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Kitzman, H., Olds, D. L., Henderson, C. R., Hanks, C., Cole, R., Tatelbaum, R., et al. (1997). Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. JAMA: The Journal of the American Medical Association, 278(8), 644–652.

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 to move the NCAST Child Responsiveness (total score) from the Child Development and School Readiness domain to the Positive Parenting Practices domain because ACF determined that outcomes assessed with the NCAST, including the NCAST total score, most appropriately belong in the Positive Parenting Practices domain.

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. From June 1990 through 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 up through the child’s 24th month. At the 24-month follow-up, the sample included 675 women, 208 in the program group and 467 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 Five federal agencies: 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 (grant 90PJ0003); the Office of the Assistant Secretary for Planning and Evaluation; and the National Center for Child Abuse and Neglect, through a transfer of funds to the National Institute of Nursing Research. Four private foundations: the Robert Wood Johnson Foundation, Princeton, NJ (grants 017934 and 11084); the Carnegie Corporation of New York, New York, NY (grant 5492); the Pew Charitable Trusts, Philadelphia, Pa (grants 88-0211-000 and 93-02363-000); and the William T. Grant Foundation, New York, NY (grants 88-1246-88 and 91-1246-88), including a William T. Grant Faculty Scholars Award 86108086) 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 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 CBCL (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 1,082 children Adjusted mean = 46.00 Adjusted mean = 49.20 Mean difference = -3.20 Not available Not statistically significant,
p > 0.05
High BSID (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 1,082 children Adjusted mean = 94.50 Adjusted mean = 94.30 Mean difference = 0.20 Not available Not statistically significant,
p > 0.05
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 Birth weight, grams
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) Birth 1,082 children Adjusted mean = 3032.20 Adjusted mean = 3050.40 Mean difference = -18.20 Not available Not statistically significant,
p > 0.05
High 5-minute Apgar
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children Adjusted mean = 8.60 Adjusted mean = 8.70 Mean difference = -0.10 Not available Not statistically significant,
p > 0.05
High Gestational age, weeks
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children Adjusted mean = 39.00 Adjusted mean = 39.00 Mean difference = 0.00 Not available Not statistically significant,
p > 0.05
High Indicated preterm delivery (percentage)
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children % (adjusted) = 3.00 Adjusted mean % = 3.00 OR = 1.00 HomeVEE calculated = 0.00 Not statistically significant,
p > 0.05

footnote2

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

Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

High Intrauterine growth restriction (percentage)
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children % (adjusted) = 9.00 Adjusted mean % = 9.00 OR = 1.00 HomeVEE calculated = 0.00 Not statistically significant,
p > 0.05

footnote2

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

Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

High Low birth weight (percentage < 2500 g)
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children % (adjusted) = 15.00 Adjusted mean % = 14.00 OR = 1.10 HomeVEE calculated = 0.05 Not statistically significant,
p > 0.05

footnote2

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

Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

High Preterm (less than 37 weeks, percentage)
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children % (adjusted) = 11.00 Adjusted mean % = 13.00 OR = 0.80 HomeVEE calculated = -0.12 Not statistically significant,
p > 0.05

footnote2

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

Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

High Spontaneous preterm delivery, percentage
FavorableUnfavorable or ambiguousNo Effect
Full, (Memphis) Birth 1,082 children % (adjusted) = 8.00 Adjusted mean % = 9.00 OR = 0.80 HomeVEE calculated = -0.08 Not statistically significant,
p > 0.05

footnote2

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

Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

High Breastfeeding attempted, percentage
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children % (adjusted) = 26.00 Adjusted mean % = 16.00 OR = 1.90 HomeVEE calculated = 0.37 Statistically significant,
p < 0.01

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

High Immunizations up to date, percentage
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children % (adjusted) = 70.00 Adjusted mean % = 68.00 OR = 1.10 HomeVEE calculated = 0.06 Not statistically significant,
p > 0.05

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

High Number of well-child visits
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 4.60 Adjusted mean = 4.80 Mean difference = -0.20 Not available Not statistically significant,
p > 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 Employed during pregnancy
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers % (adjusted) = 6.00 Adjusted mean % = 3.00 OR = 2.00 HomeVEE calculated = 0.44 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).

High In school during pregnancy
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers % (adjusted) = 44.00 Adjusted mean % = 41.00 OR = 1.20 HomeVEE calculated = 0.07 Not statistically significant,
p > 0.05

footnote2

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

Statistical significance reported on authors’ calculations of the odds ratio.

