Olds D L, Eckenrode J, Henderson C R, Kitzman H, Powers J, Cole R, Sidora K, Morris P, Pettitt L M, Luckey D
University of Colorado Health Sciences Center, Denver 80203, USA.
JAMA. 1997 Aug 27;278(8):637-43.
Home-visitation services have been promoted as a means of improving maternal and child health and functioning. However, long-term effects have not been examined.
To examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on women's life course and child abuse and neglect.
Randomized trial.
Semirural community in New York.
Of 400 consecutive pregnant women with no previous live births enrolled, 324 participated in a follow-up study when their children were 15 years old.
Families received a mean of 9 home visits during pregnancy and 23 home visits from the child's birth through the second birthday. DATA SOURCES AND MEASURES: Women's use of welfare and number of subsequent children were based on self-report; their arrests and convictions were based on self-report and archived data from New York State. Verified reports of child abuse and neglect were abstracted from state records.
During the 15-year period after the birth of their first child, in contrast to women in the comparison group, women who were visited by nurses during pregnancy and infancy were identified as perpetrators of child abuse and neglect in 0.29 vs 0.54 verified reports (P<.001). Among women who were unmarried and from households of low socioeconomic status at initial enrollment, in contrast to those in the comparison group, nurse-visited women had 1.3 vs 1.6 subsequent births (P=.02), 65 vs 37 months between the birth of the first and a second child (P=.001), 60 vs 90 months' receiving Aid to Families With Dependent Children (P=.005), 0.41 vs 0.73 behavioral impairments due to use of alcohol and other drugs (P=.03), 0.18 vs 0.58 arrests by self-report (P<.001), and 0.16 vs 0.90 arrests disclosed by New York State records (P<.001).
This program of prenatal and early childhood home visitation by nurses can reduce the number of subsequent pregnancies, the use of welfare, child abuse and neglect, and criminal behavior on the part of low-income, unmarried mothers for up to 15 years after the birth of the first child.
家庭访视服务已被推广为改善母婴健康和功能的一种手段。然而，其长期效果尚未得到研究。
研究护士进行产前和幼儿期家庭访视项目对女性人生历程以及儿童虐待和忽视情况的长期影响。
随机试验。
纽约的半农村社区。
在连续招募的400名未曾生育过活产婴儿的孕妇中，324名在其孩子15岁时参与了一项随访研究。
家庭在孕期平均接受9次家访，孩子从出生到两岁期间平均接受23次家访。
女性对福利的使用情况和后续生育子女数量基于自我报告；她们的被捕和定罪情况基于自我报告以及纽约州存档数据。经核实的儿童虐待和忽视报告从州记录中提取。
在其第一个孩子出生后的15年期间，与对照组女性相比，孕期和婴儿期接受护士家访的女性被确认为儿童虐待和忽视行为实施者的经核实报告数量为0.29份，而对照组为0.54份（P<0.001）。在初次登记时未婚且来自社会经济地位较低家庭的女性中，与对照组相比，接受护士家访的女性后续生育子女数为1.3个，而对照组为1.6个（P=0.02）；第一个孩子和第二个孩子出生间隔时间分别为65个月和37个月（P=0.001）；领取抚养儿童家庭补助的时间分别为60个月和90个月（P=0.005）；因使用酒精和其他药物导致行为障碍的比例分别为0.41和0.73（P=0.03）；自我报告的被捕率分别为0.18和0.58（P<0.001）；纽约州记录显示的被捕率分别为0.16和0.90（P<0.001）。
护士进行的这个产前和幼儿期家庭访视项目能够减少低收入未婚母亲在第一个孩子出生后的15年内的后续怀孕次数、福利使用情况、儿童虐待和忽视行为以及犯罪行为。
