Manuscript Detail

View Revisions

Kitzman, H. J., Olds, D. L., Cole, R. E., Hanks, C. A., Anson, E. A., Arcoleo, K. J., Luckey, D. W., Knudtson, M. D., Henderson, C. R., & Holmberg, J. R. (2010). Enduring effects of prenatal and infancy home visiting by nurses on children: Follow-up of a randomized trial among children at age 12 years. Archives of Pediatrics & Adolescent Medicine, 164(5), 412–418.

Model(s) Reviewed: Nurse-Family Partnership (NFP)® , NFP with Nurse Home Visitors - Mothers with low psychological resources subgroup
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 Established for race/ethnicity. Significant differences in SES, but controlled in analyses. None None
Notes:

In 2020, HomVEE updated this review in two ways. First, HomVEE moved six findings on externalizing disorders, internalizing disorders, and total problems from the Reductions in Juvenile Delinquency, Family Violence, and Crime domain to the Child Development and School Readiness domain. Second, HomVEE moved the findings on whether the child used cigarettes, alcohol, or marijuana in the past 30 days from the Child Health domain to the Child Development and School Readiness domain. These changes are because ACF determined that all measures of child behavioral health, including internalizing and externalizing behaviors and children's risky behaviors, belong in HomVEE's Child Development and School Readiness domain.

Study characteristics
Study participants From June 1, 1990 through August 31, 1991, the study enrolled primarily African American women at fewer than 29 weeks of gestation, with no previous live births, and with at least 2 of the following sociodemographic risk characteristics:unmarried, fewer than 12 years of education, and unemployed. Of the 1,290 eligible women, 1,139 consented and were randomly assigned. A subset of 743 women were involved in the postnatal aspect of the trial. Of the women enrolled, 92.1% were African American, 98.1% were unmarried, 64.1% were 18 years or younger at registration, and 85.1% came from households with annual incomes below the U.S. federal poverty guidelines. This study focused on the 12-year follow up; 594 women completed a maternal interview and 578 children completed an interview.
Setting Memphis, TN
Intervention services Women in the nurse-visited group were provided the same services as those in the comparison group, plus home visitation from pregnancy through the child’s second birthday. The nurses were provided detailed guidelines for each visit but allowed to adapt them to the needs of individual families. The nurses also linked families to other health and human services and tried to involve the children’s fathers and grandmothers in the pregnancy and care of the child. Each nurse visited a maximum of 25 families. The program is intended to provide 62 home visits for women who enroll at 16 weeks gestation. In this study, the nurses completed a mean of 7 home visits (range of 0 to 18) during pregnancy and 26 home visits (range of 0 to 71) during the first 2 years after birth. Generally the difference between the recommended and actual number of visits was the result of participants dropping out of the program.
Comparison conditions Women in the comparison group were provided developmental screening and referrals for the child at 6, 12, and 24 months of age, and free transportation for scheduled prenatal care.
Staff characteristics and training All home visitors were nurses. No other information on training is provided.
Funding sources This project was supported by National Institutes of Health research grant 1R01MH68790-01 funded by the National Institute of Mental Health and the Office of Juvenile Justice and Delinquency Prevention grant 2004-52854-CO-JS0. The earlier phases of this study were supported by several federal agencies: the National Institute of Mental Health (grant R01-MH61428- 01), the National Institute of Child Health and Human Development (grant R01-HD-043492), the National Institute of Nursing Research (grant NR01-01691-05), the Bureau of Maternal and Child Health (grant MCJ 360579), the Administration for Children and Families (grants 90PJ0003 and 90PD0215/01), the Office of the Assistant Secretary for Planning and Evaluation (Department of Health and Human Services), and the National Center for Child Abuse and Neglect through a transfer of funds to the National Institute of Nursing Research (grant R01NR01691). The earlier phases of this research also were supported by 5 private foundations: the Robert Wood Johnson Foundation (grants 017934 and 11084), the Carnegie Corporation of New York (grant B 5492), the Pew Charitable Trusts (grants 88-0211-000 and 93-02363-000), the William T. Grant Foundation (grants 88-1246-88 and 91-1246-88), and the Hearst Foundation, as well as a Senior Research Scientist Award from the National Institutes of Health (1-K05-MH01382-01) (Dr Olds).
Author affiliation David L. Olds, a study author, is a developer of this model.

Findings details

Child development and school readiness
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High GPA (reading and math) (grades 1-6)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12-year follow-up 326 mothers Mean = 2.46 Mean = 2.27 Mean difference = 0.20 HomeVEE calculated = 3.32 Statistically significant, p < .05

footnote121

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

Outcome examined with repeated measures.

High GPA (reading and math) (grades 4-6)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12-year follow-up 326 mothers Mean = 2.27 Mean = 2.08 Mean difference = 0.19 HomeVEE calculated = 2.83 Statistically significant, p < .05

footnote121

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

Outcome examined with repeated measures.

High PIAT scores (reading and math) at 12 years
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12-year follow-up 326 mothers Mean = 88.78 Mean = 85.70 Mean difference = 3.07 HomeVEE calculated = 3.91 Statistically significant, p < .05

footnote121

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

Outcome examined with repeated measures.

