White
88%
Source
Olds, D. L., Henderson, C. R., & Kitzman, H. (1994). Does prenatal and infancy nurse home visitation have enduring effects on qualities of parental caregiving and child health at 25 to 50 months of life? Pediatrics, 93(1), 89–98.
Model(s) Reviewed
Note: Navigate to model page for more information about the home visiting model. See the study manuscript for more information about how the model was implemented in this study.
Funding Sources
Bureau of Community Health Services (MCJ-360579 and MCJ-360403); the National Center for Nursing Research (R01 NR001691-01A1); the Robert Wood Johnson Foundation (grants 5263 and 6729); the W.T. Grant Foundation (grants 800723-80); the Ford Foundation (grants 840-0545 and 840723-0559); a Biomedical Research Support Grant (National Institutes of Health) (PHSS7RR05403-25); the Commonwealth Fund (grant 10443); and a William T. Grant Faculty Scholars Award to the first author (grant 861-080-86).
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | Low | Established on race and SES. |
None |
Not assessed in manuscripts reviewed under Handbook of Procedures and Standards, Version 1 |
Notes
In 2020, HomVEE updated this review to move the two findings on the number of child behavioral/parental coping problems in physician record from the Child Health domain to the Child Development and School Readiness domain because ACF determined that all measures of child behavioral health, including internalizing and externalizing behaviors belong in HomVEE's Child Development and School Readiness domain.
The Elmira sample included two deviations from the randomization procedure. First, six housemates of women already randomly assigned and enrolled in the study were assigned to the same treatment as the women already enrolled. Second, the probability of being assigned to one of the treatment groups was increased in the last 6 months of the 30 month enrollment period. The first issue suggests a mismatch between the unit of assignment (adult in the household) and the unit of analysis, which may lead to overstating the precision of the standard errors. The second issue should lead to a weighting strategy in the analysis, so that those who were enrolled later receive less weight in the analysis. Weighting, however, was not used in these studies.
The cases of abuse and neglect findings had high attrition and therefore rate moderate.
Study Participants
The sample included pregnant, first-time mothers who were less than 30 weeks pregnant. Women were recruited through health and human services agencies, including health clinics, Planned Parenthood, and public schools. In these locations, pregnant women who were less than 19 years old, were single parents, or had low socioeconomic status were actively recruited for the study. Between April 1978 and September 1980, 500 women were interviewed and 400 were randomly assigned. For this study, 46 nonwhite women were excluded from the sample. At enrollment, on average, the women were about 19 years old, 17 weeks pregnant, and had approximately 11 years of education. This study measured the sample at registration and at the 34th, 36th, 46th, and 48th months of the child’s life. For the data collection ant 48 months postpartum, the study sample included 343 women, 183 in the program group and 160 in the comparison group. (Information on sample size for this follow-up was received through communication with the author.)
Setting
The study was conducted in Elmira, a metropolitan area within a semi-rural county in the Appalachian region of New York that has approximately 100,000 residents.
Home Visiting Services
The study included two treatment groups, which were combined for the analyses. The first treatment group received home visits from a nurse during pregnancy. The nurse visited the family every other week and made nine visits, on average, which lasted one hour and 15 minutes. This treatment group also received the screening and transportation services described below for the comparison groups. The second treatment group received the same services as the first treatment group, but the home visiting continued until the child was 2 years old. Home visits were weekly for the first month after delivery, decreasing over time to once every 6 weeks when the child was 18-24 months. Home visits focused on parent education, enhancing the women’s support systems, and linkages to community services. After the child’s second birthday, home visitors provided any appropriate social service referrals to families and children with special needs. Nurses worked in two-person teams (one primary and one backup home visitor).
Model(s) Reviewed
Note: Navigate to model page for more information about the home visiting model. See the study manuscript for more information about how the model was implemented in this study.
Comparison Conditions
The study included two comparison groups, which were combined for the analyses. The first comparison group did not receive any services during pregnancy. When the children were 12 and 24 months old, they were screened for sensory and developmental problems and referred to other specialists, as appropriate. The second treatment group received free transportation (through a contract with a local taxi company) for prenatal and well-child care at local clinics and doctors’ offices. The second comparison group also received the 12- and 24-month developmental screening.
