***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
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    Input: OBJECTIVE . Our goal was to test the effect of prenatal and infancy home visits by nurses on  mothers ' fertility and children 's functioning 7 years after the program ended at child age 2 . METHODS . We conducted a r and omized , controlled trial in a public system of obstetric and pediatric care . A total of 743 primarily black women < 29 weeks ' gestation , with previous live births and at least 2 sociodemographic risk characteristics ( unmarried , < 12 years of education , unemployed ) , were r and omly assigned to receive nurse home visits or comparison services . Primary outcomes consisted of intervals between births of first and second children and number of children born per year ; mothers ' stability of relationships with partners and relationships with the biological father of the child ; mothers ' use of welfare , food stamps , and Medicaid ; mothers ' use of substances ; mothers ' arrests and incarcerations ; and children 's academic achievement , school conduct , and mental disorders . Secondary outcomes were the sequelae of subsequent pregnancies , women 's employment , experience of domestic violence , and children 's mortality . RESULTS . Nurse-visited women had longer intervals between births of first and second children , fewer cumulative subsequent births per year , and longer relationships with current partners . From birth through child age 9 , nurse-visited women used welfare and food stamps for fewer months . Nurse-visited children born to mothers with low psychological re sources , compared with control-group counterparts , had better grade -point averages and achievement test scores in math and reading in grade s 1 through 3 . Nurse-visited children , as a trend , were less likely to die from birth through age 9 , an effect accounted for by deaths that were attributable to potentially preventable causes . CONCLUSIONS . By child age 9 , the program reduced women 's rates of subsequent births , increased the intervals between the births of first and second children , increased the stability of their relationships with partners , facilitated children 's academic adjustment to elementary school , and seems to have reduced childhood mortality from preventable causes CONTEXT Home-visitation services have been promoted as a means of improving maternal and child health and functioning . However , long-term effects have not been examined . OBJECTIVE To examine the long-term effects of a program of prenatal and early childhood home visitation by nurses on women 's life course and child abuse and neglect . DESIGN R and omized trial . SETTING Semirural community in New York . PARTICIPANTS Of 400 consecutive pregnant women with no previous live births enrolled , 324 participated in a follow-up study when their children were 15 years old . INTERVENTION Families received a mean of 9 home visits during pregnancy and 23 home visits from the child 's birth through the second birthday . DATA SOURCES AND MEASURES : Women 's use of welfare and number of subsequent children were based on self-report ; their arrests and convictions were based on self-report and archived data from New York State . Verified reports of child abuse and neglect were abstract ed from state records . MAIN RESULTS During the 15-year period after the birth of their first child , in contrast to women in the comparison group , women who were visited by nurses during pregnancy and infancy were identified as perpetrators of child abuse and neglect in 0.29 vs 0.54 verified reports ( P<.001 ) . Among women who were unmarried and from households of low socioeconomic status at initial enrollment , in contrast to those in the comparison group , nurse-visited women had 1.3 vs 1.6 subsequent births ( P=.02 ) , 65 vs 37 months between the birth of the first and a second child ( P=.001 ) , 60 vs 90 months ' receiving Aid to Families With Dependent Children ( P=.005 ) , 0.41 vs 0.73 behavioral impairments due to use of alcohol and other drugs ( P=.03 ) , 0.18 vs 0.58 arrests by self-report ( P<.001 ) , and 0.16 vs 0.90 arrests disclosed by New York State records ( P<.001 ) . CONCLUSIONS This program of prenatal and early childhood home visitation by nurses can reduce the number of subsequent pregnancies , the use of welfare , child abuse and neglect , and criminal behavior on the part of low-income , unmarried mothers for up to 15 years after the birth of the first child OBJECTIVE The purpose of this study was to assess the contribution of depressive symptoms and poor contraceptive use early in the first postpartum