High Conduct grades (grades 1-6)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12-year follow-up 326 mothers Mean = 2.93 Mean = 2.86 Mean difference = 0.07 HomeVEE calculated = 1.61 Not statistically significant, p ≥ 0.05

footnote121

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

Outcome examined with repeated measures.

High Conduct grades (grades 4-6)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12-year follow-up 326 mothers Mean = 2.91 Mean = 2.86 Mean difference = 0.05 HomeVEE calculated = 0.93 Not statistically significant, p ≥ 0.05

footnote121

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

Outcome examined with repeated measures.

High Ever placed in special education (grades 1-6)
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12-year follow-up 326 mothers % = 15.00 % = 15.00 OR = 0.97 HomeVEE calculated = -0.02 Not statistically significant, p ≥ 0.05

footnote122

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

Percentages adjusted for covariates in the model (household poverty and maternal childrearing attitudes).

High Ever retained
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12-year follow-up 326 mothers % = 23.00 % = 27.00 OR = 0.77 HomeVEE calculated = -0.16 Not statistically significant, p ≥ 0.05

footnote122

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

Percentages adjusted for covariates in the model (household poverty and maternal childrearing attitudes).

High Externalizing disorders
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12 years 326 mothers % (adjusted) = 24.00 Adjusted mean % = 22.00 OR = 1.12 HomeVEE calculated = 0.07 Not statistically significant, p ≥ 0.05
High Group achievement test scores (reading and math) (grades 1-6), percentile1
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12-year follow-up 326 mothers Mean = 40.52 Mean = 34.85 Mean difference = 5.67 HomeVEE calculated = 3.39 Statistically significant, p < .05
High Group achievement test scores (reading and math) (grades 4-6), percentile1
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12-year follow-up 326 mothers Mean = 36.86 Mean = 33.67 Mean difference = 3.19 HomeVEE calculated = 1.87 Not statistically significant, p ≥ 0.05
High Internalizing disorders
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12 years 326 mothers %(adjusted) = 32.00 Adjusted mean % = 36.00 OR = 0.81 HomeVEE calculated = -0.13 Not statistically significant, p ≥ 0.05
High Leiter-R Sustained Attention test scaled score
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12-year follow-up 326 mothers Mean = 8.63 Mean = 8.72 Mean difference = -0.09 HomeVEE calculated = -0.39 Not statistically significant, p ≥ 0.05
High Total problems
FavorableUnfavorable or ambiguousNo Effect
Mothers with low psychological resources — Nurse home visitors and comparison (Memphis) 12 years 326 mothers % (adjusted = 30.00 Adjusted mean % = 27.00 OR = 1.17 HomeVEE calculated = 0.09 Not statistically significant, p ≥ 0.05
High GPA (reading and math) (grades 1–6)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and development screening comparison (Memphis) 12-year follow-up 635 children Mean = 2.48 Mean = 2.39 Mean difference = 0.09 HomeVEE calculated = 2.07 Not statistically significant, p ≥ 0.05

footnote121

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

Outcome examined with repeated measures.

High GPA (reading and math) (grades 4–6)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and development screening comparison (Memphis) 12-year follow-up 635 children Mean = 2.28 Mean = 2.20 Mean difference = 0.08 HomeVEE calculated = 1.70 Not statistically significant, p ≥ 0.05

footnote121

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

Outcome examined with repeated measures.

High PIAT scores (reading and math) at 12 years
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and development screening comparison (Memphis) 12-year follow-up 568 children Mean = 89.24 Mean = 87.96 Mean difference = 1.27 HomeVEE calculated = 2.25 Not statistically significant, p ≥ 0.05

footnote121

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

Outcome examined with repeated measures.

High Conduct grades (grades 1–-6)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and development screening comparison (Memphis) 12-year follow-up 635 children Mean = 2.95 Mean = 2.89 Mean difference = 0.06 HomeVEE calculated = 1.79 Not statistically significant, p ≥ 0.05
High Conduct grades (grades 4–6)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and development screening comparison (Memphis) 12-year follow-up 635 children Mean = 2.95 Mean = 2.88 Mean difference = 0.07 HomeVEE calculated = 1.87 Not statistically significant, p ≥ 0.05

footnote121

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

Outcome examined with repeated measures.

High Ever placed in special education (grades 1–6)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and development screening comparison (Memphis) 12-year follow-up 635 children % (adjusted) = 14.80 Adjusted mean % = 9.80 OR = 1.61 HomeVEE calculated = 0.28 Not statistically significant, p ≥ 0.05
High Ever retained
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and development screening comparison (Memphis) 12-year follow-up 635 children % (adjusted) = 24.90 Adjusted mean % = 20.80 OR = 1.26 HomeVEE calculated = 0.14 Not statistically significant, p ≥ 0.05
High Group achievement test scores (reading and math) (grades 1–6), percentile
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and development screening comparison (Memphis) 12-year follow-up 578 children Mean = 42.34 Mean = 39.79 Mean difference = 2.55 HomeVEE calculated = 2.12 Not statistically significant, p ≥ 0.05

footnote121

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

Outcome examined with repeated measures.