High Used other community services
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers % (adjusted) = 29.00 Adjusted mean % = 20.00 OR = 1.80 HomeVEE calculated = 0.30 Statistically significant,
p ≤ 0.01

footnote2

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

Statistical significance reported on authors’ calculations of the odds ratio.

High Months worked, 0–12 months postpartum
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 681 mothers Adjusted mean = 2.20 Adjusted mean = 1.70 Mean difference = 0.50 Not available Not statistically significant,
p > 0.05
High Months on AFDC , 13–24 months postpartum
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers Adjusted mean = 7.80 Adjusted mean = 8.40 Mean difference = -0.60 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).

High Months on AFDC , 0–12 months postpartum
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 681 mothers Adjusted mean = 7.30 Adjusted mean = 7.60 Mean difference = -0.30 Not available Not statistically significant,
p > 0.05
High Months worked, 13–24 months postpartum
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers Adjusted mean = 3.40 Adjusted mean = 3.40 Mean difference = 0.00 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 Diastolic blood pressure
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 66.80 Adjusted mean = 67.50 Mean difference = -0.70 Not available Not statistically significant, p ≥ 0.05

footnote9

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

This mean difference, calculated by <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>, is within |0.01| of the difference reported by the authors, with the discrepancy likely due to rounding error.

High Gestational weight gain
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 14.60 Adjusted mean = 14.90 Mean difference = -0.30 Not available Not statistically significant, p ≥ 0.05
High Number of Gardnerella infections
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 0.06 Adjusted mean = 0.07 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 hospitalizations during pregnancy
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 0.15 Adjusted mean = 0.13 Mean difference = 0.02 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 sexually transmitted diseases
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 0.22 Adjusted mean = 0.21 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 yeast infections
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 0.14 Adjusted mean = 0.19 Mean difference = -0.05 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 Obstetrical evaluation visits (total)
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 2.80 Adjusted mean = 2.80 Mean difference = 0.00 Not available Not statistically significant, p ≥ 0.05

footnote9

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

This mean difference, calculated by <abbr title="Home Visiting Evidence of Effectiveness">HomVEE</abbr>, is within |0.01| of the difference reported by the authors, with the discrepancy likely due to rounding error.

High Pregnancy-induced hypertension (percentage)
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers % (adjusted) = 13.00 Adjusted mean % = 20.00 OR = 0.60 HomeVEE calculated = -0.31 Statistically significant,
p ≤ 0.01

footnote2

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

Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

High Standard prenatal care visits (total)
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 6.20 Adjusted mean = 6.50 Mean difference = -0.30 Not available Not statistically significant, p ≥ 0.05
High Systolic blood pressure
FavorableUnfavorable or ambiguousNo Effect
Full (Memphis) 36th week of pregnancy 916 mothers Adjusted mean = 111.70 Adjusted mean = 112.60 Mean difference = -0.90 Not available Not statistically significant, p ≥ 0.05
High Anxiety (MHI), 24 months postpartum, standardized
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers Adjusted mean = 99.10 Adjusted mean = 100.30 Mean difference = -1.20 Not available Not statistically significant, p ≥ 0.05
High Depression (MHI), 24 months postpartum, standardized
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers Adjusted mean = 99.50 Adjusted mean = 100.10 Mean difference = -0.06 Not available Not statistically significant, p ≥ 0.05
High Pearlin Mastery, 24 months postpartum, standardized
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers Adjusted mean = 101.60 Adjusted mean = 99.40 Mean difference = 2.20 Not available Statistically significant,
p < 0.01
High Spontaneous abortion, 0–24 months postpartum (percentage)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers % (adjusted) = 5.00 Adjusted mean % = 3.00 OR = 1.50 HomeVEE calculated = 0.32 Not statistically significant, p ≥ 0.05

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

High Subsequent live birth, 0–24 months postpartum (percentage)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers % (adjusted) = 22.00 Adjusted mean % = 31.00 OR = 0.60 HomeVEE calculated = -0.28 Statistically significant,
p < 0.01

footnote2

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

Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

High Subsequent pregnancy, 0-24 months postpartum (percentage)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers % (adjusted) = 36.00 Adjusted mean % = 47.00 OR = 0.60 HomeVEE calculated = -0.28 Statistically significant,
p < 0.01

footnote2

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

Statistical significance reported on authors’ calculations of the odds ratio.

