Black or African American
11%
Olds, D. L., Eckenrode, J., Henderson, C. R., Kitzman, H., Powers, J., Cole, R., et al. (1997). Long-term effects of home visitation on maternal life course and child abuse and neglect. Fifteen-year follow-up of a randomized trial. JAMA: The Journal of the American Medical Association, 278(8), 637–643.
Model(s) Reviewed
Navigate to model page for more information about the home visiting model.
Funding Sources
Senior Research Scientist Award (1-K05-MH01382-01) (Dr. Olds); grants from the Prevention Research and Behavioral Medicine Branch of the National Institute of Mental Health, Rockville, Md (R01-MH49381), and the Assistant Secretary for Planning and Evaluation, U.S. Department of Health and Human Services, Washington, DC (grant 96ASPE278A).
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 |
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.
Findings that rate moderate or high in this manuscript
Maternal health
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Subsequent pregnancies | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Subsequent births | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Months between birth of first and second child | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Substance use impairments since birth of first child | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Subsequent pregnancies | 15-year follow-up | High | Not statistically significant,p ≥ 0.05 | 245 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) | |||
| Subsequent births | 15-year follow-up | High | Not statistically significant,p ≥ 0.05 | 245 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) | |||
| Months between birth of first and second child | 15-year follow-up | High | Not statistically significant,p ≥ 0.05 | 245 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) | |||
| Incidence of substance use impairments | 15-year follow-up | High | Not statistically significant,p ≥ 0.05 | 245 mothers | 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 | |
|---|---|---|---|---|---|---|---|---|
| Substantiated reports of child abuse and neglect (incidence) | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Substantiated reports of child abuse and neglect (incidence) | 15-year follow-up | High | Statistically significant,p < 0.01 | 245 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
Reductions in juvenile delinquency, family violence, and crime
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Arrests (incidence; self-report) | 15-year follow-up | High | Statistical significance not reported | 226 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Convictions (incidence; self-report) | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Days in jail (incidence; self-report) | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| NYS arrests (incidence; administrative records) | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| NYS convictions (incidence; administrative records) | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Arrests (incidence; self-report) | 15-year follow-up | High | Not statistically significant,p > 0.05 | 244 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) | |||
| Convictions (incidence; self-report) | 15-year follow-up | High | Not statistically significant,p > 0.05 | 245 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) | |||
| Days in jail (incidence; self-report) | 15-year follow-up | High | Not statistically significant,p > 0.05 | 245 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) | |||
| NYS arrests (incidence; administrative records) | 15-year follow-up | High | Not statistically significant,p > 0.05 | 245 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) | |||
| NYS convictions (incidence; administrative records) | 15-year follow-up | High | Not statistically significant,p > 0.05 | 245 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
Family economic self-sufficiency
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Months receiving AFDC | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Months employed | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Months receiving food stamps | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Months receiving Medicaid | 15-year follow-up | High | Statistical significance not reported | 227 mothers | Nurse visited during pregnancy and comparison (Elmira) | |||
| Months receiving AFDC | 15-year follow-up | High | Not statistically significant,p ≥ 0.05 | 245 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) | |||
| Months employed | 15-year follow-up | High | Not statistically significant,p ≥ 0.05 | 245 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) | |||
| Months receiving food stamps | 15-year follow-up | High | Not statistically significant,p ≥ 0.05 | 245 mothers | Nurse visited during pregnancy + infancy, and comparison (Elmira) | |||
| Months receiving Medicaid | 15-year follow-up | High | Not statistically significant,p ≥ 0.05 | 245 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
Study Participants
The sample included pregnant, first-time mothers who were less than 30 weeks pregnant. The study actively recruited and included pregnant, first-time mothers who were less than 25 weeks pregnant, were less than 19 years old, were single parents, or had low socioeconomic status. Between April 1978 and September 1980, 500 women were interviewed and 400 were randomly assigned. This study is a longitudinal follow-up at 15 years for the women originally enrolled in the study and their children. At this follow-up, the study included data on 324 of the original mothers (176 in the program group and 148 in the comparison group) and 315 children of the original mothers (171 in the program group and 144 in the comparison group). At enrollment, on average, the women included in this study were about 19 years old and had approximately 11 years of education. Roughly 40 percent of the sample was married.
Setting
The study was conducted in and around Elmira, NY, a small city of 40,000 residents in a semi-rural county in the Appalachian region of New York.
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. The 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 once a week 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.
Model(s) Reviewed
Navigate to model page for more information about the home visiting model.
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
• Subgroups defined by combinations of maternal characteristics (unmarried and low income)
This study included participants from the following locations:
- New York