Prenatal and Infancy Nurse Home Visiting Effects on Mothers: 18-Year Follow-up of a Randomized Trial

被引:42
|
作者
Olds, David L. [1 ]
Kitzman, Harriet [3 ]
Anson, Beth [3 ]
Smith, Joyce A. [3 ]
Knudtson, Michael D. [1 ]
Miller, Ted [4 ]
Cole, Robert [3 ]
Hopfer, Christian [2 ]
Conti, Gabriella [5 ]
机构
[1] Univ Colorado, Dept Pediat, Anschutz Med Campus,13121 E 17th Ave,MS 8410, Aurora, CO 80045 USA
[2] Univ Colorado, Dept Psychiat, Anschutz Med Campus, Aurora, CO 80045 USA
[3] Univ Rochester, Sch Nursing, Rochester, NY USA
[4] Curtin Univ, Sch Publ Hlth, Pacific Inst Res & Evaluat, Perth, WA, Australia
[5] UCL, Dept Econ & Social Sci, London, England
基金
美国国家卫生研究院;
关键词
MATERNAL LIFE-COURSE; VISITATION; OUTCOMES; PREGNANCY; RISK; PARAPROFESSIONALS; INTERVALS; PATTERNS; BEHAVIOR; UTILITY;
D O I
10.1542/peds.2018-3889
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
BACKGROUND: Prenatal and infancy home-visiting by nurses is promoted as a means of improving abstract 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.
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页数:10
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