NURSE-FAMILY PARTNERSHIP
OVERVIEW
The Nurse-Family Partnership (NFP) is a home visiting-based program intended to promote the well-being of first-time, low-income mothers and their children. Services such as home visiting by trained nurses, referrals to community resources, and the development of within-family resources are provided through the child's second birthday. Experimental evaluations indicate that participation in NFP has positively impacted poor, unmarried mothers' outcomes (e.g., education, employment, reproductive, mental health), and their sons' and daughters' outcomes as children (e.g., social, language, and cognitive development) and years later as teenagers (e.g., criminal/behavior problems and substance use). Participants who were poor and unmarried experienced many positive outcomes (as described below); participants who were not poor and unmarried experienced positives outcomes as well, however, these impacts were not as diverse or extensive.
DESCRIPTION OF PROGRAM
Target population: First-time low-income mothers and their families; especially women under age 19
The Nurse-Family Partnership (NFP)-formerly known as the Nurse Home Visitation Program-is a program designed to improve the well-being of first time low-income mothers and their children. Specifically, the program is designed to (a) improve pregnancy outcomes by helping women alter health-related behaviors such as smoking, alcohol consumption, and drug use, (b) improve child health and development by teaching parents how to provide more responsible and competent care, and (c) improve families' economic self-sufficiency by helping parents plan for future pregnancies, further their education, and secure employment. The program focuses on small, achievable goals that can be accomplished between nurse visits.
Program components are provided through the child's second birthday and include home visits by trained nurses, referrals to community resources, and supervision of visiting nurses by an NFP nurse supervisor. Home visits by nurses begin during pregnancy. During these visits, the nurse encourages the mother to change behaviors which may lead to poor pregnancy outcomes such as smoking, poor nutrition and drinking. The nurse also educates the mother on how to recognize signs of pregnancy complications and helps the mother build supportive relationships with family and friends. After the child is born, the nurse helps the parents provide better care (i.e., by observing signs of illness and interacting with the child in cognitively stimulating ways) and plan for potential future pregnancies. Last, the nurse links the family with other health services they may need and encourages the parents to continue their education and find work.
The Nurse-Family Partnership was established in 1977 as a research demonstration project in Elmira, N.Y. by David Olds and colleagues. The program has expanded to serve between 9,000 and 10,000 families in 23 different states annually (per Peggy Hill, Deputy Director, National Center for Children, Families and Communities at the University of Colorado). NFP is operated out of the National Center for Children, Families and Communities at the University of Colorado. Staff from the Center provide guidance to communities looking to implement Nurse-Family Partnership.
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Component |
Provided by |
Duration |
Description |
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Home visits |
Nurses who work for the department of health, visiting nurse associations, or hospitals. Nurses are trained in a 2-week course and carry a caseload of no more than 25 families. |
Visits begin during the second trimester of pregnancy and continue through to 2 years following birth. Visits typically occur weekly to monthly and last 75 to 90 minutes each. |
A nurse home visitor is assigned to the family and works with that family for the duration of the program. Nurses help parents address three areas: improvement of the mother's development, the care the parents provide their child, and the family's pregnancy planning, educational achievement, and participation in the workforce. Nurses provide a comprehensive educational program designed to help parents provide better care for their child. Nurses also help parents clarify goals, develop problem-solving skills, and develop support systems of family and friends who may be able to help them care for their child. |
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Resource referral |
Nurses |
Throughout the program |
The nurses help parents connect with various community resources as well as involve other family members in caring for the child. |
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Nursing supervision |
Nurse supervisor |
Throughout the program |
The nurse supervisor provides guidance to visiting nurses and oversees program implementation. He/she organizes individual supervisory conferences as well as weekly group conferences as well. |
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Costs: Average annual cost to implement NFP is roughly $3,200 per family during the startup phase of the program (first 3 years) and drops off to $2,800 per family after the program has established itself. The extra cost associated with the startup phase is due employee training and decreased efficiency. As of May, 2009, according to the NFP website (PDF), the program costs $4,500 per family per year with a range throughout the country of $2,914 - $6,463 per family per year.
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EVALUATION(S) OF PROGRAM
Olds, D. L., Henderson Jr., C. R., Tatelbaum, R., & Chamberlin, R. (1988).
