SAN ANTONIO — An intensive home visiting program targeting pregnant women and parents of newborns reduced premature births and significantly improved health care and pediatric health in Hispanic families, according to preliminary results of a study presented by Kimberly Dumont, Ph.D., at the annual meeting of the Society for Prevention Research.
The Healthy Families New York (HFNY) program, which is modeled after the national Healthy Families America initiative, is primarily aimed at preventing child neglect and abuse, said Dr. Dumont, senior research associate with the New York State Office of Children & Family Services in Rensselaer. Home visits are conducted by trained paraprofessionals until children reach age 5 years, with the goal of enhancing parent-child interactions and improving child health and development and parental self-sufficiency.
The study, a collaboration between the Bureau of Evaluation and Research at the Office of Children & Family Services and the Center of Human Services Research of the State University of New York at Albany, included 1,173 Hispanic, African American, and white women. A total of 42% of the sample were included because screening identified them as being at risk for depression, and 9% were included because they had a history of substantiated child abuse or neglect. The remaining 49% were randomly assigned before 31 weeks' gestation.
The subjects were randomized to the HFNY intervention or to a control group that was given information and referrals to other services in the community. Baseline interviews were conducted shortly after randomization, with follow-up interviews at birth and annually up to 3 years post partum in this preliminary report. During these interviews, participants were asked about health insurance, primary care providers, birth outcomes, and child behavior.
Preliminary results up to 2 years post partum show significantly fewer premature babies, better pediatric health care, and less pediatric somatic complaints and behavior problems in Hispanic families receiving the HFNY intervention, compared with Hispanic controls who were offered information and referral only. The intervention did not improve these outcomes in white and African American families. Dr. Dumont speculated that this may demonstrate that the Hispanic population was most in need of this type of intervention because it may reduce the health care disparities between them and non-Hispanic families.
“Hispanic women in the control group were initially well connected to a primary care provider, but this connection weakened over the course of the study,” she said in an interview. By the end of the second year of the study, Hispanic controls were less likely than non-Hispanics to have a primary care provider (relative risk 0.92). In contrast, connection to health care was relatively strong for the non-Hispanic controls throughout the study, resulting in a disparity between the Hispanic and non-Hispanic controls. The HFNY intervention prevented this disparity from emerging, with Hispanic women retaining their connection to a primary care provider (RR 1.06). “HFNY demonstrates particular success in keeping Latina women connected to health care, [which] may promote positive child outcomes,” she said.
There was a reduction in premature births in treated Hispanic women, compared with Hispanic controls in the subgroup of 116 Hispanic women who were randomized before 31 weeks' gestation. Those receiving the HFNY intervention had a 7% rate of premature births, compared with 14% in controls. “Although marginally significant, probably due to the limited sample size, this difference was clinically meaningful,” said Dr. Dumont in an interview.
In addition, using the Child Behavior Checklist, the study found a reduced rate of pediatric somatic and behavior problems in the Hispanic intervention group, compared with Hispanic controls.
For affective problems, the average number of symptoms for Hispanic target children was 2.1, compared with 1.3 in controls. For pervasive developmental problems, the average number of symptoms for target children was 2.3, compared with 3.1 in controls. For attention deficit symptom, the average number of symptoms for target children was 4.4 vs. 5.1 in controls. And for somatic complaints, the average number of symptoms for target children was 0.5 vs. 1 in controls. The HFNY intervention also resulted in improved pediatric health care in the entire study population.