Subgroups examined
• Race/ethnicity (White) • Subgroups defined by combinations of maternal characteristics (White and uncomplicated pregnancy or unmarried and low-income teen)
Findings that rate moderate or high in this manuscript
Child health
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Number of scheduled health supervision visits (25 to 50 months) |
50 months |
High | Statistical significance not reported |
209 children | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of scheduled health supervision visits with problems (25 to 50 months) |
50 months |
High | Statistical significance not reported |
209 children | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of emergency department visits (25 to 50 months) |
50 months |
High | Statistical significance not reported |
209 children | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of hospital admissions (25 to 50 months) |
50 months |
High | Statistical significance not reported |
209 children | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of days hospitalized (25 to 50 months) |
50 months |
High | Statistical significance not reported |
209 children | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of scheduled health supervision visits (25 to 50 months) |
50 months |
High | Not statistically significant, |
221 children | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of scheduled health supervision visits with problems (25 to 50 months) |
50 months |
High | Not statistically significant, |
221 children | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of emergency department visits (25 to 50 months) |
50 months |
High | Statistically significant, |
221 children | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of hospital admissions (25 to 50 months) |
50 months |
High | Not statistically significant, |
221 children | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of days hospitalized (25 to 50 months) |
50 months |
High | Statistically significant, |
221 children | Nurse visited during pregnancy + infancy and comparison (Elmira) |
Child development and school readiness
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Number of child behavioral/parental coping problems in physician record (25 to 50 months) |
50 months |
High | Statistical significance not reported |
209 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of child behavioral/parental coping problems in physician record (25 to 50 months) |
50 months |
High | Statistically significant, |
221 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Stanford Binet |
36 months |
High | Not statistically significant, |
226 children | Nurse visited during pregnancy and comparison (Elmira) |
|||
Stanford Binet |
36 months |
High | Not statistically significant, |
236 children | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Stanford Binet |
48 months |
High | Not statistically significant, |
226 children | Nurse visited during pregnancy and comparison (Elmira) |
|||
Stanford Binet |
48 months |
High | Not statistically significant, p ≥ 0.05 |
236 children | Nurse visited during pregnancy + infancy and comparison (Elmira) |
Reductions in child maltreatment
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
New substantiated cases of abuse/neglect from 25 to 48 months |
48 months |
High | 0.14 | Statistical significance not reported |
245 children | Nurse visited during pregnancy and comparison (Elmira) |
||
Number of injuries/ingestions in physician record (25 to 50 months) |
50 months |
Moderate | Statistical significance not reported |
209 children | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of emergency department visits for injuries/ingestions (25 to 50 months) |
50 months |
Moderate | Statistical significance not reported |
209 children | Nurse visited during pregnancy and comparison (Elmira) |
|||
New substantiated cases of abuse/neglect from 25 to 48 months |
48 months |
High | 0.30 | Not statistically significant |
253 children | Nurse visited during pregnancy + infancy and comparison (Elmira) |
||
Number of emergency department visits for injuries/ingestions (25 to 50 months) |
50 months |
High | Not statistically significant, |
221 children | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of injuries/ingestions in physician record (25 to 50 months) |
50 months |
High | Statistically significant, |
221 children | Nurse visited during pregnancy + infancy and comparison (Elmira) |
Positive parenting practices
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
Hazardous exposures observed in home |
34 months |
High | Statistical significance not reported |
202 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
HOME inventory (total score) |
34 months |
High | Statistical significance not reported |
227 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Hazardous exposures observed in home |
34 months |
High | Statistically significant, |
209 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
HOME inventory (total score) |
34 months |
High | Not statistically significant, |
238 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Hazardous exposures observed in home |
46 months |
High | Statistical significance not reported |
202 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
HOME inventory (total score) |
46 months |
High | Statistical significance not reported |
227 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Hazardous exposures observed in home |
46 months |
High | Statistically significant, |
209 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
HOME inventory (total score) |
46 months |
High | Not statistically significant, |
238 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations:
- New York