Four Levels of FASD Prevention 10 years On

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

Linking cannabis use with alcohol and tobacco

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

Youth understanding of substance use and pregnancy

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

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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.

Trauma-informed FASD Prevention and Care – Upcoming Webinar

Service providers and FASD prevention advocates are well aware of the intersections of trauma, substance use, and mental health issues as first described by researchers like Lisa Najavits (Najavits, Weiss, & Shaw, 1997). Research from the Women and Co-occurring Disorders and Violence study substantiated what many understood intuitively – that women with substance use problems facing complex life issues are best served through multi-leveled, integrated service models that are trauma-informed, gender-specific, and holistic (Amaro, Chernoff, Brown, Arévalo, & Gatz, 2007; Brown & Melchior, 2008).

There is an upcoming opportunity to learn more about applying these approaches to FASD prevention and care in a webinar on April 18^th at 9:00 am MST. The CSS Learning Series webinar as part of their FASD Learning Series will feature speakers Candice Sutterfield, Lakeland Centre for FASD, and Dr. Peter Choate, Assistant Professor of Social Work at Mount Royal University and clinical supervisor for the Alberta College of Registered Social Workers. They will address both a prevention and supports & services perspective. Sign up here: http://csslearningseries.ca/trauma-informed-fasd-prevention-and-care-registration-2/

Programs in Canada, like Breaking the Cycle and HerWay Home, currently offer integrated programs for/with pregnant and parenting women with substance use issues. Their program frameworks are trauma- and FASD-informed and they offer substance use treatment/support programming as well as needed social services and referrals at a single access point. Program evaluation findings show that relationship building is the key component benefiting women’s growth and supporting the mother-child relationship long-term. (See their evaluations here: Breaking the Cycle and HerWay Home).

In a very recent study undertaken in Ontario, findings from interviews with women participating in integrated programs, described qualities of a therapeutic relationship that helped women improve emotional regulation and executive functioning (Milligan, Usher, & Urbanoski, 2017). Therapeutic relationships that incorporate trust, care, positive regard and a non-punitive attitude can create a safe attachment from which women can apply effective problem solving in all areas of their lives.

Sign up for the webinar and see these earlier posts for more information:

The Mother-Child Study: Evaluating Treatments for Substance-Using Women, March 18, 2015

HerWay Home Program for Pregnant Women and New Mothers in Victoria, BC, February 12, 2013

REFERENCES

Amaro, H., Chernoff, M., Brown, V., Arévalo, S., & Gatz, M. (2007). Does integrated trauma-informed substance abuse treatment increase treatment retention? Journal of Community Psychology, 35(7), 845-862.

Brown, V. B., & Melchior, L. A. (2008). Women with co-occuring disorders (COD): Treatment settings and service needs. Journal of Psychoactive Drugs, SARC SUPPL 5, 365-385.

Milligan, K., Usher, A. M., & Urbanoski, K. A. (2017). Supporting pregnant and parenting women with substance-related problems by addressing emotion regulation and executive function needs. Addiction Research & Theory, 25(3), 251-261. doi:10.1080/16066359.2016.1259617

Najavits, L. M., Weiss, R. D., & Shaw, S. R. (1997). The link between substance abuse and posttraumatic stress disorder in women. A research review. The American Journal On Addictions / American Academy Of Psychiatrists In Alcoholism And Addictions, 6(4), 273-283.

Is FASD really 100% preventable?

A lot of progress has been made on effective FASD awareness and prevention strategies. Early efforts often used disrespectful tactics like unsettling pictures of women slugging down alcohol from a bottle while pregnant with a caption such as “Baby or the Bottle.” Those approaches have largely been abandoned. But one overly simple statement still pops up. And that is, “FASD is 100% Preventable.”

That statement is misleading because it suggests that FASD prevention is unidimensional and linked only to alcohol consumption. But alcohol use during pregnancy is linked to the social determinants of health, and its effects can be exacerbated by food insecurity, trauma, poverty and multi-substance use. It also suggests that stopping drinking is a simple choice. It puts the onus on the individual woman to make that choice and contributes to shame if they do not stop before they become pregnant. But in reality, there are many influences on women’s alcohol use, and real challenges to quitting before you know you are pregnant. Indeed, almost half of pregnancies are unplanned, so it is very challenging to be alcohol free before a pregnancy is confirmed.

In the case of other substances like tobacco or prescription painkillers, the public discourse extends beyond the individual user to corporate responsibilities, physicians and health authorities to provide harm reduction and treatment programs, and of governments to provide regulation and enforcement and policies that work toward social equity.

If we extend this perspective to alcohol use during pregnancy, we must speak about the responsibilities of the alcohol industry for targeting girls and women of childbearing age, and of health providers for providing comprehensive education and brief support during the preconception and prenatal periods. We must also consider the responsibilities of health services for providing integrated treatment programs for pregnant and parenting women; and of governments for ensuring gender equity and preventing violence against women.

