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Prevention Plenary Opening: Moira Plant and Nancy Poole introduce group from Australia

In 7 years, the FASD International Conference has grown to become a truly international event with presenters from six continents and from international health organizations such as the World Health Organization. Current research on clinical topics we’ve come to expect, like prevalence, diagnosis, and neurodevelopment outcomes, were featured this year along with newer topics like biomarkers and epigenetics (See some of the video recorded conference presentations here).

It was the emphasis on prevention, and stigma that took center stage for many attendees. For the first time, there was a specialized prevention plenary – “FASD Prevention Research – State of the Evidence, and Plans for a Global Network” – developed by Nancy Poole (CanFASD; Centre of Excellence for Women’s Health) and Moira Plant (Alcohol & Health Research Unit, University of West England).  Using a model of prevention research used worldwide that Nancy first presented in a poster in 2009, researchers, advocates and birth mothers from around the world talked about where we are and where we need to go.

Watch for upcoming blogs in the next weeks for details on specific prevention presentations.

Objectives for the Prevention Plenary

The Prevention Plenary was divided into 4 areas of presentation and discussion that we will cover in a few posts in the next weeks:

  1. Community-wide FASD prevention with Indigenous communities
  2. International research on discussing alcohol with all women and their partners, and empowering professionals to have these conversations
  3. Research on reaching and engaging women and children at highest risk using approaches that are theory based, and have an equity lens
  4. Plans for international FASD prevention research infrastructure

 

For posts on past International FASD conferences, see:

The 5th International Conference on Fetal Alcohol Spectrum Disorder: Special Session on FASD Prevention, January 14, 2013

Webcasts on 4th Annual International Conference

The Canadian Centre on Substance Abuse (CCSA) is marking November 13-19 as National Addictions Awareness Week. Across Canada, organizations like CEWH and CanFASD are joining with CCSA to bring attention to problematic substance use in Canada. We are highlighting the imbalance between the societal, health and economic costs that substance use problems/addiction brings, and the funding provided for treatment and harm reduction services/supports.

dtnaaw-03-403x213-enCCSA has been a partner in our efforts to explore how addiction can make it difficult to stop alcohol use during pregnancy, and how women-centred approaches are needed in prevention, harm reduction and treatment. You can help us and the CCSA in promoting treatment, highlighting existing barriers, and finding solutions by supporting this campaign. Download the NAAW Toolkit to get ideas for social media postings and organization activities. You can also join the dialogue over social media by following @CCSACanada and using the hashtag #NAAWCanada.

See these earlier blog posts on addictions or “Search the Blog” on the left of this page:
Honouring our Strengths: Culture as Intervention in Addictions Treatment, June 5, 2014
Young Women United: Campaign to Increase Access to Care and Treatment for Pregnant Women with Addictions, February 18, 2014

Federal, provincial, and territorial ministers met in Halifax, Nova Scotia, on October 14-5 to discuss issues of justice and public safety in Canada including the impact of FASD. Co-chairs of the meeting were Minister of Justice and Attorney General, Jody Wilson-Raybold, Minister of Public Safety and Emergency Preparedness, Ralph Goodale, and the Minister of Justice and Atto2016-09-life-of-pix-free-stock-leaves-red-sky-leeroyrney General of Nova Scotia, Diana Whalen. Five national indigenous groups participated in the meeting: the Native Women’s Association of Canada, the Assembly of First Nations, the Métis National Council, Inuit Tapiriit Kanatami, and the Congress of Aboriginal Peoples.

Vice-Chief Kim Beaudin from the Congress of Aboriginal Peoples outlined the groups’ priorities to the ministers. Stating that “the most significant issue is violence against women and girls” Beaudin further stressed related issues of FASD, Indigenous girls’ health and safety, violence against Indigenous women, and family justice reforms for Indigenous women.

During the meeting, Ministers discussed the Truth and Reconciliation Commission of Canada: Calls to Action. It underscores the need to address FASD in action numbers 33 and 34, in particular. Ministers agreed to collaborate on addressing solutions for the economic and social impacts of alcohol abuse and to release their final report on FASD and Access to Justice.

