Fetal Alcohol Spectrum Disorder
International Research and Practice Inventory:
Focus on Prevention and Intervention
Faculty of Social Work
The University of Calgary
Dorothy Badry, MSW, RSW
Isabelle Chouinard, B.Sc., BSW
September, 2003
Table of Contents
1.
Executive Summary
p.4
2.
Research Activities – Prevention & Intervention of FASD
p.6
2.1
University of Washington, Seattle
2.11 Research Emphasis Area on Fetal Alcohol Syndrome,
Fetal Alcohol Syndrome Diagnostic & Prevention Network
p. 7
p. 7
2.12
Fetal Alcohol and Drug Unit
Department of Psychiatry and Behavioral Sciences
University of Washington School of Medicine
p. 10
National Center on Birth Defects and Developmental Disabilities
(Centers for Disease Control and Prevention)
2.21 Prevention Activities
2.22 Education Activities
2.23 Tracking
2.24 Monitoring
2.25 Identification through biomarkers
2.26 Intervention Strategies
p. 14
2.2
2.3
2.4
3.
p. 14
p. 19
p. 22
p. 23
p. 27
p. 29
CSAP FAS Center for Excellence Grantee Program
List of funded projects
p. 31
FAS/ARBD Prevention: Research to Practice
p. 35
Research Publications – Prevention & Intervention of FASD
3.1
Culturally Diverse Populations
3.2
Prevention/Intervention
3.3
Surveillance/Screening
3.4
Medical (Pertaining to Intervention)
3.5
Alcoholism and Pregnancy: Social Implications Related
to Prevention
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
p. 36
p. 37
p. 41
p. 58
p. 63
p. 66
2
4.
Programs – Prevention & Intervention of FASD
4.1
4.2
4.3
4.4
4.5
4.6
4.7
4.8
4.9
5.
6.
7.
Partnership to Prevent Fetal Alcohol Syndrome
Fetal Alcohol Education Program (FAEP)
National Organization on Fetal Alcohol Syndrome (NOFAS)
International Birth Defects Information System (IBIS)
National Council on Alcohol and Drug Dependence Inc.
(Juneau Affiliate)
Statewide Fetal Alcohol Syndrome Prevention Program
Colorado AHEC Program
National Task Force on Fetal Alcohol Syndrome and
Fetal Alcohol Effect
Brief Alcohol Intervention: The Healthy Mom’s Project
p. 71
p. 72
p. 74
p. 74
p. 75
p. 75
p. 76
p. 76
p. 77
p. 78
Funding Opportunities
5.1
Maternal Alcohol Use and Prenatal Alcohol Exposure
Prevention/Intervention Initiative
5.2
March of Dimes
p. 80
p. 81
FASD Family and Practitioner Resources
6.1
Fetal Alcohol Syndrome Family Resource Institute
6.2
Family Empowerment Network: Supporting Families
Affected by FAS/E
6.3
FAS Community Resource Center
6.4
Educational Resources
6.5
Resources for Practitioners
p. 83
p. 84
p. 84
International Activities and Online Resources
p. 91
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
p. 82
p. 85
p. 85
p. 90
3
1. Executive Summary
A literature scan was undertaken to discover available research and resources outside of Canada
in relation to Fetal Alcohol Spectrum Disorder. The primary focus of the search was in the areas
of prevention and intervention. Much of the current literature emerges from the medical field.
The notion that FASD is entirely preventable through abstention from alcohol during pregnancy
is a common thread within the literature. The recognition of social issues such as alcoholism,
poverty, oppressive social structures and systems that are distinctly related to the birth of children
with FASD is not given a voice in the literature. There are underlying reasons why women drink
during pregnancy and this requires further examination. Past and current research has tended to
focus on the teratogenicity of alcohol and on observed disabilities in children exposed to alcohol
during pregnancy. Recognition that best practices in prevention are lacking is the driving force
behind some of the research projects currently under way. A review of the current literature in
regards to research and activities towards prevention and intervention of FASD uncovered only a
few publications. There are existing programs highlighted in this report that are currently being
implemented and evaluated for success rates. Most research in this field tends to concentrate in
the United States, whereas other countries appear to focus research efforts in the description of
FASD and also in providing this information in support to families.
Ann Streissguth, PhD, a noted researcher in the field of FASD refers to the 5 P’s of prevention:
Public Education, Professional training, Public Policy, Programs and Services, and Parent and
Citizen Activism. The current efforts as it appears in the literature tend to focus on public
education and professional training. Although some projects are currently being conducted to
address the need for programs and services as well as public policy, there is a critical gap in the
number of prevention and intervention programs being developed and implemented. In
particular, most programs tend to focus on educational aspects of prevention, and programs that
are supportive in nature are few.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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As a source of information, the World Wide Web stands out as a primary source of knowledge
regarding FASD. There are many credible organizations with websites that have done a great
deal to promote solid education regarding FASD. However, it should be noted that information
on the web should be scrutinized in terms of its claims of truth or knowledge regarding FASD.
International sources that were found on the Internet promoted family advocacy and support and
did not reveal information about ongoing research, and this is either due to lack of information, or
information presented in another language. International links are documented within this report.
Health related professions have been instrumental in promoting awareness regarding FASD and
clinical medical research has been critical in developing an understanding of the complexities of
this disability. There is a large body of literature which offers a focus on community activities,
advocacy and support networks for individuals with FASD and their caregivers.
The research
on prevention primarily focuses on educating birth mothers and pregnant women on the dangers
of alcohol consumption during pregnancy. A great deal has been invested on advertising
campaigns that recommend women who are pregnant refrain from consuming alcohol. What
appears to be lacking around FASD prevention is a broader focus on the socioeconomic
structures which gives rise to alcoholism and substance abuse. Literature that focuses on
intervention with women who are at risk of giving birth to children with FASD is limited. Many
activities regarding prevention are community based and do not have a direct link to research that
would examine the efficacy of their activities.
In summary, the research on prevention and intervention is only at an early beginning stage.
Most of the information found in this report refers to ongoing programs who are just starting to
evaluate the quality of different interventions. The need for prevention has been thoroughly
identified, while the scope and focus on actual prevention programs remains narrow. Within the
scope of this search the great majority of activities are focused on prevention, while information
on the actual interventions at different ages and stages is extremely limited. This suggests that a
focus in future research should be directed towards implementation and evaluation of
intervention programs.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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2. Research Activities – Prevention & Intervention of FASD
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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2.1 University of Washington, Seattle
2.11 Research Emphasis Area on Fetal Alcohol Syndrome
http://depts.washington.edu/chdd/MRDDRC/REAs/FetalAlcoholREA.html,
Fetal Alcohol Syndrome Diagnostic & Prevention Network
http://depts.washington.edu/fasdpn/
Faculty investigators for the Research Emphasis Area on Fetal Alcohol Syndrome address
four main problems within an interdisciplinary framework:




First, they seek to develop and test screening and diagnostic tools for accurate and
reproducible identification of the full spectrum of disorders associated with fetal
alcohol exposure. Research efforts are focused on rigorously testing the
performance of the tools (e.g., sensitivity, specificity, predictive value positive,
construct validity, test-retest) in clinical and population-based samples. Research
efforts are also focused on assessing the diagnostic utility of magnetic resonance
imaging (MRI), spectroscopy (MRS), functional MRI (fMRI) and fetal ultrasound.
Accurate diagnoses not only lead to more appropriate interventions, but also to more
accurate estimates of prevalence over time for assessment of primary prevention
efforts.
Second, investigators are engaged in FASD prevention and intervention research
using randomized control trial methodology. The prevention research seeks to assess
the efficacy of paraprofessional advocacy programs targeted to high-risk women.
Key goals are reduction in alcohol use and improved family planning. The
intervention research seeks to assess the efficacy of behavioral consultation and
social communication intervention programs targeted to children with FASD, their
parents, and their teachers. Key goals are increased parent/teacher skills in meeting
the needs of their children and improved child social communication skills.
A third area of concentration is descriptive research that seeks to elucidate the
lifelong cognitive/behavioral profile(s) of individuals with prenatal alcohol
exposure. This research is instrumental in setting public health policy for meeting
the lifelong needs of these individuals.
