Revitalizing Culture and Healing: Indigenous Approaches to FASD Prevention is a new resource developed by program providers and experts in Indigenous women’s health and researchers from the Centre of Excellence for Women’s Health, in partnership  with the First Nations Health Authority in BC. The resource includes a beautiful and FASD preventionthoughtful introduction by Marilyn Van Bibber and highlights seven community led and culture driven programs. Each program successfully integrates culture, language, and healing into their program in order to improve the health and wellness of women, children, their families, and their communities. Marilyn is well known for her development of the first resource on Indigenous approaches to FASD prevention in Canada, entitled It Takes a Community published in 1996.

The programs highlighted in this resource use the traditional holistic view of health and wellness that encourages balance between mental, physical, emotional, and spiritual health. They incorporate culture and language, coordinate basic needs, and address women, their families, and their communities’ unique and complex needs by promoting healing through language, ceremony, traditional knowledge, land-based programming, involvement of Elders, and more.

The driving principles that contribute to the success of these programs is that they are community led, culture driven, strengths-based, and provide wraparound support that address broad social and structural factors that impact individuals’ and their families’ lives across the lifespan.

Program planners and service providers can learn from the lessons shared from these programs and integrate the following 4 considerations that support healthy beginnings:

  1. Use Non-Stigmatizing Language

Service providers and healthcare professionals should use strengths based language that promotes wellbeing, creates safe spaces for women and girls to discuss their substance use, and helps women and girls build confidence and ask for support. Providers should shift towards using person-first language in their practices, where clients are identified as a person rather than by their health condition or behaviours. Some examples my include shifting from language “addicts” to “women who use alcohol” and from “she admitted to drinking alcohol during pregnancy” to “she reported drinking during pregnancy.”

For more information on the strengths-based language, the Canadian Centre on Substance Use and Addiction and Canada FASD Research Network have released language guides to support the use of non-stigmatizing language when discussing substance use and FASD.

  1. Identify Existing Community Strengths and Programming

Meeting with existing services to see how they are, or could be, a part of wellness and FASD prevention initiatives is an important strategy in identifying community strengths and linkages that can better support healthy beginnings and healthy families. Identifying these strengths and linkages can better support current or existing program planners in developing a realistic goal for program delivery in your community.

  1. Connecting with those who have Walked the Path Before Us

The programs featured in this booklet enact approaches that have been successful at implementing community led, and culture based approaches to improving the health of women, their families, and their communities. The lessons and approaches in these programs demonstrate what decolonized approaches to FASD prevention can look like.

  1. Identifying Potential Funding Partners

Building relationships with potential funders is an important step towards developing or supporting community-based prevention programs. The breadth of these programs – in addressing a multitude of needs – demonstrate the varied funding that can support families. Given how the programs enact evidence informed and wise practices, it is important that stable and long term support is provided to ensure the programs’ ongoing responsivity and development.

For more information on the seven highlighted programs, four critical considerations, and to review the eight reflection questions on how to support healthy beginnings in your community, see the booklet, Revitalizing Culture and Healing: Indigenous Approaches to FASD Prevention.

Pregnancy Outreach Programs (POPs) in British Columbia incorporate FASD prevention efforts in their community-based programming. While these programs do not necessarily advertise themselves as providing FASD prevention, their open, non-stigmatizing, and non-judgemental nature make them successful in offering brief support on a range of issues, including alcohol and other substance use.

There are over 70 local pregnancy outreach programs available across the province, including a number of programs that are funded through the Canada Prenatal Nutrition Programs (CPNP). These outreach programs provide support to high-risk pregnant women who are interested in accessing free and voluntary prenatal information and perinatal support services.

Originally, these programs were developed to improve the nutritional status of high-risk pregnant women who typically don’t access such information and services. They offer a variety of supports, often unique to the community that they serve. Some offer daytime support groups for parents and caregivers. Others offer nighttime events where participants get together for arts, crafts, and mocktails. Among other things, these programs provide women with free access to nutrition and health counselling; peer support groups; physical needs (i.e. food vouchers & prenatal vitamins); referrals to counselling services; supports to address issues with alcohol and/or substance use; and supports and resources to help care for their newborns. The diversity in what is offered and their dedication to meeting women where they’re currently at in their life is what makes these programs so effective.

