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p
r e v e n t i n g a l c o h o l - e x p o s e
d p r e g n a c i e s
CDC supports
the following prevention activities:
Reducing
Alcohol-Exposed Pregnancies Through the Use of Community-Level
Guided Self-Change Programs
Community resources for assisting individuals who are problem
drinkers but who are not alcohol-dependent are limited in
most communities. Over the past decade, increasing attention
has been directed toward programs focused on engaging the
individual’s own capacity for self-change as a means
of achieving recovery from alcohol problems. This approach
is supported by findings that up to 75% of individuals who
change their problem drinking habits do so without the use
of formal treatment programs. Guided self-change (GSC) programs
tend to be of low intensity as compared with traditional treatments,
targeted toward the community at large, and focused on problem
drinkers as opposed to severely alcohol-dependent drinkers.
The goal of these programs is to attract and assist motivated
individuals in the early stages of alcohol abuse to take part
in an intervention aimed at facilitating a client-driven,
self-change process of alcohol reduction or abstinence. GSC
intervention components are similar to those of brief interventions
and include personal feedback, advice, goal-setting, and self-monitoring
of behavior reformatted into self-administered materials that
can be completed at home.
In 2004,
CDC funded two universities to 1) develop, implement, and
evaluate community-level, self-guided change projects targeting
women 18 to 44 years of age who are at risk for an alcohol-exposed
pregnancy; and 2) demonstrate a 15% reduction in the proportion
of women at risk for an alcohol-exposed pregnancy in community-based
intervention sites as compared with non-intervention community-based
sites.
FUNDED
PROJECTS
Nova Southeastern University—Ft.
Lauderdale, Florida
An intervention will be instituted for a sample of women 18
to 44 years of age who are at risk for an alcohol-exposed
pregnancy in three counties in south Florida. Participants
will be recruited through the media (e.g., newspaper advertisements,
mail flyers, television, billboards, and radio public service
announcements). Once respondents are screened and determined
to be eligible, they will be randomly assigned either to a
motivational intervention promoting self-change, or to a control
intervention that will provide information only about the
risk of fetal alcohol syndrome. The intervention group will
receive a one-time mailing about how to either reduce alcohol
consumption or increase use of effective birth control. Women
who are unsuccessful at reducing their risk can access professional
services for help. The specific goals of the study are to
1) determine the degree to which participants decrease their
risk for an alcohol-exposed pregnancy, and 2) determine the
level of use of professional resources for self-change. The
efficacy of the intervention will be evaluated and the results
will be disseminated to health care providers in the local
community. For more information about the program at Nova
Southeastern University, contact the Guided Self-Change Clinic
at (954) 262-5968 or visit their web site at http://www.nova.edu/gsc.
St. Louis University—St.
Louis, Missouri
A community-based self-change project will be conducted with
the goal of reducing the risk of alcohol-exposed pregnancies
by 15% among African-American women in St. Louis. St. Louis
has a high number of childbearing age women in an at-risk
community, with a high prevalence of binge drinking that continues
during pregnancy. Kansas City is the comparison community.
Baseline risk for alcohol-exposed pregnancies in both St.
Louis and Kansas City will be assessed using a random digit
dial survey. Behaviors relating to both alcohol use and contraceptive
use will be assessed. Recruitment of participants will take
place through advertisements in the media, through the random
digit dial survey, and through health care provider offices
and WIC clinics. Educational materials about reducing at-risk
drinking or increasing proper use of birth control will be
mailed to participants, but will also be available through
the Internet. These materials will guide participants through
a self-change process. Follow-up will occur 4 months after
enrollment.
Project
CHOICES
(Changing High-Risk AlcOhol Use and Increasing Contraception
Effectiveness Study) Preventing Alcohol-Exposed Pregnancies
Among High-Risk Women in Special Community-Based Settings
In September 1997, CDC awarded cooperative agreements to three
university grantees to develop brief interventions aimed at
preventing alcohol-exposed pregnancies among women of childbearing
age in special settings. The selected settings have access
to relatively large numbers of women of childbearing age who
drink at high-risk levels and do not use contraception effectively.