Theoretically, stopping alcohol use in pregnancy, or ideally, before, sounds simple – just do it. But it takes a lot of individuals and sectors to do their part to make it realizable.  Simplifying it to statements like “FASD is 100% preventable” is not the best approach.

These previous blogs illustrate the full context of FASD and prevention approaches.

HOUSING IS KEY COMPONENT TO WOMEN’S RECOVERY, August 19, 2017

TARGETING STIGMA AND FASD IN MANITOBA, June 26, 2017

HEAVY DRINKING AMONG WOMEN: NORMALISING, MORALISING AND THE FACTS, Jan 24, 2017

FASD IS A PUBLIC SAFETY AND JUSTICE PRIORITY FOR ABORIGINAL GROUPS, October 23, 2016

HOW DO PARTNERS AFFECT WOMEN’S ALCOHOL USE DURING PREGNANCY? August 11, 2014

 

Indigenous Approaches to FASD Prevention – A response to TRC Call-to-Action #33

 

Brief Interventions Indigenous Mothering Welness Community Action Reconciliation & Healing

Five new booklets on Indigenous Approaches to FASD Prevention have just been published. They were developed  following the Dialogue to Action on Prevention of FASD meeting in May 2017, and reflect the 8 tenets of the Consensus Statement created by participants for enacting the Truth and Reconciliation Commission of Canada Call-to-Action #33: “We call upon the federal, provincial, and territorial governments to recognize as a high priority the need to address and prevent Fetal Alcohol Spectrum Disorder (FASD), and to develop, in collaboration with Aboriginal people, FASD preventive programs that can be delivered in a culturally appropriate manner.” – Truth and Reconciliation Commission of Canada The booklets were written by Tasnim Nathoo and Nancy Poole of the Centre of Excellence for Women’s Health in collaboration with the Thunderbird Partnership Foundation, and Canada FASD Research Network. Topics include: Brief Interventions with Girls and Women, Mothering, Wellness, Community Action, and Reconciliation and Healing. Printed booklets are being shared with those who attended the meeting in May and with Indigenous communities who may find them helpful as they plan FASD prevention efforts. Links to PDF versions are included in this blog. Grounded in research, the booklets prioritize Indigenous knowledge for implementing culturally-safe, cross-disciplinary, cross-organizational, and collaborative approaches to FASD prevention. As well, each booklet offers discussion questions that shift the lens from a primary focus on alcohol use during pregnancy, to a holistic focus that aligns with Indigenous values and worldviews to support change and transformation in all systems of care. The Truth and Reconciliation Commission of Canada (TRC) provided a process for discovering the harms and injustices that Aboriginal people experienced as part of the Indian Residential School system with an aim to build a lasting and respectful foundation of reconciliation across Canada. TRC findings were released in 2015 along with 94 Calls-To-Action (CTA), including CTA #33, which focuses on FASD prevention.   See earlier posts on these topics: DEVELOPING AN INDIGENOUS APPROACH TO FASD PREVENTION IN BC’S FRASER SALISH REGION December 11, 2017 INNU COMMUNITY FASD PREVENTION IN LABRADOR October 27, 2017 FASD PREVENTION WITH INDIGENOUS COMMUNITIES IN AUSTRALIA April 3, 2017 THE MOTHERING PROJECT/MANITO IKWE KAGIIKWE IN WINNIPEG, MANITOBA May 1, 2015 POSTCOLONIAL THEORY FOR BEGINNERS September 1, 2010

Discussing alcohol use with women – does the SBIR model need rearranging?

How to discuss alcohol use with women of childbearing age is a topic in women’s health that is getting more attention and focus. Within FASD prevention circles, we have understood that women and their partners may not know about the risks of alcohol consumption during pregnancy or may drink before they realize they are pregnant.  Thus, they benefit from discussion of what they know, what the evidence says and options for action.

Screening, Brief Intervention, and Referral (SBIR) has long been known as an approach to guide clinicians when assessing risky alcohol use. But is the SBIR model the best approach to discussing alcohol with women of childbearing age and their partners? What are the approaches currently used across Canada? How should we discuss alcohol with women and who should do it? What works best according to the evidence?

The Centre of Excellence for Women’s Health (CEWH), the Canadian Centre on Substance Use and Addiction (CCSA), and the University of British Columbia Midwifery Program have teamed up to answer these questions. The Dialogue to Action on Discussing Alcohol with Women project has three high-level objectives: to identify current approaches; to summarize and share the available evidence; and, to promote best practices.

Nancy Poole of CEWH and Audrey McFarlane of CanFASD and Lakeland Centre for FASD at the Dialogue to Action regional meeting in Edmonton.

