FASD Prevention in Australia

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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:

What are the unintended consequences of alcohol and pregnancy warning labels?

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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.

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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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“Alcohol and Women” resource from Éduc’alcool (Quebec)

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A few years ago, the Quebec-based non-profit organization, Éduc’alcool, ran a wonderful campaign promoting Canada’s new sex-specific low risk drinking guidelines.

Éduc’alcool has just released a new publication called “Alcohol and Women.” The 16-page resource (available in French and English) discusses: How do women drink? Why do they drink? What impact does drinking have on their health and well-being?

The resource is intended for women of all ages as well as men.

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Statistics on women and alcohol in Quebec indicate that:

  • 82% of Quebec women drank alcohol in the last year; two thirds of those women drink regularly.
  • 13% of women who drink do so four or more times a week.
  • Among women 18 to 24, the annual prevalence of excessive drinking is 83%; among women 25 to 34, it is 70%, and among women 45 to 54, it is 53%.
  • Among teenage girls 15 to 17, 5% drink excessively at least once a month, and among young women 18 to 24, 19% do.
  • 0.9% of women in Quebec have been diagnosed as alcohol dependent.

“Alcohol and Women” is available for download from the Éduc’alcool website. Free copies can be ordered from Éduc’alcool at 1-888-ALCOOL1. As well, the publication will soon be available in hospitals, CLSCs (local community service centres) and Société des alcools du Québec outlets.

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“What have you heard about alcohol and pregnancy?” Information Cards from the Saskatchewan Prevention Institute

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These information cards from the Saskatchewan Prevention Institute are intended to help clear up confusing information about alcohol and pregnancy.

The first card targets women who are pregnant or trying to get pregnant and explains how drinking alcohol can affect a developing baby and cause a lifelong disability. The second is in plain language and explains how drinking can hurt a growing baby when a woman is pregnant.

The cards can be downloaded or ordered from the Saskatchewan Prevention Institute website.

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A ReThink of the Way We Drink – “Whiteboard Med School” video from Dr. Mike Evans

Some of you might be familiar with Dr Mike Evans and the great work of the Evans Health Lab. The Evans Health Lab “fuses clinicians and creatives, filmmakers and patients, social entrepreneurs and best evidence to create “edutaining” healthcare information.”

In 2011, his YouTube video  “23 and 1/2 Hours: What is the single best thing we can do for our health?” went viral. To date, the video has been viewed 7.5 million times and translated into eight languages, including Arabic and Gaelic.

The latest video in his “Whiteboard Med School” series is called “A ReThink of the Way We Drink.” In this video, he explores some of the recent research on alcohol and health. He touches on low risk drinking guidelines and sex-specific differences. He also talks about why many health care providers are often reluctant to ask about alcohol use due to fears about alienating patients or appearing judgmental.

Check out this video and others here.

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text4baby program in the United States: can text messaging be an effective alcohol brief intervention?

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Health interventions using mobile phones and related technologies are growing worldwide and some research is suggesting that text messaging can be one strategy to support behaviour change in areas ranging from quitting smoking to HIV testing to healthy living.

The text4baby program launched in the United States in February 2010 and has enrolled more than 700,000 participants. The service delivers text messages to pregnant women and new mothers on a schedule timed to the baby’s due date or birth date.

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There have been a number of studies evaluating the program (see here) and the program is expanding to include dads. A recent study published in the Journal of Medical Internet Research mhealth and uhealth takes a closer look at the effects of the program in the context of the US military by conducting a randomized trial with pregnant female soldiers and family members. One of the key questions the researchers were interested in was alcohol consumption: “Since you found out about your pregnancy, have you consumed alcoholic beverages?”

In total, there were six messages related to risks of alcohol consumption, including both recommendations not to drink and warnings about the risk of FASD. The researchers found a dose-response relationship, with higher levels of text message exposure predicting lower self-reported alcohol consumption. The text4baby participants also reported lower quantities of alcohol consumed postpartum.

This study suggests that text messaging can be an effective brief intervention for addressing prenatal alcohol use. For more on this topic, see an earlier post: Healthy Pregnancy, Healthy Baby Text Messaging Service in Tanzania (December 17, 2013).

Reference

Evans, W., Nielsen, P.E., Szekely, D.R., Bihm, J.W., Murray, E.A., Snider, J., and Abroms, L.C. (2015). Dose-Response Effects of the Text4baby Mobile Health Program: Randomized Controlled Trial. JMIR mHealth uHealth, 3(1):e12. DOI: 10.2196/mhealth.3909. PMID: 25630361. (Open Access)

Will classism and racism doom FASD prevention efforts?