A fourth area of concentration is the study of newborn cerebrovascular responses to
maternal alcohol use. This research will further elucidate the pathogenesis of brain
damage associated with prenatal alcohol use.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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Investigators with interests in prevention/intervention
Faculty Investigators and Interest Areas
Susan Astley, PhD
Associate Professor of Epidemiology
Research Affiliate, Center on Human Development and Disability
Director, Fetal Alcohol Syndrome Diagnostic & Prevention Network
Coordinator, Research Emphasis Area on Fetal Alcohol Syndrome
astley@u.washington.edu
206-685-9665
University of Washington
Box 357920
Seattle, WA 98195-7920
Astley's major research interests include developing effective tools for surveillance,
screening and diagnosis of fetal alcohol syndrome (FAS). Her work also includes the
design and implementation of randomized control trials for identification of effective
interventions for individuals with specific conditions including FAS, cystic fibrosis and
cerebral palsy.
Therese M. Grant, PhD
Research Assistant Professor, Psychiatry and Behavioral Sciences
Principal Investigator, Parent-Child Assistance Program (P-CAP), Fetal Alcohol and
Drug Unit
Research Affiliate, Center on Human Development and Disability
granttm@u.washington.edu
206-543-7155
University of Washington
Box 359112
Seattle, WA 98195-9112
Dr. Grant holds a Ph.D. in epidemiology from the University of Washington. A research
assistant professor of psychiatry and behavioral sciences, she is principal investigator of
the Parent-Child Assistance Program, an intervention model working effectively with
high-risk mothers who abuse alcohol and drugs during pregnancy. The program has been
replicated at a dozen locations in the United States and Canada. Grant's research focuses
on perinatal substance abuse and the effects of prenatal exposure to drugs and alcohol,
fetal alcohol syndrome, development of assessment instruments and intervention
strategies, as well as the challenges of community intervention and prevention with highrisk mothers and their children.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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Leslie Olswang, PhD
Professor and Associate Chair, Speech and Hearing Sciences
Research Affiliate, Center on Human Development and Disability
lolswang@u.washington.edu
206-543-7974
University of Washington
Box 354875
Seattle, WA 98195-4875
Olswang's research focuses on language disorders in children. She investigates the
benefits of treatment for children with impairments in communication and is particularly
interested in using treatment to uncover the processes underlying communication. She
examines treatment efficacy in infants with cerebral palsy and in children with fetal
alcohol syndrome.
Ann Streissguth, PhD
Professor of Psychiatry and Behavioral Sciences
Director, Fetal Alcohol and Drug Unit
Research Affiliate, Center on Human Development and Disability
astreiss@u.washington.edu
206-543-7155
University of Washington
Box 359112
Seattle, WA 98195-9112
For more than 25 years, fetal alcohol syndrome (FAS) has been recognized as an outcome
of prenatal exposure to alcohol. Streissguth's research focuses on elucidating the longterm neuropsychological consequences of prenatal alcohol exposure. Streissguth and her
colleagues at the Fetal Alcohol & Drug Unit have demonstrated a broad array of
attentional, memory, learning and neurobehavioral effects of prenatal alcohol exposure
from birth to adulthood, and are now investigating the neuroanatomic correlates of these
dysfunctional behaviors. With colleagues at the Fetal Alcohol and Drug Unit, she has
developed and demonstrated effective strategies for preventing effects of prenatal
exposure to alcohol and drugs, including an ongoing program that provides three years of
paraprofessional advocacy for mothers abusing alcohol and drugs during pregnancy and
getting little or no prenatal care.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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2.12 Fetal Alcohol and Drug Unit
Department of Psychiatry and Behavioral Sciences
University of Washington School of Medicine
http://depts.washington.edu/fadu/
The Fetal Alcohol and Drug Unit is a research unit dedicated to the prevention,
intervention and treatment of Fetal Alcohol Syndrome (FAS) and Fetal Alcohol Effects
(FAE). Their main goals are to conduct research on fetal alcohol and drug effects across
the life span, to disseminate information on fetal alcohol and drug effects, to provide
consultation for persons of any age thought to be affected by prenatal exposure to alcohol,
and to provide training in human behavioral teratology.
Over the past twenty-eight years, their work has focused on research to identify and
examine the effects of prenatal alcohol and drug exposure across the life span, with
particular emphasis on FAS and FAE, and on interventions with high-risk mothers who
abuse alcohol and drugs. Their focus includes prevention and intervention projects on an
individual and community basis and multidisciplinary population-based and clinical
follow-up studies. The unit also provides staffing and curricula for workshops, invited
lectures and conferences on FAS/FAE prevention and intervention at the regional,
national and international level.
Fetal Alcohol and Drug Unit Research projects:
A)
Prospective Longitudinal Study on Health and Pregnancy
Funded by the
National Institute on Alcohol Abuse & Alcoholism (NIAAA)
This longitudinal prospective study evaluates the effects of alcohol, nicotine, drugs, and
other prenatal factors that can affect children's health and development. The basic
hypothesis for the study is that prenatal alcohol exposure exerts an enduring dosedependent influence on offspring health and development across the life span.
This study has far-reaching public health implications. Alcohol remains the teratogenic
drug most frequently ingested during pregnancy. Data from this study led to an estimated
incidence rate of Fetal Alcohol Syndrome (FAS) and Alcohol Related Neurobehavioral
Disorder (ARND) combined of nearly 1 per 100 births. Recent work has demonstrated
that prenatal exposure to alcohol is significantly associated with alcohol problems in
young adults. Unfortunately, alcohol-affected infants, children and adults are often denied
needed services when they lack the characteristic FAS face and/or mental retardation as
defined by a standardized IQ score of less than 70. It is essential that the long-term adult
consequences of these birth defects be understood and that markers of clinically affected
individuals be identified to support appropriate diagnosis and intervention.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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Selected Publications
Barr, H.M. & Streissguth, A.P. (2001). Identifying maternal self-reported alcohol use
associated with fetal alcohol spectrum disorders. Alcoholism: Clinical & Experimental
Research, 25(2), 283-287.
Baer, J.S., Barr, H.M., Bookstein, F.L., Sampson, P.D., & Streissguth, A.P. (1998).
Prenatal alcohol exposure and family history of alcoholism in the etiology of adolescent
alcohol problems. Journal on Studies on Alcohol, 59, 553-543.
Carmichael Olson, H., Streissguth, A.P., Sampson, P.D., Barr, H.M., Bookstein, F.L., &
Thiede, K. (1997). Association of prenatal alcohol exposure with behavioral and learning
problems in early adolescence. Journal of the American Academy of Child & Adolescent
Psychiatry, 36(9), 1187-1194.
Streissguth, A.P., Bookstein, F.L., Sampson, P.D., & Barr, H.M. (1995). Attention:
Prenatal alcohol and continuities of vigilance and attentional problems from 4 through 14
years. Development and Psychopathology, 7, 419-446.
Carmichael Olson, H., Sampson, P.D., Barr, H.M., Streissguth, A.P., & Bookstein, F.L.
(1992). Prenatal exposure to alcohol and school problems in late childhood: A
longitudinal prospective study. Development and Psychopathology, 4, 341-359.
B)
Parent-Child Assistance Program (P-CAP)/Birth to 3 Program
Funded by Washington State Legislature
(Division of Alcohol and Substance Abuse);
originally funded by Center for Substance Abuse Prevention (CSAP)
The Parent-Child Assistance Program (PCAP), originally known as the Seattle Birth to 3
Project, began in 1991 as a 5-year federally funded research demonstration project
designed to test the efficacy of a model of intensive, long-term paraprofessional advocacy
with high-risk mothers who abuse alcohol or drugs heavily during pregnancy and are
estranged from community service providers. The primary goal of the program is a
straightforward one -- to prevent alcohol and drug exposure among the future children of
these mothers. In 1996, on the basis of demonstrated positive outcomes, the Washington
State Legislature appropriated funds for continuation of the Seattle program and
expansion to a Tacoma site; in 1999 sites in Yakima and Spokane (including Grant
County) were funded, creating a capacity to serve 360 families statewide. Since 1991,
PCAP has served over 650 women and their families in Washington. The PCAP model
has been commended by Drug Strategies, a Washington D.C.-based policy research
institute, as one of a few federally funded interventions that are succeeding nationwide.
