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Kitzman, H., Olds, D. L., Sidora, K., Henderson, C. R., Hanks, C., Cole, R., et al. (2000). Enduring effects of nurse home visitation on maternal life course: A 3-year follow-up of a randomized trial. JAMA: The Journal of the American Medical Association, 283(15), 1983–1989.

Model(s) Reviewed: Nurse-Family Partnership (NFP)®
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 Difference in SES, but controlled in analysis. None None
Notes:

In 2020, HomVEE updated this review in two ways. First, HomVEE removed mother's partnership status/family structure findings from the Family Economic Self-Sufficiency domain because ACF determined that mother's partnership status is ineligible for review by HomVEE. Second, HomVEE removed the partner employment finding from the Family Economic Self-Sufficiency domain because partner SES is not eligible for review unless the same SES variable is measured for the mother, and the partner is coresident with the mother.

Study characteristics
Study participants The sample included pregnant, first-time mothers who were less than 29 weeks pregnant. Women were recruited through an obstetrical clinic if they had no previous live births, no chronic illnesses linked to fetal growth retardation or preterm delivery, and at least two of the following sociodemographic characteristics: unmarried, less than 12 years of education, and unemployed. Between June 1990 and August 1991, 1,290 women were invited to participate and 1,139 consented and were randomly assigned. At enrollment, 92 percent of the women enrolled were African American, 98 percent were unmarried, and 64 percent were age 18 or younger. This study measured the sample when the children were 3 to 5 years old. The study sample included 646 women, 203 in the program group and 443 in the comparison group.
Setting Memphis, Tennessee
Intervention services The study included two treatment groups. The first treatment group received home visits from a nurse during pregnancy and two postpartum visits (one in the hospital prior to discharge and one in the home). The treatment group also received the screening and transportation services described below for the comparison groups. The second treatment group received the same services as the first treatment group, but the home visiting continued until the child was 2 years old. On average, the nurses completed 7 home visits during pregnancy and 26 home visits postpartum. Nurses used a detailed protocol for each visit, which focused on health-related behaviors, parenting, education, and employment. The two treatment groups were combined for the prenatal analysis. Only the second treatment group was followed for postnatal outcomes.
Comparison conditions The study included two comparison groups. The first comparison group received taxicab transportation for prenatal care appointments. The second comparison group received the transportation plus developmental screening and referral to services when the children were 6, 12, and 24 months old. The two comparison groups were combined for the prenatal analysis. Only the second group was followed for postnatal outcomes.
Staff characteristics and training All home visitors were nurses. No other information on training is provided.
Funding sources Grant 90PD0215/01 from the Administration for Children and Families, Department of Health and Human Services; grant 9704-014 from the Carnegie Corporation of New York; grant 031052 from the Robert Wood Johnson Foundation; and a Senior Research Scientist Award (1-K05-MH01382-01) to Dr. Olds.
Author affiliation David L. Olds, a study author, is a developer 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 Number of subsequent low birth weight newborns (< 2500 g)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Mean = 0.12 Mean = 0.15 Mean difference = -0.03 Not available Not statistically significant,
p ≥ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of subsequent neonatal intensive care unit or special care admissions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Mean = 0.14 Mean = 0.20 Mean difference = -0.06 Not available Not statistically significant,
p ≥ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

footnote3

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

Authors report the difference in this outcome to be statistically significant, p < 0.10, which is greater than the acceptable alpha for this review (&alpha; = 0.05).

