Effects of a Home Visiting Program on Child’s Health, Mother’s Health, and Parenting Behaviors

• In Event: Supporting Families during Formation: Examining predictors of engagement and outcomes of home visiting and supplemental nutrition programs

Abstract

Research links prenatal and early childhood health to numerous outcomes later in life, establishing this period as critical for future learning, behavior, and health (Currie & Almond, 2011; Francis, 2009; Shonkoff, 2017). As part of the home visiting initiatives funded through Maternal, Infant, and Early Childhood Home Visiting (MIECHV), Texas implements Nurse Family Partnership (NFP) to improve maternal and early childhood health and development. However, evidence of NFP’s effects on perinatal outcomes is mixed. While a recent randomized control trial finds NFP participants do not differ significantly from comparison participants across a composite measure of adverse birth outcomes (McConnell et al., 2022), others identify effects of the program on similar outcomes. For example, recent studies show NFP positively affected outcomes such as birthweights of second born children (Holland et al., 2019), incidence of preterm births (Thorland & Currie, 2017), and 20-year mortality rates for mothers and children in certain contexts (Olds et al., 2014).

Expanding upon the existing evidence base, our study evaluates the effectiveness of NFP in Texas for participants over the 2009-2019 period in the following areas: child’s health at birth, mother’s receipt of adequate prenatal care, healthy parental behaviors, healthier pregnancies and births, and prevalence of father being listed on the child’s birth certificate. Our large sample, available variables of interest, and balanced comparison group allow us to not only estimate effects of the program with greater precision than most related studies, but also to conduct racial subgroup analyses that have implications for reducing health disparities. To estimate the effects of NFP, we compare differences between participants and non-participants on the following outcomes: preterm births, early preterm births, low birthweight, very low birthweight, number of prenatal visits, prenatal care adequacy, smoking during third trimester, breastfeeding, preeclampsia/eclampsia, gestational diabetes, and father listed on birth certificate.

Beginning with the entire Texas NFP participant population from 2009-2019, we use exact and fuzzy matching techniques to identify 86% of 15,754 participating families in Texas birth records. We use Coarsened Exact Matching to select similar non-participating comparison families from Texas birth records. Table 1 displays descriptive statistics of our final sample (NFP n = 11,554, comparison n = 11,554). Controlling for additional covariates, we compare outcomes between the two groups using multivariate regression and multivariate logistic regression. Table 2 includes the main NFP effect for each outcome.

Findings suggest that NFP participants engage in healthier behaviors than non-participants, as seen by higher odds of receiving adequate prenatal care and initiating breastfeeding before hospital discharge, and lower odds of smoking during the third trimester for mothers who smoked pre-pregnancy. However, we observe no significant differences between the two groups for health outcomes or whether mothers listed fathers on the birth certificate. Preliminary analyses of racial subgroups indicate that statistically significant findings in the full sample are driven largely by program effects on Black and Hispanic families. Our findings have implications for future decisions regarding federally funded prenatal care initiatives, as well as for potential levers to alleviate health disparities by race.

Authors

• Mason Shero, Vanderbilt University
  Presenting Author

• Hilary Ann Doe, Vanderbilt University

• Cynthia A Osborne, Vanderbilt University

• Jennifer Huffman, Vanderbilt University