Prenatal and Infancy Nurse Home Visiting and 18-Year Outcomes of a Randomized Trial

Author:

Kitzman Harriet1,Olds David L.2,Knudtson Michael D.2,Cole Robert1,Anson Elizabeth1,Smith Joyce A.1,Fishbein Diana3,DiClemente Ralph4,Wingood Gina5,Caliendo Angela M.6,Hopfer Christian7,Miller Ted8,Conti Gabriella9

Affiliation:

1. School of Nursing, University of Rochester, Rochester, New York;

2. Departments of Pediatrics and

3. Edna Bennett Pierce Prevention Research Center, Pennsylvania State University, State College, Pennsylvania;

4. College of Global Public Health, New York University, New York, New York;

5. Mailman School of Public Health, Columbia University, New York, New York;

6. Warren Alpert Medical School, Brown University, Providence, Rhode Island;

7. Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, Colorado;

8. Pacific Institute for Research and Evaluation and School of Public Health, Curtin University, Beltsville, Maryland; and

9. Departments of Economics and Social Science, University College London, London, United Kingdom

Abstract

OBJECTIVES: Given earlier effects found in randomized clinical trials of the Nurse-Family Partnership, we examined whether this program would improve 18-year-old first-born youths' cognition, academic achievement, and behavior and whether effects on cognitive-related outcomes would be greater for youth born to mothers with limited psychological resources (LPR) and on arrests and convictions among females. METHODS: We enrolled 742 pregnant, low-income women with no previous live births and randomly assigned them to receive either free transportation for prenatal care plus child development screening and referral (control; n = 514) or prenatal and infant home nurse visit (NV) plus transportation and screening (n = 228). Assessments were completed on 629 18-year-old first-born offspring to evaluate these primary outcomes: (1) cognitive-related abilities (nonverbal intelligence, receptive language, and math achievement) and (2) behavioral health (internalizing behavioral problems, substance use and abuse, sexually transmitted infections, HIV risk, arrests, convictions, and gang membership). RESULTS: Compared with control-group counterparts, NV youth born to mothers with LPR had better receptive language (effect size = 0.24; 95% confidence interval [CI]: 0.00 to 0.47; P = .05), math achievement (effect size = 0.38; 95% CI: 0.14 to 0.61; P = .002), and a number of secondary cognitive-related outcomes. NV females, as a trend, had fewer convictions (incidence ratio = 0.47; 95% CI: 0.20 to 1.11; P = .08). There were no intervention effects on other behaviors. CONCLUSIONS: The program improved the cognitive-related skills of 18-year-olds born to mothers with LPR and, as a trend, reduced female convictions but produced no other effects on youth behavioral health.

Publisher

American Academy of Pediatrics (AAP)

Subject

Pediatrics, Perinatology, and Child Health

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