Family economic self-sufficiency
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Current socioeconomic status (percentile ranked by U.S. occupational codes)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 15.62 Adjusted mean = 13.73 Mean difference = 1.89 Not available Not statistically significant,
p ≥ 0.05
High Highest education level
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 11.61 Adjusted mean = 11.67 Mean difference = -0.06 Not available Not statistically significant,
p ≥ 0.05
High Number of months mother or child received AFDC (0–60 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 32.55 Adjusted mean = 36.19 Mean difference = -3.64 Not available Statistically significant,
p ≤ 0.01
High Number of months mother or child received food stamps (0–60 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 41.57 Adjusted mean = 45.04 Mean difference = -3.47 Not available Statistically significant,
p ≤ 0.01
High Number of months received WIC (0–54 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 21.51 Adjusted mean = 23.33 Mean difference = -1.82 Not available Not statistically significant,
p ≥ 0.05
High Number of months received Medicaid (0–54 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 39.59 Adjusted mean = 41.08 Mean difference = -1.49 Not available Not statistically significant,
p ≥ 0.05
High Number of months worked (0–54 months postpartum)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 19.89 Adjusted mean = 18.84 Mean difference = 1.05 Not available Not statistically significant,
p ≥ 0.05
Maternal health
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Number of months between birth or first and second child
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 30.25 Adjusted mean = 26.60 Mean difference = 3.65 Not available Statistically significant,
p ≤ 0.01
High Number of subsequent live births
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 0.85 Adjusted mean = 0.96 Mean difference = -0.11 Not available Not statistically significant,
p ≥ 0.05
High Number of subsequent pregnancies
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 1.15 Adjusted mean = 1.34 Mean difference = -0.19 Not available Statistically significant,
p < 0.05
High Number of subsequent pregnancies with short intervals (< 6 months from previous delivery or termination)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 0.22 Adjusted mean = 0.32 Mean difference = -0.10 Not available Statistically significant,
p < 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of subsequent spontaneous abortions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 0.10 Adjusted mean = 0.12 Mean difference = -0.12 Not available Not statistically significant,
p ≥ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of subsequent still births
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 0.01 Adjusted mean = 0.02 Mean difference = -0.01 Not available Not statistically significant
p ≥ 0.05

footnote1

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

Statistical significance reported on authors’ calculations of the log-incidence difference.

High Number of subsequent therapeutic abortions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 3-year follow-up 646 mothers Adjusted mean = 0.05 Adjusted mean = 0.10 Mean difference = -0.05 Not available Not statistically significant,
p ≥ 0.05

footnote3

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

Authors report the difference in this outcome to be statistically significant, p < 0.10, which is greater than the acceptable alpha for this review (&alpha; = 0.05).

Outcome measure summary

Child health
Outcome measure Description of measure Data collection method Properties of measure

Number of subsequent NICU or special care admissions

Number of NICU or special care admissions episodes the mother experienced after the birth of the study’s focal child Parent/caregiver report

Not applicable

Number of subsequent low birth weight newborns (< 2,500 g)

Number of low birth weight newborns the mother experienced after the birth of the study’s focal child Parent/caregiver report

Not applicable

Family economic self-sufficiency
Outcome measure Description of measure Data collection method Properties of measure

Current SES

Percentile rank of the mother’s occupation estimated by calculating percentile rank for each occupation using Census categories and the median income and educational achievement associated with each occupation Parent/caregiver report

Not applicable

Highest education level

The highest year of school the mother had completed Parent/caregiver report

Not applicable

Number of months mother or child received AFDC

Counts of the number of months the mother received AFDC Review of Tennessee Department of Human Services records

Not applicable

Number of months mother or child received food stamps

Counts of the number of months the mother received food stamps. The outcome was measured for the period of 0 to 60 months postpartum. Review of Tennessee Department of Human Services records

Not applicable

Number of months received WIC

Counts of the number of months the mother received WIC Parent/caregiver report

Not applicable

Number of months received Medicaid

Counts of the number of months the mother received Medicaid Parent/caregiver report

Not applicable

Number of months worked

Counts of the number of months the mother was employed Parent/caregiver report

Not applicable

Maternal health
Outcome measure Description of measure Data collection method Properties of measure

Number of months between birth of first and second child

Number of months that passed between the birth of the mother’s first and second child Parent/caregiver report

Not applicable

Number of subsequent live births

The number of subsequent live births experienced by the mother Parent/caregiver report

Not applicable

Number of subsequent pregnancies

The number of subsequent pregnancies experienced by the mother Parent/caregiver report

Not applicable

Number of subsequent pregnancies with short intervals

The number of pregnancies where conception occurred less than 6 months from the previous delivery or termination Parent/caregiver report

Not applicable

Number of subsequent spontaneous abortions

Number of subsequent spontaneous abortions experienced by the mother Parent/caregiver report

Not applicable

Number of subsequent stillbirths

Number of subsequent stillbirths experienced by the mother Parent/caregiver report

Not applicable

Number of subsequent therapeutic abortions

Number of subsequent therapeutic abortions experienced by the mother Parent/caregiver report

Not applicable