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To the Editor
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David L. Olds, Denver, CO, U.S. Professor, University of Colorado at Denver and Health Sciences Center
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I am writing to clarify a slight misrepresentation of findings on the impact of the Nurse-Family Partnership (NFP) on rates of subsequent pregnancies and births discussed in the Barnet et al. report(1) on paraprofessional home visiting. The authors indicate that the Nurse- Family Partnership (NFP) had no impact on rates of subsequent pregnancies and births, citing the 4-year follow-up of the Denver trial of the NFP in which families were randomly assigned to receive this program when delivered either by nurses or by paraprofessional visitors, or to a control group.(2) While the authors are correct that 2 years after the program ended, there were no statistically significant program effects on these outcomes, a more appropriate comparison would have been to examine the program effect on subsequent pregnancies and births within 2 years following birth of the first child, which corresponds to the period examined in the Barnet report, and which represents the interval that is most important from a clinical perspective.(3-6) During the 2-year period following birth of the first child, compared to women in the control group, nurse-visited women in the Denver trial had significantly lower rates of subsequent pregnancies (29% versus 41%) and births (12% versus 19%, p<.05); the corresponding effects for paraprofessional-visited women whose visitors had followed the NFP model were not statistically significant (33% versus 41% and 13% versus 19%, p<.10).(3) Moreover, at both the 24 and 48-month follow-ups, nurses in the Denver trial produced statistically significant, larger intervals between births of first and second children compared to the control group.(2;3) It may be even more appropriate to compare the Barnet report with nurse program effects on rates of subsequent pregnancies and births in the largely African-American sample enrolled in the Memphis randomized trial of the NFP: within 24 months after delivery of the first child, the rates of subsequent pregnancies were 36% vs. 47% (p<.01) and births were 22% vs. 31% (p<.01).(7) Again, the NFP nurses produced consistent effects on inter-birth intervals. Sincerely, David Olds, PhD Professor of Pediatrics, Psychiatry, Preventive Medicine, and Nursing; Director, Prevention Research Center for Family and Child Health; University of Colorado at Denver and Health Sciences Center; Denver, Colorado Reference List 1. Barnet B, Liu J, DeVoe M , Alperovitz-Bichell K, Duggan AK. Home visiting for adolescent mothers: effects on parenting, maternal life course, and primary care linkage. Annals of Family Medicine 2007;5:224-32. 2. Olds DL, Robinson J, Pettitt L, Luckey DW, Holmberg J, Ng RK, Isacks K, Sheff K. Effects of home visits by paraprofessionals and by nurses: age-four follow-up of a randomized trial. Pediatrics 2004;114:1560-8. 3. Olds DL, Robinson J, O'Brien R, Luckey DW, Pettitt LM, Henderson CR Jr, Ng RK, Sheff KL, Korfmacher J, Hiatt S, et al. Home visiting by paraprofessionals and by nurses: a randomized, controlled trial. Pediatrics 2002 Sep;110(3):486-96. 4. Polit DF, Kahn JR. Early subsequent pregnancy among economically disadvantaged teenage mothers. Am J Public Health 1986 Feb;76 (2):167-71. 5. Mott FL. The pace of repeated childbearing among young American mothers. Fam Plann Perspect 1986 Jan-1986 Feb 28;18(1):5-12. 6. Khoshnood B, Lee KS, Wall S, Hsieh HL, Mittendorf R. Short interpregnancy intervals and the risk of adverse birth outcomes among five racial/ethnic groups in the United States. Am J Epidemiol 1998 Oct 15;148(8):798-805. 7. Kitzman H, Olds DL, Henderson CR Jr, Hanks C, Cole R, Tatelbaum R, McConnochie KM, Sidora K, Luckey DW, Shaver D, et al. Effect of prenatal and infancy home visitation by nurses on pregnancy outcomes, childhood injuries, and repeated childbearing. A randomized controlled trial. JAMA 1997 Aug 27;278(8):644-52. Competing interests: None declared |
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