The grantees, along with the special settings they are working
in, are:
Nova Southeastern University in Ft. Lauderdale, Florida
Adult
and Pediatric Primary Care Centers in the North Brossard
Hospital District of Ft. Lauderdale
Recruitment
of a cohort of women concerned about problem drinking through
media advertisement in the Ft. Lauderdale area
University
of Texas Health Sciences Center at Houston, School of Public
Health in Houston, Texas; Harris County Jail; Houston Recovery
Campus
Virginia
Commonwealth University, Medical College of Virginia in
Richmond, Virginia; Gynecology Outpatient Clinic of the
Medical College of Virginia; South Richmond Health Center
Funded
grantees worked collaboratively with one another and CDC to
develop a uniform study protocol for implementation in the
six special settings. The objectives of the study are to:
Characterize
the women in the special high-risk settings.
Reduce
the rate of alcohol consumption among women who are not
using contraception effectively and increase contraception
effectiveness among women who do not reduce their alcohol
consumption.
Examine
the relationship between selected process variables and
study outcomes.
An epidemiologic
survey, administered to approximately 500 women in each of
the six settings, was conducted during the first phase of
the study. The purpose of the survey is to characterize the
overall population in the special settings in terms of prevalence
and patterns of alcohol use, prevalence of characteristics
associated with heavy alcohol use, reproductive health status
(for example, parity, contraceptive practices, current sexual
activity, and fertility), alcohol treatment histories, and
history of psychiatric illnesses. To get more information
about the Project CHOICES epidemiologic survey findings, click
here:
PROJECT CHOICES.PDF
A common protocol for a behavioral intervention was developed,
implemented, and evaluated in each of the six settings. A
feasibility study designed to test the behavioral intervention
was conducted from March 2000 until May 2001. Study participants
(50 women from each of the six special settings) were provided
a brief intervention of four sessions delivered over the course
of eight weeks. The intervention consists of the following:
In-depth
assessment of alcohol use and contraceptive use patterns.
Counseling
about the consequences of alcohol use during pregnancy.
Brief
advice and counseling for moderate-to-heavy drinkers to
reduce intake levels, or referral to community treatment
services for alcohol-dependent drinkers.
Reproductive
health education about contraceptive methods, provision
of contraceptive services, and client follow-up.
Click
here to get more information about the Project CHOICES feasibility
study: MI
PROJECT CHOICES.PDF
The next phase of Project CHOICES will assess the efficacy
of this behavioral intervention further in a scientifically
rigorous manner (through a randomized control group design).
This phase began in June 2002 and is expected to be completed
by June 2004.
Project BALANCE
(Birth Control and ALcohol Awareness: Negotiating Choices
Effectively)
Preventing Alcohol-Exposed Pregnancies in Adolescents
Many young women in the United States who drink alcohol and
have unprotected sex are putting themselves at risk for an
alcohol-exposed pregnancy. Not much is known about the relationship
between moderate-to-heavy alcohol use, unprotected sex, and
unplanned pregnancies in young women. Well-designed epidemiological
and behavioral studies are needed to better understand and
intervene with this population. The following project is exploring
these issues.
FUNDED
PROJECTS
Virginia Commonwealth University—Richmond,
Virginia
Project BALANCE consists of (1) a brief epidemiologic survey,
(2) focus groups, and (3) a randomized, controlled trial of
a motivational intervention directed at Virginia Commonwealth
University (VCU) college students from 18 to 24 years of age.
The proposed intervention is a modified form of Project CHOICES,
a pre-conceptional, motivational intervention designed collaboratively
with CDC and three institutions, of which VCU is one. Project
BALANCE’s objectives are to identify the prevalence
of risky drinking and contraceptive behaviors in this population,
and to test the efficacy of an intervention in a randomized
trial comparing a group receiving both assessment and one
face-to-face session with a group receiving assessment only.
A brief survey is being administered to college women to identify
those eligible for intervention and to further characterize
the population. Focus groups with college women are also underway
to explore qualitative issues related to drinking, contraception,
and sexual behavior. The intervention focuses both on drinking
and unprotected sex, allowing a woman to modify either or
both behaviors. Follow-up will occur at 1 month and 4 months.
