A two-level hierarchical linear model was used to investigate the impact of poor community health and maternal isolation on mothers' active engagement in a home-visiting family support program. Data came from 4,057 mothers with firstborn infants who enrolled in the Oregon Healthy Start (OHS) home-visiting program from 1995 through 1998. At the time of this study OHS operated in 15 Oregon counties. Results showed that if the mother was living in a county that displayed poor community health, or if the mother was isolated from immediate family and friendship networks, the likelihood of actively engaging in home visits was significantly reduced. Implications for programming and study limitations are discussed.
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