Research shows that a helpful way to encourage disclosure about alcohol consumption during pregnancy is by using a conversational approach.  Approaches that are non-confrontational, women-centred, and recognize the social pressure that women may be experiencing are effective at opening “doorways to conversation.” These approaches allow providers to build relationships with their participants, creating a safe space to discuss risks of  alcohol and other substance use, and related challenges women face during their pregnancy. In providing a safe and non-judgemental environment that is based on building trust and relationships with women, the practice model of POPs providers fits with this best practice.

Facilitating understanding of FASD and brief support in POPs

Nancy Poole with Heather Cameron, BCPOPs Executive Director, at BCAPOP Annual Conference

The British Columbia Association of Pregnancy Outreach Programs (BCAPOP) is the provincial association for all of the pregnancy outreach programs (POP). Through their work, they provide a platform through which skills, supports, resources, expertise, and information can be shared. Their recent resource, BC Pregnancy Outreach Program Handbook Supplement on Perinatal Substance Use includes information on how to support women and girls facing substance use concerns in a trauma-informed way.  The content of this resource is being shared for free through in-person training throughout BC to over one hundred outreach workers by November 2019. BCAPOP also offered a workshop led by Myles Himmelreich at their recent annual conference in Richmond BC, to support understanding by POP workers of the realities of living with FASD.

Nancy Poole with Myles Himmelreich at BCAPOP Annual Conference.

The important role of social service providers in delivering effective brief interventions on alcohol and substance use, should not be ignored or underestimated. Outreach programs, including CPNP programs, offer a space that provides unconditional supports and resources for women, regardless of where they are at in their health or recovery journeys. We should look to the practice approaches modeled by these programs to find additional ways to meet community needs for action on FASD prevention and build programs that respond to the unique needs of each woman and each community.

Building awareness about the risks surrounding alcohol use when pregnant and supports for making change in alcohol use are foundational to preventing Fetal Alcohol Spectrum Disorder (FASD).

AFPC-1-Bingo-20190814

Awareness building can come in many forms, from posters and websites to warning labels and events. However, not all awareness approaches are effective. Over the past several decades, researchers have conducted studies to determine the most effective approaches for awareness raising. By using these evidence-based approaches and linking them to other levels of prevention we will have more impact.

As September comes to a close, we’d like to share three Canadian FASD Awareness initiatives that used evidence informed and innovative messaging and/or images, to raise awareness this International FASD Awareness month.

1. New Posters from the Foster Family Coalition of the North West Territories

These beautiful new posters from the Foster Family Coalition of the NWT highlight the importance of noticeability in developing effective communications. These bright posters have a simple and consistent colour scheme that draws the eye.

They’ve also aimed to increase the effectiveness of the campaign through integration. Integration is when you combine your messaging with how to act on the information. This could involve collaboration with other organizations, releasing materials in many different formats (i.e. social media, posters, brochures, events), or incorporating other related information into your messaging.

In this case, they’ve included the phone number and website of the NWT Help Line for those in need of support to make changes.

2. New Campaign from the Piruqatigiit Resource Centre

FASD awanareness month campaign

One very important consideration to keep in mind when developing your communication campaigns is comprehension. Your message needs to have clear, simple, and direct information that your specific audience can relate to. Every audience that we communicate with is different.

The new FASD awareness approach from the Pirugatigiit does an amazing job of respecting the culture of their audience when developing their resources. They are working to raise awareness of FASD in Nunavut, which has a large Inuit population. Not only do they offer resources in English and Inuktitut, but they’ve also integrated imagery, values, terminology, and practices specific to Nunavummiut within their approach.

3. Alcohol and Pregnancy Don’t Mix Brochures by BC Liquor Stores

Research shows us that it’s important for us to develop a message that is relevant for our audience (threat) while at the same time encourages them to take action (efficacy).  It is a balance between providing the information needed while preventing feelings of helpless to act.

