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Follow-up of a Randomized Trial Among Children at Age 12 Years

David L. Olds, PhD; Harriet J. Kitzman, RN, PhD; Robert E. Cole, PhD; Carole A. Hanks, RN, DrPH; Kimberly J. Arcoleo, PhD, MPH; Elizabeth A. Anson, MS; Dennis W. Luckey, PhD; Michael D. Knudtson, MS; Charles R. Henderson Jr, MA; Jessica Bondy, MHA; Amanda J. Stevenson, BS

Arch Pediatr Adolesc Med. 2010;164(5):419-424.

Objective  To test, among an urban primarily African American sample, the effects of prenatal and infancy home visiting by nurses on mothers' fertility, partner relationships, and economic self-sufficiency and on government spending through age 12 years of their firstborn child.

Design  Randomized controlled trial.

Setting  Public system of obstetric and pediatric care in Memphis, Tennessee.

Participants  A total of 594 urban primarily African American economically disadvantaged mothers (among 743 who registered during pregnancy).

Intervention  Prenatal and infancy home visiting by nurses.

Main Outcome Measures  Mothers' cohabitation with and marriage to the child's biological father, intimate partner violence, duration (stability) of partner relationships, role impairment due to alcohol and other drug use, use and cost of welfare benefits, arrests, mastery, child foster care placements, and cumulative subsequent births.

Results  By the time the firstborn child was 12 years old, nurse-visited mothers compared with control subjects reported less role impairment owing to alcohol and other drug use (0.0% vs 2.5%, P = .04), longer partner relationships (59.58 vs 52.67 months, P = .02), and greater sense of mastery (101.04 vs 99.60, P = .005). During this 12-year period, government spent less per year on food stamps, Medicaid, and Aid to Families with Dependent Children and Temporary Assistance for Needy Families for nurse-visited than control families ($8772 vs $9797, P = .02); this represents $12 300 in discounted savings compared with a program cost of $11 511, both expressed in 2006 US dollars. No statistically significant program effects were noted on mothers' marriage, partnership with the child's biological father, intimate partner violence, alcohol and other drug use, arrests, incarceration, psychological distress, or reports of child foster care placements.

Conclusion  The program improved maternal life course and reduced government spending among children through age 12 years.

Trial Registration  clinicaltrials.gov Identifier: NCT00438165

Author Affiliations: Department of Pediatrics, School of Medicine, Aurora (Dr Olds and Mr Knudtson), and Department of Biostatistics and Informatics, University of Colorado, Denver (Dr Luckey and Mss Bondy and Stevenson); School of Nursing, University of Rochester Medical Center, Rochester (Drs Kitzman and Cole and Ms Anson), and Department of Human Development, Cornell University, Ithaca (Mr Henderson), New York; Louise Herrington School of Nursing, Baylor University, Waco, Texas (Dr Hanks); and College of Nursing and Health Innovation, Arizona State University, Phoenix (Dr Arcoleo).

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