FASD prevention efforts in Canada call for multiple approaches that are holistic and move beyond just advising women not to drink during pregnancy (See: Four-part Model of Prevention). The impact of violence and trauma in all its forms on the mental and physical health and safety of women and their families and communities informs and shapes these efforts.

For more on related topics, see earlier blog posts:

New Zealand has published an action plan on how best to address FASD. Described as a “whole of government action plan” by Associate Minister of Health, Peter Dunne, Taking Action on Fetal Alcohol Spectrum Disorder: 2016-1019 builds on the best practices being done across communities and service sectors including government policy and partnerships, as well as front line prevention and intervention. According to Fetal Alcohol Network NZ, the government is earmarking an initial 12 million for these efforts, which will increase support and services to women with alcohol and substance use issues.

New Zealand began the process of building the action plan with a discussion document of principles, priorities and action areas. They spent over a year seeking submissions and comments on the plan from professionals, communities, families and whānau (Maori extended family.)  Notable changes to the principles based on those submissions included issues of ethnic and services inequities, as well as stigmatization of women, families and individuals with FASD. The resulting principles defined the core priorities of the plan: prevention, early identification, support and evidence. These priorities framed its action building blocks and designated indications of success of plan outcomes. You can view an analysis of the Ministry of Health action plan submissions here.

By underscoring a collaborative and practical approach, the goal is to make sure that “FASD is prevented and people with FASD and their family/whānau live the best possible lives.”(1) Read more about New Zealand’s efforts:
http://www.health.govt.nz/publication/taking-action-fetal-alcohol-spectrum-disorder-2016-2019-action-plan

To read more about New Zealand’s prevention efforts see these previous posts:

First FEBFAST and Debates about Alcohol Labeling in New Zealand, February 1, 2011


References

  1. FASD Working Group. 2016. Taking Action on Fetal Alcohol Spectrum Disorder: 2016–2019: An action plan. Wellington, NZ: Ministry of Health.

 

 

 

 

FASD Conference 2

Marsha Wilson, Nancy Poole and Dorothy Badry at the 7th National Biennial Conference on Adolescents and Adults with Fetal Alcohol Spectrum Disorder (FASD). Session E3: Developments in Prevention of FASD – The Work of the Can FASD Prevention Network Action Team

At the 7th National Biennial Conference on Adolescents and Adults with FASD in Vancouver on April 9, 2016, Nancy Poole and Dorothy Badry described the work of CanFASD’s Prevention Network Action Team (pNAT).  They provided examples of the pNAT’s work on:

  1. Network building – Sharing expertise and skills through a network of researchers, policy analysts, clinicians, community-based service providers and advocates dedicated to FASD prevention
  2. Research – Building multidisciplinary research teams, developing research proposals, and conducting research
  3. Collaborative knowledge exchange – Developing and implementing strategies for moving “research into action” such as through workshops, curricula development for health and social service professionals, and policy analysis
  4. Influencing policy and service provision  Guiding service and policy improvements with governments and communities

Given the conference focus on adolescents and adults with FASD, the 2011 research led by pNAT member Deborah Rutman on prevention with girls and women with FASD and substance use problems was highlighted.   Treatment and support with girls and women who live with FASD is one of the least researched areas of FASD prevention.

A list of FASD prevention resource materials developed by pNAT members was provided. Reports and infographics that summarize research, and thereby support research-to-practice and -policy are included below.

LINKS

7th National Biennial Conference on Adolescents and Adults with FASD

Research on prevention with girls and women with FASD

CanFASD  – description of the pNAT

FASD Prevention Resources Spring 2016

FASD Resources

plan

Elizabeth Elliott recently wrote a short article describing current FASD prevention efforts in Australia for the journal Public Health Research and Practice (available here).

Increasing awareness and understanding of FASD has resulted in a number of positive developments at a national level, including a federal parliamentary inquiry into FASD (2011), the development of an Australian Government action plan to prevent FASD (2013) and the announcement of government funding to progress the plan and appoint a National FASD Technical Network (June 2014).

Some of the earliest FASD prevention activities in Australia were led by indigenous communities. In 2007, a group of Aboriginal women from Fitzroy Crossing in remote northern Western Australia led a campaign to place a ban on the sale of full strength alcohol in their community.

