Effects of nurse home visiting on maternal and child functioning: age-9 follow-up of a randomized trial.
OBJECTIVE
Our goal was to test the effect of prenatal and infancy home visits by nurses on mothers' fertility and children's functioning 7 years after the program ended at child age 2.


METHODS
We conducted a randomized, controlled trial in a public system of obstetric and pediatric care. A total of 743 primarily black women <29 weeks' gestation, with previous live births and at least 2 sociodemographic risk characteristics (unmarried, <12 years of education, unemployed), were randomly assigned to receive nurse home visits or comparison services. Primary outcomes consisted of intervals between births of first and second children and number of children born per year; mothers' stability of relationships with partners and relationships with the biological father of the child; mothers' use of welfare, food stamps, and Medicaid; mothers' use of substances; mothers' arrests and incarcerations; and children's academic achievement, school conduct, and mental disorders. Secondary outcomes were the sequelae of subsequent pregnancies, women's employment, experience of domestic violence, and children's mortality.


RESULTS
Nurse-visited women had longer intervals between births of first and second children, fewer cumulative subsequent births per year, and longer relationships with current partners. From birth through child age 9, nurse-visited women used welfare and food stamps for fewer months. Nurse-visited children born to mothers with low psychological resources, compared with control-group counterparts, had better grade-point averages and achievement test scores in math and reading in grades 1 through 3. Nurse-visited children, as a trend, were less likely to die from birth through age 9, an effect accounted for by deaths that were attributable to potentially preventable causes.


CONCLUSIONS
By child age 9, the program reduced women's rates of subsequent births, increased the intervals between the births of first and second children, increased the stability of their relationships with partners, facilitated children's academic adjustment to elementary school, and seems to have reduced childhood mortality from preventable causes.
Olds
David L
DL
Department of Pediatrics, University of Colorado at Denver and Health Sciences Center, Denver, CO 80218, USA. olds.david@tchden.org
Kitzman
Harriet
H
Hanks
Carole
C
Cole
Robert
R
Anson
Elizabeth
E
Sidora-Arcoleo
Kimberly
K
Luckey
Dennis W
DW
Henderson
Charles R
CR
Holmberg
John
J
Tutt
Robin A
RA
Stevenson
Amanda J
AJ
Bondy
Jessica
J
D000293:Adolescent; D001721:Birth Intervals; D001724:Birth Weight; D002648:Child; D046688:Child Mortality; D002675:Child, Preschool; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006699:Home Care Services; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007398:Interpersonal Relations; D007407:Interviews as Topic; D015397:Program Evaluation; D011632:Public Assistance / Q000706:statistics & numerical data; D012946:Social Welfare / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology; D013714:Tennessee / Q000453:epidemiology; D013997:Time Factors