Catherine Nicole L A, Boyle Michael, Zheng Yufei, McCandless Lawrence, Xie Hui, Lever Rosemary, Sheehan Debbie, Gonzalez Andrea, Jack Susan M, Gafni Amiram, Tonmyr Lil, Marcellus Lenora, Varcoe Colleen, Cullen Ange, Hjertaas Kathleen, Riebe Caitlin, Rikert Nikolina, Sunthoram Ashvini, Barr Ronald, MacMillan Harriet, Waddell Charlotte
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.
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
CMAJ Open. 2020 Oct 27;8(4):E667-E675. doi: 10.9778/cmajo.20200063. Print 2020 Oct-Dec.
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.
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.
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.
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. ClinicalTrials.gov, no. NCT01672060.
护士-家庭伙伴关系（NFP）项目中，公共卫生护士会在孕妇怀孕初期至孩子2岁期间频繁进行家访，服务对象主要是面临社会经济困境的初为人父母者。我们旨在评估NFP在改善儿童及孕产妇健康方面的效果。
我们对不列颠哥伦比亚省一项正在进行的随机对照试验中的产前次要结局进行了分析；本分析所用数据收集于2014年1月至2017年5月。参与者为年龄在14 - 24岁、首次怀孕且面临社会经济困境的女孩和女性。她们被1:1随机分配至干预组（NFP加现有服务）或对照组（现有服务）。预先设定的产前次要结局指标为妊娠34 - 36周时吸烟和饮酒情况的变化。我们还报告了预先设定的探索性大麻和街头毒品使用情况的测量指标。我们使用混合效应模型对纵向和聚类数据进行分析，以估计干预效果。分析采用意向性分析。
739名参与者（干预组368人，对照组371人）基线时的中位孕周为20周零6天。到妊娠34 - 36周时，NFP显著减少了吸烟者的吸烟量（过去2天内）（吸烟量变化差值[DIC]为 -1.6，95%置信区间[CI]为 -6.4至 -1.3）。NFP还显著降低了产前大麻使用率（DIC为 -6.4，95% CI为 -17.0至 -1.7），但未降低街头毒品或“任何”物质的使用率。虽然我们观察到两组的吸烟和饮酒率均有所下降（比例变化的DIC分别为 -2.8，95% CI为 -15.3至0.6；DIC为 -0.5，95% CI为 -8.7至1.8），但这些变化无统计学意义。
我们没有发现证据表明NFP能有效降低产前吸烟和饮酒率；然而，它能降低产前大麻使用率，对于吸烟者，它能适度减少吸烟量。因此，NFP可能有望减少弱势群体中某些类型的产前物质使用。ClinicalTrials.gov，编号：NCT01672060。