In order to meet their first objective, project researchers are currently conducting 12 regional meetings across Canada with physicians, midwives, nurses, and service providers in, sexual health clinics, violence against women services, alcohol and drug services, and Indigenous health services.

They are learning what is already being done and sharing what is known about promising practices and existing resources that can guide discussions and referrals. Participants are suggesting resources and tools – such as webinars, guidelines, policies and programs – that will be helpful in conducting meaningful discussions and support in their communities with women who use legal substances – or soon to be legal, like cannabis.

One early emerging idea arising from this project is that “screening” may be currently placed in the wrong location in the mnemonic list of SBIR.  Starting with brief information sharing and support (the relationship first), followed by screening/referral can be more engaging, trauma-informed, collaborative and person-centred. The rearranged approach prioritizes eliciting and appreciating individual needs and perspectives.

So the list might become BISR or even BISBIRT – repeating the conversation about substance use and ideas for action after screening as well as before it.

Participants from a regional meeting in Winnipeg, MB, discuss approaches to discussing alcohol with women that are working in their communities.

This project is one of several projects addressing FASD in Canada being funded by the Public Health Agency of Canada. You can learn more about all the projects here: https://www.canada.ca/en/public-health/news/2017/05/fetal_alcohol_spectrumdisorderincanadanewprojectfunding1.html

Read more:

Conversations on alcohol: Women, their partners, and professionals – April 23, 2017

Preconception Interventions: Trending or Mainstream? – July 21, 2016

Alcohol and FASD: It’s not just about women  – June 6, 2017

 

 

New Infographic for FASD Awareness Day – Prevention means supporting pregnant women

For International FASD Awareness Day on September 9th, the CanFASD Research Network, through its Prevention Network Action Team (pNAT) and the Centre of Excellence for Women’s Health, developed this infographic on what we know about alcohol use and preventing FASD. You can download a PDF version here.

CanFASD focuses on all aspects of FASD that impact women, individuals, caregivers, and service providers through its network action teams, each with a different focus – prevention, intervention, research, and policy and service providers. These teams aim to put forth knowledge in a way that is useful to communities and organizations in Canada in developing effective programs and policies.

You can search hashtags #FASDay2017 #CanFASD on Twitter to see examples of what others in Canada, or visit some of our pNAT partners using the links on the left side of this blog.

 

Housing is key component to women’s recovery

Sheway is well-known in Canada for its success in providing wrap-around services for pregnant and newly parenting women who are dealing with complex personal and social circumstances. It is trauma-informed, women-centred, culturally responsive and uses a harm reduction approach with a focus on connection with self and others. Women and their children can remain in the program up to 18 months post-partum. Last December, Lenora Marcellus, University of Victoria, and Sheway published findings to their study on how women make the transition from Sheway to living on their own – Supporting Families at Sheway and Beyond. Additionally, Dr. Marcellus has published a journal article:

Marcellus, L. (2017). A grounded theory of mothering in the early years for women recovering from substance use. Journal of Family Nursing. E-print ahead of press. 

In order to learn what elements of a positive transition could be identified and built upon, they followed 18 women for 3 years after leaving Sheway. These women faced multiple obstacles in this transition process with the overarching theme being “holding it together.” Their daily efforts are explored in these 3 ways:

Download Sheway Report

Restoring Self: gaining recovery and taking care of self, reconnecting with self and others, and rebuilding trust and credibility.

Centering Family: parenting their children, preserving a routine, dealing with partners, and handling custody issues.

Creating  Home: “chasing housing”, having to take whatever housing is available even if inadequate, and maintaining not only a physical space but a feeling of home for the family

While acknowledging the value for pregnancy and postpartum support as most often provided in maternity programs, their findings underscore that secure housing is a key component to a successful transition for women and their families. Yet, although housing is important to the overall health of women and their families, the choices they must make often result in a double bind. For example, women often are faced with choosing between affordable housing that is far from supports versus more expensive housing that is near supports. Some women must choose between staying in an unsafe relationship or losing housing. As well, some women must accept inadequate housing because of their substance use history, which serves to undermine their recovery and their maintaining custody of their children.

“Poor housing was identified by women as a potential trigger to relapse in their recovery.” – [1] p. 39

Complete findings are detailed within the report and recommendations are framed within the Levels of Prevention model developed by this prevention network.  Among the research team recommendations is to extend the time women can stay in the program in order to solidify recovery, supports and resources. As well, they stress that housing needs to be a core component of intensive, integrated maternity programs.

