Conversations on alcohol: Women, their partners, and professionals

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 7^th International FASD Conference Prevention Plenary. They discussed whether or not brief interventions work, and if they do, then which strategies work best.

Russia – 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.

Canada – 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.

World 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.

South 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.

U.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

Report on alcohol policy in Canada: How do the provinces stack up?

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.

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

• Minimum Alcohol Pricing Policies: Making the Connection to FASD Prevention (February 7, 2013)
• Integrating FASD Prevention and Alcohol Policy (March 17, 2011)

Testing pregnant low-income moms for drugs in New York creates outrage and controversy

A few days ago, Pix11 (part of the CW Television Network) published an article called Outrage as hospitals test pregnant moms for drugs near low-income neighborhoods (Stephanie Tsoflias, December 27, 2012).

The article looks at how pregnant moms across New York are being tested for drug use, specifically marijuana.  Many health care providers are administering the test without women’s consent. In some places, all women are asked to agree to testing; if women refuse, then babies are tested.

The article explores how this practice is not as supportive as one might think. In low-income neighborhoods, all mothers are being tested while in high-income neighborhoods, only women who are clearly under the influence of alcohol and/or drugs are being tested.

More worrisome is how the test results are being used – results are being sent to child protection services, with the implication that the results are an indicator of whether a woman is fit to parent.

While this article is taking a look at marijuana testing, it is directly relevant to those involved with FASD prevention or who are concerned about reducing alcohol use during pregnancy. I’ve blogged in the past about meconium testing which examines a baby’s first stools for evidence of whether a mother consumed alcohol during pregnancy. In Canada, meconium testing has been proposed as part of a comprehensive approach to addressing FASD.

While supporters of universal meconium testing believe that this will help with early identification of FASD in children, there are a lot of unresolved murky ethical issues and, at present, the practice would likely lead to more harm than good. As this article shows, while women in all socio-economic brackets use substances, certain groups of women are unfairly targeted and subject to more invasion of their privacy and are likely to experience adverse outcomes from testing.

See earlier posts on meconium screening:

• New mothers reluctant to participate in voluntary meconium testing pilot program (April 25, 2012)
• Testing for Fetal Exposure to Alcohol (November 15, 2011)
• The Ethics of Meconium Screening (October 3, 2011)
• Thinking About Meconium Screening (September 28, 2010)

FASD Throughout the Lifespan Conference and 14th National FACE Research Roundtable: Call for Abstracts

The FASD Newfoundland & Labrador Network (fasdNL) will be hosting a national FASD Conference & the 14^th National FACE Research Roundtable in St. John’s, Newfoundland & Labrador in September 2013.

September 5 & 6, 2013 – Conference: FASD Throughout the Lifespan: from prevention to lifelong support

September 7, 2013 – 14th Annual Fetal Alcohol Canadian Expertise (FACE) Research Roundtable

The event has three key components: 1) professional training sessions on FASD screening and diagnoses; 2) best practices on FASD prevention campaigns, strategies, programs & policies; and 3) evidence-based approaches to FASD intervention & lifelong support for people living with FASD.

The conference is open to family members, physicians, medical specialists, allied health professionals, service providers in health/mental health, addictions, justice, education, prevention, child welfare, and anyone interested in FASD.

Information about submitting abstracts to the conference can be found on the fasdNL website and you can take a look at the keynote speakers here.