This study assesses the long-term effects of an intensive program of prenatal and infancy nurse home visitation on maternal and child development, adjustment, and competence. The study has two broad aims: 1) To discern whether the program has an enduring impact on maternal life course (fertility, education, work, and reliance on welfare) and child functioning (intelligence, school achievement, behavioral adaptation, and emotional adaptation); and 2) to examine the pathways through which the program affects child outcomes, giving particular attention to maternal life course and caregiving as major mediating processes. With this proposal, we request funds to carry out an assessment of the life-course development of the parents (primarily mothers) and their first-born children when they are 15 years of age, 13 years after the program ended. For the mothers, we hypothesize that those who received the prenatal and postpartum nurse visitation (and especially those who were from low-income households when they registered in the program during pregnancy), In contrast to their counterparts randomly assigned to comparison services, will have increased labor-force participation; decreased use of AFDC; and fewer subsequent pregnancies. We have predicted, secondarily, that they will have higher standards for their children's behavior and more consistent enforcement of those standards; reduced rates of child abuse and neglect perpetrated by parents; a greater sense of mastery and control over their life circumstances; lower levels of psychological distress; lower levels of economic and social stress; and greater support from the child's father and their own mothers. For the children, we hypothesize that children born to women who received a nurse both during pregnancy and the first two years of the child's life (and especially those born to women from low-income households when they registered in the program during pregnancy), in contrast to their counterparts in the comparison groups, will display more competent school functioning (higher achievement scores in reading and math; better grade-point averages; and fewer cases of grade retention, placement in special educational classes and receipt of special education services); better behavioral adaptation (fewer serious behavioral problems, greater social competence, fewer adverse health-related behaviors, and more adaptive peer relations); and better emotional adaptation (less depression and increased perceptions of competence and self-efficacy). Children born to nurse-visited women who smoked cigarettes when they registered in the program during pregnancy, in contrast to their comparison-group counterparts, will have higher IQ scores, school functioning, and fewer behavioral and emotional problems. We hypothesize that families who received a nurse during pregnancy and the first two years of the child's life will cost the government less between the first child's 4th and 15th years of life than those families who had been assigned to the comparison groups.