Improving the life-course development of socially disadvantaged mothers: A
randomized trial of nurse home visitation. American Journal of Public Health,
78(11), 1436-1445.
Evaluated population: 354 women from a small, semi-rural Appalachian
region of New York State who were pregnant with what would be their first child.
Program staff specifically targeted mothers who were under 19, unmarried, from a
low SES family, and less than 25 weeks pregnant; however, they allowed women
without these characteristics (roughly 15% of the participant group) to enroll
as long as they were first-time mothers.
Approach: Women were enrolled in the program in the first 30 weeks of
pregnancy. Program evaluators randomly assigned 165 women to one of two control
groups that were later combined into one control group; 90 women were randomly
assigned to an experimental group that received home visits only during
pregnancy (pregnancy group), and 99 women were randomly assigned to an
experimental group that received home visits during pregnancy and 2 years into
the child's life (pregnancy/infancy group). Interviews of the women were
conducted at the time of registration for the program and again at the 6th,
10th, 22nd, and 46th months of the children's lives. Records from county
departments of social services were also used for data.
Results: At the 6-month interview, 59 percent of the pregnancy/infancy
group and 27 percent of the control group had graduated from or enrolled in an
educational program. This difference was statistically significant (p < .05). At
the 10-month interview, the program no longer had an effect that reached
significance, but unmarried women receiving the intervention appeared to still
be more likely to graduate from or enroll in an educational program. Among
unmarried women, 60 percent of the pregnancy/infancy group and 31 percent of the
control group had graduated from school or enrolled in an educational program.
At the 22-month and 46-month interviews there were no differences among the
three groups. Throughout the follow-ups, there were no education differences
between the pregnancy group and the control group.
At the 22-month interview, poor, unmarried women in the pregnancy/infancy group
had worked 2.5 times longer than poor, unmarried women in the control group. At
the 46-month interview, poor, unmarried women in both experimental groups had
worked longer on average than poor, unmarried women in the control group.
Poor, unmarried women in the pregnancy/infancy group were less likely to have
had a subsequent pregnancy at the 22-month follow-up than their counterparts in
the control group. Poor, unmarried women in the pregnancy/infancy group had an
average of .17 subsequent pregnancies, and those in the control group had an
average of .51 subsequent pregnancies. At the 46-month interview, women in the
three groups were equally as likely to have had subsequent pregnancies. For
poor, unmarried women, however, those in the pregnancy/infancy group were less
likely to have had a subsequent pregnancy (0.58 pregnancies) than their
counterparts in the control group (1.02 pregnancies).
Poor, unmarried women in the experimental groups were 82 percent more likely to
be employed, had 43 percent fewer subsequent pregnancies, and delayed a
subsequent pregnancy 12 months longer than their control counterparts. The
researchers state that the nurse home visitation seems to shift a parent's focus
from education to gaining employment. Overall, the effects of the program were
stronger for women in the pregnancy/infancy group than for those in the
pregnancy group.
Olds, D., Henderson Jr., C., Cole, R., Eckenrode, J., Kitzman, H., & Luckey,
D. (1998). Long-term effects of nurse home visitation on children's criminal and
antisocial behavior: 15-year follow-up of a randomized controlled trial. Journal
of the American Medical Association, 280(14), 1238-1244.
Evaluated population: Children of mothers in the Nurse Home Visitation
program (now called the Nurse-Family Partnership) from April 1978 through
September 1980 in Elmira, N.Y. (see above study).
Approach: The objective of the study was to examine the long-term impacts
of the Nurse Home Visitation Program on children 15 years after the
program-specifically, the impacts on children's antisocial behavior. Data were
gathered from 148 of the control group's children and 176 of the experimental
group's children. The mothers of 79 of the children in the experimental group
had received nurse visits from pregnancy through the child's birth (the
"pregnancy group") and the mothers of 97 had received nurse visits from
pregnancy until the child's second birthday (the "pregnancy/infancy group").
Measurement instruments used were children's self-reported delinquency, school
records of suspension, teachers' reports of behavior in school, parent's report,
Achenbach Youth Self-Report of Problem Behaviors, and county records.
Results: This study showed few statistically significant findings, but
the program seems to be effective for those in the low-SES, unmarried subgroup.