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For more on these topics, see earlier posts:

HOLISTIC AND SPECIALIZED SUPPORT FOR PREGNANT WOMEN: LEVEL 3 PREVENTION, November 21, 2016
THE MOTHER-CHILD STUDY: EVALUATING TREATMENTS FOR SUBSTANCE-USING WOMEN, MARCH 18, 2015
SUPPORTING PREGNANT AND PARENTING WOMEN WHO USE SUBSTANCES: WHAT COMMUNITIES ARE DOING TO HELP, OCTOBER 1, 2012
HERWAY HOME ‘ONE-STOP ACCESS’ PROGRAM IN VICTORIA SET TO OPEN, MAY 20, 2012
“NEW CHOICES” FOR PREGNANT AND PARENTING WOMEN WITH ADDICTIONS, JANUARY 9, 2012
TORONTO CENTRE FOR SUBSTANCE USE IN PREGNANCY (T-CUP), DECEMBER 19, 2011
CLINICAL WEBCAST ON BREAKING THE CYCLE PROGRAM: SEPTEMBER 20, 2011, AUGUST 2, 2011

1. Marcellus, L., Supporting families at Sheway and beyond: Self, recovery, family home. 2016, Sheway: Vancouver, BC.

 

Headlines, research and prevention: Do research findings on risks of alcohol use during pregnancy improve prevention efforts?

When you sign up for online alerts regarding new FASD research, a lot of research articles come your way. Some offer hope like the recent article on a possible future treatment for newborns diagnosed with FASD (see Common drugs reverse signs of fetal alcohol syndrome in rats). But most are headlines about newly identified risks associated with alcohol-exposed pregnancies.

For instance, these four recent headlines:

Drinking alcohol during pregnancy could have transgenerational effects

Prenatal exposure to alcohol increases likelihood of addiction later in life

Any alcohol consumption during pregnancy affects craniofacial development

Foetus absorbs mother’s alcohol and nicotine intake in just 2 hours

From a scientific research standpoint, it’s important to fully understand effects of alcohol -exposed pregnancies. But, from a prevention point of view, does it add anything to our efforts to know one more reason drinking alcohol during pregnancy is risky? Does it lessen the stigma these women face? Would one more identified risk be the thing a woman needed to hear in order to stop drinking in her pregnancy or while trying to become pregnant?

Obviously, the full picture of effects is important, and this kind of medical and scientific research should continue. At the same itme, it would be helpful to see more headlines on what has been discovered around prevention – focusing on programs that support the mother child dyad, efforts to reduce stigma, and implementation of trauma-informed and FASD-informed practices and policies.

How about five headlines like these?

Relational treatment programs reduce risk of alcohol-exposed pregnancies and FASD

Connection to culture is key to prevention for many women

Changes in alcohol policy contribute to reduction of violence against women and incidence of alcohol-exposed pregnancies

Secure housing contributes to reduction in alcohol-exposed pregnancies

Women who can safely discuss alcohol with their health provider are  more likely to stop risky drinking

This real headline deserves more coverage: “ If we want to save lives, control alcohol. ”

We have lots of information of the risks of alcohol-exposed pregnancies. The work now is about prevention and we will work to bring you those “headlines.”

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For more information on these topics, see these previous posts:

REACHING AND ENGAGING WOMEN: WHAT WORKS AND WHAT’S NEEDED May 15, 2017

THUNDER BAY’S FAMILY HEALTH PROGRAM PUBLISHES RESEARCH REPORT FOR PREVENTING ALCOHOL-EXPOSED PREGNANCY October 4, 2016

THE WORK OF THE NETWORK ACTION TEAM ON FASD PREVENTION FROM A WOMEN’S HEALTH DETERMINANTS PERSPECTIVE (CANFASD RESEARCH NETWORK) April 11, 2016

FASD ISSUE PAPERS FROM THE CANADA FASD RESEARCH NETWORK PROVIDE A QUICK OVERVIEW OF RECENT RESEARCH December 1, 2014

SUPPORTING PREGNANT WOMEN WHO USE ALCOHOL OR OTHER DRUGS: A GUIDE FOR PRIMARY HEALTH CARE PROFESSIONALS MAY 15, 2016

FREE WEBINAR: UPDATED RESOURCES ON WOMEN AND ALCOHOL: APPLYING RESEARCH TO PRACTICE – MAY 8, 2014 April 21, 2014

FASD PREVENTION RESEARCH AND KNOWLEDGE TRANSLATION: DEVELOPING A PAN-CANADIAN AGENDA WORKSHOP January 29, 2014

FASD INFORMED PRACTICE FOR COMMUNITY BASED PROGRAMS March 27, 2014

RESEARCH MAKES LINKS BETWEEN GENDER, ETHNICITY, CHILDHOOD ABUSE AND ALCOHOL USE April 2, 2013

TRAUMA MATTERS: GUIDELINES FOR TRAUMA‐INFORMED PRACTICES IN WOMEN’S SUBSTANCE USE SERVICES April 17, 2013