The Healthy Families Healthy Babies (HFHB) program, a Government of New Brunswick initiative, offers home-based early intervention services for at-risk first-time mothers and their infants, targeting health and developmental concerns. In collaboration with NB-IRDT, this program has undergone comprehensive evaluation, examining short-term and longer-term outcomes, extending up to preschool age, among participants in the postnatal HFHB services. Notably, HFHB postnatal program participation was found to have a positive impact on the duration of breastfeeding. Postnatal program participants were more likely to be breastfeeding at 18 months and had a longer average duration of breastfeeding than non-participants.

1. Impact of Public Health Postnatal Home
Visiting in NB on Breastfeeding among
Disadvantaged Families: A Population-
Based Retrospective Outcome Evaluation
Research Lead: Dr. Sandra Magalhaes
sandra.magalhaes@unb.ca

2. BACKGROUND
• Healthy Families Healthy Families (HFHB) is a Government of New Brunswick
Department of Health Public Health program
• HFHB postnatal program is home–based early intervention service to promote the
healthy development are provided by a public health nurse or dietitian over the
first 2 years of baby’s life
• Secondary prevention program targeting at-risk first-time mothers with an
infant at risk of health and/or developmental concerns (arising from
congenital/acquired health challenges, developmental factors, and/or family
interaction factors)
• Eligibility for postnatal HFHB services is determined at birth using the universal
screening tool, Public Health Priority Assessment, conducted for all births in NB
2

3. BACKGROUND
• The HFHB program is presently under review by Public Health
• Current program operating with the same inclusion criteria since 2011
• An important objective of the program review is to evaluate impact on child health
and development
• Public Health partnered with NB-IRDT to undertake a summative evaluation of the
HFHB program
• This study only examined the postnatal portion of HFHB
• The ability to link data holdings at NB-IRDT provides the opportunity to evaluate
longer term outcomes, up to preschool age, among HFHB program participants
3

4. RESEARCH GOAL
To evaluate the short- and longer-term impact of participation in postnatal HFHB-
targeted services on selected child health and developmental outcomes
4

5. RESEARCH QUESTIONS
Among eligible first-time moms, are babies who participated in postnatal HFHB-
targeted services more likely, than those who did not participate in HFHB,
1. to be breastfeeding at time of Healthy Toddler Assessment?
2. to have longer duration of breastfeeding, measured at time of Healthy
Toddler Assessment?
5

6. METHODS

7. STUDY DESIGN
• Prospective cohort study of births between April 1, 2012 and March 31, 2014
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HFHB Postnatal Program (birth to 2 years)
Newborn
Screening:
Public Health
Priority
Assessment
@ birth
Developmental
Assessment:
Public Health
Healthy Toddler
Assessment
@ ~18 months
School
Readiness:
EECD Early
Years
Evaluation
@ 4-5 years

8. SAMPLE SELECTION
• HFHB postnatal program has specific eligibility criteria
• Parenting for first time and meeting one the following
• Participation in HFHB prenatal program
• Higher PHPA score
• Of all births in NB, those to first-time parents, that did not parent a child for >6
months, were identified to serve as a comparison group
8

9. PROPENSITY SCORES
• PHPA score and other socioeconomic characteristics capture important
information about health and developmental risk
• Important to identify a comparable group of 1st time moms to participants
• Propensity score matching is a methodological tool used to handle confounding
• PHPA component score, maternal demographic and socioeconomic
characteristics, maternal prenatal health (current and history) and maternal
health history
• No information about father and several socioeconomic characteristics only
available at area-level
9

10. COMPARISON GROUPS
10
n=1211
HFHB participants
• Moms enrolled in the HFHB postnatal program between April 1, 2012 to March 31, 2014
n=4885
All first time moms
• All 1st time moms giving birth in NB between April 1, 2012 to March 31, 2014 who were not
HFHB postnatal participants
n=1366
Matched
non-participants
• A subset of 1st time mothers giving birth in NB between April 1, 2012 to March 31, 2014 who
were not HFHB postnatal participants, but are similar to participants based on several maternal
demographic, socioeconomic and health characteristics