The model has been replicated at a dozen sites in the United States and Canada.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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PCAP paraprofessional advocate case managers work with a caseload of approximately
15 families each, for 3 years beginning at enrollment during pregnancy or in the
postpartum period. PCAP does not provide direct treatment services. Instead, advocates
help substance-abusing mothers address a wide range of environmental problems, connect
mothers and their families with existing community services, coordinate services among
this multidisciplinary network, assist mothers in following through with provider
recommendations (including obtaining substance abuse treatment and staying in
recovery), and assure that the children are in safe home environments and receiving
appropriate health care. A unique feature of the model is that women are never asked to
leave the program because of relapse or setbacks.
The lives of mothers enrolled in PCAP are characterized by poverty, upbringing by
substance-abusing parents, childhood abuse, abusive adult relationships, trouble with the
law, and chaotic and unstable living conditions. As products of this background they are
often distrustful of community service agencies. PCAP paraprofessional advocates have
themselves overcome many difficult life circumstances prior to achieving successes in
school, jobs, and parenting. Because of this, the advocates are able to inspire trust and
hope, and act as realistic role models and guides toward meaningful change.
Notably, there has been relatively low staff turnover in a field known for high rates of
burnout. Three administrative components contribute to job satisfaction and retention:
weekly group staffing, individual weekly supervision by a masterUs level supervisor, and
a dynamic evaluation process allowing advocates to see that they are indeed helping
clients make gains, as well as to observe areas for improvement.
The effectiveness of PCAP has been demonstrated. Among 156 PCAP mothers recently
exiting the program: 88% completed alcohol/drug treatment; 47% had been abstinent
from alcohol/drugs for more than 6 months at program exit, and 89% had more than 6
months abstinence from alcohol/drugs while in the program; 73% were using a
contraceptive method on a regular basis, and 51% were using a more reliable method;
25% delivered a subsequent child, and of these 41% were clean and sober throughout the
pregnancy, and another 37% quit using alcohol and drugs after pregnancy recognition.
A study of 45 original PCAP clients followed-up an average of 2.5 years after graduation
indicated that benefits of the program were sustained. The proportion of clients abstinent
from alcohol and drugs for at least 6 months at the time of interview increased
significantly from 31% at graduation to 51% at follow-up. Those abstinent for at least one
year increased from 38% to 48%. Subsequent births decreased from 27% during the
program to 9% during the follow-up period.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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Selected Publications
Grant, T., Ernst, C.C., Pagalilauan G., & Streissguth, A.P. (2003). Post-program followup effects of paraprofessional intervention with high-risk women who abused alcohol and
drugs during pregnancy. Journal of Community Psychology 31(3), 211-222.
Grant, T., Streissguth, A., Ernst, C. (2002). Benefits and challenges of paraprofessional
advocacy with mothers who abuse alcohol and drugs and their children. Zero to 3.
23(2):14-20.
Grant, T.M., Streissguth, A.P., & Ernst, CC. (2002). Intervention with alcohol & drug
abusing mothers and their children: The role of the paraprofessional. The Source:
Newsletter of the National Abandoned Infants Assistance Resource Center, 11(3): 5-26
Kartin, D., Grant, T.M., Streissguth, A.P., Sampson, PD & Ernst, CC. (2002). Three-year
developmental outcomes in children with prenatal alcohol and drug exposure. Pediatric
Physical Therapy, 14: 145-153
Grant, T.M., Ernst, C.C., & Streissguth, A.P. (1999). Intervention with high-risk alcohol
and drug-abusing mothers: I. Administrative Strategies of the Seattle Model of
Paraprofessional Advocacy. Journal of Community Psychology, 27(1), 1-18. Click here to
order.
Ernst, C.C., Grant, T.M., & Streissguth, A.P. (1999). Intervention with high-risk alcohol
and drug-abusing mothers: II. 3-year findings from the Seattle Model of Paraprofessional
Advocacy. Journal of Community Psychology, 27(1), 19-38.
Grant, T.M., Ernst, C.C., Streissguth, A.P., & Porter (1997). An advocacy program for
mothers with FAS/FAE. In: Streissguth, A.P. & Kanter J. (eds.) The Challenge of Fetal
Alcohol Syndrome: Overcoming Secondary Disabilities (pp. 102-112). Seattle: University
of Washington Press.
Grant, T.M., Ernst, C.C., McAuliff, S., & Streissguth, A.P. (1997). The Difference Game:
An assessment tool and intervention strategy for facilitating change in high-risk clients.
Families in Society, 78 (4), 429-432.
Grant, T.M., Ernst, C.C., Streissguth, A.P., Phipps, P., & Gendler, B. (1996). When case
management isn't enough: A model of paraprofessional advocacy for drug- and alcoholabusing mothers. Journal of Case Management, 5 (1), 3-11.
Grant, T.M., Ernst, C.C., & Streissguth, A.P. (1996). An intervention with high risk
mothers who abuse alcohol and drugs: The Seattle Advocacy Model. American Journal of
Public Health, 86(12), 1816-1817.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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2.2
National Center on Birth Defects and Developmental Disabilities
(Centers for Disease Control and Prevention)
http://www.cdc.gov/ncbddd/fas/
2.21
CDC supports the following prevention activities:
A)
Preventing Alcohol-Exposed Pregnancies
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
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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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.
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.
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.
B)
Preventing Alcohol-Exposed Pregnancies
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 Project:
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
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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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.
C)
Preventing Alcohol-Exposed Pregnancies
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 are underway to address this issue.
Funded Projects:
San Diego State University—San Diego, California
This project is (1) determining 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) testing 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 will provide information on the women and their use of alcohol. The
intervention group will receive educational feedback on their self-reported current
consumption. The intervention will assess intention to reduce current alcohol
consumption and/or avoid alcohol use in a future pregnancy. Outcomes regarding future
intentions will be measured through a post-intervention telephone interview 3 months
following the baseline interview.
University of Texas at San Antonio—San Antonio, Texas
This project is exploring characteristics regarding alcohol use and pregnancy, and plans to
demonstrate the effectiveness of a social action approach to prevent alcohol-exposed
pregnancies among Latinas in San Antonio. The project will investigate 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 will pilot test a social action intervention model that aims to alter
normative drinking behavior and/or sexual behavior. Quantitative measures will be used
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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to determine differences in knowledge, attitudes, and behaviors and qualitative methods
will be used to understand the interplay between individual and social change. Follow-up
will be conducted 6 months after the intervention.
D)
Preventing Alcohol-Exposed Pregnancies
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,
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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saturating specific neighborhoods in two communities of southern California over a 12month 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.
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2.22
CDC supports the following education activities:
A)
Educating Families and Professionals
Fetal Alcohol Syndrome Awareness and Education Project
While surveys indicate that people have heard the term fetal alcohol syndrome (FAS),
reports from parents, school staff, and health care providers indicate that the general level
of understanding about the condition and the needs of children who have it are not well
understood. The purpose of this project is to (1) develop, implement, and evaluate
materials to educate parents and professionals working in school systems, public health
service agencies, social service agencies, and judicial systems about FAS and other fetal
alcohol-related disorders and (2) identify how to secure access to appropriate diagnostic
and treatment services for affected children and their families.
Funded Projects:
The Arc of the United States—Silver Spring, Maryland
This project is developing and testing a comprehensive curriculum that can be presented
to adult learners in a workshop format. The modules address general information about
FAS, components of care for the affected child, and family stressors and coping
strategies. The Arc's team of seven chapters is using available resources and printed
materials and creating new materials as part of the development of the comprehensive
curriculum.
Double ARC—Toledo, Ohio
This project is developing and testing a training curriculum for parents that describes the
core deficits of children with FAS; teaches effective parenting techniques; and informs
how to access service resources for children, including school programs. The training
curriculum for teachers describes FAS, ways to recognize children who might have the
condition, and approaches to enhancing school performance for children with FAS.
