title: Association of maternal and community factors with enrollment in home visiting among at-risk, first-time mothers.
abstract: OBJECTIVE
  We identified individual and contextual factors associated with referral and enrollment in home visiting among at-risk, first-time mothers.
  
  
  METHODS
  We retrospectively studied referral and enrollment in a regional home visiting program from 2007 to 2009 in Hamilton County, Ohio. Using linked vital statistics and census tract data, we obtained individual and community measures on first-time mothers meeting eligibility criteria for home visiting (low income, unmarried, or age < 18 years). Generalized linear modeling was performed to determine factors associated with relative risk (RR) of (1) referral to home visiting among eligible mothers and (2) enrollment after referral.
  
  
  RESULTS
  Of 8187 first-time mothers eligible for home visiting, 2775 were referred and 1543 were enrolled. Among referred women, high school completion (RR = 1.10) and any college (RR = 1.17) compared with no high school completion were associated with increased enrollment, and enrollment was less likely for those living in communities with higher socioeconomic deprivation (RR = 0.71; P < .05).
  
  
  CONCLUSIONS
  Barriers to enrollment in home visiting persisted at multiple ecological levels. Ongoing evaluation of enrollment in at-risk populations is critical as home visiting programs are implemented and expanded.
authors.affiliation: Neera K. Goyal, Eric S. Hall, David E. Jones, Jareen K. Meinzen-Derr, Jodie A. Short, Robert T. Ammerman, and Judith B. Van Ginkel are with the Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
authors.forename: Neera K
authors.initials: NK
authors.lastname: Goyal
authors.forename: Eric S
authors.initials: ES
authors.lastname: Hall
authors.forename: David E
authors.initials: DE
authors.lastname: Jones
authors.forename: Jareen K
authors.initials: JK
authors.lastname: Meinzen-Derr
authors.forename: Jodie A
authors.initials: JA
authors.lastname: Short
authors.forename: Robert T
authors.initials: RT
authors.lastname: Ammerman
authors.forename: Judith B
authors.initials: JB
authors.lastname: Van Ginkel
mesh_terms: D004522:Educational Status; D005260:Female; D064650:Home Health Nursing / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D009035:Mothers / Q000706:statistics & numerical data*; D009820:Ohio / Q000453:epidemiology; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult