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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.

 

 

 

 

Each year, researchers with the Prevention Network Action Team (pNAT) of CanFASD Research Network conduct an international literature review of academic articles published on FASD prevention. Rose Schmidt and Nancy Poole of BC Centre of Excellence for Women’s Health looked at articles published between January and December 2015 and compiled a comprehensive bibliography of 88 FASD prevention-related articles – an increase of 25 articles from last year. With this review, those working on FASD prevention will be able to update themselves on the most current evidence and tailor policy and practice accordingly.

The bulk of the articles have come from the U.S., Canada and Australia, the United Kingdom and South Africa, in that order. The articles are organized under the four-level prevention framework created by the pNAT, as well as including articles related to FASD prevalence, influences, issues of preconception, indigenous women and young women. Fourteen articles were assigned to more than one topic category.

A look at “prevalence”

The topic category with the most articles was prevalence, followed in order by brief intervention with girls and women of childbearing age (Level 2), and influences. Preconception, raising awareness (Level 1), and specialized prenatal report (Level 3) also had a significant number of articles. We will highlight these topics individually in this blog over time in order to focus on key components of FASD prevention.

There were 26 articles having to do with prevalence rates as compared to seven articles in that category in 2014. They relate to specific location, U.S., Canada, Uganda, Norway and Tanzania, for instance, as well as pregnancy intentions, characteristics of women at risk for alcohol-exposed pregnancy, women’s understanding of risk factors during pregnancy, rates of binge drinking, adverse childhood experiences, and use of both alcohol and tobacco during pregnancy.

Some of the more compelling findings include:

  • new data from Canada shows that 27% of pregnancies are unintended – useful in that previous data on unintended pregnancies has been from the U.S. only [1];
  • smoking currently or in the past increased the likelihood of consuming alcohol during pregnancy [2];
  • experiences of abuse and violence are associated with higher levels of drinking during pregnancy[3], as well as higher education levels and older maternal age [4-9];
  • a “dose response” relationship was found to exist between adverse childhood experiences and drinking during pregnancy[3], and;
  • smoking during pregnancy was the most consistent predictor of drinking during pregnancy[10] .

Preconception behaviors as they relate to prevalence of alcohol-exposed pregnancies, in general, has become more of a focus in prevention efforts, and will be further discussed in upcoming blog posts on this bibliography.

For more information on FASD Prevention and Prevalence, see these earlier posts:


REFERENCES
  1. Oulman, E., et al., Prevalence and predictors of unintended pregnancy among women: an analysis of the Canadian Maternity Experiences Survey. BMC Pregnancy & Childbirth, 2015. 15: p. 1-8.
  2. Lange, S., et al., Alcohol use, smoking and their co-occurrence during pregnancy among Canadian women, 2003 to 2011/12. Addictive Behaviors, 2015. 50: p. 102-109.
  3. Frankenberger, D.J., K. Clements-Nolle, and W. Yang, The association between adverse childhood experiences and alcohol use during pregnancy in a representative sample of adult women. Women’s Health Issues, 2015. 25(6): p. 688-695.
  4. English, L., et al., Prevalence of Ethanol Use Among Pregnant Women in Southwestern Uganda. Journal Of Obstetrics And Gynaecology Canada: JOGC = Journal D’obstétrique Et Gynécologie Du Canada: JOGC, 2015. 37(10): p. 901-902.
  5. González-Mesa, E., et al., High levels of alcohol consumption in pregnant women from a touristic area of Southern Spain. Journal of Obstetrics & Gynaecology, 2015. 35(8): p. 821-824.
  6. Dunney, C., K. Muldoon, and D.J. Murphy, Alcohol consumption in pregnancy and its implications for breastfeeding. British Journal of Midwifery, 2015. 23(2): p. 126-134.
  7. Kingsbury, A.M., et al., Women’s frequency of alcohol consumption prior to pregnancy and at their pregnancy-booking visit 2001–2006: A cohort study. Women & Birth, 2015. 28(2): p. 160-165 6p.
  8. Kitsantas, P., K.F. Gaffney, and H. Wu, Identifying high-risk subgroups for alcohol consumption among younger and older pregnant women. Journal of Perinatal Medicine, 2015. 43(1): p. 43-52 10p.
  9. Lanting, C.I., et al., Prevalence and pattern of alcohol consumption during pregnancy in the Netherlands. BMC Public Health, 2015. 15(1): p. 1-5.
  10. O’Keeffe, L.M., et al., Prevalence and predictors of alcohol use during pregnancy: findings from international multicentre cohort studies. BMJ Open, 2015. 5(7): p. e006323-e006323.

 

man drinking with family

For over 25 years, there have been studies seeking to understand if paternal drinking affects fetal and infant health and FASD in particular. Finding that 75% of children born with FASD had fathers who were alcoholics, Abel et al. conducted a number of animal studies that described negative effects from paternal alcohol consumption but without clear or satisfactory links to humans [1]. Consequently, FASD prevention programs have primarily focused on pregnant women, where the evidence was certain, and treated paternal drinking as largely a risk factor for maternal drinking rather than a risk factor for FASD itself.

Now, with advances in epigenetic research, two recent analyses of studies are showing that paternal factors, and alcohol use, in particular, play a larger role in fetal/child health than just passing along genes. Each study analysis systematically reviewed findings about the role of paternal alcohol consumption on conception, pregnancy, and fetal and infant health. One analysis used a paternal-alcohol consumption lens, while the other used a birth-defect lens. These results provide evidence to expand prevention efforts to men, especially in the preconception period, and to continue research in the field of epigenetics and alcohol-exposed pregnancy. (To learn about epigenetics click here.)

The first review by McBride and Johnson looked at 150 research studies and distilled them down to 11 good-quality studies. The associated effects of paternal drinking fell into three themes: impact on maternal drinking, sperm health, and fetal/infant health. Two studies showed an association between low levels of paternal drinking with lowered sperm count, as well as underdeveloped sperm leading to conception problems and miscarriage. Seven studies showed an increased risk of miscarriage when men drank 10 drinks or more per week in the preconception period, and one study found an association of all cases of ventricle malformation (heart defect) with daily paternal alcohol consumption during the preconception period [2].

The second study review by Day and Savani et al. focused on birth defects and links to paternal alcohol consumption, age and environmental factors. The authors explore the evidence for how these factors impact sperm DNA and, therefore, how the developing cells of an embryo “read” and “express” genetic instructions. For example, genes that are normally “silenced” may be “activated”. Paternal alcohol consumption epigenetically impacts the “gene expression governing individual organ development” that can adversely affect fetal development, in the immediate instance and in future generations [3]. Deficiencies in brain size, heart formation, and cognitive and motor abilities (noted as being symptoms of FASD) were linked to paternal alcohol use even when there was no maternal alcohol consumption.

Both of these study analyses contend that more research is needed in order to understand the full impact of alcohol and epigenetics, and the interplay between maternal and paternal factors. Still, this latest research supports the need for health promotion policies and practices that address men’s alcohol use, not only as an influence on women’s alcohol use, and to benefit men’s health, but also for its potential adverse effect on fetal/child health.

For more on men and FASD prevention, see earlier posts:

REFERENCES/SUGGESTED READING

Abel, E., Paternal contribution to fetal alcohol syndrome. Addiction Biology, 2004. 9(2): p. 127-133. (Link here)

McBride, N. and S. Johnson, Fathers’ role in alcohol-exposed pregnancies: Systematic review of human studies. American Journal of Preventive Medicine, Article in Press.

Day, J., et al., Influence of paternal preconception exposures on their offspring: Through epigentics to phenotype. American Journal of Stem Cells, 2016. 5(1): p. 11-18.

 

NDARC Guide

This new resource from the National Drug & Alcohol Research Centre, University of New South Wales, Australia, is designed for all primary health care professions who see women in a broad range of health care service settings during the course of their practice.

The best practices guide builds on the evidence for providing coordinated, supportive and comprehensive care to pregnant women who use substances by providing a model for reducing the harm from alcohol and substance for women and their babies. See page 12 of this guide for a clearly charted overview of how physicians and other health care practitioners can support withdrawal, do psycho-social and nutritional interventions, and address barriers to care for pregnant women.