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

High Therapeutic abortion, 0–24 months postpartum (percentage)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 671 mothers % (adjusted) = 2.00 Adjusted mean % = 4.00 OR = 0.50 HomeVEE calculated = -0.43 Not statistically significant, p ≥ 0.05

footnote6

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

The odds ratio compares the nurse-visited group to the comparison.

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 HOME (emotional/ cognitive stimulation)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 675 mothers Adjusted mean = 32.30 Adjusted mean = 30.90 Mean difference = 1.40 Not available Statistically significant,
p < 0.01
High NCAST Child Responsiveness (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 1,082 children Adjusted mean = 17.70 Adjusted mean = 17.40 Mean difference = 0.30 Not available Not statistically significant,
p > 0.05
High NCAST Maternal Teaching (total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 675 mothers Adjusted mean = 36.70 Adjusted mean = 36.50 Mean difference = 0.20 Not available Not statistically significant,
p > 0.05
High Beliefs associated with child abuse (AAPI total score)
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postpartum 672 mothers Adjusted mean = 98.70 Adjusted mean = 100.50 Mean difference = -1.80 Not available Statistically significant,
p < 0.01
Reductions in child maltreatment
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 days hospitalized–injuries/ingestions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 0.04 Adjusted mean = 0.18 Mean difference = -0.14 Not available Statistically significant,
p < 0.01

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 emergency department visits–injuries/ingestions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 0.33 Adjusted mean = 0.34 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 hospitalizations–injuries/ingestions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 0.01 Adjusted mean = 0.03 Mean difference = -0.02 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 outpatient visits–injuries/ingestions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 0.11 Adjusted mean = 0.20 Mean difference = -0.09 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 Total number of health care encounters–injuries/ingestions
FavorableUnfavorable or ambiguousNo Effect
Nurse visited during pregnancy + infancy and developmental screening comparison (Memphis) 2 years postnatal 671 children Adjusted mean = 0.43 Adjusted mean = 0.56 Mean difference = -0.13 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.

Outcome measure summary

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

BSID

The BSID tests the mental, motor, and behavioral development and abilities of young children. Child assessment

Not reported by author

CBCL

The CBCL is a questionnaire that assesses behavioral problems in young children. Child assessment

Not reported by author

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

Activity, pulse, grimace, appearance, and respiration (Apgar) score: 5-minute

The Apgar test was administered five minutes after the child’s birth. The test evaluates the newborn along five dimensions: (1) activity and muscle tone; (2) pulse and heart rate; (3) grimace response; (4) appearance and skin coloration; and (5) respiration, breathing rate, and effort. Each dimension is scored 0 to 2, with higher scores associated with better health. Review of medical records

Not applicable

Birth weight

The child’s recorded birth weight in grams Review of medical records

Not applicable

Breastfeeding attempted

Percentage of mothers who had attempted breastfeeding Parent/caregiver report

Not applicable

Gestational age

Gestational age in days was estimated from the reported last menstrual period (LMP) and ultrasound scans performed before 26 weeks’ gestation. If LMP and ultrasound converged within 14 days, then LMP was used for estimating gestational age. When LMP and ultrasound differed by more than 14 days, ultrasound was used as the estimate. In cases where ultrasound was not performed before 26 weeks’ gestation, or LMP was not known, the record was reviewed by two independent clinicians who were unaware of treatment condition to determine the most reliable estimate of gestational age. Review of medical records

Not applicable

Immunizations up-to-date

Percentage of children whose immunizations were up-to-date at their 2nd birthday Review of medical records

Not applicable

Indicated preterm delivery

Percentage of children who had an indicated preterm birth performed for maternal or fetal complications Review of medical records

Not applicable

Intrauterine growth restriction

Percentage of children with a birth weight less than the 10th percentile for their gestational age Review of medical records

Not applicable

Low birth weight

Percentage of children with a birth weight below 2,500 grams Review of medical records

Not applicable

Number of well-child visits

Number of well-child visits the child received Review of medical records

Not applicable

Preterm

Percentage of children who were delivered at less than 37 weeks’ gestation Review of medical records

Not applicable

Spontaneous preterm delivery

Percentage of children who had a spontaneous preterm birth after preterm labor with or without premature rupture of the membranes Review of medical records

Not applicable

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

Employed during pregnancy

Percentage of women who were employed at 28 weeks gestation Parent/caregiver report

