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April 21, 1999

Long-term Effects of Home Visits on Children's Behavior—Reply

Author Affiliations

Margaret A.WinkerMD, Deputy EditorIndividualAuthorPhil B.FontanarosaMD, Interim CoeditorIndividualAuthor

JAMA. 1999;281(15):1375-1377. doi:10-1001/pubs.JAMA-ISSN-0098-7484-281-15-jbk0421

In Reply: The first of Dr Dunn's points raises 2 issues. One concerns the validity of the estimate of program effects when study participants volunteered for the study. This is a classic problem addressed by randomization. Random assignment of patients to intervention or comparison services and high rates of follow-up participation in the current study eliminate systematic bias in favor of or against the intervention.

The second aspect concerns the application of these findings to the larger population of low-income, unmarried women who eventually might participate in such services. High rates of participation in the study (80% of the low-income pregnant women recruited) suggest that these findings apply to a large portion of women with these characteristics in central New York State. Moreover, many of the program benefits found early in life among whites in New York State1,2 can now be extended to low-income blacks living in a major urban area.3