Education Development Center—Newton, Massachusetts
This project is developing an online education package targeting teachers and parents
about FAS and related disorders, and an online education package for training the trainer.
Content includes a comprehensive review of the physical, neurodevelopmental, and
behavioral characteristics of children with FAS; secondary disabilities; needed services;
family stressors and coping strategies; and what schools can do with limited community
resources.
National Indian Justice Center—Santa Rosa, California
This project is developing and testing a training curriculum for three-day regional training
sessions focusing on medical and psychological aspects of FAS/ARND, with breakout
sessions that provide information more specifically geared toward various subgroups such
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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as tribal court judges, state court judges, and tribal leaders. Focus groups and a
community needs assessment are being conducted to inform materials development.
B)
Educating Families and Professionals
Regional Centers for the Education and Training of Medical and Allied
Health Students and Students and Professionals on Fetal Alcohol Syndrome
and Other Prenatal Alcohol-Related Disorders
The purposes of the FAS Regional Training Centers are to (1) develop, conduct, and
analyze population-based surveys of medical and allied health students and practitioners
to assess their knowledge, attitudes, and beliefs about diagnosis, treatment, and
prevention of FAS and other prenatal alcohol-related disorders and to identify their
perceived barriers to diagnosis, treatment, and prevention, current practices, and resources
needed to improve current practice behaviors; (2) develop, implement, and evaluate
educational curricula for medical and allied health students and practitioners that
incorporate evidence-based diagnostic guidelines for FAS and other prenatal alcoholrelated disorders; (3) disseminate curricula to audiences; and (4) seek to have diagnostic
guidelines and curricula incorporated into the training curricula of medical and allied
health schools at the grantee’s university or college, other colleges and universities
throughout the region, and into the credentialing requirements of professional boards.
Funded Projects:
Meharry Medical College – Nashville, Tennessee
Morehouse School of Medicine – Atlanta, Georgia
Meharry Medical College is partnering with Morehouse School of Medicine and
Tennessee State University to develop the Southeastern U.S. Educational Center for
Prevention of Fetal Alcohol Syndrome. At Morehouse Medical School, the program will
work closely with the new National Center for Primary Care and its network of more than
150 clinics throughout the southeast. Also, via a joint program in Allied Health at
Meharry and Tennessee State, contacts have been made with College of Allied Health
Deans throughout the region to enhance dissemination of educational materials. The
Meharry/Morehouse partnership will disseminate the FAS curriculum among medical and
allied health professionals in Alabama, Florida, Kentucky, Mississippi, North Carolina,
South Carolina and Tennessee.
University of Medicine and Dentistry of New Jersey (UMDNJ) – Newark, New
Jersey
The NJ/New England Regional FAS Education & Training Center is based in the New
Jersey Medical School – UMDNJ in the Departments of Preventive Medicine, Pediatrics
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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and Psychiatry. It is closely associated with the NJ state-funded FAS Diagnostic Centers,
one of which is also located in the New Jersey Medical School. This gives the Education
& Training Center direct access to child developmental specialists and pediatricians,
allowing for practical assessment of strategies and materials developed as part of the CDC
educational network. Through collaboration with the UMDNJ School of Allied Health
Professionals, the Center also has access to online web teaching (Web CT) resources that
will facilitate the development of materials useful in outreach across the New England
region. The state of New Jersey has a number of other existing resources that will enhance
the development of the New Jersey Regional Training Center. New Jersey convenes a
state Task Force on FAS and since 1988, New Jersey has regionalized Maternal and Child
Health Consortia that assist with the provision and coordination of hospital and
community-based maternal and child health services.
St. Louis University School of Medicine – St. Louis, Missouri
The Midwest Regional Fetal Alcohol Syndrome Training Center is a collaboration among
the Department of Community and Family Medicine of the University of St. Louis
Medical School, University of Missouri-Columbia and the St. Louis Arc. Physician and
allied health practitioner training initiatives will cover Missouri and 6 contiguous states.
Highlights of the program include: plans to audit curricula at medical schools in the 7state area consortium; two-day train-the-trainer workshops with nationally recognized
FAS experts; televised conferences and video-taped conference proceedings; a curriculum
CD ROM; and an FAS Speaker’s Bureau.
University of California at Los Angeles School of Medicine – Los Angeles, California
The UCLA Medical Allied Health Education on Fetal Alcohol Exposure Center will
establish community partnerships with Kaiser Permanente, Harbor - UCLA County
Hospital, Edelman Mental Health Clinic, Greater Los Angeles VA Hospitals, Venice
Family Clinic, Betty Ford Center and Didi Hirsch Community Mental Health Center. To
disseminate the curriculum in diverse academic settings, UCLA proposes the following
study sites: David Geffen School of Medicine at UCLA, Martin Luther King - Charles R.
Drew University of Medicine and Science, UC Riverside, UCSF, UCSD, UC Irvine,
Loma Linda, and UCLA Extension. The program will include a variety of innovative
education experiences in addition to classroom learning, such as videotapes and audience
response systems; individualized learning with Web-based CD-ROM learning and written
materials; and small group learning opportunities that employ practicing with
standardized patients and discussing written case vignettes.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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2.23
CDC Activities for Tracking Fetal Alcohol Syndrome:
Tracking Fetal Alcohol Syndrome
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The reported prevalence rates of FAS vary widely depending on the population studied
and the surveillance methods used. CDC studies show FAS prevalence rates ranging from
0.2 to 1.5 per 1,000 live births in different areas of the United States. Other prenatal
alcohol-related conditions, such as alcohol-related neurodevelopmental disorder (ARND)
and alcohol-related birth defects (ARBD), are believed to occur approximately three times
as often as FAS.
Population-based surveillance of FAS is important to document the magnitude of the
problem and to monitor trends in the occurrence of this preventable birth defect. In 1997,
the Centers for Disease Control and Prevention (CDC) established or enhanced statewide,
population-based surveillance of fetal alcohol syndrome (FAS).
Purposes of FAS Surveillance Network
The specific purposes of the population-based Fetal Alcohol Syndrome Surveillance
Network (FASSNet) initiative and the cooperative agreements are to
Enhance an existing system or develop and implement a new system that uses a multiplesource surveillance methodology to enable researchers to determine the prevalence of
FAS within a geographically defined area (statewide, multiple states, or regions within a
state);
Improve the capacity to ascertain true cases of FAS and generate population-based
surveillance data;
Establish relations with facilities or programs where FAS is likely to be diagnosed or
children with FAS receive services, such as high-risk newborn registries, special
diagnostic units, special education programs, special needs registries, and other programs
or settings for children with developmental disabilities;
Evaluate the completeness of the surveillance system methodology, the system's ability to
generate a prevalence rate for FAS, and the potential for monitoring trends; and
Implement health-care provider training and education on FAS to improve case
ascertainment, referral and case-management practices, and prevention activities.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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2.24
CDC Activities for Monitoring Alcohol Use Among Women of Childbearing
Age:
Monitoring Alcohol Use Among Women of Childbearing Age
CDC monitors the prevalence of alcohol use among women of childbearing age in the
U.S. using the Behavioral Risk Factor Surveillance System (BRFSS). The BRFSS is an
ongoing, state-based, random-digit-dialed telephone survey of individuals, 18 years of age
and older. Data from BRFSS are important for monitoring alcohol-use patterns in women
of childbearing age to assess and inform public health efforts to reduce these risk
behaviors. These findings also help in developing strategies to identify populations that
are risk drinkers and in designing prevention programs to improve pregnancy outcomes.
To determine the numbers of women at risk for an alcohol-exposed pregnancy, data from
the BRFSS are analyzed for women aged 18-44 years in all 50 states. Women are asked
about their use of alcohol during the 30 days before the survey. Three alcohol drinking
patterns are examined: any alcohol use (one or more drinks), binge drinking (5 or more
drinks on any one occasion), and frequent drinking (7 or more drinks per week or binge
drinking). Click here for the most recent CDC report on alcohol consumption rates among
women of childbearing age.