'Alcohol, Pregnancy, and Racial and Social Class Bias I Psychology Today'

Dr. Ira J. Chasnoff has an interesting piece on the Psychology Today blog called “Alcohol, Pregnancy, and Racial and Social Class Bias.” (December 9, 2014)

Dr. Chasnoff looks at current class and race dynamics in the United States and how they influence the ways women interpret risks related to alcohol consumption during pregnancy and how physicians and other health care providers focus on screening and intervening with certain groups of women only.

Data from the Centers for Disease Control and Prevention show that white, college-educated, middle to upper class women are the most likely group to drink during pregnancy. And while research has shown that in many contexts white and African American women use alcohol and illicit drugs at exactly the same rates – physicians still select pregnant women for drug testing based on race and social class – sometimes 10 times more frequently.

Chasnoff comments:

“This is why current prevention campaigns don’t work. These campaigns fail because they focus on informing people about the risk of alcohol use in pregnancy.  However, it is no longer an issue of ignorance; at a cognitive level, most people recognize the potential danger of alcohol use during pregnancy. Prevention efforts fail because the information applies to “them,” not “us.” And as long as attitudes of specialness within middle to upper class men and women hold, as long as physicians continue to deny that alcohol use in pregnancy is a universal problem affecting a significant portion of children across all walks of life in this country, prevention campaigns will continue to fall short.”

 Read the full article on Psychology Today.

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The Prevention Conversation Project – Free Webcast on January 21, 2015 (Alberta FASD Learning Series)

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The Alberta FASD Learning Series helps individuals with FASD and their caregivers to learn more about FASD and how to support a person with FASD. The webcast and videoconference educational sessions cover a broad range of topics that target both urban and rural audiences.

On January 21, 2015 (9-11am), the topic in the series will be The Prevention Conversation Project. The aim of this project is to support open and non-judgemental conversations with women and their support systems about alcohol and pregnancy.

For registration information and more information about the learning series, visit the Alberta FASD website here.

Learn more about The Prevention Conversation on the Edmonton and area Fetal Alcohol Network Society website here.

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Alcohol and Pregnancy: Warning Signage Information Kit for Local Governments from British Columbia

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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.

British Pregnancy Advisory Service reports an increase in women considering an abortion due to binge drinking prior to pregnancy awareness

'Media scare stories over drinking during pregnancy are causing women to ask for abortions

BBC, The Independent, The Telegraph, and a number of other media sources are covering a recent report from the British Pregnancy Advisory Service.

The British Pregnancy Advisory Service provides help to women with an unplanned pregnancy or a pregnancy they choose not to continue with.

The organization recently reported an increase in the number of women considering an abortion because of fears about the possible harms of binge drinking prior to knowing they were pregnant. The organization is quoted as saying:

“Warnings that even one episode of binge drinking by a pregnant woman can cause lifelong damage to her baby are causing serious and unnecessary distress.  We are now regularly seeing women so concerned that they have harmed their baby before they knew they were pregnant they consider ending what would otherwise be a wanted pregnancy.”

The Telegraph interviewed experts and government officials to explore issues related to “pre-pregnancy test binge drinking.” Some of the issues discussed in the media coverage is the ambiguity in the research evidence about low levels of alcohol use during pregnancy, reassurance for women who are considering an abortion due to drinking prior to pregnancy awareness, and the reality that almost 50% of pregnancies are unplanned.

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Official advice on alcohol use during pregnancy in the United Kingdom, from the National Health Service, recommends that pregnant women should avoid alcohol altogether. However, if women choose to drink, they should drink no more than one or two units of alcohol (equivalent to a glass of wine) once or twice a week.

The British Pregnancy Advisory Service suggested that women’s concerns were spurred by a recent study stating that one episode of binge drinking was enough to cause considerable harm to a fetus. This type of reporting relates to ongoing discussions in the field of FASD prevention about the framing of messages about the potential harms of alcohol use during pregnancy. Some individuals and groups in the field are concerned that strongly worded messages (e.g., “Pregnant women should NEVER drink alcohol”) and the use of shocking or threatening images (e.g., a baby in an alcohol bottle) can have unintended consequences – such as unnecessary worry and fear throughout pregnancy or considering having an abortion.

While it’s important to inform women about the dangers of alcohol use during pregnancy, some researchers are suggesting that it might be helpful to be honest with women about the ambiguity in the academic research about low levels of alcohol use – rather than discouraging abstinence, this might help women to understand why official guidelines suggest that “the safest option is to not drinking during pregnancy” and that “there is no known amount of alcohol use during pregnancy that has been shown to be safe.”

For more on this issue, see an earlier post: Do concerns about alcohol use during pregnancy lead women to consider having an abortion? (February 1, 2013)