The model acknowledges the interconnections that impact a woman’s use of substances during pregnancy – including domestic violence, mental health, smoking, and stigma – and provides a guide for identifying risk and next steps for further assessment, support and/or treatment. See page 9 for a view of how identification differs for women who are pregnant, planning a pregnancy, or not planning a pregnancy.

It also moves beyond normal referral and coordination practices by using a holistic assessment process and designating a case coordinator or clinical lead to ensure “assertive follow-up.” Assertive follow-up consists of: making sure women are supported during pregnancy and birth; keeping mothers and their babies in the hospital so that post-birth assessments for mother and child can be done and plans for support and services are in place; providing breastfeeding, safe sleeping, parenting skills and contraception support; as well as, interfacing with partners, family members, and community agencies in support of the woman and her child.  See page 16 for more discussion on assertive follow-up and pages 19-20 for “Addressing barriers to care”.

Although the extensive resources that are included in this guide are geared for practitioners in Australia, many of them provide topic-specific information that practitioners everywhere may find helpful. See pages 24-27 for website links.

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

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

 

 

 

 

Edmonton inner-city program - Aboriginal - CBC'

The Healthy, Empowered and Resilient (H.E.R.) Pregnancy Program in Edmonton, Alberta uses professional staff and peer support workers to reach at-risk pregnant and parenting women in inner city Edmonton. The program, developed by Streetworks, supports street-involved women to access healthcare services before and throughout their pregnancy and address issues such as addiction, poverty and family violence.

CBC News featured the H.E.R. Pregnancy Program last week in the article “Pregnant aboriginal women find ‘world of difference’ in Edmonton inner-city program” (July 27, 2015). Nikki Wiart interviewed staff and clients of the program and learned about the importance of outreach, peer support, and the impact of early engagement with services on pregnancy and parenting outcomes.

90% of the program’s clients are Aboriginal while 50% of the staff is Aboriginal. Morgan Chalifoux, a pregnancy support worker, with the program describes how her personal experiences as a teen mother and living on the streets can make a difference: “”Honestly, if I wasn’t aboriginal, if I didn’t have the experience, if I didn’t use when I was on the street, if I didn’t understand what it was like to have my son threatened to be taken away from me … I wouldn’t be able to have the success that I have now with the clients.”

The program uses a harm reduction approach to addressing alcohol and other substance use during pregnancy. An evaluation of the program found that:

  • 76% of 139 pregnant women who connected with the program reported substance use, typically alcohol (32%), marijuana, and other drugs
  • While connected with the program, women reported elimination of use (40%), safer use (37%), and reduction of substance use (26%) at least once during their pregnancy with the program

The Alberta government has committed to funding the program for another three years as well as developing similar programs in Red Deer and Calgary.

For more on the H.E.R. Pregnancy Program, see earlier posts:

cbc mothering project

Manito Ikwe Kagiikwe (The Mothering Project), located at Mount Carmel Clinic in Winnipeg’s North End, provides prenatal care, parenting and child development support, group programming, advocacy, and addiction support for vulnerable pregnant women and new mothers.

CBC News interviewed Stephanie Wesley and Margaret Bryans about the program earlier this week. Bryans, a nurse and program manager at Manito Ikwe Kagiikwe, discusses the successes of the program since it first opened two years ago. The article focuses on the importance of supportive relationships and the value of a ‘focus on kindness’: “Women who are pregnant, who are using drugs and alcohol are one of the most stigmatized groups in our community.” (The Mothering Project aims to break cycle of addiction, CBC News, April 28, 2015).

MC_WebBanner_Mom

The program is a wonderful example of a integrated and holistic pregnancy program for women with addiction and related concerns. The program is based on principles of harm reduction. (Learn more about harm reduction and similar programs in this booklet, Harm Reduction and Pregnancy: Community-based Approaches to Prenatal Substance Use in Western Canada).

