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3rd in Series: First-ever FASD Prevention Plenary at the 7th International Conference on FASD: PART 2

“International Research on Discussing Alcohol with Women and Their Partners, and Empowering Professionals to Have These Conversations”: Tatiana Balachova, PhD, Associate Professor, University of Oklahoma Health Sciences Center & Prevent FAS Research Group; Jocelynn Cook, Chief Scientific Officer for The Society of Obstetricians and Gynaecologists; Lisa Schölin, Consultant at WHO Regional Office for Europe – Alcohol, Illicit Drugs and Prison Health; Leana Oliver, CEO of FARR; Cheryl Tan, Health Scientist CDC

Research shows that building awareness and offering brief interventions can help women reduce alcohol-exposed pregnancies. For a variety of reasons, not all providers feel comfortable or confident in giving information or asking about alcohol use, and they may not be sure it makes a difference in preventing alcohol-exposed pregnancies. Consequently, researchers from around the world presented their findings at the 7th International FASD Conference Prevention Plenary. They discussed whether or not brief interventions work, and if they do, then which strategies work best.

Russian study picRussia – Positive Messaging Improves Knowledge and Action

Tatiana Balachova, PhD, and her research group conducted a 3-part study to develop, implement, and test a prevention program in Russia. They found that women in Russia most trusted their OB/GYN physicians, so they developed FASD educational materials and trained physicians to deliver prevention information in two face-to-face structured interventions. FASD brochures using positive messages and images improved women’s knowledge of FASD and reduced risk for alcohol-exposed pregnancies. As well, they found that women who received the intervention reduced their frequency of alcohol use – most quitting – during in pregnancy.

JOGC picCanada – Care/Service Provider Education is key

Jocelynn Cook, Chief Scientific Officer for The Society of Obstetricians and Gynaecologists of Canada (SOGC) detailed the Vision 2020 strategies: advocacy, quality of care, education, and growing stronger. These strategies underpin their goals for care providers to focus on preconception as well as pregnancy, and deliver consistent messaging. In line with these goals. Alcohol Use and Pregnancy Consensus Clinical Guidelines that were first published by the SOGC in August 2010 were updated in 2016. The guidelines highlight the value of brief interventions and will be supported in the coming year with online education and training that recognizes “red flags” and provide best practices for supporting women’s health and engagement in discussions on potentially stigmatizing topics such as alcohol use.

who-coverWorld Health Organization – Prevalence Rates Inform Strategy

Lisa Schӧlin, consultant with the World Health Organization’s European office, described the data from Europe on alcohol consumption and drinking during pregnancy. The most recent prevalence data shows that Europe has the highest consumption rate of alcohol per capita of anywhere else in the world. As well, at 25.2%, it has the highest rate of alcohol consumption during pregnancy and the highest rate of FAS (37.4 per 10,000). These data were published in a review of the evidence and case studies illustrating good practices and areas of European action called “Prevention of harm caused by alcohol exposure in pregnancy” – you can view or download here.

FARR picSouth Africa – Short Messages Can Build Awareness

Leana Oliver, CEO of Foundation for Alcohol Related Research (FARR), explained how FARR builds upon existing health services by providing prenatal support, pregnancy planning and teaching of coping strategies to women through their programmes. Their “Do you have 3 Minutes?” campaign has been successful in building awareness within communities and in supporting prevention programmes (learn more here). As well, the FARR Training Academy offers accredited trainings and continued professional development on FASD to professionals, providers and educators. Research projects and FARR publications detail what has been learned such as the benefits of motivational interviewing and the need for preconception care and planning.

