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Helping poor mothers and children.

This issue of JAMA contains 2 reports of randomized clinical trials showing that a nurse home-visit program has bettered the situations of disadvantaged mothers and their children. The trials are remarkable for demonstrating that the program improved not just poor mothers' infant care, but an array of health and social outcomes, as long as 15 years following childbirth. Olds et al 1 report that their program in Elmira, NY, reduced poor white women's subsequent pregnancies, child abuse and neglect, use of welfare, substance abuse problems, and crime and increased their labor force participation. Kitzman et al 2 report that the Elmira experiment, replicated in Memphis, Tenn, reduced poor black women's hypertension and subsequent pregnancies, improved home rearing environments for their children, and reduced the children's injuries. Such impressive findings from rigorous experiments suggest that a nationwide policy favoring nurse home visits based on models that have been tested and found