Since the program opened two years ago, 49 women have participated. Early evaluation findings show that, at the beginning of the program, 100% of women were actively using substances, 97% had never completed a substance use treatment program and 56% did not have a prenatal health care provider. Over the course of the program, 36% stopped using alcohol and drugs, 47% reduced their use, 39% attended an addiction treatment facility and 100% accessed prenatal care. Over half of mothers have been able to take their babies home with them from the hospital. Check out the infographic below for more.

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Final HWH conference date saver

HerWay Home in Victoria, BC is organizing a community conference and networking event for September 29, 2014.

HerWay Home is a child-focused, women-centred, family-oriented drop-in and outreach program for pregnant women and new moms with substance use challenges and their children.

When: Monday September 29, 2014

Where:  DaVinci Centre, 195 Bay Street, Victoria

Time:  09:00 – 4:00

Cost: Free to those attendees from Vancouver Island. A minimal charge of $50 to attendees from off the island.

Who should attend: HWH works with women who are pregnant or early parenting and also affected by substance use, mental health issues, violence, and trauma. This conference will be of interest to those working with women or in settings that are more focused on working with the baby (such as the NICU, foster care etc.),  along with those working on the social determinants of health such as housing, poverty, food security.

Registration information will be available in August. For more information or if you have any questions please contact HerWay Home at  Herwayhome@viha.ca

For more information about HerWay Home, see earlier posts:

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.

IJCH cover

The International Journal of Circumpolar Health is a multidisciplinary journal that specializes in Arctic and Antarctic health issues, with a particular interest in the health of indigenous peoples.

The journal has just published a special supplement (Supplement 1, 2013) which includes 100 full length papers, 90 extended abstracts and nearly 100 short abstracts from the 15th International Congress on Circumpolar Health held in August 2012.

This issue has a number of full length and brief papers related to FASD, women’s addictions, and indigenous health. Here are some of the papers you might be interested in taking a look at:

Perceptions of needs regarding FASD across the province of British Columbia, Canada – Anne George, Cindy Hardy, Erica Clark (p. 91)

This study describes the perceived needs for services for people affected by FASD in rural and urban British Columbia.

Prenatal alcohol exposure among Alaska Native/American Indian infants – Burhan A. Khan, Renee F. Robinson, Julia J. Smith, Denise A. Dillard (p. 147)

A survey which found that rates of prenatal alcohol use are primarily limited to pre-conception and the 1st trimester, with a dramatic decrease in the 2nd and 3rd trimesters.

An examination of the social determinants of health as factors related to health, healing and prevention of foetal alcohol spectrum disorder in a northern context – the Brightening Our Home Fires Project, Northwest Territories, Canada – Dorothy Badry, Aileen Wight Felske (p. 169)

An exploratory study of the issue of the prevention of FASD from a women’s health perspective in the Northwest Territories of Canada.

Resituating the ethical gaze: government morality and the local worlds of impoverished Indigenous women – Caroline L. Tait (p. 200)

Drawing from a project documenting 100 life histories of Indigenous women with addictions and who have involvement with the child welfare system, as children or adults, this paper explores the influence of government policies and programs in Canada on recovery and healing.

Coordinating foetal alcohol syndrome interventions in Alaska – Kris Broom, Wendy Getchell, Chantelle Hardy, Garrett Hartley and Jessica Olson (p. 241)

A review of current Alaska FAS policies and interventions.

The healing constellation: a framework for understanding and treating trauma in Alaska Native women – Wendy H. Arundale (p. 243)

Connecting theory, research, and treatment approaches, a look at indigenous women’s substance use in relation to mental health, intergenerational trauma and other factors.

Community-driven alcohol policy and foetal alcohol spectrum disorder prevention: implications for Canada’s North? – Nancy Poole, Tasnim Nathoo and Arlene Hache (p. 250)

An exploration of the potentially important role of alcohol policy in northern communities in influencing alcohol use in pregnancy and risk of FASD.

The full publication is freely available for download here.

For more on FASD prevention in northern regions, see earlier posts:

Overview: Four Levels of FASD Prevention

Information Sheet: What Men Can Do To Prevent FASD

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