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Interim Impact Findings:
Elmira Trial:
“We found that during pregnancy, nurse-visited women improved the quality of their diets to a greater extent, and those identified as smokers smoked 25% fewer cigarettes by the end of the pregnancy, than did their counterparts in the comparison group. By the end of pregnancy, nurse-visited women had fewer kidney infections, experienced greater informal social support, and made better use of formal community services. Among women who smoked, those who were nurse-visited had 75% fewer pre-term deliveries, and among very young adolescents (aged 14-16), those who were nurse-visited had babies who were nearly 400 grams heavier, than their counterparts assigned to the comparison group.”
“After delivery, 19% of the poor, unmarried teens in the comparison group abused or neglected their children during the first 2 years after delivery as opposed to 4% of the poor, unmarried teens visited by a nurse.”
“Overall, the children of nurse-visited women were less likely to receive emergency room treatment and to visit either a physician or emergency room for injuries and ingestions from their 12th to 48th month of life than were their comparison group counterparts.”
“Children born to women who smoked a moderate to heavy amount when they registered in the program during pregnancy and who received prenatal home visitation had significantly higher IQ scores at 3 and 4 years of age than their counterparts in the comparison group.”
“During the 4 year period after delivery of the first child, among low income, unmarried women, the rate of subsequent pregnancy was reduced by 42%, and the number of months that nurse-visited women participated in the work force was increased by 83%. By the first-born’s 2nd year of life, the rate of subsequent pregnancy was reduced by 33%. Much of the impact of the program on work force participation among the adolescent portion of the sample did not occur until the 2-year period after the program ended, when the teens were old enough to obtain jobs.”
“The 15-year follow-up study provides even more compelling results. During the 15-year period after delivery of their first child, unmarried women from low socioeconomic (SES) households at enrollment who were visited by nurses during pregnancy and infancy, in contrast to those in the comparison group, had 1.1 versus 1.6 subsequent births (p=.02), 65 versus 37 months between the birth of their first and 2nd children (p=.001), 60 versus 90 months on welfare (p=.005), 0.41 versus 0.73 behavioral impairments due to substance abuse (p=.03), and 0.18 versus 0.58 arrests by self-report (p=.0009). New York State records revealed that they had 0.16 versus 0.90 arrests (p=.00002).”
Memphis Trial:
“There were no treatment main effects on birthweight, low birthweight, length of gestation, spontaneous pre-term delivery, indicated pre-term delivery, or Apgar scores. Nevertheless, by the 36th week of pregnancy, nurse-visited women were more likely to use other community services than women in the control group (p= .01). They also were more likely to be working (p=.06), an effect that was particularly strong among women who were not in school when they were randomized (14% vs. 8%, p=.045, and 8% vs. 2% (p=.01), at the 28th and 36th weeks, respectively).”
“In contrast to women in the comparison group, nurse-visited women had fewer yeast infections after randomization and fewer instances of Pregnancy-Induced Hypertension (PIH) (p = .05 and p= .02, respectively). In contrast to those in the comparison group, women with PIH who received a nurse home visitor had mean arterial blood pressures during labor that were 3.5 points lower (p = .05), although there were no treatment differences in birthweight, length of gestation, or Apgar scores for women with PIH.”
“During their first 2 years, nurse-visited children had fewer health-care encounters in which injuries and ingestions were detected than children in the comparison condition (p=.05), an effect that was accounted for primarily by a reduction in outpatient encounters (p=.02). Nurse-visited children also were hospitalized for fewer days with injuries and/or ingestions than children in the comparison condition (p=.0002).”
“By the 24th month of the child’s life, in contrast to their comparison-group counterparts, nurse-visited women held fewer beliefs about child-rearing associated with child abuse and neglect—lack of empathy, belief in physical punishment, unrealistic expectations for infants (p=.003). Moreover, the homes of nurse-visited women were rated on the HOME scale as more conducive to children's development (p=.003).”
“There were no program effects on the children’s rates of immunization, mental development, or reported behavioral problems. The failure to affect immunization rates calls for a closer examination of the clinical protocols employed in promoting well-child care as the program is tested in new settings. Immunization rates approaching 100% could easily be realized simply by including immunization among the nurses’ responsibilities.”
“At the 24th month of the first child’s life, nurse-visited women reported 23% fewer second pregnancies and 32% fewer subsequent live births than women in the comparison group. The program-control difference in subsequent live births was limited to women with high levels of psychological resources, for whom the rates were 14% versus 31%, respectively. Nurse-visited women and their first-born children relied upon AFDC for fewer months during the 2nd year of the child’s life than comparison-group women and their children. There were no program effects on reported educational achievement or length of employment. The program was able to help those women with fewer mental health symptoms, higher IQs, and more active coping styles become less dependent upon welfare, but it was unable to help women with fewer psychological resources.”
Interim Cost-Benefit Findings:
Elmira Trial:
In 1980 dollars, the program cost $3,173 for 2½ years of intervention. We conceived of government savings as the difference in government spending for these other services between the group that received postnatal home visitation and the comparison group. Savings also were expressed in 1980 dollars and were adjusted using a 3% discount rate. By the time the children were 4 years of age, low-income families who were visited by a nurse during pregnancy and through the 2nd year of life cost the government $3,313 less than their counterparts in the comparison group. Thus, when focused on low-income families, the investment in the service was recovered with a dividend of about $180 within 2 years after the program ended. This $3,300 cost savings to government for low-income families was largely due to reductions in expenditure for AFDC and for food stamps.
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