Children in the pregnancy/infancy group reported significantly fewer arrests
(.16-.17 arrests for the intervention groups and .36 arrests for the control
group). However, children in this group also reported significantly more police
stops from birth to age 15 than children in the other groups (an average of 2.25
stops vs. 0.53 stops for the pregnancy group and 0.80 stops for the control
group). The researchers attribute this higher number of police stops to sampling
or reporting bias. Children in the pregnancy/infancy group also reported
significantly fewer convictions and violations of probation (0.10
convictions/probation violations vs. .06 for the pregnancy group and .27 for the
control group). These impacts were strongest for children of poor, unmarried
mothers from low SES families. Among children in this subgroup, those in the
pregnancy/infancy group experienced an average of 1.46 stops by police, 0.20
arrests, and 0.09 convictions or violations of probation. For children in the
pregnancy group, these numbers were 0.78, 0.15, and 0.07, respectively; for
children in the control group, they were 1.16, 0.45, and 0.47, respectively.
Children in both experimental groups who were born to poor, unmarried mothers
from low SES backgrounds reported smoking significantly fewer cigarettes per day
than their counterparts in the control group. Children in the pregnancy/infancy
group reported smoking 1.5 cigarettes, children in the pregnancy group 1.32
cigarettes, and children in the control group 2.5 cigarettes. Children in the
pregnancy/infancy group born to poor, unmarried mothers from low SES backgrounds
reported consuming alcohol on significantly fewer days in the last 6 months than
the control group. Children in the pregnancy/infancy group reported drinking
alcohol an average of 1.09 days and children in the control group reported an
average of 2.49 days. Children in the pregnancy subgroup reported drinking
alcohol an average of 1.84 days, a difference that is not statistically
significant.
Low SES, unmarried mothers in the pregnancy group reported significantly fewer
behavioral problems for their children due to alcohol and drug use (0.15
problems) than their counterparts in either the pregnancy/infancy group (0.62
problems) or the control group (0.34 problems). Teacher reports did not indicate
differences among the three groups in school behavior.
Olds, D. L., Robinson, J., O'Brien, R., Luckey, D. W., Pettitt, L. M.,
Henderson Jr., C. R., Ng, R. K., Sheff, K. L., Korfmacher, J., Hiatt, S., &
Talmi, A. (2002). Home visiting by paraprofessionals and by nurses: A
randomized, controlled trial. Pediatrics, 110(3), 486-496.
Evaluated population: 735 low-income women from 21 clinics in the
Denver, CO, area. Women in the study had no previous live births and either
qualified for Medicaid or had no private health insurance. Women were randomly
assigned to one of two experimental groups or a control group: 245 women
received home visits from a paraprofessional, 235 received home visits from a
nurse, and 255 women were assigned to the control group.
Approach: The objective of the study was to determine the effectiveness
of the Olds model of home visiting by paraprofessionals and by nurses.
Measurement instruments used were interviews with the mothers, analysis of
videotapes of mother-infant interactions at all lab and home postpartum
assessments, analysis of videotapes of infants' emotional reactivity, and the
Mental Development Index was used to assess the child's functioning at the 24
month follow-up. It should be noted that women in the nurse group received
significantly more home visits than women in the paraprofessional group: an
average of 6.5 visits during pregnancy and 21 home visits during infancy vs. an
average of 6.3 home visits during pregnancy and 16 home visits during infancy
for the paraprofessional group.
Results: Women in the group seen by paraprofessionals showed a slight
trend toward fewer subsequent pregnancies or births in the 24 months following
delivery, compared with the control group. 33% of women in the paraprofessional
group had a subsequent pregnancy at 24 months compared with 41% in the control
group and 13% of women in the paraprofessional group had a subsequent birth
compared with 19% in the control group. Women classified as having low resources
in the paraprofessional group had significantly higher scores on measures of
mother-infant responsive interaction (99.45) than their counterparts in the
control group (97.54).