Campaigns with strong fear based messages (i.e. “One drink can harm your baby”) or that have unnecessarily graphic images (i.e. a fetus floating in alcohol) can be off-putting. Such messages and images can prompt a fear-based response that can cause women who have consumed alcohol while pregnant to feel helpless and ashamed.

The messaging in the BC pamphlet is effective because it does a good job of balancing the threat with an appropriate response with sentences like:

  • “If you did drink and find out you’re pregnant, it’s important to realize it’s never too late to quit or cut down on your drinking if quitting isn’t possible.”
  • “There is no known safe level of alcohol use during pregnancy, so it is safest not to drink at all when women are pregnant.”

Above all, these campaigns are positive! They help break down the stigma surrounding alcohol and pregnancy by highlighting FASD as a relational and societal issue, and not just the responsibility of women who are pregnant. These campaigns show us that we all play a part in FASD prevention.

To find out more tips for how to create effective alcohol and pregnancy awareness campaigns please check out this resource from Canada FASD Research Network and the Government of Alberta.

One year ago, the Centre of Excellence for Women’s Health released Doorways to Conversation: Brief Intervention on Substance Use with Girls and Women. Since then, there has been a growing interest in expanding work on brief interventions and FASD prevention, to be inclusive of multiple substances and multiple health issues for women, their families and communities.

Here are four innovative ways that brief discussion about alcohol and other substance use is being expanded:

In Sexual Health

Sexual health clinicians are well positioned to deliver brief substance use interventions due to their open, non-judgmental and harm reduction-oriented model of practice. Sexual health providers are able to discuss substance use together with contraceptive use and/or sexually transmitted and blood borne infections [1, 2]. Conversations about substances, sex, and safety can support a woman’s decisions and confidence for change towards improving health in whatever area fits for her.

Linking Discussion of Multiple Substances

Cannabis legalization provides a ‘window of opportunity’ to engage in discussions about alcohol, tobacco, and cannabis use in pregnancy. Discussing what we know and don’t know about cannabis use in pregnancy can now be linked to open conversations about alcohol and other substance use in pregnancy.

Understanding the Link to Adverse Childhood Experiences (ACEs)

Research on ACEs shows how a history of childhood stressors, including physical, sexual, and emotional abuse, may influence alcohol use among adults including pregnant women [3]. Adopting a trauma-informed approach in conversations about alcohol use in pregnancy supports women who experienced childhood adversity with safety, choices, collaboration, self compassion and skills for change.

Advancing Indigenous Wellness Approaches

Holistic, relational, community-based, and culture-led FASD prevention initiatives are key to wellness for pregnant women in Indigenous communities [4]. These interventions address the broad social and structural determinants of health that are associated with substance use and respond to the Truth and Reconciliation Commission Call to Action #33.

References

  1. Lane, J., et al., Nurse-provided screening and brief intervention for risky alcohol consumption by sexual health clinic patients. Sexually Transmitted Infections, 2008. 84(7): p. 524-527.
  2. Crawford, M.J., et al., The clinical effectiveness and cost-effectiveness of brief intervention for excessive alcohol consumption among people attending sexual health clinics: a randomised controlled trial (SHEAR). Health Technology Assessment, 2014. 18(8): p. 1-48.
  3. Frankenberger, D.J., K. Clements-Nolle, and W. Yang, The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women. Women’s Health Issues, 2015. 25(6): p. 688 – 695.
  4. Wolfson, L., et al., Collaborative Action on Fetal Alcohol Spectrum Disorder Prevention: Principles for Enacting the Truth and Reconciliation Commission Call to Action #33. International Journal Of Environmental Research And Public Health, 2019. 16(9).

AnnBib cover 2018Researchers associated with the Prevention Network Action Team (pNAT) of the CanFASD Research Network search the academic literature each year for articles related to prevention of fetal alcohol spectrum disorder (FASD). Articles are reviewed for relevancy, identified by topic and country, and the findings briefly summarized. This year’s Annotated Bibliography of Articles Published in 2018 was published in time for the 8th International Conference on FASD in March. A total of 58 articles were identified from 17 countries. The number of articles varies each year based on journal articles published in English about ongoing or new research on FASD prevention research. Countries with highest number of published articles in 2018 were USA (26 articles), Canada (9 articles), the UK and Ireland (6 articles), and Australia and South Africa (5 articles each). 