year to the risk of unintended repeat pregnancy at the end of that year among adults with low educational status ( < 12th grade or equivalence ) . STUDY DESIGN This was a prospect i ve observational cohort study of 643 sexually active , low-income , inner-city adult women ( age > or = 19 ) who enrolled prenatally ( 14.7 + /- 6.9 weeks gestational age ) and were followed twice after delivery ( 3.3 + /- 1.3 months and 11.0 + /- 1.3 months ) . Associations were assessed by multivariate logistic regression . RESULTS Low educational status ( odds ratio , 2.32 ; 95 % CI , 1.25 - 4.33 ) and less effective contraceptive use ( odds ratio , 2.31 ; 95 % CI , 1.05 - 4.51 ) were associated with unintended pregnancy . Neither depressive symptoms nor contraceptive use reduced the risk of pregnancy that was associated with low educational status . CONCLUSION Low educational status was associated with more than twice the risk of unintended pregnancy 1 year after delivery . We found no evidence that depression or poor contraceptive use mediate this relationship OBJECTIVE To evaluate the efficacy and sustainability of a couple-focused human immunodeficiency virus ( HIV ) prevention intervention in reducing unprotected sex and increasing intent to use condoms and knowledge about AIDS . DESIGN R and omized controlled trial . SETTING Urban community setting s in Southern California . PARTICIPANTS Primarily Latino couples ( 168 couples ; 336 individuals ) who were aged 14 to 25 years , English or Spanish speaking , and coparenting a child at least 3 months of age . INTERVENTION A 12-hour theory-based , couple-focused HIV prevention program culturally tailored for young Latino parents , with emphasis on family protection , skill building , and issues related to gender and power . The 1½-hour control condition provided basic HIV-AIDS information . MAIN OUTCOME MEASURES Primary outcome measures included self-report of condom use during the past 3 months ; secondary , intent to use condoms and knowledge about AIDS . RESULTS The HIV prevention intervention reduced the proportion of unprotected sex episodes ( odds ratio , 0.87 per month from baseline to 6 months ; 95 % confidence interval [ CI ] , 0.82 - 0.93 ) and increased intent to use condoms ( slope increase , 0.20 ; 95 % CI , 0.04 - 0.37 ) at the 6-month follow-up ; however , these effects were not sustained at 12 months . Knowledge about AIDS was increased in both groups from baseline to 6 months ( slope estimate , 0.57 ; 95 % CI , 0.47 - 0.67 ) and was maintained in the intervention group only through 12 months . Female participants in both groups had higher intent to use condoms and knowledge about AIDS than male participants ( P ≤ .01 ) . CONCLUSIONS The couple-focused HIV prevention intervention reduced risky sexual behaviors and improved intent to use condoms among young Latino parents at the 6-month evaluation . A maintenance program is needed to improve the sustainability of effects over time CONTEXT Women with multiple pregnancies in adolescence may experience medical , psychological and social complications . Improved underst and ing of the individual- , dyad- , family- , peer/community- and social system-level risk factors for repeat pregnancy may lead to the development of more effective prevention strategies for adolescent mothers in a variety of setting s. METHODS Between 1993 and 1996 , white , black and Mexican American adolescent mothers at a labor and delivery unit in Texas were interviewed after delivery and completed written surveys prospect ively for up to 48 months . Logistic regression analyses were used to determine predictors of repeat pregnancy within 24 months , using social ecological theory as a guide . RESULTS Forty-two percent of adolescent mothers experienced a repeat pregnancy within 24 months ; 73 % of these delivered a second child . Individual-level predictors were planning to have another baby within five years ( odds ratio , 1.6 ) and not using long-acting contraceptives within three months of delivery ( 2.4 ) . Dyad-level predictors were not being in a relationship with the father of the first child three months after delivery ( 2.0 ) , being more than three years younger than the first child 's father ( 1.6 ) and experiencing intimate partner violence within three months after delivery ( 1.9 ) . Peer/community-level predictors were not being in school three months postpartum ( 1.8 ) and having many friends who were adolescent parents ( 1.5 ) . CONCLUSION Adolescent mothers are at high risk for a rapid subsequent pregnancy . Interventions that address the complex and multifaceted aspects of the lives of adolescent mothers are