This led to the Lililwan Project, the first ever prevalence study of FASD in Australia and a partnership between Nindilingarri Cultural Health Services, Marninwarntikura Woman’s Resource Centre, the George Institute for Global Health and the Discipline of Paediatrics and Child Health at The University of Sydney Medical School.

This ‘research in action’ project included diagnosis and development of individualised management plans to address the health issues of each child. Earlier this year, the researchers reported that one in eight (or 120 per 1000) children born in 2002 or 2003 in the Fitzroy Valley have FAS.

In 2009, the National Health and Medical Research Council revised the guidelines regarding alcohol use in pregnancy to state “For women who are pregnant or planning a pregnancy, not drinking is the safest option.”

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In 2014, the Women Want to Know project was launched. Developed by the Foundation for Alcohol Research and Education (FARE) in collaboration with leading health professional bodies across Australia and with support from the Australian Government Department of Health, the project encourages health professionals to routinely discuss alcohol and pregnancy with women in keeping with the revised guidelines.

FARE also launched the Pregnant Pause campaign in 2013 to encourage ‘dads-to-be’ and all Australians to support someone they care about through their pregnancy by taking a break from alcohol.

November 2013 also marked the first Australasian Fetal Alcohol Spectrum Disorders Conference  held in Brisbane.

Organizations such as the National Organisation for FASD Australia have taken a leadership role in education and advocacy related to FASD, including advocating for pregnancy warning labels on alcohol.

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Drinkwise, an alcohol industry-funded organization, has voluntarily developed ‘consumer information messages’ such as ‘It is safest not to drink while pregnant’ and ‘Kids and Alcohol Don’t Mix.’ However, an audit found that 26% of products carried a DrinkWise alcohol pregnancy warning label. (Visit Drink Tank for a discussion of alcohol industry led product labeling in Australia).

For more on FASD prevention in Australia, see earlier posts:

HealthWarning

Alcohol warning labels have been used by a number of provinces, states, and countries as a way of trying to prevent FASD by encouraging women to abstain from alcohol consumption during pregnancy.

While popular with the general public and widely promoted by many groups and organizations, their use remains controversial as there is limited evidence for their effectiveness. A scoping review published last year (Thomas et al, 2014) concluded that alcohol warning messages have the most influence on low-risk drinkers and have not been shown to change the drinking behavior of those who drink heavily or binge during pregnancy.

In a recent article published in The American Journal of Bioethics, Emily Bell, Natalie Zizzo & Eric Racine (2015) discuss ethical concerns stemming from the questionable effectiveness of alcohol and pregnancy warning labels:

There are good reasons to question the use of alcohol labels and the narrow messages they convey as methods of primary prevention for FASD. They risk perpetuating restrictive and unsupportive policies toward pregnant women with alcohol abuse issues. They may create fear and anxiety among women who drink before realizing they are pregnant, and they fail to support a comprehensive picture of FASD prevention (i.e., no information resources, no focus on the family’s, partner’s, or society’s roles). (p.19)

They comment on how the promotion of alcohol and pregnancy warning labels may be related to a belief that “doing something is better than doing nothing.” And, while it could be argued that alcohol warning labels support longer term changes in the acceptability of drinking patterns among women and the public, research has failed to demonstrate measurable changes in drinking since they were introduced.

Drink-Responsibly-Logo

For more on warning labels, see earlier posts:

References

Bell, E., Zizzo, N. and Racine, E. (2015) Caution! Warning Labels About Alcohol and Pregnancy: Unintended Consequences and Questionable Effectiveness. The American Journal of Bioethics, 15:3, 18-20, DOI:10.1080/15265161.2014.998376

Thomas, G., Gonneau, G., Poole, N., and Cook, J. (2014). The effectiveness of alcohol warning labels in the prevention of Fetal Alcohol Spectrum Disorder: A brief review. International Journal of Alcohol and Drug Research, 3(1):91-103. doi: 10.7895/ijadr.v3i1.[Open Access]

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fasd-warning-signage-info-kit-booklet-web

The government of British Columbia recently released Alcohol and Pregnancy: Warning Signage Information Kit for Local Governments in British Columbia.