Preventing
Alcohol-Exposed Pregnancies in Diverse Populations
Rates of harmful drinking among women from diverse populations
and the characteristics of those at greatest risk are not
well understood. Well-designed epidemiologic studies are needed
to better understand these populations of women. Likewise,
intervention studies aimed at reducing the risk of alcohol-exposed
pregnancies need to be designed and evaluated to determine
the most effective approaches for high-risk women from diverse
populations. The following projects were funded to address
this issue.
FUNDED
PROJECTS
San Diego State University—San
Diego, California
This project’s goal was to (1) determine the frequency
of self-reported alcohol consumption in a sample of low-income
pregnant and non-pregnant Latinas of childbearing age and
examine risk factors for alcohol use, and (2) test the effectiveness
of an educational feedback intervention among non-pregnant
Latinas on intent to change alcohol consumption behaviors
in a future pregnancy. Screening questionnaires and in-person
interviews provided information on the women and their use
of alcohol. The intervention group received educational feedback
on their self-reported current consumption. The intervention
assessed intention to reduce current alcohol consumption and/or
avoid alcohol use in a future pregnancy. Outcomes regarding
future intentions were measured through a post-intervention
telephone interview 3 months following the baseline interview.
Click here to find more information about the project’s
findings regarding alcohol consumption among low-income, pregnant
Latinas: ALCOHOL
AMONG LATINAS.PDF
University of Texas at San Antonio—San
Antonio, Texas
This project explored characteristics regarding alcohol use
and pregnancy, and tested the effectiveness of a social action
approach to prevent alcohol-exposed pregnancies among Latinas
in San Antonio. The project investigated the values, attitudes,
and behaviors of Latinas regarding motherhood and pregnancy,
patterns of alcohol use and familial patterns, sexual activity,
and knowledge of fetal alcohol syndrome. The study pilot tested
a social action intervention model that aims to alter normative
drinking behavior and/or sexual behavior. Quantitative measures
were used to determine differences in knowledge, attitudes,
and behaviors and qualitative methods were used to understand
the interplay between individual and social change. Follow-up
was conducted 6 months after the intervention.
Increasing
Public Awareness of the Risks of Alcohol Use During Pregnancy
Through Targeted Media Campaigns
Effective media campaigns create awareness, change attitudes,
and motivate individuals and communities to engage in healthy
behaviors. Successful campaigns target specific audiences
taking into account the unique preferences and needs of particular
groups. The targeted media campaign is one strategy to enhance
current prevention efforts related to fetal alcohol syndrome
(FAS) and other prenatal alcohol-related effects. Evidence-based
approaches to the design, implementation, and evaluation of
these types of projects are needed and are currently underway
to determine the most effective strategies for use in media
campaigns aimed at reducing prenatal alcohol use.
FUNDED
PROJECTS
St. Louis University—St.
Louis, Missouri
This project is designing, implementing, and evaluating a
media campaign targeting African-American women, aged 18 through
35 years, at risk for pregnancy. The primary purpose of the
campaign is to increase knowledge and change attitudes about
alcohol use during pregnancy. A comprehensive media campaign
has been developed using a variety of strategies including
visual, audio, and print advertisements, direct marketing,
media interviews with experts, and community event exposure.
The campaign is built around four core messages: (1) drinking
alcohol during pregnancy harms unborn babies, (2) pregnant
women should abstain from alcohol, (3) sexually active women
should not drink if they could be pregnant, and (4) women
at risk for an alcohol-exposed pregnancy should see a physician.
Evaluation of the intervention consists of pre- and post-intervention
random-digit dialing surveys of the African-American community
both in St. Louis and Kansas City (control group).
University of California at Los Angeles—Los
Angeles, California
This project is developing, implementing, and evaluating a
social marketing campaign using a “narrowcasting approach”
that warns women about the dangers of drinking alcohol during
pregnancy. Narrowcasting refers to information that is directed
to a highly specific segment of the public. The purpose of
the project are to change norms and perceptions of women who
are light or moderate drinkers both prior to and during pregnancy.
The target groups include White, Hispanic, and African-American
women, aged 18 through 30 years. Print materials have been
developed and disseminated, saturating specific neighborhoods
in two communities of southern California over a 12-month
period, with a third community serving as a comparison group.
