Minkovitz, C., Strobino, D., Hughart, N., Scharfstein, D., Guyer, B., & Healthy Steps Evaluation Team (2001). Early effects of the Healthy Steps for Young Children Program. Archives of Pediatrics & Adolescent Medicine, 155(4), 470–479.
| Screening decision | Screening conclusion |
|---|---|
| Passes screens | Eligible for review |
| Rating | Design | Attrition | Baseline equivalence | Reassignment | Confounding factors |
|---|---|---|---|---|---|
| High | Randomized controlled trial | Low | Not established on race/ethnicity or SES (i.e., maternal education). | None | None |
In 2020, HomVEE updated this review to move the measures of whether the parent gave the baby cereal or water from the Positive Parenting Practice domain to the Child Health domain because ACF determined that HomVEE should place all child feeding outcomes under the Child Health domain.
Study presents unadjusted program and comparison group means (columns 5 and 6). Tests of statistical significance apply to adjusted results in column 7 (means difference or odds ratio).
The standard errors in Minkovitz et al. (2001) are adjusted for clustering by site.
| Study participants | The sample included 1,987 mothers with children ages 2 to 4 months at assessment. All women enrolled in Healthy Steps within four weeks of the child’s birth. Study enrollment occurred between September 1996 and November 1998. Most mothers had a high school degree (~85%) and one in four also had a college degree. Most study participants were white (~62%) or African American (~24%). The most common maternal age groups were 20-29 (~51%) and over 30 (~33%). Nearly two-thirds of mothers were married. |
|---|---|
| Setting | The six sites—Allentown, PA, Amarillo, TX, Florence, SC, Iowa City, IA, Pittsburgh, PA, and San Diego, CA—were randomly assigned as part of the national evaluation. (There were nine other sites that used quasi-experimental comparisons. These comparisons received a low rating, however. See Study Ratings for details.) Sites were group practices, hospital-based clinics, or pediatric practices in health maintenance organizations. |
| Intervention services | Healthy Steps Specialists provided well-child care, home visits, a child development telephone information line, child development and family health checkups, written materials for parents that emphasize prevention, parent group meetings, and links to community resources. Home visits typically occurred at least once during the first month after birth and a total of six times by the time the children were age 3. Three in four mothers in the intervention group had received a home visit by the two- to four-month follow-up. |
| Comparison conditions | Children in the control group received routine pediatric care but had no exposure to the Healthy Steps Specialist or to Healthy Steps materials. |
| Staff characteristics and training | Specialists were early childhood educators, nurses, nurse practitioners, social workers, or professionals with other relevant expertise. Each attended annual trainings conducted by the Boston University Healthy Steps team and administered services in cooperation with pediatricians and pediatric nurse practitioners. Sites also received program and training manuals and technical assistance through biweekly teleconferences. Implementation of written protocols was monitored by the Healthy Steps national program office. See Guyer et al. (2003) for more details. |
| Funding sources | The Commonwealth Fund and local funders. |
| Author affiliation | None of the study authors are developers of this model. |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Continuing to breastfeed | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.56 | Mean = 0.54 | OR = 1.15 | HomeVEE calculated = 0.08 | Not statistically significant, p ≥ 0.05 | |
| High | Gave baby cereal | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.30 | Mean = 0.32 | OR = 0.88 | HomeVEE calculated = -0.08 | Not statistically significant, p ≥ 0.05 | |
| High | Gave baby water | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.38 | Mean = 0.41 | OR = 0.80 | HomeVEE calculated = -0.14 | Statistically significant, p < 0.05 |
| Rating | Outcome measure | Effect | Sample | Timing of follow-up | Sample size | Intervention group | Comparison group | Group difference | Effect size | Statistical significance | Notes |
|---|---|---|---|---|---|---|---|---|---|---|---|
| High | Car seat in back seat | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.90 | Mean = 0.90 | OR = 1.08 | HomeVEE calculated = 0.05 | Not statistically significant, p ≥ 0.05 | |
| High | Followed at least 2 routines | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.94 | Mean = 0.93 | OR = 1.27 | HomeVEE calculated = 0.14 | Not statistically significant, p ≥ 0.05 | |
| High | Lowered water temperature | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.31 | Mean = 0.33 | OR = 0.93 | HomeVEE calculated = -0.04 | Not statistically significant, p ≥ 0.05 | |
| High | Played with baby daily | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.93 | Mean = 0.93 | OR = 1.02 | HomeVEE calculated = 0.01 | Not statistically significant, p ≥ 0.05 | |
| High | Showed picture books daily | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.28 | Mean = 0.27 | OR = 1.08 | HomeVEE calculated = 0.05 | Not statistically significant, p ≥ 0.05 | |
| High | Used wrong sleep position | FavorableUnfavorable or ambiguousNo Effect |
The 6 RCT national evaluation sites | 2-4 mo. | 1,987 mothers | Mean = 0.11 | Mean = 0.14 | OR = 0.76 | HomeVEE calculated = -0.17 | Statistically significant, p < 0.05 |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Continuing to breastfeed |
Percentage of mothers who were breastfeeding, including those that continued to breastfeed, among women who had initiated breastfeeding | Parent/caregiver report | Not applicable |
Gave baby cereal |
Percentage of mothers who fed their infant cereal |
Parent/caregiver report during telephone interview |
Not applicable |
Gave baby water |
Percentage of mothers who fed their infant water |
Parent/caregiver report during telephone interview |
Not applicable |
| Outcome measure | Description of measure | Data collection method | Properties of measure |
|---|---|---|---|
Car seat in back seat |
Percentage of mothers who placed the child’s car seat in the back seat | Parent/caregiver report during telephone interview | Not applicable |
Followed at least two routines |
Percentage of mothers who followed at least two routines at bedtime, naptime, or mealtime | Parent/caregiver report during telephone interview | Not applicable |
Lowered water temperature |
Percentage of mothers who lowered the temperature of the hot water heater at home | Parent/caregiver report during telephone interview | Not applicable |
Played with baby daily |
Percentage of mothers who played with their child at least once daily | Parent/caregiver report during telephone interview | Not applicable |
Showed picture books daily |
Percentage of mothers who showed their child picture books daily | Parent/caregiver report during telephone interview | Not applicable |
Used wrong sleep position |
Percentage of mothers who used the wrong sleep position at both nap and bedtime | Parent/caregiver report during telephone interview | Not applicable |