Not applicable

In school during pregnancy

Percentage of women who were enrolled in school at 28 weeks gestation Parent/caregiver report

Not applicable

Months on AFDC

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

Not applicable

Months worked

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

Not applicable

Used other community services

Percentage of women who used other community services at 28 weeks’ gestation Parent/caregiver report

Not applicable

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

MHI: Anxiety MHI: Depression

The MHI assesses mental health in the areas of anxiety, depression, behavior, positive affect, and general distress. The researchers used the assessment to examine anxiety and depression in the sample. Parent/caregiver report

Not reported by author

Diastolic blood pressure

The mother’s diastolic blood pressure (mm Hg) upon admission for labor Review of medical records

Not applicable

Gestational weight gain

The amount of weight the mother gained over the course of her pregnancy in kilograms Review of medical records

Not applicable

Number of Gardnerella infections

The number of diagnosed Gardnerella infections after the mother was randomized to a treatment condition Review of medical records

Not applicable

Number of hospitalizations during pregnancy

The number of mother hospitalizations that occurred during pregnancy Review of medical records

Not applicable

Number of sexually transmitted diseases

The number of diagnosed sexually transmitted diseases after the mother was randomized to a treatment condition. The count includes diagnoses of Neisseria gonorrheas, Chlamydia trachomatis, and Trichomonas vaginalis. Parent/caregiver medical examination

Not applicable

Number of yeast infections

The number of diagnosed yeast infections after the mother was randomized to a treatment condition Review of medical records

Not applicable

Obstetrical evaluation visits

The total number of obstetrical evaluation visits the mother received Review of medical records

Not applicable

Pearlin Mastery Scale

The Pearlin Mastery Scale assesses the degree to which a person has a sense of mastery or control over their life. Parent/caregiver report

Not reported by author

Pregnancy-induced hypertension

Percentage of mothers with pregnancy-induced hypertension. The outcome includes cases of preeclampsia, eclampsia, toxemia, and pregnancy-induced hypertension. Review of medical records

Not applicable

Spontaneous abortion

Percentage of mothers who had a spontaneous abortion 0–24 months postpartum Parent/caregiver report

Not applicable

Standard prenatal care visits

The total number of standard prenatal care visits the mother received Review of medical records

Not applicable

Subsequent live birth

Percentage of mothers who had a subsequent live birth 0–24 months postpartum Parent/caregiver report

Not applicable

Subsequent pregnancy

Percentage of mothers who had a subsequent pregnancy 0–24 months postpartum Parent/caregiver report

Not applicable

Systolic blood pressure

The mother’s systolic blood pressure (mm Hg) upon admission for labor Review of medical records

Not applicable

Therapeutic abortion

Percentage of mothers who had a therapeutic abortion 0–24 months postpartum Parent/caregiver report

Not applicable

Positive parenting practices
Outcome measure Description of measure Data collection method Properties of measure

NCAST: Caregiver total score

The NCAST assesses the quality of teaching interaction between caregivers and young children. The researchers examined the composite score for parent interaction. Observation

Not reported by author

AAPI

The AAPI assesses parenting and childrearing attitudes. The researchers examined the AAPI total score to measure beliefs associated with child abuse. Parent/caregiver report

Not reported by author

HOME: Total score

The HOME assesses parenting practices and aspects of the home environment. Parent/caregiver interview and observational assessment

Not reported by author

NCAST Child Responsiveness

Mothers and children were observed while the mothers taught their children a developmentally challenging task. The mothers’ behaviors were coded and summarized to characterize their sensitivity, responsiveness, and quality of teaching. The infants’ behaviors were coded and aggregated to characterize their responsiveness and clarity of communication toward their mothers.

Observation conducted at the project offices

Not reported by author

Reductions in child maltreatment
Outcome measure Description of measure Data collection method Properties of measure

Number of emergency department visits—injuries/ingestions

Counts of child ER visits for injuries and poison ingestions Review of children’s medical records

Not applicable

Number of hospitalizations—injuries/ingestions

Counts of child hospitalizations for injuries and poison ingestions Review of children’s medical records

Not applicable

Number of outpatient visits—injuries/ingestions

Counts of child outpatient visits for injuries and poison ingestions Review of children’s medical records

Not applicable

Total number of health care encounters—injuries/ingestions

Counts of child injuries and poison ingestions Review of children’s medical records

Not applicable