Selected Publications
Alcohol use among childbearing-age women---United States, 1991--1999
Sidhu, J, Floyd, RL. [published erratum appears in Morbidity and Mortality Weekly
Report 2002;51(14):308]. MMWR Morbidity and Mortality Weekly Report 2002;51:273276. [Full Text: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5113a2.htm]
Combined tobacco and alcohol use by pregnant and reproductive-aged women in the
U.S.
Ebrahim S, Decoufle P, Palakthodi AS. Obstetrics & Gynecology 2000;96:767-771.
Abstract
OBJECTIVE: To assess trends in the concurrent use of alcohol and tobacco among
pregnant women. METHODS: Using behavioral risk factor surveillance system data from
1987 through 1997, we determined the prevalence of concurrent tobacco and alcohol use
among women aged 18-44 years by pregnancy status and indirectly estimated pregnancyrelated disuse rates. RESULTS: The percentage of women who used alcohol and tobacco
decreased significantly from 1987 to 1990 among pregnant (5.4% to 3.0%) and
nonpregnant women (17.6% to 14.2%), but thereafter did not change significantly. The
estimated pregnancy-related disuse rate of tobacco and alcohol increased insignificantly
from 70% in 1987 to 82% in 1997. Among women who used both substances, pregnancyFetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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related disuse was slightly greater for alcohol alone (74%) than for tobacco alone (52%).
There was not a significant decline in concurrent use of tobacco and alcohol between
1987 and 1997 among women 18-20 years old (pregnant, 4.4% to 3.6%; nonpregnant,
13.5% to 13.7%). That age group also showed a smaller pregnancy-related disuse rate
than older women (1997, 74% versus 83%). CONCLUSION: The steady trend in
concurrent use of tobacco and alcohol by young women emphasizes the need for
enhanced efforts to reduce the initiation of tobacco and alcohol use by young people.
Women who report abuse of tobacco or alcohol should be evaluated for abuse of both
substances, and interventions should address abuse of both substances.
Pregnancy-related alcohol use among women in the United States, 1988 through
1995.
Ebrahim SH, Diekman ST, Decoufle P, Tully M, Floyd RL. Prenatal and Neonatal
Medicine 1999;4:39-46.
Comparison of binge drinking among pregnant and nonpregnant women, United
States, 1991-1995.
Ebrahim SH, Diekman ST, Floyd RL, Decoufle P. American Journal of Obstetrics and
Gynecology 1999;180:1-7.
Abstract
Our goal was to measure the pregnancy-related reduction in the prevalence of reported
binge drinking (>/=5 alcoholic drinks per occasion) and to characterize binge drinkers
among pregnant and nonpregnant women aged 18-44 years, in the United States, 19911995. We used the Behavioral Risk Factor Surveillance System data from 46 states. We
used the prevalence rate ratio between pregnant and nonpregnant women to determine the
magnitude of the reduction in reported binge drinking and multiple logistic regression
models to identify characteristics associated with binge drinking. Between 1991 and
1995, the prevalence of binge drinking among pregnant women increased significantly
from 0.7% (95% confidence interval 0.2-0.9) to 2.9% (95% confidence interval 2.2-3.6),
whereas among nonpregnant women the prevalence changed little (11.3% vs 11.2%).
Over the study period pregnant women were one fifth (prevalence rate ratio 0.2, 95%
confidence interval 0.1-0.2) as likely as nonpregnant women to binge drink. Among
various population subgroups of women, pregnancy-related reduction in binge drinking
was smallest among black women and largest among women aged </=30 years and
among those who had quit smoking. Among pregnant women binge drinking was
independently associated with being unmarried, being employed, and current smoking.
Among nonpregnant women binge drinking was independently associated with age </=30
years, nonblack race, college level education, being unmarried, being employed or a
student, and current smoking. Clinicians serving women of childbearing age need to be
aware of the recent rise in reported binge drinking during pregnancy, as well as the known
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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risk factors for binge drinking.
Alcohol consumption by pregnant women in the United States during 1988-1995.
Ebrahim SH, Luman ET, Floyd RL, Murphy CC, Bennett EM, Boyle CA. Obstetrics &
Gynecology 1998;92:187-192.
Abstract
OBJECTIVE: To examine trends in alcohol use among pregnant women in the United
States and to characterize pregnant women who use alcohol, with an emphasis on frequent
use (at least five drinks per occasion or at least seven drinks per week). METHODS: We
used the Behavioral Risk Factor Surveillance System data from 1988 through 1995 to
obtain the percentage of pregnant women who used alcohol. We used multiple logistic
models to identify subgroups of pregnant women who are at increased risk for alcohol
use. RESULTS: Overall, 14.6% (869 of 5983) of pregnant women consumed alcohol and
2.1% (133 of 5983) consumed alcohol frequently. Among pregnant women, alcohol use
decreased from 22.5% (95% confidence interval [CI] 20.8, 23.9) in 1988 to 9.5% (95% CI
7.9, 11.8) in 1992 and then increased to 15.3% (95% CI 13.1, 17.2) by 1995. Among
pregnant women, frequent alcohol use decreased from 3.9% (95% CI 2.4, 5.2) in 1988 to
0.9% (95% CI 0.4, 1.6) in 1991 and then increased to 3.5% (95% CI 2.0, 5.1) by 1995.
Pregnant women who were at high risk for alcohol use were college educated, unmarried,
employed, or students, had annual household incomes of more than $50,000, or were
smokers. Pregnant women who were at high risk for frequent alcohol use were more
likely to be unmarried, or smokers. CONCLUSION: The increasing prevalence of alcohol
use among pregnant women calls for increased ascertainment of alcohol use among
preconceptional and pregnant women. Brief interventions by clinicians, increased referral
to alcohol treatment programs, and increased use of contraception by women of
reproductive age who are problem drinkers should be considered as means of preventing
alcohol-exposed pregnancies.
Alcohol consumption among pregnant and childbearing age women -- United States,
1991 and 1995.
Centers for Disease Control and Prevention. MMWR Morbidity and Mortality Weekly
Report 1997;46(16):346-350. [Full Text:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00047306.htm]
Frequent alcohol consumption among women of childbearing age, Behavioral Risk
Factor Surveillance System, 1991.
Centers for Disease Control and Prevention. MMWR Morbidity and Mortality Weekly
Report 1994;43:328-329, 335. [Full Text:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00030910.htm]
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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Prevalence and characteristics of alcohol consumption and fetal alcohol syndrome
awareness -- Alaska, 1991 and 1993.
Centers for Disease Control and Prevention. MMWR Morbidity and Mortality Weekly
Report 1994;43:3-6. [Full Text:
http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/00023555.htm]
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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2.25
CDC Activities for Identifying Alcohol-Exposed Pregnancies through
Biomarkers:
Identifying Alcohol-Exposed Pregnancies through Biomarkers
Moderate-to-heavy alcohol use by pregnant women is known to be harmful to the
developing fetus. Currently, there is no specific laboratory marker to indicate fetal alcohol
syndrome. Obtaining such a marker could lead to the identification and treatment of
women at risk for an alcohol-exposed pregnancy, who may not otherwise provide this
information because of the stigma associated with prenatal alcohol use. Also, research has
shown that early identification of children with fetal alcohol exposure reduces secondary
disabilities resulting from the condition. Possible biomarkers include maternal blood and
meconium (first stool of the newborn infant) testing. The studies described below are
designed to devise and test sensitive and specific biomarkers to help identify alcoholexposed pregnancies and/or newborns exposed to alcohol prenatally.
Funded Projects:
University Hospital of Cleveland—Cleveland, Ohio
It is estimated that 1% of all newborns are affected by prenatal alcohol exposure.
However, identifying alcohol-exposed newborns is difficult. Currently, there is no
systematic approach, nor definitive laboratory tool that can be used for such
identification. A biological marker, fatty acid ethyl esters (FAEE), would allow earlier
identification and intervention for affected infants, and recognition of women at risk for
alcohol abuse. This also facilitates research on dose-response relationships between
alcohol exposure and alcohol-related birth defects. The project proposes that FAEE in
meconium is a useful biological marker for exposure of low-to-moderate maternal alcohol
use during pregnancy, and for identification of a group of infants at high risk for poor
neurodevelopmental outcomes. The study seeks to validate FAEE in meconium as a
biomarker of prenatal exposure to alcohol.
