Black or African American
21%
Source
Minkovitz, C. S., Strobino, D., Mistry, K. B., Scharfstein, D. O., Grason, H., Hou, W., Guyer, B. (2007). Healthy Steps for Young Children: Sustained results at 5.5 years. Pediatrics, 120(3), 658–668.
Model(s) Reviewed
Funding Sources
The Commonwealth Fund (grant 20010683) and the Agency for Healthcare Quality and Research (grant R01HS13086).
Study Design
| Design | Attrition | Baseline equivalence | Confounding factors | Valid, reliable measures? |
|---|---|---|---|---|
| Randomized controlled trial | High | Established on race/ethnicity and SES (i.e., family income). Equivalence on baseline measures is not feasible. | None |
Notes
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).
Study Participants
The sample included 1,308 mothers with children about 5.5 years old 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. Just over one in three parents had a college degree, and 40% had incomes above $50,000 at baseline. Most study participants were white (65%) or African American (21%). The most common maternal age groups were 20-29 (48%) and over 30 (42%).
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.
Home Visiting Services
Healthy Steps Specialists provided well-child care, up to six home visits in the first three years, 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. Families actually received fewer than two visits, on average, during the child’s first 2.5 years.
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.
Findings that rate moderate or high in this manuscript
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Child hospitalized in past year | 5.5 years | Moderate | 0.02 | Not statistically significant, p ≥ 0.05 | 1308 children | The 6 RCT national evaluation sites |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Clinical or borderline concern about child behavior | 5.5 years | Moderate | 0.14 | Not statistically significant, p ≥ 0.05 | 1308 children | The 6 RCT national evaluation sites |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Used emergency department in past year for injury | 5.5 years | Moderate | 0.02 | Not statistically significant, p ≥ 0.05 | 1308 children | The 6 RCT national evaluation sites |
| Outcome measure | Timing of follow-up | Rating | Direction of Effect | Effect size (absolute value) | Stastical significance | Sample size | Sample description | |
|---|---|---|---|---|---|---|---|---|
| Ever slap in face/spank with object | 5.5 yrs | Moderate | 0.10 | Not statistically significant, p ≥ 0.05 | 1308 mothers | The 6 RCT national evaluation sites | ||
| Use harsh discipline | 5.5 yrs | Moderate | 0.15 | Not statistically significant, p ≥ 0.05 | 1308 mothers | The 6 RCT national evaluation sites | ||
| Often/almost always negotiate | 5.5 yrs | Moderate | 0.14 | Not statistically significant, p ≥ 0.05 | 1308 mothers | The 6 RCT national evaluation sites | ||
| Often/almost always ignore misbehavior | 5.5 yrs | Moderate | 0.04 | Not statistically significant, p ≥ 0.05 | 1308 mothers | The 6 RCT national evaluation sites | ||
| Routine/regular bedtime | 5.5 yrs | Moderate | 0.17 | Not statistically significant, p ≥ 0.05 | 1308 mothers | The 6 RCT national evaluation sites | ||
| Looked at/read books in past week | 5.5 yrs | Moderate | 0.04 | Not statistically significant, p ≥ 0.05 | 1308 mothers | The 6 RCT national evaluation sites |
This study included participants with the following characteristics at enrollment:
Race/Ethnicity
Maternal Education
Other Characteristics
This study included participants from the following locations:
- California
- Iowa
- Pennsylvania
- South Carolina
- Texas