Findings are organized using a four-level prevention framework used by the pNAT to describe the wide range of work that comprises FASD prevention (see panel at left for more information). This year 15 articles pertained to Influences on women’s drinking;  12 articles pertained to Level 2, discussion of alcohol use with women and their support networks; and, 11 articles pertained to Level 3, specialized and holistic support of pregnant women. Articles pertaining to Level 1 and Prevalence of alcohol use in pregnancy were also well represented. Some articles are assigned to more than one category.

4-levels-fasd-prevention

Figure 1: Four Levels of FASD Prevention

The annual literature search is intended to update those involved in FASD prevention in Canada, to inform their practice and policy work with current evidence. The members of the pNAT also have the opportunity to discuss the implications for their work of the findings of selected articles, in monthly web meetings.

Find earlier Annotated Bibliographies below and on the CanFASD Prevention page under “Bibliographies”.

A few of our Prevention Network (pNAT) members recently spotted an online article entitled “Demonising smoking and drinking in pregnancy may lead women to do it in private, says study.” Read the online article about the study here.

This study from the University of Cardiff in Wales has confirmed what most women’s health advocates know – that judging pregnant women for behaviours that may negatively affect fetal and child health, did not cause them to stop, but instead caused them avoid public and professional scrutiny, and to use in private. Women felt judged by healthcare professionals for their smoking and poverty, which made interactions with health care providers awkward. (See journal article on the study here.)

In the research 10 low-income, pregnant women in Wales were asked to “tell their stories” including how pregnancy affects their everyday life. Although smoking was discussed extensively by the women, interviewers did not raise the topic during the interviews. As part of their stories, women described their smoking behaviours, and reactions from the public, family, friends, and health care providers.

  

Liberation: Helping Women Quit Smoking

  

Doorways to Conversation

This study underscores what we know about substance use prevention in general – shame and stigma are not solutions to helping people change use, and specifically that the judgement of health professionals is tied to not accessing the support that is needed and deserved. In that way, the professionals become part of the problem instead of the solution. Evidence has established that using non-judgmental approaches are key to supporting behaviour change. These approaches emphasise harm reduction and employ collaborative and empathic conversations that respect individuals’ self determination and understand the underlying issues of substance use problems. Further to collaborative conversations, it is critical to understand substance use, and challenges to change substance use, as related to the burdens of violence and poverty faced by women – this forces us to move beyond a focus on individual behaviour and instead to action for social justice on these conditions of women’s lives.

Collaborative Approaches for Health Care Professionals

Indigenous Approaches to FASD Prevention

Mothercraft Study: “A Focus on Relationships”

The pNAT has written extensively about the importance of non-judgmental Level 2 discussions with women and their partners about alcohol, other substance use and the determinants of health that affect use. Included here are some resources that can help practitioners to engage in those discussions with women in a way that builds connection and relationship and supports movement toward positive change in alcohol and tobacco use, and related health and social concerns. As well, practitioners can connect to local pregnancy and addictions support programs to learn what community action to address stigma and promote social justice is underway.

References

Weinberger, A. H., Platt, J., Esan, H., Galea, S., Erlich, D., & Goodwin, R. D. (2017). Cigarette Smoking is Associated with Increased Risk of Substance Use Disorder Relapse: A Nationally Representative, Prospective Longitudinal Investigation. The Journal of clinical psychiatry, 78(2), e152-e160.