University of Maryland—Baltimore, Maryland
The purpose of this study is to investigate the use of biochemical tests and ultrasound
findings to identify women who abuse alcohol and are at risk for having a child affected
adversely by prenatal alcohol exposure. Criteria, derived from alcohol-use questionnaires,
biochemical markers and ultrasound studies, are being developed to identify at-risk,
pregnant women who need special counseling or intervention. This information will be
correlated with infant development indices taken at birth and at 6 and 12 months of age to
predict the prenatal risk for fetal alcohol syndrome (FAS) and other prenatal alcoholrelated conditions. Eliminating or reducing alcohol consumption during pregnancy would
have a significant effect on the incidence of fetal alcohol syndrome and other prenatal
alcohol-related conditions.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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Massachusetts General Hospital—Boston, Massachusetts
The goals of this project are to: (1) identify women at risk for having an alcohol-exposed
pregnancy through a combination of questionnaire screening and biochemical markers of
alcohol use, and (2) motivate the women at risk to decrease their alcohol intake through
brief intervention meetings and results of their blood marker levels throughout their
pregnancies. Previous studies show that certain blood markers can be used to identify
alcohol-using pregnant women more accurately than women’s self-reported use. This
study will use a combination of blood markers and self-report to identify women at risk of
having an alcohol-exposed pregnancy. Pregnant women receiving prenatal care at
obstetric clinics at several sites in the Boston area receive a questionnaire to determine if
they are risk drinkers. The women who are not identified as risk drinkers on the
questionnaire serve as the comparison group for the study. Women who are identified as
risk drinkers are asked to provide a blood sample, and a series of blood markers of
alcohol use are assessed. Women with positive blood markers are then asked to
participate in a series of brief interventions and agree to ongoing monitoring of and
feedback on the blood markers throughout their pregnancy. Infant outcomes will be
assessed on all women participating in the study and the role of specific markers on the
achievement of alcohol abstinence or reduction will also be explored.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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2.26
CDC Developing Intervention Strategies for Children:
Intervening with Children and/or Adolescents with Fetal Alcohol Syndrome or
Alcohol-Related Neurodevelopmental Disorders
Prenatal alcohol exposure can result in facial abnormalities, growth problems, and
developmental and behavioral problems, as well as other birth defects. Children with fetal
alcohol syndrome (FAS) or alcohol-related neurodevelopmental disorder (ARND) can
have serious lifelong disabilities. CDC-sponsored studies find that children with
FAS/ARND are at very high risk for developing secondary conditions such as difficulties
in school, trouble with the law, substance abuse problems, and mental health problems.
Currently, interventions for children with FAS/ARND are often non-specific,
unsystematic, and/or lack scientific evaluation or validation.
Grantees are working together with CDC, through a collaborative effort, to identify,
develop, and evaluate effective strategies for intervening with children with FAS/ARND
and their families. Through these interventions, researchers are trying to help children
with FAS/ARND develop to their full potential, prevent secondary conditions, and
provide education and support to caregivers and families.
Funded Projects:
Marcus Institute—Atlanta, Georgia
This intervention focuses on Behavioral Regulation Training (BRT), as a readiness-forlearning strategy, and math skills for improving cognition. BRT teaches parents ways to
modify the child’s environment to reduce excess stimulation, use appropriate social
reinforcement, and communicate choices rather than commands. All children in the study
population diagnosed with FAS or ARND and their families participate in the BRT and
are taught self-awareness, decision-making, and verbalization of situations and actions. In
addition, intervention participants receive individualized math skills training, a common
area of significant disability for children with FAS/ARND. The intervention is designed
for children aged 3 through 9 years.
University of Washington—Seattle, Washington
The purpose of this project is to explore two intervention models for school-age children.
One consists of an individualized, supportive, behavioral consultation intervention for
school-age children (aged 5 through 11 years) with FAS or ARND. Consultation includes
FAS education, emotional/practical support, teaching child management strategies
specific to children with FAS/ ARND, advocacy assistance, and school consultation. The
second intervention is a school-based social communication intervention provided
directly to children with FAS/ARND. This intervention targets critical deficits in social
communication and peer relations and is designed to teach children (aged 8 through 12
years) how to use an interactive checklist to guide them through resolution of peer
conflicts. An intervention and a control group will be compared using pre- and post-test
measures, with post-tests occurring at the conclusion of the intervention and at a 9 month
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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follow-up.
University of Oklahoma Health Services Center – Oklahoma City, Oklahoma
This project uses Parent Child Interaction Therapy (PCIT) to intervene with parents and
their children (aged 2 through 7 years) who have been diagnosed with FAS or ARND.
The treatment group receives 90-minute group sessions once a week for 14 weeks.
Behavioral specialists conduct group sessions with parents to teach them appropriate and
effective behaviors and interaction techniques. Parent-child interactions are observed and
individualized guidance is provided. The control group receives standard referrals and
services, along with participation in a parent support group. Pre- and post-test
comparisons will be made between groups at the conclusion of the intervention and at
6,12, and 18 month follow-ups.
University of California—Los Angeles, California
This project focuses on parent-assisted social skills training, with particular attention to
development of best friend relationships. Children (aged 6 through 8 years) receiving the
intervention participate in didactic training sessions, behavior rehearsal, and coaching to
reduce maladaptive behaviors and promote pro-social interaction skills. Simultaneously,
parents are taught about core deficits of FAS and ARND and given the companion
information to their children’s intervention. A control group receives standard community
care and both groups of participants are re-evaluated at 4 months post-intervention.
Children’s Research Triangle—Chicago, Illinois
This intervention proposes to develop a program of neurocognitive habilitation within a
systematic intervention strategy for children with prenatal alcohol exposure. The target
population is children (aged 6 through 12 years) diagnosed with FAS or ARND, currently
in the care of the Illinois welfare system. Children and their families are randomized into
two groups. Children and families participating in the treatment group receive 12 weeks
of neurocognitive habilitation and psychotherapy services along with family education
and case management services. Children and families participating in the control group
will receive the current standard of care through existing community and school-based
agencies. Pre- and post- measures will be analyzed for each group and post-test follow-up
will occur at 12 and 24 months.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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2.3
CSAP FAS Center for Excellence Grantee Program
http://www.fascenter.samhsa.gov/about/granteeintro.cfm
The Center for Substance Abuse Prevention (CSAP) has funded seven FAS prevention
projects. Two started in 2000: Alaska's comprehensive statewide effort and the Four-State
Consortium formed by Minnesota, Montana, North Dakota, and South Dakota. These
programs are dedicated to improving the science-based knowledge on diagnosed cases,
risk factors, prevalence, and prevention.
Five additional Community Initiated Prevention Intervention projects were funded in
September 2001. These five projects are designed to field test FAS prevention approaches
that have been shown to prevent, reduce, or delay alcohol use for groups at risk for having
children with FAS.
These projects vary and each will test different prevention interventions. Three projects
are focused on statewide or multiple county areas, while four are focused on a
metropolitan area or tribal group. Six of the projects are funded for 3 years and Alaska is
funded for 5 years.
The FAS Center for Excellence is operating a Project Coordinating Center to provide
support and coordination for the grantees. The Project Coordinating Center also:
 Offers strategic and operational advice;
 Identifies common data measures across grantee programs; and
 Collects, manages, and analyzes data from grantees.
A cross-site analysis of the grantee's programs will be conducted and evaluation of the
grantee's programs will be used to identify best practices.
A) Alaska's Statewide Fetal Alcohol Syndrome 5-Year Comprehensive Project
Office of Fetal Alcohol Syndrome
State of Alaska Department of Health and Social Services
Juneau, AK
Overview
Alaska's Five-Year Fetal Alcohol Syndrome (FAS) Project is an effort to address issues
related to FAS and other alcohol-related birth defects (ARBD) throughout Alaska.
