Home Visits During Pregnancy and Infancy Have Enduring Positive Effects

EMBARGOED UNTIL 2 P.M. August 26, 1997

Contact: Sarah Ellis, (303) 315-5571

Home Visits During Pregnancy and Infancy Have Enduring Positive Effects

The long-term benefits of nurse home visits to low-income, unmarried women during pregnancy and the early years of their children's lives endure for many years after the program of home visitation ends, according to two newly published studies appearing in today's issue of the Journal of the American Medical Association.

These benefits include less use of welfare, fewer childhood injuries, less child abuse, and fewer arrests among the women. The results come from both a 15-year follow-up study conducted in Elmira, N.Y., and from a replication study in Memphis, Tenn.

"We now have data showing that the early impact nurses made on the lives of young mothers lasts and even grows over time," said David Olds, PhD, professor of pediatrics at the University of Colorado Health Sciences Center and director of the Prevention Research Center for Family and Child Health in Denver. "As a group, low-income, unmarried women who received nurse home visitors had fewer instances of child abuse and neglect, fewer subsequent children, less use of welfare, and less involvement in the criminal justice system than their control-group counterparts over a 15-year period. This is very exciting news, both for the health and well-being of families and for government spending."

Dr. Olds' team of researchers is currently implementing the program in Denver as part of a study comparing the effectiveness of nurses as home visitors to paraprofessionals as home visitors. This study, involving 735 first-time mothers locally, was funded by The Colorado Trust and will be complete in about a year.

The Elmira study involved about 400 women who were first-time parents. Some of the women received nurse home visits -- an average of nine visits during pregnancy and 23 during the child's first two years -- and others were randomly assigned to a control group. During the visits, nurses worked with mothers on nutrition and health, reducing smoking and other drug use, life planning skills, parenting and child development, and other environmental or social conditions that could affect their well-being as a family.

The research team for the Elmira study, including Olds, John Eckenrode, PhD, and Charles Henderson at Cornell University, and Harriet Kitzman, RN, PhD, and Robert Cole, PhD, at the University of Rochester, followed the families after the program ended to see if the families stayed on a successful path through the next 15 years.

Specifically, among women who were low-income and unmarried, in contrast to those in a comparison group, those who were provided a nurse home visitor had: -- 46 percent fewer verified reports of child abuse or neglect; -- 31 percent fewer subsequent births 15 years after delivery of the first child and more than two years' longer intervals between the births of first and second children; -- 30 months less use of Aid to Families with Dependent Children; -- 44 percent fewer behavioral problems arising from alcohol and drug abuse, and -- 69 percent fewer maternal arrests.

The Memphis study replicated the program in an urban area with a large population of African-American mothers. The pattern of benefits seen among program participants in Memphis is similar to that observed in semi-rural Elmira (where the sample was primarily white women) through the child's second year of life. The program reduced low-income African-American women's pregnancy-induced hypertension, reduced the rates of subsequent pregnancies and reduced children's injuries.

The researchers attribute these differences to the combined influences of improved prenatal health, early caregiving, family planning, and economic self-sufficiency.

"We think that this program worked because it focused on families with greater needs and because it employed nurses who were able to address those needs from a truly multidisciplinary perspective," Dr. Olds said.

The findings of the program have been so positive that in spite of its up-front costs of approximately $7,000 per family for two-and-a-half years of service, several state governments and local communities have begun implementing the program with funds from maternal and child health, welfare reform, juvenile justice, Medicaid and private sources such as hospitals or foundation grants.

Cost analyses indicate that the public investment is recovered by the time children reach age four. This is because, in the nurse-visited group, far fewer government services were needed since there were fewer additional pregnancies and fewer cases of child abuse and neglect, welfare services were relied upon less, and fewer emergency room visits were required.

The U.S. Department of Justice has provided funding for the Prevention Research Center at the CU-Health Sciences Center to assist six high-crime communities around the country in establishing the program as a long-term investment in family health and crime prevention. The program is being implemented in selected communities in Florida, Oklahoma, and California, with additional sites under consideration.

The University of Colorado Health Sciences Center is one of four campuses in the University of Colorado system. Located in Denver, Colo., the campus includes schools of medicine, pharmacy, and dentistry, a graduate school, and two hospitals.