples and not reported on the summary page for this model’s report). Subgroups are not listed for manuscripts reviewed before 2021. |
| Funding sources | The Commonwealth Fund and local funders. |
| Author affiliation | None of the study authors are developers of this model. |
| Peer reviewed | Peer reviewed status is not listed for manuscripts reviewed before 2021. |
Findings that rate moderate or high
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Continuing to breastfeed | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.56 | Mean = 0.54 | OR = 1.15 | HomVEE calculated = 0.08 | Not statistically significant, p ≥ 0.05 | |
| High | Gave baby cereal | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.30 | Mean = 0.32 | OR = 0.88 | HomVEE calculated = -0.08 | Not statistically significant, p ≥ 0.05 | |
| High | Gave baby water | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.38 | Mean = 0.41 | OR = 0.80 | HomVEE calculated = -0.14 | Statistically significant, p < 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Car seat in back seat | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.90 | Mean = 0.90 | OR = 1.08 | HomVEE calculated = 0.05 | Not statistically significant, p ≥ 0.05 | |
| High | Followed at least 2 routines | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.94 | Mean = 0.93 | OR = 1.27 | HomVEE calculated = 0.14 | Not statistically significant, p ≥ 0.05 | |
| High | Lowered water temperature | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.31 | Mean = 0.33 | OR = 0.93 | HomVEE calculated = -0.04 | Not statistically significant, p ≥ 0.05 | |
| High | Played with baby daily | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.93 | Mean = 0.93 | OR = 1.02 | HomVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 | |
| High | Showed picture books daily | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.28 | Mean = 0.27 | OR = 1.08 | HomVEE calculated = 0.05 | Not statistically significant, p ≥ 0.05 | |
| High | Used wrong sleep position | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.11 | Mean = 0.14 | OR = 0.76 | HomVEE calculated = -0.17 | Statistically significant, p < 0.05 |