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15-Year Follow-up of a Randomized Controlled Trial

David Olds, PhD; Charles R. Henderson, Jr; Robert Cole, PhD; John Eckenrode, PhD; Harriet Kitzman, RN, PhD; Dennis Luckey, PhD; Lisa Pettitt, PhD; Kimberly Sidora, MPH; Pamela Morris; Jane Powers, PhD

JAMA. 1998;280:1238-1244.

Context.— A program of home visitation by nurses has been shown to affect the rates of maternal welfare dependence, criminality, problems due to use of substances, and child abuse and neglect. However, the long-term effects of this program on children's antisocial behavior have not been examined.

Objective.— To examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on children's antisocial behavior.

Design.— Fifteen-year follow-up of a randomized trial. Interviews were conducted with the adolescents and their biological mothers or custodial parents.

Setting.— Semirural community in New York.

Participants.— Between April 1978 and September 1980, 500 consecutive pregnant women with no previous live births were recruited, and 400 were enrolled. A total of 315 adolescent offspring participated in a follow-up study when they were 15 years old; 280 (89%) were born to white mothers, 195 (62%) to unmarried mothers, 151 (48%) to mothers younger than 19 years, and 186 (59%) to mothers from households of low socioeconomic status at the time of registration during pregnancy.

Intervention.— Families in the groups that received home visits had an average of 9 (range, 0-16) home visits during pregnancy and 23 (range, 0-59) home visits from birth through the child's second birthday. The control groups received standard prenatal and well-child care in a clinic.

Main Outcome Measures.— Children's self-reports of running away, arrests, convictions, being sentenced to youth corrections, initiation of sexual intercourse, number of sex partners, and use of illegal substances; school records of suspensions; teachers' reports of children's disruptive behavior in school; and parents' reports of the children's arrests and behavioral problems related to the children's use of alcohol and other drugs.

Results.— Adolescents born to women who received nurse visits during pregnancy and postnatally and who were unmarried and from households of low socioeconomic status (risk factors for antisocial behavior), in contrast with those in the comparison groups, reported fewer instances (incidence) of running away (0.24 vs 0.60; P=.003), fewer arrests (0.20 vs 0.45; P=.03), fewer convictions and violations of probation (0.09 vs 0.47; P<.001), fewer lifetime sex partners (0.92 vs 2.48; P=.003), fewer cigarettes smoked per day (1.50 vs 2.50; P=.10), and fewer days having consumed alcohol in the last 6 months (1.09 vs 2.49; P=.03). Parents of nurse-visited children reported that their children had fewer behavioral problems related to use of alcohol and other drugs (0.15 vs 0.34; P=.08). There were no program effects on other behavioral problems.

Conclusions.— This program of prenatal and early childhood home visitation by nurses can reduce reported serious antisocial behavior and emergent use of substances on the part of adolescents born into high-risk families.

From the University of Colorado Health Sciences Center, Denver (Drs Olds and Luckey); Cornell University, Ithaca, NY (Mr Henderson, Drs Eckenrode and Powers, and Ms Morris); the University of Rochester, Rochester, NY (Drs Cole and Kitzman and Ms Sidora); and the University of Denver (Dr Pettitt).

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