ITHACA, N.Y. -- Visiting nurses have helped reduce child abuse and neglect by up to 80 percent over a 15-year period among a group of low-income, unmarried women visitedduring their pregnancies and the first two years of their babies' lives. This is the conclusion reached by researchers at Cornell University in the longest study on record of the effects of nurse home visits during pregnancy and following birth.
However, the study, published in the latest issue of JAMA , the Journal of the American Medical Association , (Sept. 20, 2000) shows the visits had little or no effect in homes where domestic violence was moderate to severe.
The results come from a 15-year follow-up study of 324 socially disadvantaged women and their first-born children who participated in the Prenatal/Early Infancy Project, a visiting nurse program launched 20 years ago in Elmira, N.Y.
"The study strongly suggests that the beneficial effects of a nurse home visitation program "are not merely short-term but cumulative," says John Eckenrode, professor and chair of human development at Cornell and co-director of the university's Family Life Development Center.
Eckenrode and his collaborators previously reported -- in 1997 -- that these long-term effects include less use of welfare, fewer arrests, higher rates of getting and keeping jobs, fewer subsequent births and a longer interval between births. In a 1998 report, they showed that the 15-year-old children had fewer encounters with the criminal justice system, less alcohol use and fewer sexual partners over the 15-year period.
"Child abuse is a major public health problem. More than 1 million cases of overt abuse or neglect are reported each year, and that's probably just the tip of the iceberg. About half of all women in their lifetime will also report an incident of partner violence," says Eckenrode. "This study suggests that nurse home visits are a promising strategy to reduce child abuse and neglect and to improve the health and welfare of both high-risk mothers and their children. Also knowing that domestic violence can limit the effectiveness of these programs is very important information in planning future child maltreatment prevention strategies."
The Prenatal/Early Infancy Project was launched in 1977 in Elmira by David Olds (Cornell Ph.D. 1976) and Charles Henderson, senior research associate in human development at Cornell, co-authors on the new report. Four hundred women, many unmarried and low-income, and all pregnant for the first time, participated in the initial study; about half received nurse home visits (an average of nine visits during pregnancy and 23 during a child's first two years) and were compared with a control group of mothers who did not receive nurse visits. During the visits, the nurses discussed nutrition, prenatal care, developmental stages and needs of children and other health, behavioral and psycho-social conditions that could affect maternal and child well-being.
The researchers suspect that these pervasive, long-term differences between the control group and women visited by nurses at home are due to the combined influences of improved prenatal health, reduced care-giving problems early in the life cycle, improved family planning and economic self-sufficiency, all working in synergistic ways that improve the lives of the low-income mothers and their children.
The findings from the Prenatal/Early Infancy Project have been so positive that the program has been widely emulated around the country and has resulted in a recommendation from the U.S. Advisory Board on Child Abuse and Neglect that home-visitation services be made available to all parents of newborns as a means of preventing child abuse and neglect.
Although such programs are not inexpensive, an economic analysis by the Rand Corp. in 1998 showed that for every dollar spent on the program, there were projected savings of about $4 by the time these children reached young adulthood. The reason: In the nurse-visited group, far fewer government services were needed, since there were fewer additional pregnancies and fewer cases of child abuse and neglect. In addition, there was less call on welfare services, hospital emergency rooms and fewer encounters with the criminal justice system when these children became adolescents.
The children in the study are now in their late teens. The team currently is doing a follow-up study on the young people as 19-year-olds to see if there are lasting benefits from the nurse home visits as they leave high school.
The co-authors on the new study, besides Eckenrode, Henderson and Olds (now professor of pediatrics, psychiatry and preventive medicine at the University of Colorado Health Sciences Center), include Cornell graduate student Barbara Ganzel, Cornell research associates Elliott Smith and Jane Powers (Cornell Ph.D. 1985), and University of Rochester researchers Harriet Kitzman, Kimberly Widora and Robert Cole (Cornell Ph.D. 1976).
Related World Wide Web sites: The following sites provide additional information on this news release. Some might not be part of the Cornell University community, and Cornell has no control over their content or availability.
o Family Life Development Center: http://www.human.cornell.edu/fldc/
o John Eckenrode:http://www.human.cornell.edu/faculty/facultybio.cfm?netid=jje1&facs=1
Journal
JAMA