See earlier posts

LINKING CANNABIS USE WITH ALCOHOL AND TOBACCO November 13, 2018
NEW RESOURCES FOR COLLABORATIVE CONVERSATIONS ON SUBSTANCE USE WITH GIRLS AND WOMEN June 18, 2018
REACHING AND ENGAGING WOMEN: WHAT WORKS AND WHAT’S NEEDED May 15, 2017
TARGETING STIGMA AND FASD IN MANITOBA June 26, 2017
ADVERSE CHILDHOOD EXPERIENCES AND ALCOHOL USE DURING PREGNANCY August 18, 2015
BRIEF INTERVENTIONS TO DECREASE ALCOHOL MISUSE IN WOMEN November 26, 2013
LET’S START A CONVERSATION ABOUT HEALTH . . . AND NOT TALK ABOUT HEALTH CARE AT ALL June 23, 2011

The Hope Project app

With most everyone having a smartphone these days, people are using apps to support their health. There are a few apps directed to pregnant women about their substance use and mental health. Some recent efforts developed together by researchers and health providers show how these apps can be used to offer focused information and support to pregnant women.

A perinatal mental health research project in Alberta, The Hope Project, is exploring how e-technology can be used to support pregnant women with mental health concerns. Dr. Dawn Kingston and her team at the University of Calgary developed an app for screening and treating pregnant women experiencing anxiety and depression. It provides information, support, and help to women in the research study whenever they need it. The project will also look at how this intervention affects post-partum depression and the health of their children.

SmartMom Canada, was developed as part of a study from the University of British Columbia. Through text messaging, Optimal Birth BC provides women in Northern BC with prenatal education endorsed by the Society of Obstetricians and Gynaecologists of Canada (SOGC). Many of these women live in rural areas and may have limited access to prenatal care. Women who enroll in the study complete a confidential survey and then receive personalized text messages that include pregnancy tips, info on health topics, and available resources in their own community.

SmartMom Canada app

Women outside of these studies may find it challenging to find similar apps. Popular pregnancy apps do not offer much info or ideas for resources for women with mental health or substance use issues. One that has been positively evaluated is Text4baby in the U.S. The sponsors partner with national, state, and private organizations and offer local resource information in some states. Also available to Spanish speakers, an evaluation of the app can be found here.

As well, apps are being targeted to health care providers on improving the care they provide. A preconception care app available to physicians provides them with information from the National Preconception Health and Health Care Initiative and makes suggestions for responding to patient questions. Research is being done on using an app to provide motivational interviewing interventions to pregnant women who use substances.

Most apps available on smartphones are directed toward the general population and seek a large user base. Mental health apps and substance use apps that might support prevention, are not designed specifically for women, pregnant or not. And most pregnancy apps focus on fetal growth and “kick counters”, the woman’s weight and blood pressure, and checklists to get ready for a child.

So, while there is an app for everything, they may not an app for everyone. However, healthcare technology is growing at a fast pace, so hopefully we will see more apps in future that can expand FASD prevention efforts.

Related topics:

TEXT4BABY PROGRAM IN THE UNITED STATES: CAN TEXT MESSAGING BE AN EFFECTIVE ALCOHOL BRIEF INTERVENTION? February 2, 2015

HEALTHY PREGNANCY, HEALTHY BABY TEXT MESSAGING SERVICE IN TANZANIA December 17, 2013

In developing a panel presentation at the FASD International conference in 2007, Nancy Poole highlighted why the traditional “primary, secondary, and tertiary” model used for disease prevention did not fit as well for prevention of FASD. While designing that panel together with service providers and a birth mother to a child diagnosed with FASD, it dawned on Nancy and the panelists that FASD prevention wasn’t just about alcohol or pregnancy.

When asked to prepare a write-up of this emerging thinking for the Public Health Agency of Canada (PHAC), Poole assembled a group of 25 Canadian prevention specialists to collectively discuss and build the final 4 part model. It was published by PHAC in 2008 (see page 18 for the list of 25 co-developers – Full MODEL Here). The model illustrates how it is important to link mother child and community health in prevention, including continuing to support women and children past the perinatal period.

Over these last 10 years, this Canadian model has been adopted or built upon by FASD prevention specialists in Canada and a number of countries.

Figure 1: Four Levels of FASD Prevention

A recent article discussing what to do about high levels of alcohol use during pregnancy in the United Kingdom recommended the 4-level prevention model as a way to help women make informed decisions.

In Australia, Dr. James Fitzpatrick of Telethon Kids has used and built upon the multi-level model by showing how important it is to link, intervention, research and diagnosis to FASD prevention efforts (Figure 2). He has led community-based FASD prevention initiatives in remote parts of Western Australia that have significantly reduced alcohol use during pregnancy.

