Nicole L A Catherine1, Michael Boyle1, Yufei Zheng1, Lawrence McCandless1, Hui Xie1, Rosemary Lever1, Debbie Sheehan1, Andrea Gonzalez1, Susan M Jack1, Amiram Gafni1, Lil Tonmyr1, Lenora Marcellus1, Colleen Varcoe1, Ange Cullen1, Kathleen Hjertaas1, Caitlin Riebe1, Nikolina Rikert1, Ashvini Sunthoram1, Ronald Barr1, Harriet MacMillan1, Charlotte Waddell2. 1. Children's Health Policy Centre, Faculty of Health Sciences (Catherine, Zheng, Lever, Sheehan, Cullen, Hjertaas, Riebe, Rikert, Sunthoram, Waddell), Simon Fraser University, Vancouver, BC; Offord Centre for Child Studies, Faculty of Health Sciences (Boyle, Gonzalez, Jack, MacMillan), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (McCandless, Xie), Simon Fraser University, Burnaby, BC; Arthritis Research Canada (Xie), Richmond, BC; School of Nursing, Faculty of Health Sciences (Jack) and Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Gafni), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Tonmyr), Ottawa, Ont.; School of Nursing (Marcellus), University of Victoria, Victoria, BC; School of Nursing (Varcoe); Department of Pediatrics (Barr), Faculty of Medicine, University of British Columbia, Vancouver, BC. 2. Children's Health Policy Centre, Faculty of Health Sciences (Catherine, Zheng, Lever, Sheehan, Cullen, Hjertaas, Riebe, Rikert, Sunthoram, Waddell), Simon Fraser University, Vancouver, BC; Offord Centre for Child Studies, Faculty of Health Sciences (Boyle, Gonzalez, Jack, MacMillan), McMaster University, Hamilton, Ont.; Faculty of Health Sciences (McCandless, Xie), Simon Fraser University, Burnaby, BC; Arthritis Research Canada (Xie), Richmond, BC; School of Nursing, Faculty of Health Sciences (Jack) and Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences (Gafni), McMaster University, Hamilton, Ont.; Public Health Agency of Canada (Tonmyr), Ottawa, Ont.; School of Nursing (Marcellus), University of Victoria, Victoria, BC; School of Nursing (Varcoe); Department of Pediatrics (Barr), Faculty of Medicine, University of British Columbia, Vancouver, BC charlotte_waddell@sfu.ca.
Abstract
BACKGROUND:Nurse-Family Partnership (NFP) involves public health nurses providing frequent home visits from early pregnancy until children reach age 2 years, focusing on first-time parents experiencing socioeconomic disadvantage. Our aim was to evaluate NFP's effectiveness in improving child and maternal health. METHODS: We conducted an analysis of prenatal secondary outcomes in an ongoing randomized controlled trial in British Columbia; the data used in this analysis were collected from January 2014 to May 2017. Participants were pregnant girls and women aged 14-24 years who were preparing to parent for the first time and experiencing socioeconomic disadvantage. They were randomly allocated 1:1 to the intervention (NFP plus existing services) or control group (existing services). Prespecified prenatal secondary outcome indicators were changes in use of nicotine cigarettes and alcohol use by 34-36-weeks' gestation. We also report on prespecified exploratory cannabis and street drug use measures. We used mixed-effect models for longitudinal and clustered data to estimate intervention effects. Analyses were by intention to treat. RESULTS: The median gestational age at baseline for the 739 participants (368 participants in the intervention group, 371 in the comparison group) was 20 weeks, 6 days. By 34-36 weeks' gestation, NFP significantly reduced cigarette counts (over the past 2 d) (difference in changes [DIC] of count -1.6, 95% confidence interval [CI] -6.4 to -1.3) in those who smoked. NFP also significantly reduced rates of prenatal cannabis use (DIC -6.4, 95% CI -17.0 to -1.7), but not rates of street drug or "any" substance use. While we observed decreased rates of cigarette and alcohol use in both groups (DIC of proportions -2.8, 95% CI -15.3 to 0.6; DIC -0.5, 95% CI -8.7 to 1.8, respectively), these changes were not statistically significant. INTERPRETATION: We found no evidence that NFP was effective in reducing rates of prenatal cigarette and alcohol use; however, it led to reduced prenatal cannabis use, and in smokers it led to modest reductions in cigarette use. NFP may therefore hold promise for reducing some types of prenatal substance use in disadvantaged populations. Trial registration: ClinicalTrials.gov, no. NCT01672060. Copyright 2020, Joule Inc. or its licensors.
RCT Entities:
BACKGROUND: Nurse-Family Partnership (NFP) involves public health nurses providing frequent home visits from early pregnancy until children reach age 2 years, focusing on first-time parents experiencing socioeconomic disadvantage. Our aim was to evaluate NFP's effectiveness in improving child and maternal health. METHODS: We conducted an analysis of prenatal secondary outcomes in an ongoing randomized controlled trial in British Columbia; the data used in this analysis were collected from January 2014 to May 2017. Participants were pregnant girls and women aged 14-24 years who were preparing to parent for the first time and experiencing socioeconomic disadvantage. They were randomly allocated 1:1 to the intervention (NFP plus existing services) or control group (existing services). Prespecified prenatal secondary outcome indicators were changes in use of nicotine cigarettes and alcohol use by 34-36-weeks' gestation. We also report on prespecified exploratory cannabis and street drug use measures. We used mixed-effect models for longitudinal and clustered data to estimate intervention effects. Analyses were by intention to treat. RESULTS: The median gestational age at baseline for the 739 participants (368 participants in the intervention group, 371 in the comparison group) was 20 weeks, 6 days. By 34-36 weeks' gestation, NFP significantly reduced cigarette counts (over the past 2 d) (difference in changes [DIC] of count -1.6, 95% confidence interval [CI] -6.4 to -1.3) in those who smoked. NFP also significantly reduced rates of prenatal cannabis use (DIC -6.4, 95% CI -17.0 to -1.7), but not rates of street drug or "any" substance use. While we observed decreased rates of cigarette and alcohol use in both groups (DIC of proportions -2.8, 95% CI -15.3 to 0.6; DIC -0.5, 95% CI -8.7 to 1.8, respectively), these changes were not statistically significant. INTERPRETATION: We found no evidence that NFP was effective in reducing rates of prenatal cigarette and alcohol use; however, it led to reduced prenatal cannabis use, and in smokers it led to modest reductions in cigarette use. NFP may therefore hold promise for reducing some types of prenatal substance use in disadvantaged populations. Trial registration: ClinicalTrials.gov, no. NCT01672060. Copyright 2020, Joule Inc. or its licensors.
Authors: S M Jack; N Catherine; A Gonzalez; H L MacMillan; D Sheehan; D Waddell Journal: Health Promot Chronic Dis Prev Can Date: 2015 Oct-Nov Impact factor: 3.240
Authors: David Hammond; Jessica L Reid; Vicki L Rynard; Geoffrey T Fong; K Michael Cummings; Ann McNeill; Sara Hitchman; James F Thrasher; Maciej L Goniewicz; Maansi Bansal-Travers; Richard O'Connor; David Levy; Ron Borland; Christine M White Journal: BMJ Date: 2019-06-20