CDC picU.S. – Promoting Universal Screening and Brief Intervention

Cheryl Tan, Health Scientist, Centers for Disease Control and Prevention reviewed FASD activities currently underway. Surveillance of alcohol consumption by women of reproductive age is ongoing alongside efforts by the CDC to promote universal screening and brief interventions (aSBI) of adults 18+ years. She noted the wide discrepancy between how often providers say they conduct SBI (85%) and how often patients say they receive it (25%). As well, as a partner of the Collaborative of Alcohol-free Pregnancy, the CDC is helping to change healthcare practice through high-impact projects: 1) implement interprofessional model for prevention of AEP; 2) provide evidence for aSBI to insurers in the US; and, 3) reduce stigma associated with drinking during pregnancy.

For more these topics see earlier posts:

First-ever FASD Prevention Plenary at the 7th International Conference on FASD, March 22, 2017
WHO Europe: Prevention of harm caused by alcohol exposure in pregnancy, December 22, 2016
“Supporting pregnant women who use alcohol or other drugs: A guide for primary health care professionals”, May 15, 2016
How do partners affect women’s alcohol use during pregnancy?, August 11, 2014
Empowering Conversations to Prevent Alcohol Exposed Pregnancies: Extended Learning Webinars, May 8, 2014
The Prevention Conversation Project – Free Webcast on January 21, 2015 (Alberta FASD Learning Series), December 15, 2014
Alcohol and Pregnancy campaign from Norway, December 12, 2011
FASD Prevention in Russia, February 15, 2012

Pages from WHO report-2

The World Health Organization recently released Guidelines for identification and management of substance use and substance use disorders in pregnancy.

These guidelines were primarily written for health-care providers managing women from conception to birth, and during the postnatal period, and their infants.

The guidelines focus on six areas:

  1. Screening and brief intervention
  2. Psychosocial interventions
  3. Detoxification
  4. Dependence management
  5. Infant feeding
  6. Management of infant withdrawal

Download the Guidelines from the WHO website.

FASD prevention can be approached from many levels. For example, Poole (2008) discusses four levels of FASD prevention:

Level 1 – Broad awareness building, health promotion efforts, and public policy
Level 2 – Brief Counselling with Girls and Women of Childbearing Age
Level 3 – Specialized Prenatal Support
Level 4 – Postpartum Support

Levels of FASD Prevention_Poole 2008

Level 2 focuses on ensuring girls and women of childbearing years have the opportunity for safe discussion about reproductive health, contraception, pregnancy, alcohol use, and related issues, with their support networks and healthcare providers.

Overall, research evidence supports screening and brief interventions for alcohol misuse as efficacious and cost-effective in a variety of settings. While there are many variations in “brief intervention” approaches, most are grounded in social-cognitive theory and commonly incorporate elements of motivational interviewing. Brief interventions often provide feedback on alcohol use (e.g., is it considered “risky”?), information on the effects and possible consequences of alcohol use, and discussion of possible strategies to moderate or reduce alcohol use.

A recent systematic review by Gebara et al (2013) specifically examines brief interventions to reduce at-risk drinking in women, including studies related to alcohol use during pregnancy. They found that many types of brief interventions could be effective for women, e.g., face-to-face or by computer or telephone, and resulted in changes in both in the number of days of consumption and in the number of doses, or both.

For more on this topic, see earlier posts:

References

Gebara, C., Bhona, F., Ronzani, T., Lourenço, L. and Noto, A. (2013). Brief intervention and decrease of alcohol consumption among women: a systematic review. Substance Abuse Treatment, Prevention, and Policy, 8: 31  doi:10.1186/1747-597X-8-31

Poole, N. (2008). Fetal Alcohol Spectrum Disorder (FASD) Prevention: Canadian Perspectives. Ottawa, ON: Public Health Agency of Canada

grass

A few weeks ago, the Centre for Addiction and Mental Health (CAMH) released a report that took a look at 10 different evidence-based alcohol policies designed to reduce individual and societal harm from alcohol misuse and gave each province a score based on the degree to which each has implemented these policies.

Alcohol policies, when widely implemented, have considerable potential to reduce the health and social harms from alcohol, including influencing rates of FASD.