Over the past decade, several B.C. municipalities have passed bylaws under the Community Charter Act requiring alcohol retailers to post point-of-sale FASD warning or prevention signs.

Point-of-sale prevention messages can be helpful in:

  1. Influencing knowledge and levels of awareness, changing attitudes and beliefs, and (with sufficient exposure) reducing risk behaviours;
  2. Encouraging information seeking;
  3. Conveying information about how to make positive change;
  4. Indicating where to receive support and services; and
  5. Encouraging people who already know the facts.

This new resource provides city councils with information about the rationale for point-of-purchase FASD warning and prevention sign bylaws and discusses the form and types of messages that can be effective, including
examples of recommended messages designed to help prevent/reduce drinking in pregnancy and promote health among women of childbearing ages.

While intended for a local audience, the information about effective messaging as well as issues such as visibility, recall, and comprehension of signs will be helpful for anyone involved in developing FASD awareness materials. Appendix 3 is especially valuable with a discussion of alcohol and pregnancy messages for women at different levels of risk.

The resource can be downloaded from the BC government website.

WHO report 2014

The Global status report on alcohol and health 2014 from the World Health Organization provides a global overview of alcohol consumption.

It looks at patterns of alcohol use, including binge drinking, and the relationship between alcohol and over 200 health conditions. It also looks at alcohol policy and interventions and provides country-by-country profiles of patterns and trends.

  • Globally, alcohol causes approximately 3.3 million deaths every year (or 5.9% of all deaths); and 5.1% of the global burden of disease is attributable to alcohol consumption. In 2012, 7.6% of deaths among males and 4.0% of deaths among females were attributable to alcohol.
  • While alcohol is the leading risk factor for death in males aged 15–59 years, women are more vulnerable to alcohol-related harm for a given level of alcohol use or a particular drinking pattern. As well, alcohol use among women is continuing to increase and is linked to economic development and changing gender roles.
  • Worldwide, 61.7% of the population (ages 15+) had not drunk alcohol in the past 12 months, and 13.7% had ceased alcohol consumption (i.e. they have consumed alcohol earlier in life but not in the past 12 months).
  • Almost half of the global adult population (48.0%) has never consumed alcohol.

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Just over 70 countries reported nationwide awareness-raising activities related to alcohol and pregnancy. The report also discusses the role of health services in reducing alcohol-related harm and supports:

  • initiatives for screening and brief interventions for hazardous and harmful drinking at primary health care and other settings, including early identification and management of harmful drinking among pregnant women and women of child-bearing age;
  • improving capacity for prevention of, identification of, and interventions for individuals and families living with fetal alcohol syndrome and a spectrum of associated disorders

For more on global alcohol patterns and trends, see earlier posts:

The Women Want to Know project encourages health professionals to routinely discuss alcohol and pregnancy with women and to provide advice that is consistent with the National Health and Medical Research Council’s Australian Guidelines to Reduce Health Risks from Drinking Alcohol. This is the first national campaign targeted at health professionals since the Alcohol Guidelines were last updated in 2009.

A survey of 300 health professionals conducted prior to the project  found that one in five health professionals had not heard of the Guidelines and more than two in five (45%) were aware of the Guidelines but not familiar with the content.

The guidelines state that  ‘Maternal alcohol consumption can harm the developing fetus or breastfeeding baby’ and ‘For woman who are pregnant or planning a pregnancy, not drinking is the safest option’ and ‘For women who are breastfeeding, not drinking is the safest option’.

Research has also shown that 97 per cent of Australian women want to be asked about alcohol use during pregnancy.

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The Women Want to Know project was developed by the Foundation for Alcohol Research and Education (FARE) in collaboration with leading health professional bodies across Australia and is supported by funding from the Australian Government Department of Health.

There are two main components to the project: (1) resources to support health professionals in discussing alcohol use and pregnancy with women, and (2) accredited training.

Resources from the Women Want to Know project include:

In addition three online e-Learning courses with Continuing Professional Development accreditation are available for health professionals through the:

Read the press release from the Foundation for Alcohol Research and Education here. Learn more about the project and recently developed resources here.

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Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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