In the group seen by nurses, women who smoked at the start of the intervention
had significantly greater reductions (259.00 ng/mL) in nicotine levels than
smokers in the control group (12.32 ng/mL). Women in the nurse-visited group
were significantly less likely to have a subsequent birth or pregnancy in the 24
months following delivery than women in the control group. 29% of women in the
nurse-visited group had a subsequent pregnancy at 24 months compared with 41% in
the control group and 12% of women in the nurse-visited group had a subsequent
birth compared with 19% in the control group. Women in the nurse group were
employed for longer periods on average (6.83 months) in the second year
following delivery than women in the control group (5.65 months). Women in the
nurse group showed significantly higher levels of mother-infant responsive
interaction (mean score=100.31) than women in the control group (mean
score=98.99). Furthermore, children of women in the nurse-visited group were
less likely to exhibit emotional vulnerability to fear stimuli (16%) than
children of women in the control group (25%). Children in the nurse group were
also less likely to exhibit low emotional vitality to anger stimuli (13%) than
children in the control group (32%). Children in the nurse-visited condition
were also significantly less likely to have language delays (6%) at 21 months
compared with the control group (12%). Children who were born to mothers with
low psychological resources in the nurse-visited group had higher levels of
language development (101.52) at age 21 months than children in the control
group (96.85) and higher mental development at 24 months (90.18 for
nurse-visited, 86.20 for control).
Children in paraprofessional-visited conditions had lower language development
compared with children who were visited by nurses. Other than this difference,
there were no significant impacts observed between the two interventions.
Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R.
K., Isacks, K., Sheff, K., & Henderson Jr., C. R. (2004). Effects of home visits
by paraprofessionals and by nurses: Age 4 follow-up results of a randomized
trial. Pediatrics, 114(6), 1560-1568.
Evaluated Population: 735 women who presented at 21 antepartum
clinics in low-income areas of Denver. To qualify for the study, women had to
have no previous live births and had to either qualify for Medicaid or have no
private insurance. Across the three conditions, 14-16% of women were
African-American, 44-47% were Mexican-American, and 33-37% were Caucasian. The
average age of the women ranged from 19.46-20.14 years. 10.97-20.75% of
participants were below the poverty line and the average annual income of
participants was between $12,792-13,566.
Approach: Participants were randomly assigned to conditions in a 3 strata
randomization process based on race, gestational age at enrollment, and region.
Women in the control condition received free developmental screenings and
referrals for their children at 6, 12, 15, 21, and 24 months (N=255). Women in
the paraprofessional-visitation treatment condition received free screenings and
the same referrals for their children along with paraprofessional home visits
during the pregnancy up until the child was two years old (N=245). Women in the
nurse-visitation treatment condition received the same intervention as the
paraprofessional condition except that home visitation was done by a registered
nurse (N=235).
Mothers were assessed on self-report measures of general intelligence, mental
health, sense of mastery, subsequent pregnancy outcomes, educational
achievement, number of months working, use of welfare, marriage and cohabitation
status, alcohol and marijuana use, and experiences of physical violence.
Children were assessed using mother-reported measures of externalizing behavior,
rule-breaking, aggressive behavior, and whether they were in some form of care
(school or day care). Children's home environment, language use, motor control,
and behavior/emotion regulation were additional measures assessed by
researchers.
Results: At the two year follow-up data collection women in the
paraprofessional- condition were less likely to be married (32.2%) or live with
the child's biological father (32.7%) compared with women in the control
condition (44.0% married and 43.1% living with child's biological father). Women
in the paraprofessional-visited condition (15.13 months) worked more than those
in the control condition (13.38 months) at the 2-year follow-up. Women in the
paraprofessional-visited condition also had a higher sense of mastery (101.25)
and overall level of mental health (101.21) compared with the control condition
(99.31, 99.16). No significant impacts were found for the
paraprofessional-visited condition on educational achievement, welfare use,
marijuana and alcohol use, or domestic violence. Women in the nurse-visited
condition had longer intervals between their pregnancy at the start of the study
and subsequent births (24.51 months) compared with the control condition (20.39
months). At the four year follow-up interval, women in the nurse-visited
condition were less likely to experience domestic violence (6.9%) and were also
less likely to enroll their children in preschool or day care programs (59.4%)
compared with the control condition (13.6% experienced domestic violence, 65.9%
enrolled children in preschool or day care). The nurse-visited conditions did
not have any effect on educational achievement, employment, welfare use, mental
health, sense of mastery, use of alcohol or marijuana, and marriage or
cohabitation status.