Some of the policy areas particularly relevant to FASD prevention that were examined include:

  • Marketing and advertising
  • Screening, Brief Intervention and Referrals
  • Warning Labels and Signs

The research team commented on how evidence from more than several hundred empirical studies has shown that the use of screening, brief interventions and referrals (SBIR) in health care settings is an effective method for reducing alcohol consumption and associated problems. They looked at the inclusion of SBIR in provincial strategies and plans (e.g., encouraging health care providers to screen for alcohol misuse with pregnant women or in the general population), fee for service codes which allow physicians to receive payment for conducting SBIR, and the inclusion of SBIR in health professional guidelines.

The report found that British Columbia and Ontario had perfect to almost perfect scores while other provinces had little or no activity on SBIR. Notably, British Columbia has a fee for service code specific to SBIR.

While the authors comment on the limited evidence of effectiveness for warning labels when used in isolation, they comment that warning labels on alcohol containers and point of sale warning signs are a good policy practice because of their potential to raise awareness of alcohol as a health issue and to support the adoption of other more directly effective policies.

While Ontario has legislated mandatory warning signs for both off-premise and on-premise outlets with a clear and direct health message pertaining to the risks of consuming alcohol while pregnant, most other provinces do have strong health oriented warning messages about alcohol use, including alcohol use during pregnancy.

You can view the press release here (March 6, 2013) and download the full report Strategies to Reduce Alcohol-Related Harms and Costs in Canada: A Comparison of Provincial Policies here.

Executive Summary_ENG_FINALrevised2_Page_1

For more on alcohol policy and FASD prevention, see earlier posts:

Handbook Cover

“The Handbook for Aboriginal Alcohol and Drug Work is a practical tool written for Aboriginal drug and alcohol workers, mental health workers and others working in this field. It offers a detailed look at alcohol and drug work from clinical, through to prevention, early intervention and harm reduction. This handbook is also likely to help people working to improve policy and those advocating for change.

The idea for it came from workers all over Australia. They told us that they needed an easy to use handbook that can help them respond to the range of alcohol and drug issues they face every day. They also told us that such a book needs to take into account the complex challenges facing workers when helping clients, their families and, sometimes, whole communities.”

This plain language, evidence-based guide was created in partnership between the University of Sydney and Aboriginal and non-Aboriginal agencies and health professionals. Four of the six editors are Aboriginal.

It covers alcohol and drug use as well as a whole range of other issues, including child protection notifications, legal issues, working with clients without housing, mental health and polydrug use, and community-wide approaches.

Chapter 2 focuses on alcohol and Chapter 16 focuses on Special situations, settings, and groups, including pregnancy, breastfeeding and early childhood. It discusses the use of brief intervention and counselling approaches in the context of alcohol and pregnancy. It also has sections covering Neonatal Abstinence Syndrome, Alcohol use in pregnancy and Foetal Alcohol Spectrum Disorders.

The handbook was first distributed to alcohol and drug professionals from around Australia at the National Indigenous Drug and Alcohol Conference in Western Australia in June 2012.

The project started in 2010 with a grant from the Foundation for Alcohol Research and Education (FARE) and continued with the support of the NSW Ministry of Health.

The handbook is available online.

SBIR - Home

Alcohol Screening, Brief Intervention and Referral: Helping Patients Reduce Alcohol-related Risks and Harms is a resource for Canadian family physicians, nurse practitioners and other healthcare professionals developed by the College of Family Physicians of Canada and the Canadian Centre on Substance Abuse.

The online resource, available in both English and French, uses a three-step alcohol screening, brief intervention, and referral process. The resource section includes information on seven sub-populations, including women, alcohol and pregnancy, and alcohol and breastfeeding.

Research evidence supports screening and brief interventions for alcohol misuse as efficacious and cost-effective in a variety of settings.

There are a range of screening tools out there (see posts listed below for more); this resource incorporates Canada’s Low-Risk Alcohol Drinking Guidelines which were released in November 2011.

SBIR Clinical Guide

For more on screening in primary care settings, see previous posts:

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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