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Nurse Home Visits Have Lasting Positive Effects

August 26, 1997

ITHACA, N.Y. -- The 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 University of Colorado Health Sciences Center/Cornell University studies appearing in this week's issue of the Journal of the American Medical Association (Aug. 27, 1997).

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.

The Elmira study looked at how 324 at-risk women and their first-born children were faring 15 years after they participated in the Prenatal/Early Infancy Project, a nurse home visit program. "We knew from earlier studies of the project that the home visits resulted in fewer and less closely spaced pregnancies, fewer cases of child abuse and neglect, fewer emergency room visits and more maternal labor-force participation during the child's first four years of life," said John Eckenrode, professor of human development at Cornell and a co-author of the new Elmira study.

"This follow-up study, however, now shows that the nurse home visit program has enduring and positive effects on both the mothers' and children's lives years later."

The Prenatal/Early Infancy Project was launched in 1977 in Elmira by David Olds (Cornell Ph.D. 1976) and Charles Henderson, senior research associate in human development at Cornell, co-authors on both new papers. Four hundred women, many unmarried and low-income, and all

pregnant with their first babies, participated in the initial study; about half received nurse home visits (an average of nine visits during pregnancy and 23 during the child's first two years) and were compared with a control group of mothers. During the visits, the nurses discussed nutrition, prenatal care, developmental stages and needs of children, and other health, behavioral and psycho-social conditions that could affect maternal and child well-being.

"What is particularly encouraging about these new results," Henderson said, "is that not only are there clear benefits of the program for those families most in need but also that the savings in government spending seen for the first four years after birth of the child continue to accumulate over the succeeding decade."

The research team for the Elmira follow-up study includes Olds, now professor of pediatrics, psychiatry and preventive medicine at the University of Colorado Health Sciences Center, Eckenrode, Henderson, Jane Powers (Cornell Ph.D. 1985) and Pamela Morris of Cornell, as well as Harriet Kitzman and Robert Cole (Cornell Ph.D. 1976) at the University of Rochester. The intervention program continues in Elmira under the direction of John Shannon at Comprehensive Interdisciplinary Developmental Services.

Specifically, the research team found that, among women who were low-income and unmarried, those who were provided a nurse home visitor had:
  • 46 percent fewer verified reports of child abuse or neglect;

  • 31 percent fewer subsequent births;

  • more than two years' greater interval between the birth of their first and second child;

  • 30 months less use of Aid to Families with Dependent Children;

  • 44 percent fewer behavioral problems arising from alcohol and drug abuse;

  • 69 percent fewer maternal arrests.

The researchers suspect that these pervasive, long-term differences between home-visited women and the control group are due to the combined influences of improved prenatal health, reduced caregiving problems early in the life cycle, improved family planning and economic

self-sufficiency, all working in synergistic ways that improve the life-course of the low-income mothers and their children.

The findings from the Prenatal/Early Infancy Project have been so positive that the program has been widely emulated around the country and has resulted in the U.S. Advisory Board on Child Abuse and Neglect recommendation that home-visitation services be made available to all

parents of newborns as a means of preventing child abuse and neglect.

Although such a program is costly, the economic analysis of the first four years of Prenatal/Early Infancy Project, published in Medical Care (Vol. 31, No. 2, 1993), showed that the program paid for itself by the time children reach age 4. That's 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 Memphis study replicated the research with 1,100 young women in an urban area with a large population of African Americans. 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) through the child's second year of life. The program reduced low-income women's pregnancy-induced hypertension, reduced the rates of subsequent pregnancies and reduced children's injuries.

The Elmira follow-up study was supported by the Prevention Research Branch of the National Institute of Mental Health.

Cornell University

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