Children in the paraprofessional-visited condition had more responsive mothers
(100.92) and more supportive home environments (24.63) compared to children in
the control condition (98.66 responsiveness score and 23.35 home environment
score). The paraprofessional-visited condition did not have any impact on
language development, executive functioning, emotional regulation, behavior, or
mother-reported externalizing behavior. When mothers' had low psychological
resources, children in the nurse-visited condition had more supportive home
environments (24.61), better language development (91.39), superior executive
functioning (100.16), and better researcher-rated behavior (100.41) compared
with children in the control condition (respective scores of 23.35, 86.73,
95.48, 96.66). Nurse-visitation did not have any impacts on mother-child
interaction, emotional regulation, or externalizing behavior.
Olds, D. L., Kitzman, H., Cole, R., Robinson, J., Sidora, K., Luckey, D. W.,
Henderson Jr., C. R., Hanks, C., Bondy, J., & Holmberg, J. (2004). Effects of
nurse home-visiting on maternal life course and child development: Age 6
follow-up results of a randomized trial. Pediatrics, 114(6), 1550-1559.
Evaluated Population: 1139 women from the Memphis area who were
pregnant and less than 29 weeks into the gestation period. Women had to have at
least two of the following risk factors to be included in the study: unmarried,
less than 12 years of education, or unemployed. Participants also had to have no
previous live births and no known conditions which would contribute to fetal
growth retardation or preterm delivery. 92% of participants were
African-American, 98% were unmarried, 64% were under the age of 18, and 85% were
from federally defined poverty-level households.
Approach: Participants were randomly assigned to one of four treatment
conditions. The first treatment consisted of free taxicabs to scheduled prenatal
care appointments (N=166). Treatment 2 received free cab fares and received
developmental screening and referrals for the child at 6, 12, & 24 months
(N=515). Treatment 3 received free cab fares and nurse home-visiting services (NFP)
during the pregnancy, 1 postpartum visit before discharge, and 1 visit at home
post-birth (N=230). Treatment 4 received the same services as treatment 3 but
children were visited by nurses until the age of 2 (N=228). Data from treatments
2 and 4 were analyzed in this study. The researchers collected data on children
when they had completed at least 7 months of kindergarten at follow-up intervals
of 4.5 and 6 years after mothers' initial intake into the study.
Mothers were assessed on self-report measures of number and timing of subsequent
pregnancies and births, substance use, behavioral problems, educational
achievement, employment status, occupational type, welfare/food stamp/Medicaid
receipt, marriage and cohabitation, duration of relationships, current partner's
education, partner's employment, partner's social class, domestic violence since
the birth of the first child, and current partner's relation to the child.
Children were assessed using mother-reported measures of internalizing and
externalizing behavior problems. Classroom behavior of students and school
engagement were measured through teacher reports. Children also responded to 8
open ended stories and the content of their responses were analyzed to determine
the presence of aggressive content/behavior, coherency and consistency, and
parental warmth and empathy.
Results: Mothers in the nurse-visited condition had fewer pregnancies and
longer intervals between first and second births (1.16 pregnancies and 34.28
month interval) than mothers in the control condition (1.38 pregnancies and
30.23 month interval). Participants in the nurse-visited condition received
welfare and food stamps for fewer months (7.21 months on welfare, and 9.67
months on food stamps) compared with participants in the control condition (8.96
months on welfare, and 11.50 months on food stamps). Participants in the
nurse-visited condition also had longer relationships with their current
partners (54.36 months) compared with the control group (45.00 months). No
impacts of treatment were found on measures of mother's sense of mastery, mental
health, education, employment, whether married or in an other partnered
relationship, living with father of the child, outcomes of subsequent
pregnancies, current partner's education or socioeconomic status, drug use, or
domestic violence experience since first birth.
Children in the nurse-visited condition had higher scores of intellectual
functioning (92.34) and receptive language (84.32) compared with the control
group (90.24, 82.13). Mothers reported fewer children with problems (1.8%) in
borderline or clinical range on the Child Behavior Checklist compared with
children in the control group (5.4%). Children of mothers with low psychological
resources benefited in other ways from the intervention. Children in the
nurse-visited condition had higher arithmetic scores (88.61) compared with
children in the control condition (85.42). Children in the intervention
condition also had less dysregulated aggression evident in their open-ended
story (98.58) and these stories were more often coherent (20.90) when compared
with the stories told by children in the control group (101.10 for mean
aggression and 29.84 mean incoherency score). No impacts of treatment were found
on measures of child internalizing or externalizing behaviors, evidence of
empathy in stories, reading achievement, or on teacher-reported behavior.
