David L Olds1, Harriet Kitzman2, Elizabeth Anson2, Joyce A Smith2, Michael D Knudtson3, Ted Miller4, Robert Cole2, Christian Hopfer5, Gabriella Conti6. 1. Departments of Pediatrics and david.olds@cuanschutz.edu. 2. School of Nursing, University of Rochester, Rochester, New York. 3. Departments of Pediatrics and. 4. Pacific Institute for Research and Evaluation, School of Public Health, Curtin University, Perth, Australia; and. 5. Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, Colorado. 6. Departments of Economics and Social Science, University College London, London, United Kingdom.
Abstract
BACKGROUND: Prenatal and infancy home-visiting by nurses is promoted as a means of improving maternal life-course, but evidence of long-term effects is limited. We hypothesized that nurse-visitation would lead to long-term reductions in public-benefit costs, maternal substance abuse and depression, and that cost-savings would be greater for mothers with initially higher psychological resources. METHODS: We conducted an 18-year follow-up of 618 out of 742 low-income, primarily African-American mothers with no previous live births enrolled in an randomized clinical trial of prenatal and infancy home visiting by nurses. We compared nurse-visited and control-group women for public-benefit costs, rates of substance abuse and depression, and examined possible mediators of intervention effects. RESULTS: Nurse-visited women, compared with controls, incurred $17 310 less in public benefit costs (P = .03), an effect more pronounced for women with higher psychological resources ($28 847, P = .01). These savings compare with program costs of $12 578. There were no program effects on substance abuseor depression. Nurse-visited women were more likely to be married from child age 2 through 18 (19.2% vs 14.8%, P = .04), and those with higher psychological resources had 4.64 fewer cumulative years rearing subsequent children after the birth of the first child (P = .03). Pregnancy planning was a significant mediator of program effects on public benefit costs. CONCLUSIONS: Through child age 18, the program reduced public-benefit costs, an effect more pronounced for mothers with higher psychological resources and mediated by subsequent pregnancy planning. There were no effects on maternal substance abuse and depression.
RCT Entities:
BACKGROUND: Prenatal and infancy home-visiting by nurses is promoted as a means of improving maternal life-course, but evidence of long-term effects is limited. We hypothesized that nurse-visitation would lead to long-term reductions in public-benefit costs, maternal substance abuse and depression, and that cost-savings would be greater for mothers with initially higher psychological resources. METHODS: We conducted an 18-year follow-up of 618 out of 742 low-income, primarily African-American mothers with no previous live births enrolled in an randomized clinical trial of prenatal and infancy home visiting by nurses. We compared nurse-visited and control-group women for public-benefit costs, rates of substance abuse and depression, and examined possible mediators of intervention effects. RESULTS: Nurse-visited women, compared with controls, incurred $17 310 less in public benefit costs (P = .03), an effect more pronounced for women with higher psychological resources ($28 847, P = .01). These savings compare with program costs of $12 578. There were no program effects on substance abuseor depression. Nurse-visited women were more likely to be married from child age 2 through 18 (19.2% vs 14.8%, P = .04), and those with higher psychological resources had 4.64 fewer cumulative years rearing subsequent children after the birth of the first child (P = .03). Pregnancy planning was a significant mediator of program effects on public benefit costs. CONCLUSIONS: Through child age 18, the program reduced public-benefit costs, an effect more pronounced for mothers with higher psychological resources and mediated by subsequent pregnancy planning. There were no effects on maternal substance abuse and depression.
Authors: D L Olds; J Eckenrode; C R Henderson; H Kitzman; J Powers; R Cole; K Sidora; P Morris; L M Pettitt; D Luckey Journal: JAMA Date: 1997-08-27 Impact factor: 56.272
Authors: Margaret L Holland; Yinglin Xia; Harriet J Kitzman; Ann M Dozier; David L Olds Journal: Am J Public Health Date: 2014-08-14 Impact factor: 9.308
Authors: D Olds; C R Henderson; R Cole; J Eckenrode; H Kitzman; D Luckey; L Pettitt; K Sidora; P Morris; J Powers Journal: JAMA Date: 1998-10-14 Impact factor: 56.272
Authors: Bridget Basile Ibrahim; Julia D Interrante; Alyssa H Fritz; Mariana S Tuttle; Katy Backes Kozhimannil Journal: Children (Basel) Date: 2022-07-19
Authors: Daniel Fatori; Pedro Fonseca Zuccolo; Elizabeth Shephard; Helena Brentani; Alicia Matijasevich; Alexandre Archanjo Ferraro; Lislaine Aparecida Fracolli; Anna Maria Chiesa; James Leckman; Euripedes Constantino Miguel; Guilherme V Polanczyk Journal: Sci Rep Date: 2021-07-13 Impact factor: 4.379