High Group achievement test scores (reading and math) (grades 4–6), percentile
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and development screening comparison (Memphis) 12-year follow-up 635 children Mean = 39.37 Mean = 38.27 Mean difference = 1.09 HomeVEE calculated = 0.89 Not statistically significant, p ≥ 0.05

footnote121

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

Outcome examined with repeated measures.

High Leiter-R Sustained Attention test scaled score
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and development screening comparison (Memphis) 12-year follow-up 578 children Mean = 8.68 Mean = 8.75 Mean difference = -0.07 HomeVEE calculated = -0.42 Not statistically significant, p ≥ 0.05
High Externalizing disorders
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 12 years 594 mothers, 578 children, and 548 teachers % (adjusted) = 19.70 Adjusted mean % = 17.80 OR = 1.13 HomeVEE calculated = 0.08 Not statistically significant, p ≥ 0.05
High Incidence of days of substance use in the past 30 days
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 12 years 578 children = 0.03 = 0.18 IR = 0.15 Not available Statistically significant, p < .05
High Internalizing disorders
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 12 years 578 children %(adjusted) = 22.10 Adjusted mean % = 30.90 OR = 0.63 HomeVEE calculated = -0.28 Statistically significant, p < .05
High Number of substances used in the past 30 days
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 12 years 578 children = 0.02 = 0.08 IR = 0.06 Not available Statistically significant, p < .05
High Total problems
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 12 years 594 mothers, 578 children, and 548 teachers % (adjusted) = 23.70 Adjusted mean % = 19.80 OR = 1.26 HomeVEE calculated = 0.14 Not statistically significant, p ≥ 0.05
High Used cigarettes, alcohol, or marijuana in the past 30 days
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 12 years 578 children %(adjusted) = 1.70 Adjusted mean % = 5.10 OR = 0.31 HomeVEE calculated = -0.69 Statistically significant, p < .05
Reductions in juvenile delinquency, family violence, and crime
Rating Outcome measure Effect Sample Timing of follow-up Sample size Intervention group Comparison group Group difference Effect size Statistical significance Notes
High Ever arrested
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 12 years 594 mothers and 578 children % (adjusted) = 3.10 Adjusted mean % = 3.10 Difference = 0.00 HomeVEE calculated = 0.00 Not statistically significant

Outcome measure summary

Child development and school readiness
Outcome measure Description of measure Data collection method Properties of measure

GPA (reading and math)

Reading and math end-of-year grade point averages (GPAs)  (score ranges from 0 to 4)

 Review of school records

Not applicable 

PIAT scores (reading and math)

Peabody IndividualAchievement Tests (PIATs) assess reading, mathematics, and spelling ability in children

 Child report

Not reported by author

Conduct grades

A scale of child conduct ranging from 1 (unsatisfactory) to 4 (honors)

Review of school records

 Not applicable

Ever placed in special education (grades 1-6)

Percentage of children that had ever been placed in special education during grades 1 to 6

Review of school records

Not applicable

Ever retained

Percentage of children that had ever been grade retained during grades 1 to 6

Review of school records

Not applicable

Externalizing disorders

Externalizing behavioral problems such as aggression and rule breaking scored from parents’, teachers’, and children’s reports. Children were scored as positive whenever at least 2 of the 3 reporters gave a child a score in the borderline or clinical range

 Parent/caregiver, teacher, and adolescent report

Not reported by author

Group achievement test scores (reading and math) percentile

Reading and math achievement in terms of score percentiles derived from the Tennessee Comprehensive Assessment Program test scores

Review of school records

Not reported by author

Incidence of days of substance use in the past 30 days

Count of days of substance use (theoretical range, 0-90)

Interview

Not applicable

Internalizing disorders

Internalizing behavioral problems scored from parents’, teachers’, and children’s reports. Children were scored as positive whenever at least 2 of the 3 reporters gave a child a score in the borderline or clinical range

Parent/caregiver, teacher, and adolescent report

Not reported by author

Leiter-R Sustained Attention test scaled score

Leiter-R Sustained Attention test assesses skills in memory or attention in children

Direct assessment 

Not reported by author

Number of substances used in the past 30 days

Count of substances used in the past 30 days (0-3)

Interview

Not applicable

Total problems

A measure of internalizing and externalizing behavioral problems scored from parent, teacher, and adolescent reports. Youth were scored as positive whenever at least 2 of the 3 reporters gave the adolescent a score in the borderline or clinical range.

Parent/caregiver, teacher, and adolescent report

Not reported by author

Used cigarettes, alcohol, or marijuana in the past 30 days

Whether cigarettes, alcohol, or marijuana in the past 30 days (yes or no)

Interview

Not applicable

Reductions in juvenile delinquency, family violence, and crime
Outcome measure Description of measure Data collection method Properties of measure

Ever arrested

Percentage of children that had been arrested by the age of 12 years Parent/caregiver and adolescent report

Not applicable