SOURCES FOR MORE INFORMATION
References
Marcenko, M. O., & Spence, M. (1994). Home visitation services for at-risk
pregnant and postpartum women: A randomized trial. American Journal of
Orthopsychiatry, 64(3), 468-478.
Olds, D. (1999). The Nurse Home Visitation Program. The Future of Children,
9(1), 190-191.
Olds, D.L., Henderson, C.R., Chamberlin, R., & Tatelbaum, R. (1986). Preventing
child abuse and neglect: A randomized trial of nurse home visitation.
Pediatrics, 78(1), 65-78.
Olds, D., Henderson Jr., C., Cole, R., Eckenrode, J., Kitzman, H., & Luckey, D.
(1998). Long-term effects of nurse home visitation on children's criminal and
antisocial behavior: 15-year follow-up of a randomized controlled trial. Journal
of the American Medical Association, 280(14), 1238-1244.
Olds, D. L., Henderson Jr., C. R., Tatelbaum, R., & Chamberlin, R. (1988).
Improving the life-course development of socially disadvantaged mothers: A
randomized trial of nurse home visitation. American Journal of Public Health,
78(11), 1436-1445.
Olds, D. L., Hill, P., & Rumsey, E. (1997). Prenatal and early childhood nurse
home visitation. Office of Juvenille Justice and Delinquency Prevention: Issue
No. NCJ172875.
Olds, D. L., Kitzman, H., Cole, R., Robinson, J., Sidora, K., Luckey, D. W.,
Henderson Jr., C. R., Hanks, C., Bondy, J., & Holmberg, J. (2004). Effects of
nurse home-visiting on maternal life course and child development: Age 6
follow-up results of a randomized trial. Pediatrics, 114, 1550-1559.
Olds, D. L., Robinson, J., O'Brien, R., Luckey, D. W., Pettitt, L. M., Henderson
Jr., C. R., Ng, R. K., Sheff, K. L., Korfmacher, J., Hiatt, S., & Talmi, A.
(2002). Home visiting by paraprofessionals and by nurses: A randomized,
controlled trial. Pediatrics, 110(3), 486-496.
Olds, D. L., Robinson, J., Pettitt, L., Luckey, D. W., Holmberg, J., Ng, R. K.,
Isacks, K., Sheff, K., & Henderson Jr., C. R. (2004). Effects of home visits by
paraprofessionals and by nurses: Age 4 follow-up results of a randomized trial.
Pediatrics, 114, 1560-1568.
Website:
http://www.nursefamilypartnership.org/index.cfm?fuseaction=home
Program also discussed in the following Child Trends publication(s):
Hair, E., Ling, T., & Cochran, S. W. (2003). Youth development programs serving
educationally disadvantaged youth: A synthesis of experimental evaluations.
Washington, DC: Child Trends.
Halle, T., Zaff, J., Calkins, J., & Margie, N. G. (2000). Background for
community-level work on school readiness: A review of definitions, assessments,
and investment strategies. Part II: Reviewing the literature on contributing
factors to school readiness. Washington, DC: Child Trends, Inc.
Program categorized in this guide according to the following:
Evaluated participant ages: birth to age 15 for children and 15-24 years for
mothers / Program age ranges in the guide: early childhood, mid-childhood,
adolescence, youth, young adults
Program components: child care/early childhood education, clinic/provider based,
home visiting, parent or family component
Measured outcomes: educational and cognitive development, social and emotional
health, life skills, physical health, behavioral problems, teen pregnancy and
reproductive health, mental health
KEYWORDS: Home Visitation, Low-Income Families, Education, Employment,
Reproductive Health, Gender Specific (Female Only), Teen Pregnancy, Substance
Abuse, Life Skills Training, Social Emotional Health and Development, Child
Care, Rural, Adolescents, Youth, Children, Young Adults (18-24), Internalizing
and Externalizing Behavior Problems, School Engagement, Academic Achievement,
Infants, Toddlers, Early Childhood (0-5), Middle Childhood (6-11), Early
Childhood Education, Clinic-Based, Provider-Based, Delinquency, Behavioral
Problems, Mental Health, African American or Black, Hispanic or Latino,
Caucasian or White, Adolescence (12-17), Education, Social Supports,
Self-Esteem, Violence, Marital Status, Cognitive Development, Physical Health.
Program information last updated 3/14/07
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