needed to prevent repeat pregnancy OBJECTIVE To examine the effectiveness of home visiting by paraprofessionals and by nurses as separate means of improving maternal and child health when both types of visitors are trained in a program model that has demonstrated effectiveness when delivered by nurses . METHODS A r and omized , controlled trial was conducted in public- and private-care setting s in Denver , Colorado . One thous and one hundred seventy-eight consecutive pregnant women with no previous live births who were eligible for Medicaid or who had no private health insurance were invited to participate . Seven hundred thirty-five women were r and omized to control , paraprofessional , or nurse conditions . Nurses completed an average of 6.5 home visits during pregnancy and 21 visits from birth to the children 's second birthdays . Paraprofessionals completed an average of 6.3 home visits during pregnancy and 16 visits from birth to the children 's second birthdays . The main outcomes consisted of changes in women 's urine cotinine over the course of pregnancy ; women 's use of ancillary services during pregnancy ; subsequent pregnancies and births , educational achievement , workforce participation , and use of welfare ; mother-infant responsive interaction ; families ' home environments ; infants ' emotional vulnerability in response to fear stimuli and low emotional vitality in response to joy and anger stimuli ; and children 's language and mental development , temperament , and behavioral problems . RESULTS Paraprofessional-visited mother-child pairs in which the mother had low psychological re sources interacted with one another more responsively than their control-group counterparts ( 99.45 vs 97.54 st and ard score points ) . There were no other statistically significant paraprofessional effects . In contrast to their control-group counterparts , nurse-visited smokers had greater reductions in cotinine levels from intake to the end of pregnancy ( 259.0 vs 12.32 ng/mL ) ; by the study child 's second birthday , women visited by nurses had fewer subsequent pregnancies ( 29 % vs 41 % ) and births ( 12 % vs 19 % ) ; they delayed subsequent pregnancies for longer intervals ; and during the second year after the birth of their first child , they worked more than women in the control group ( 6.83 vs 5.65 months ) . Nurse-visited mother-child pairs interacted with one another more responsively than those in the control group ( 100.31 vs 98.99 st and ard score points ) . At 6 months of age , nurse-visited infants , in contrast to their control-group counterparts , were less likely to exhibit emotional vulnerability in response to fear stimuli ( 16 % vs 25 % ) and nurse-visited infants born to women with low psychological re sources were less likely to exhibit low emotional vitality in response to joy and anger stimuli ( 24 % vs 40 % and 13 % vs 33 % ) . At 21 months , nurse-visited children born to women with low psychological re sources were less likely to exhibit language delays ( 7 % vs 18 % ) ; and at 24 months , they exhibited superior mental development ( 90.18 vs 86.20 Mental Development Index scores ) than their control-group counterparts . There were no statistically significant program effects for the nurses on  women 's  use of ancillary prenatal services , educational achievement , use of welfare , or their children 's temperament or behavior problems . For most outcomes on which either visitor produced significant effects , the paraprofessionals typically had effects that were about half the size of those produced by nurses . CONCLUSIONS When trained in a model program of prenatal and infancy home visiting , paraprofessionals produced small effects that rarely achieved statistical or clinical significance ; the absence of statistical significance for some outcomes is probably attributable to limited statistical power to detect small effects . Nurses produced significant effects on a wide range of maternal and child outcomes PURPOSE To compare effects of an early intervention program ( EIP ) of intense home visitation by public health nurses ( PHNs ) with effects of traditional public health nursing care ( TPHN ) on infant health and selected maternal outcomes of adolescent mothers . METHODS EIP adolescents ( N = 102 ) received preparation-for-motherhood classes and individual home visits  ( from pregnancy through 1 year postpartum ) from PHNs employed in a county 
    Output:
    
DISCUSSION Effective programs to support expectant and parenting teens have diverse characteristics , indicating there is no single approach for promoting teens ' education and healthy birth spacing .