Girls whose mothers were visited at home by nurses during pregnancy and the children's infancy are less likely to enter the criminal justice system before age 19 than their counterparts whose mothers were not visited, reports a study in the January issue of Archives of Pediatrics & Adolescent Medicine (Vol. 164, No. 1).

Nurses visited the homes of 400 pregnant women between 1978 and 1980 in Elmira, N.Y., to help women improve health-related behaviors during pregnancy, provide care during infancy and improve their economic self-sufficiency; 85 percent of the pregnant women were age 19 or younger, unmarried or from households with low socioeconomic status.

The Nurse-Family Partnership Program cost about $7,000 per child, said lead author John Eckenrode, Cornell professor of human development, but benefit-cost analyses have found that the program has produced total benefits of about $41,000 per child of low-income, unmarried, nurse-visited mothers and about $9,000 per child of lower-risk nurse-visited mothers.

"Our studies of the Nurse-Family Partnership Program over the years, including this one, show that providing parents of young children with strategies that improve parental competencies and the early learning environment of the child are promising ways to reduce health and developmental problems across the life course and associated costs to government and society," said Eckenrode.

Of the 310 families followed up when the children were 19 years of age, 79 received visits during pregnancy only, 91 received visits during pregnancy and infancy, and 140 were in the control group. Families in the program received an average of nine home visits by nurses during pregnancy and 23 from birth through the child's second birthday.

Compared with 73 girls in the control group, 44 girls whose families were visited during pregnancy and infancy were less likely to have been arrested by age 19 (10 percent vs. 30 percent) or convicted (4 percent vs. 20 percent) and had fewer lifetime arrests (an average of 0.1 vs. 0.54) and convictions (0.04 percent vs. 0.37 percent). When the analysis was restricted to girls whose mothers were high-risk (unmarried and low-income), those who were visited by nurses had fewer children (11 percent vs. 30 percent) and were less likely to use Medicaid (18 percent vs. 45 percent) than those who were not visited.

For boys, the likelihood of an arrest increased significantly in the intervention and control groups after age 12, with no difference in arrests between groups through age 19.

"Overall, these findings suggest that the Nurse-Family Partnership Program has the potential to produce lasting changes in criminal offending trajectories, early childbearing and economic outcomes for girls born to low-resource mothers," the authors wrote. "Given that other long-term follow-up studies of model early-childhood interventions for infants and preschoolers have reported continued treatment effects with older adolescents and young adults, the impact of well-designed and implemented early interventions on crime reduction is promising."

Eckenrode concluded: "This and other evaluations of early intervention programs strongly suggest that a modest investment in the lives of families can have enormous payoff."

The research was supported by the Smith Richardson Foundation, with earlier phases of the study funded by the National Institute of Mental Health, Department of Health and Human Services, Robert Wood Johnson Foundation, W.T. Grant Foundation, Ford Foundation and Commonwealth Fund.