Project partners work with community participants and professional
agencies to create high-quality campaign messages and materials.
Evaluation consists of a repeated cross-sectional survey design.
University of Iowa—Iowa
City, Iowa
The goals of the project are to design, implement, and evaluate
the effectiveness of a broad-based and localized media campaign
aimed at reducing prenatal alcohol use in rural areas, targeting
women enrolled in the Women, Infants, and Children (WIC) program.
Through formative research, project staff are producing commercial-quality
materials for dissemination in three channels (a broad based
30-second television commercial, a eight minute video for
localized distribution in WIC clinics, and a printed pamphlet
for distribution in WIC clinics) to increase awareness about
the dangers of alcohol use during pregnancy. WIC clinics in
rural Iowa will be paired and randomly assigned to usual-care
or intervention groups. The usual-care group will be exposed
to the 30-second commercial and printed pamphlet, while the
intervention group will be exposed to messages in all three
channels. Evaluation will consist of pre- and post-test surveys
assessing changes in knowledge, interactions with health care
professionals, reported alcohol use, and perceptions of normative
expectations in the social network regarding consumption of
alcohol during pregnancy.
Enhancing Clinical Practices to Prevent Alcohol-Exposed Pregnancies
In 2004, 11.2% of pregnant women aged 15 to 44 reported alcohol
use and 4.5% reported binge drinking. Among nonpregnant women
of childbearing age, 52.8% reported alcohol use and 23.3%
reported binge drinking. Half of all pregnancies are unplanned,
and many women will not know they are pregnant during the
early weeks of gestation and may continue drinking. Identifying
women who are at high risk for an alcohol-exposed pregnancy
and intervening with them before conception (or at least as
early as possible thereafter) is an essential strategy for
preventing alcohol-exposed pregnancies.
FUNDED
PROJECT
American College of Obstetricians and
Gynecologists—Washington,
D.C.
To address the prevention of alcohol-exposed pregnancies,
the American College of Obstetricians and Gynecologists (ACOG),
in collaboration with CDC’s Fetal Alcohol Syndrome Prevention
Team, is developing educational materials and practice tools
for women’s health care providers. These materials will
guide providers to screen, educate, and intervene with women
who are at risk for an alcohol-exposed pregnancy. These materials
will include brief background research and information, the
components of brief interventions, harm-reduction messages,
and resource and referral information. They will be packaged
as a short provider’s guide, available both in print
and on CD-ROM, and as a pocket card with information to prompt
the clinician for screening and intervention. The information
in the guide will also be available for downloading on the
ACOG website. An advisory committee, made up of obstetrician/gynecologists,
content experts, CDC staff, and others, is guiding the development
and distribution of these materials. The materials should
be available in mid-2006.
Improving Community-Based
Fetal Alcohol Syndrome Prevention Efforts Using the
Fetal and Infant Mortality Review Methodology
Prenatal exposure to alcohol is one of the leading preventable
causes of birth defects, mental retardation, and neurodevelopmental
disorders in the United States. One of the national health
objectives for 2010 is to increase the percentage of pregnant
women abstaining from alcohol from 86% to 94%. According to
national data collected in 2002 by the Behavioral Risk Factor
Surveillance System, 10% of women reported drinking alcohol
during pregnancy. CDC studies have documented fetal alcohol
syndrome (FAS) prevalence rates ranging from 0.2 to 1.5 per
1,000 live births.
FUNDED
PROJECT
American College of Obstetricians and
Gynecologists—Washington,
D.C.
The National Fetal and Infant Mortality Review Program (FIMR)
is a collaborative effort between the American College of
Obstetricians and Gynecologists and the Maternal and Child
Health Bureau, Health Resources and Services Administration.
FIMR is a community-based program to improve the health and
well-being of women, infants, and families.
The goal of this project is to use the established FIMR process
to expand the knowledge base about service systems, specifically
the personal knowledge, attitudes, and beliefs of women who
have experienced a loss that might be associated with infant
morbidity and mortality due to prenatal alcohol exposure,
and to suggest areas where service system improvements, or
enhanced health education, might improve outcomes for future
families.
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