Focuses both on prevention and improvement of services to individuals and families
affected by this disability. Alaska's FAS project is a comprehensive, integrated effort
encompassing prevention, intervention, screening and diagnosis, and improved service
delivery.
Four statewide goals have been identified for the 5-year period:
 Prevent all fetal alcohol spectrum disorders (FASD).
 Screen and diagnose children at risk of FASD as early as possible.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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 Improve lifelong outcomes through improved service delivery to families and
individuals affected by FASD.
 Document our progress and evaluate program outcomes.
The project is multidisciplinary, culturally appropriate, and community based. The
approach aims to coordinate existing systems and processes that now operate separately;
integrate service delivery and information management systems to the greatest extent
possible; and set up structures that will be self-sustaining in the future.
Alaska's Mission
To prevent all alcohol-related birth defects and to improve the delivery of services to
those already affected by fetal alcohol spectrum disorders.
B) Effectiveness of a Culturally Focused Skills Enhancement Approach to Reduce
Alcohol Use in Native Women
College of Public Health
University of Arizona
Tucson, AZ
Overview
The University of Arizona College of Public Health is implementing and evaluating the
effectiveness of a culturally based cognitive/behavioral intervention to reduce alcohol use
among adult Native American women of childbearing age. This 3-year study will
compare the effectiveness of a skills training approach with an education-only approach
with 280 Pasqua Yaqui women.
Mission
To reduce alcohol use and prevent FAS births among Pasqua Yaqui women of
childbearing age.
C) Four-State Consortium on Fetal Alcohol Syndrome/Fetal Alcohol Effects
Center for Disabilities
Department of Pediatrics
School of Medicine
University of South Dakota
Sioux Falls, SD
Overview
The Four-State Consortium on Fetal Alcohol Syndrome/Fetal Alcohol Effects (FAS/FAE)
includes Minnesota, Montana, North Dakota, and South Dakota. The Consortium
improves data collection systems to understand the extent of the problem; identifies
female populations in the region at risk for giving birth to children with FAS; evaluates
and implements prevention programs; and evaluates the effectiveness of a multistate
effort to prevent FAS/FAE.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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Mission
To build the capacity in the States of Minnesota, Montana, North Dakota, and South
Dakota through the establishment of the Four-State Consortium to reduce the risk factors
that result in children being born affected by fetal alcohol syndrome or fetal alcohol
effects.
D) Rural Prevention of Fetal Alcohol Syndrome and Fetal Alcohol Effects
Bluegrass Prevention Center
Bluegrass Regional Mental Health-Mental
Retardation Board, Inc.
Lexington, KY
Overview
The Bluegrass Prevention Center is evaluating the effectiveness of a multicomponent fetal
alcohol syndrome (FAS)/fetal alcohol effects (FAE) prevention approach in rural
communities in 13 central Kentucky counties. The 3-year study will test a
multicomponent strategy focusing on health care provider interventions with pregnant
women, an awareness campaign, and training on diagnosis and early intervention through
family care practices and early childhood service providers.
Mission
To reduce FAS/FAE births by educating county health department staff who deal with
pregnant women; developing a community awareness campaign; and providing training to
pediatric, foster care, and elderly childhood service workers on diagnosis and early
intervention.
E) Baby First Partnership Project
Governor's Institute on Alcohol and Substance Abuse, Inc.
Research Triangle Park, NC
Overview
The Baby First Partnership Project is evaluating two alcohol abuse interventions in Wake
County, North Carolina to prevent the birth of children with fetal alcohol syndrome/fetal
alcohol effects (FAS/FAE). The 3-year study will implement and test interventions that
educate health care providers about FAS screening. It will also assist in preventing
women who are at risk for using alcohol during pregnancy from giving birth to infants
with FAS/FAE.
Mission
To improve health care services to women at risk of delivering babies with FAS, to
provide support and mentoring services, and to educate health care providers about
prevention and screening for women at risk.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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F) Beyond the 7th Generation: A Native American Fetal Alcohol Syndrome/AlcoholRelated Birth Defects Prevention/Intervention Project
American Indian Institute
University of Oklahoma
Norman, OK
Overview
The American Indian Institute at the University of Oklahoma is evaluating the
effectiveness of the 7th Generation FAS/FAE Prevention Curriculum on American Indian
youth in several school systems, faith-based organizations, and youth clubs. The 3-year
study will implement and test the curriculum with 1,500 youths in grades 6 through 12 to
determine its effectiveness in preventing, delaying, or reducing problems associated with
substance abuse.
Mission
To implement and test the scientifically developed curriculum, 7th Generation FAS/FAE
Prevention Curriculum, with 1,500 youths in grades 6 through12 to reduce the likelihood
of behaviors that will lead women to giving birth to babies with FAS.
G) Fetal Alcohol Syndrome/Alcohol-Related Birth Defects Prevention: Research to
Practice
Fetal Alcohol and Drug Unit
School of Medicine
University of Washington
Seattle, WA
Overview
The Fetal Alcohol and Drug Unit at the University of Washington is evaluating a
successful substance abuse prevention and intervention program for women at risk for
giving birth to infants with fetal alcohol syndrome (FAS) and associated disorders. The 3year study will use multiple measures to evaluate the program in new settings, including
women's use of substance abuse treatment, their reduction in alcohol and drug use,
improvements in the access and usage of community services, their use of family
planning, and the appropriate placement of exposed children.
Mission
To enable communities to respond, through long-term advocacy, to the problems of
mothers who have abused alcohol and drugs during pregnancy and to the needs of their
children.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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2.4
FAS/ARBD Prevention: Research to Practice
http://depts.washington.edu/fadu/FADU.projects.html#CSAP
Funded by the Center for Substance Abuse Prevention (CSAP),
a division of the Substance Abuse and Mental Health Services Administration
(SAMHSA)
Over the past 12 years they have developed and tested a paraprofessional advocacy
intervention model (Parent-Child Assistance Program, or PCAP) to intervene with highrisk mothers who abuse alcohol and drugs during pregnancy. The research project
"FAS/ARBD Prevention: Research to Practice" field-tests a modification of the PCAP
model. The project (1) enrolls women who primarily abuse alcohol during pregnancy; (2)
identifies and recruits subjects through community referral or through a postpartum
screening process at two hospitals (one in Seattle and one in Tacoma) using a method we
have developed and tested previously on postpartum floors at several urban hospitals; and
(3) tests a more intensive and focused intervention for a shorter period of time (12 months
instead of 36). A total of 120 women will be enrolled and randomized to either of two
treatment groups: the 12-month PCAP intervention (PCAP12) or the community standard
of care (CSC). The primary aim of the project is to prevent future alcohol- affected births,
either by motivating women to abstain from alcohol during their next pregnancy, or by
educating and encouraging alcohol-abusing women to use reliable birth control methods
on a regular basis. After 12 months of PCAP12 intervention or CSC, we will evaluate (a)
utilization of substance abuse treatment, (b) reduction in maternal alcohol and drug use,
(c) maternal use of effective family planning methods, (d) improved access and successful
utilization of appropriate community services (e.g. housing, health, mental health,
domestic violence services). This project will maximize primary prevention efforts by
targeting limited resources to women at highest risk for producing a child with Fetal
Alcohol Syndrome (FAS) and Alcohol Related Birth Disorders (ARBD).
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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3.
Research Publications – Prevention & Intervention of FASD
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
36
3.1
Culturally Diverse Populations
A model for fetal alcohol syndrome prevention in Native American population.
Ma, G.X.; Toubbeh, J.; Cline, J.; & Chisholm, A. (2002). In Ethnicity and substance
abuse: Prevention and intervention, Ma, G.X. & Henderson, G. (Eds). Springfield, IL,
US: Charles C. Thomas Publisher, Ltd. xviii, (pp. 284-295).
Abstract
Describes the development and evaluation of a fetal alcohol syndrome (FAS) prevention
program. Program objectives were to develop substance abuse prevention (SAP) products,
as well as materials and tools, with a special emphasis on communication strategies to
address prevention and/or reduction of the incidence of FAS among Native American
(NA) adolescents. The health communication process model was used as a theoretical
foundation for this SAP program design. The model involves: (1) planning and strategy
selection, (2) selecting communication channels and materials, (3) developing materials,
(4) implementation, (5) assessing effectiveness, and (6) feedback to refine the program.
