The proposed study tests the effectiveness of prenatal and postpartum nurse home visitation as a means of enhancing the health and well-being of socially disadvantaged women and their first-born children. 1468 poor, unwed, pregnant women bearing first babies will be recruited for the study through six public health department clinics; after stratification by clinic site, poverty level, smoking status, and age, the women will be randomly assigned to one of two treatment groups. In the first group, all 734 women will be provided transportation for regular prenatal care; a randomly selected subset of these (N=500) will be followed for purposes of research through the second year of the child's life, during which time they will be provided sensory and developmental screening services for their children. In the second group, 734 women will be provided intensive nurse home-visitation services during pregnancy, in addition to the transportation services provided to the first group; a randomly selected subset of these (N=250) will be followed for purposes of research through the child's second birthday, during which time they will be provided comprehensive nurse home-visitation services. (By following approximately half of the sample during the postpartum phase of the study, with fewer families followed in the experimental program than the comparison group, we meet our criteria for statistical power and simultaneously minimize costs.) Those women randomly assigned to the nurse home-visitation program will be assigned at random to one of the experimental home-visiting nurses. The evaluation is designed to determine whether the nurse home- visitation program improves the women's prenatal health habits, infant caregiving skills, social support, mental health functioning, use of community services, educational and occupational achievements, and helps them reduce unwanted additional pregnancies and their reliance on welfare. For the children, the evaluation is designed to determine whether the program prevents prematurity and low birthweight, growth and nutritional problems, accidents, ingestions, acute infectious illnesses, cognitive delays, behavioral problems, and child abuse and neglect. A cost-benefit analysis will be carried out. It is hypothesized that the home-visitation program will promote the health and well-being of the women and children, and that the effectiveness of the program will be greater for those at greater risk for the particular problem under consideration.
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