11. OUTCOMES
Breastfeeding in first 18 months of life
• duration (months)
• yes/no at HTA
11

12. DATA ANALYSIS
• Percentages of the outcomes by group are presented
• All 1st time mom non-participants, HFHB postnatal participants, matched non-
participants
• Logistic regression and zero inflated Poisson regression used to estimate relative
measures of risk and 95% confidence intervals
1. Unadjusted models: compared to all 1st time mom non-participants
2. PS adjusted: compared to all 1st time mom non-participants, adjusting for group
differences
3. PS matched: compared to a selected group of 1st time moms that are similar to HFHB
moms, but didn’t participate postnatally in HFHB
12

13. RESULTS

14. PROPENSITY SCORE BALANCE
Before After Matching
14

15. SOCIODEMOGRAPHIC CHARACTERISTICS
1st time moms
HFHB Postnatal
Participants Matched Sample
Average age 27.6 23.9 25.9
Social Assistance 10% 35% 21%
Marital Status
Married 53% 28% 35%
Single 40% 66% 58%
Residential Instability Quintiles
1 (best) 20% 14% 14%
2 20% 18% 19%
3 20% 17% 18%
4 21% 22% 22%
5 (worst) 20% 30% 27%
15

16. COMPLETION RATES
• Program participants had highest % completion HTA
16
1st time moms HFHB Postnatal Participants Matched Sample
ASQ completed ASQ not completed
47% 58% 40%

17. • HFHB participants was the group with highest % breastfeeding at 18 months
17
BREASTFEEDING AT 18 MONTHS
Descriptive Statistics
Breastfeeding at HTA Not Breastfeeding at HTA
1st time moms HFHB Postnatal Participants Matched Sample
6.6% 10.1% 5.5%

18. • HFHB postnatal participants are 60%
more likely than all 1st time moms to be
breastfeeding at 18 months
• HFHB postnatal participants are twice as
likely to be breastfeeding at 18 months
than 1st time moms who are like them
but did not participate in the HFHB
program
18
BREASTFEEDING AT 18 MONTHS
Regression Model Estimates

19. • HFHB postnatal participants had a longer average duration of breastfeeding than
matched sample, but shorter than all 1st time moms
• Though they had lowest rates of initiating breastfeeding
19
DURATION OF BREASTFEEDING
Descriptive Statistics
1st time moms HFHB Postnatal Participants Matched Sample
1 month or less 1-6 months 6-12 months 12+ months

20. • HFHB postnatal participants are less
likely to ever breastfeed and do so for a
short duration than all 1st time moms
who did not participate
• Compared to 1st time moms like them,
HFHB postnatal participants are as likely
to ever breastfeed, but when they do
participants breastfeed for a longer
duration
20
DURATION OF BREASTFEEDING
Regression Model Estimates

21. STRENGTHS
• Population-based data
• Long-term follow-up
• Large sample size
• Ability to consider outcomes across different government departments
• Propensity score modelling
21

22. LIMITATIONS
• Administrative (messy) data
• Reliance on area-level proxies for individual level socioeconomic characteristics
• Imperfect match between HFHB participants and non-participants
• Incomplete follow-up of all children
• COVID
22

23. CONCLUSIONS
• As expected, children of postnatal HFHB participants have poorer outcomes than
the average child in NB
• Though results differed when comparing to families who were similar
• HFHB postnatal program participation was found to have a positive impact on
duration of breastfeeding
• Postnatal program participants were more likely to be breastfeeding at 18
months, and had a longer average duration of breastfeeding than non-
participants
• HFHB postnatal program participant had lower rates of initiating breastfeeding
• Research currently underway to examine impacts of prenatal participation
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24. FUNDING ACKNOWLEDGMENTS