Figure 2: Adaptation of 4-Level Model of FASD Prevention by Dr. James Fitzpatrick, Telethon Kids, AU

Perhaps the model has influenced recent action plans regarding FASD, such as that of New Zealand. It emphasises the need for wrap-around services that pair women’s and children’s health including substance use services and treatment for pregnant and post-partum women. They also emphasize collaboration across sectors at the policy and community level.

Looking back, the 4-level prevention model was developed from the collective wisdom of researchers, service providers, policy analysts and birth mothers while implementing prevention initiatives in Canada. Further adaptations have included larger policy components that are key to prevention of alcohol problems. The development process of the model underscores how no one agency or approach can cover FASD prevention. It requires efforts in each of the levels, in ways that are mutually reinforcing.

For more on these topics, see earlier posts:

FASD PREVENTION WITH INDIGENOUS COMMUNITIES IN AUSTRALIA April 3, 2017

FASD PREVENTION CAMPAIGNS LINK TO SUPPORT January 29, 2018

BRIEF INTERVENTIONS TO DECREASE ALCOHOL MISUSE IN WOMEN November 26, 2013

HOLISTIC AND SPECIALIZED SUPPORT FOR PREGNANT WOMEN: LEVEL 3 PREVENTION November 21, 2016

THE MOTHERING PROJECT/MANITO IKWE KAGIIKWE IN WINNIPEG, MANITOBA May 1, 2015

INTEGRATING FASD PREVENTION AND ALCOHOL POLICY March 17, 2011

NEW ZEALAND’S NEW ACTION PLAN TO ADDRESS FASD September 17, 2016

Because alcohol and tobacco have long been legal substances, there is a lot of evidence about their use during the preconception, pregnancy and perinatal periods. With the legalization of cannabis in Canada, new research on cannabis use may begin to fill the existing evidence gaps and better define its risks.

Because of its illegal status, women may have been reluctant to report using cannabis during pregnancy unless it was being used medically, and research ethics may have prohibited its study. Consequently, much of what we know about cannabis use in pregnancy has come from data gathered during studies on alcohol and tobacco. That is why it now makes sense to link the work of all three substances.

For instance, research shows that women who use cannabis during pregnancy are more likely to smoke cigarettes and use alcohol.1 As well, co-use of tobacco and cannabis is associated small head circumference and may increase other birth defects (cardio, musculoskeletal, and gastrointestinal) compared to no-use and single-use groups.2 This finding of association should be interpreted with some caution based on the number of limitations of the study. Still, it does underscore the need for more robust research in order to understand the association.

Researching all three substances allows for understanding the “clustering of risks” and the interactions between those risks in a way that targeting individual substances cannot do.3 By looking at the clustering of risk as described by researchers, holistic prevention efforts can target social determinants of health that affect poly-substance use.

Linking the findings on the three substances allows researchers to parse out the differences among those who use substances in pregnancy, and the clusters of risk for the substances they use. That will help to further prevention efforts in messaging, discussing substance use with women and their partners, and supporting women with holistic and safe approaches.

References

1. Ko, J.Y., Tong, V.T., Bombard, J.M., Hayes, D.K., Davy, J., & Perham-Hester, K.A. (2018). Marijuana use during and after pregnancy and association of prenatal use on birth outcomes: A population-based study. Drug and alcohol dependence, 187, 72-78.
2. Coleman-Cowger, V.H., Oga, E.A., Peters, E.N., & Mark, K. (2018). Prevalence and associated birth outcomes of co-use of Cannabis and tobacco cigarettes during pregnancy. Neurotoxicology and teratology, 68, 84-90.
3. Passey, Megan E. et al. (2014). Tobacco, alcohol and cannabis use during pregnancy: Clustering of risks. Drug & Alcohol Dependence, Volume 134, 44–50. https://www.sciencedirect.com/science/article/pii/S0376871613003700#bib0185

For more on these topics, see earlier posts:

DISCUSSING ALCOHOL USE WITH WOMEN – DOES THE SBIR MODEL NEED REARRANGING? October 4, 2017
ALCOHOL, COCAINE, MARIJUANA, AND CIGARETTE USE DURING PREGNANCY: LOOKING AT RELATIVE HARMS March 17, 2014

With marketing of alcohol and nicotine delivery products to youth, legalization of cannabis, and the crisis in prescription pain medication use, there are new opportunities to have conversations with youth about substance use and pregnancy, with the aim of reducing the harms and improving their overall health.

