White
88%
Source
Olds, D. L., Henderson, Jr., C. R., Tatelbaum, R., & Chamberlin, R. (1988). Improving the lifecourse development of socially disadvantaged parents: A randomized trial of nurse home visitation. American Journal of Public Health, 78, 1436–1445.
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 (HHS-MCJ-360403-07 and HHS-MCJ-363378-01-0), the Robert Wood Johnson Foundation (Grant Nos. 5263 and 6729), the W.T. Grant Foundation (Grant Nos. 800723-80 and 840723-80), the Ford Foundation (Grant Nos. 840-0545 and 875-0559), a Biomedical Research Support Grant (NIH) (PHSS7RR05403-25), and a Faculty Scholars Award from the W.T. Grant Foundation to the first author (Grant No. 861080-86).
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
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.
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 the 6th, 10th, 22nd, and 46th months of the children’s lives. The study sample included 354 women, 189 in the program group and 165 in the comparison group.
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. 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
• Maternal education (less than 12 years of education) • Subgroups defined by combinations of maternal characteristics (White and uncomplicated pregnancy, unmarried and less than 12 years of education, unmarried and low income, or unmarried and low-income teen)
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 | |
|---|---|---|---|---|---|---|---|---|
Number of pregnancies (0–22 months postpartum) |
22 months postpartum |
High | Statistical significance not reported |
188 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of pregnancies (0–46 months postpartum) |
46 months, postpartum |
High | Statistical significance not reported |
194 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of spontaneous abortions (0–46 months postpartum) |
46 months, postpartum |
High | Statistical significance not reported |
194 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of therapeutic abortions (0–46 months postpartum) |
46 months, postpartum |
High | Statistical significance not reported |
194 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of births including first born (0–46 months postpartum) |
46 months, postpartum |
High | Statistical significance not reported |
203 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of months between first and second child (0–46 months postpartum) |
46 months, postpartum |
High | Statistical significance not reported |
203 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of pregnancies (0–22 months postpartum) |
22 months, postpartum |
High | Not statistically significant, p ≥ 0.05 |
196 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of pregnancies (0–46 months postpartum) |
46 months, postpartum |
High | Not statistically significant, p ≥ 0.05 |
205 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of spontaneous abortions (0–46 months postpartum) |
46 months, postpartum |
High | Not statistically significant, p ≥ 0.05 |
205 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of therapeutic abortions (0–46 months postpartum) |
46 months, postpartum |
High | Not statistically significant, p ≥ 0.05 |
205 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of births including first born (0–46 months postpartum) |
46 months, postpartum |
High | Not statistically significant, p ≥ 0.05 |
216 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of months between first and second child (0–46 months postpartum) |
46 months, postpartum |
High | Not statistically significant, p ≥ 0.05 |
216 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 | |
|---|---|---|---|---|---|---|---|---|
Concern about finding work |
10 months postpartum |
High | Statistical significance not reported |
195 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Help with child care |
10 months postpartum |
High | Statistical significance not reported |
197 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of months employed (0–22 months postpartum) |
22 months postpartum |
High | Statistical significance not reported |
185 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Concern about finding work |
22 months postpartum |
High | Statistical significance not reported |
183 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Help with child care |
22 months postpartum |
High | Statistical significance not reported |
189 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of days on public assistance (0–22 months postpartum) |
22 months postpartum |
High | Statistical significance not reported |
185 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of months employed (0–46 months postpartum) |
46 months postpartum |
High | Statistical significance not reported |
196 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Help with child care |
46 months postpartum |
High | Statistical significance not reported |
167 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Number of days on public assistance (0–48 months postpartum) |
48 months postpartum |
High | Statistical significance not reported |
196 mothers | Nurse visited during pregnancy and comparison (Elmira) |
|||
Concern about finding work |
10 months postpartum |
High | Not statistically significant, |
202 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Help with child care |
10 months postpartum |
High | Not statistically significant, |
204 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of months employed (0–22 months postpartum) |
22 months postpartum |
High | Not statistically significant, |
194 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Concern about finding work |
22 months postpartum |
High | Not statistically significant, |
192 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Help with child care |
22 months postpartum |
High | Not statistically significant, |
197 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of days on public assistance (0–22 months postpartum) |
22 months postpartum |
High | Not statistically significant, |
194 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of months employed (0–46 months postpartum) |
46 months postpartum |
High | Not statistically significant, |
208 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Help with child care |
46 months postpartum |
High | Not statistically significant, |
183 mothers | Nurse visited during pregnancy + infancy and comparison (Elmira) |
|||
Number of days on public assistance (0–48 months postpartum) |
48 months postpartum |
High | Not statistically significant, |
208 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