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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.

Model(s) Reviewed: Healthy Steps (National Evaluation 1996 Protocol)
Manuscript screening details
Screening decision Screening conclusion
Passes screens Eligible for review
Study design details
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
Notes:

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. 

footnote33

Submitted by user on Fri, 03/15/2019 - 14:29

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).

footnote34

Submitted by user on Fri, 03/15/2019 - 14:29

The standard errors in Minkovitz et al. (2001) are adjusted for clustering by site.

Study characteristics
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.

Findings details

Child health
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
Positive parenting practices
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 summary

Child health
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

Positive parenting practices
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