What do we know about youth understanding of substance use and pregnancy?

Existing research and data on youth behaviour provide a window.

One U.S. study showed a relationship between pregnancy and prior substance use among adolescents, and among younger adolescents in particular.

  • 59% of pregnant teens and 35% of nonpregnant teens reported having used substances in the previous 12 months.
  • Some substance use continued in pregnancy particularly among younger pregnant adolescents ages 12-14. (1)

The McCreary Centre Society conducts an adolescent health survey in BC every 5 years. The 2018 evaluation is underway, but findings from 2013 indicated a number of factors related to youth substance use and pregnancy.

Those at higher risk for harmful alcohol use include:

  • Youth in rural areas
  • Youth who were born in Canada
  • Youth who were employed
  • Youth living in poverty
  • Youth experiencing abuse or violence
  • Sexual minority youth
  • Peer relationships have risks in terms of starting drinking earlier and binge drinking particularly when friend groups are large.

Those at greater risk of being involved in a pregnancy include:

  • Youth who first had sex before their 14th birthday
  • Youth in rural areas
  • Youth who had been in government care. Among these youth, girls were more likely than boys to be have been involved in a pregnancy
  • Youth who had been physically abused
  • Youth who had been sexually abused. Among these youth, males who were more likely to have been involved in a pregnancy.

The Ontario Student Drug Use and Health Survey (OSDUHS) from 2017 shows that:

  • 17% of youth have participated in binge drinking and 16% cannot remember what happened during that time
  • Boys are more likely to use e-cigarettes and all forms of tobacco, over-the-counter cold/cough medications, energy drinks, cannabis, and psychedelics
  • Girls are more likely to use prescription opioids for pain relief and tranquilizers medically

IMPART info sheet on “Youth, Gender and Substance Use” recaps how the harms of early substance use are gender-specific.

How do we approach building awareness and prevention?

Opening “Doorways to Conversation” about substance use and pregnancy allows for brief interventions and support for youth as well as women and girls. Many providers think that they need to have appropriately tested screening tools along with the knowledge, skills and confidence to conduct them. As one United Nations study found, less than 30% of health providers routinely screened youth for substance use for these reasons.(2)

Trauma-informed, culturally relevant, and gender-specific relational approaches build trusting relationships that can support youth who may be dealing with more complex issues like violence and abuse, gender identity, or the foster care system.

Promising Approaches for Reaching Youth on Substance Use and Pregnancy

Here are some current promising approaches to improving youth understanding of substance use and pregnancy in Canada.

Projects like “Let’s Get Real About Drinking Alcohol” are trainings for youth focusing on the interconnection of substance use, safe sex, birth control, and drinking during pregnancy. You can view a webcast about the project here.
This handout offers conversation starters on substance use for group facilitators. Girls Action Foundation “Take Care” program provides a curriculum and resources for facilitators of girls’ groups to promote critical thinking about healthy living including substance use and sexuality.
Canadian Centre on Substance Use and Addiction (CCSA) has created a low-risk drinking guide for youth.

Online sexual health resources for youth:

Teen Health Source Native Youth Sexual Health Network

  1. Christopher P. Salas-Wright, Michael G. Vaughn, Jenny Ugalde, Jelena Todic. Substance Use and Teen Pregnancy in the United States: Evidence from the NSDUH 2002–2012. Addictive Behaviors, 2015; DOI: 10.1016/j.addbeh.2015.01.039
  2. Chakravarthy, B., Shah, S., & Lotfipour, S. (2013). Adolescent drug abuse – Awareness & prevention. The Indian Journal of Medical Research, 137(6), 1021–1023.

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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