Consistent with this model, data are presented in 3 segments, as Phase 1, Professional
Needs Assessment (49 prevention professionals); Phase 2, Development of FAS
Prevention Program; and Phase 3, Evaluation (90 6th through 8th grade students, 85
completing pre- and post-tests). The survey revealed: (1) the lack of adequate and
appropriate prevention resources and programs on alcohol use and its relationship to FAS
for early adolescents and (2) the dearth of programs that address the needs of early
adolescents at high risk of involvement in decision-making and behavior that can lead to
addiction or FAS. [PsycINFO]
Native American adolescents' views of fetal alcohol syndrome prevention in schools
Ma, G.X.; Toubbeh, J., Cline, J.; Chisholm, A. Journal of School Health. 68(4):131-6,
1998 Apr.
Abstract
Alcohol is the most commonly abused substance among adolescents in the United States.
Adolescent females are recognized as one group at risk for giving birth to babies with
fetal alcohol syndrome (FAS). Sixth through eighth grade Native Americans were
surveyed about their attitudes toward and knowledge of FAS risk factors and prevention
strategies. Data revealed that 52% of students drank alcohol prior to the survey. Though
sexually active, students lacked knowledge about the relationship between alcohol and
FAS. The study revealed 1) limited prevention programs in middle schools and 2) the
most influential factor in determining attitudes and decisions about alcohol use was the
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
37
immediate family. Students felt FAS prevention is an important topic in school health
education, noting the important role peers play in teaching and role modeling. Various
strategies incorporating music and communication technology such as videotape and
computer-assisted interactive tools into prevention materials are discussed. [Medline]
Fetal alcohol syndrome among Native American adolescents: A model prevention
program.
Ma, G.X.; Toubbeh, J., Cline, J.; Chisholm, A. Journal of Primary Prevention. Vol 19(1)
Fal 1998, 43-55.
Abstract
Surveyed 49 prevention specialists and gatekeepers in major prevention programs in 6
states with large American Indian populations in order to design and evaluate a viable
prevention strategy targeting Native American adolescents at highest risk of engaging in
behaviors that lead to fetal alcohol syndrome births. The results indicate that a
community-based prevention program targeting 6th-8th grade students had the highest
probability of success. Specific strategies, including types of communication media,
materials and tools acceptable to the target population, as well as the role of parents,
extended family, peers, and culture are discussed. [PsycINFO]
Fetal alcohol syndrome--South Africa, 2001.
Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep.
2003 Jul 18;52(28):660-2.
Abstract
Fetal alcohol syndrome (FAS) is caused by maternal alcohol use during pregnancy and is
one of the leading causes of preventable birth defects and developmental disabilities. The
FAS phenotype is characterized by a combination of facial dysmorphic features, growth
retardation, and central nervous system (CNS) abnormalities. State-based estimates of the
prevalence of FAS in the United States vary from 0.3 to 1.5 per 1,000 live-born infants.
Recently, the highest prevalence of FAS worldwide was reported among first-grade
children in a wine-growing region in the Western Cape province of South Africa.
Investigators for the National Institutes of Alcoholism and Alcohol Abuse (NIAAA)
reported a FAS prevalence of 40.5 to 46.4 per 1,000 children aged 5-9 years in one
community in Western Cape. To determine whether FAS was associated exclusively with
the wine-growing region in Western Cape or was more endemic in other areas of the
country, CDC, in collaboration with the University of Witwatersrand and the Foundation
for Alcohol Related Research in Johannesburg, South Africa, conducted a prevalence
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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study in Gauteng province and is developing ongoing surveillance and prevention
activities. This report summarizes the findings of the study, which indicate a high
prevalence of FAS among first-grade children in four nonwine-growing communities
around Johannesburg. Because South Africa has limited resources and many competing
health problems (e.g., human immunodeficiency virus/acquired immunodeficiency
syndrome, tuberculosis, and sexually transmitted diseases), integrating prenatal alcoholexposure prevention activities with existing prevention programs should be explored.
[Pubmed]
Relationship of Prenatal Alcohol Use with Maternal and Prenatal Factors in
American Indian Women
Kvigne, V.L.; Bad-Heart-Bull, L.; Welty, T.K.; Leonardson, G.R.; Lacina, L. Social
Biology, 1998, 45, 3-4, fall-winter, 214-222.
Abstract
Demographic factors & patterns of substance use are comparatively examined among 177
Northern Plains Indian women who did, vs did not, consume alcohol during pregnancy,
based on self-administered questionnaire data. Compared with nondrinkers, subjects (Ss)
who drank during pregnancy were more likely to be single, have less education, & have
less access to transportation resources. Ss who drank during pregnancy consumed more
alcohol more frequently before pregnancy than did Ss who drank before but not during
pregnancy; they were also more likely to smoke cigarettes & use illicit drugs, have
parents who drank, feel they drank the same or more than other pregnant women, or have
experienced more relationship breakups & physical & emotional abuse. Prenatal patients
who drink alcohol need more intensive counseling regarding their multiple risk behaviors.
[Sociological Abstracts 1986-2002/12]
Understanding drinking during pregnancy among urban American Indians and
African Americans: Health messages, risk beliefs, and how we measure
consumption.
Kaskutas, L.A. Alcoholism: Clinical & Experimental Research. Vol 24(8) (pp 12411250), 2000.
Abstract
Background: Little is known about urban American Indian and African American
women's drinking during pregnancy, or their beliefs about the risk of doing so. However,
rates of fetal alcohol syndrome (FAS) are believed to be highest among those ethnic
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
39
groups. Methods: The Developing Effective Educational Resources (DEER) project
recruited pregnant American Indian, African American, and white women from urban
California areas (n = 321), to develop culturally appropriate consumption measures, to
gather epidemiological data about drinking during pregnancy, and to assess exposure and
reactions to health warnings intended to encourage abstinence during pregnancy. Results:
The study found high levels of exposure to health warnings among all ethnic groups, but
many women were unclear about the actual consequences of FAS, about the risk of
drinking even beer or wine or wine coolers, or about the value of reducing intake at any
time during pregnancy. The majority of the women who drank malt liquor, fortified wine,
wine, and spirits reported having larger than standard drinks, and daily drinkers had the
highest levels of reporting error. When drink size was considered in the calculation of
alcohol volume, average daily volume of consumption during pregnancy increased to the
FAS risk level (average daily volume >= 1) in the overall sample and among the African
American and white subjects. Conclusions: Because some women, especially heavy
drinkers, will continue drinking despite exposure to abstention-oriented health messages,
it may be prudent to develop campaigns and interventions that provide factual information
to help at-risk women reduce their drinking during pregnancy. Women could be advised
of beverage equivalency, of standard drink sizes, and of how their own drinks compare
with standard ones. Reliance on standard drink sizes in research can result in significant
underreporting of consumption, especially among pregnant risk drinkers.
Knowledge and misconceptions among inner-city African-American mothers
regarding alcohol and drug use.
Donnelly, F.M. American Journal of Drug and Alcohol Abuse, v. 24 no. 4 (November
1998) p. 675-83.
Abstract
Beliefs among African-American mothers living in the inner city with regard to alcohol
and drug abuse were assessed. A total of 84 postpartum mothers known to have had
problems with alcohol and drug abuse during pregnancy received the Department of
Education's publication Growing Up Drug Free: A Parent's Guide to Prevention. The
results of a phone-administered quiz revealed that half of the women were not aware that
alcohol is the most frequently used drug in the U.S. Few of the women knew that alcohol,
tobacco, and marijuana are the 3 drugs most frequently used by children. Lack of teenage
experience of substance use was thought to raise the risk of chemical dependency.
Drinkers and drug users were 4-fold more likely to correctly answer a minimum of 6
questions. Parental knowledge of substance use, and particularly use of alcohol, remains
insufficient. [Social Sciences Abstracts]
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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3.2
Prevention / Intervention
Fetal alcohol syndrome prevention research.
Hankin, J.R.; Health & Research World, Vol 26(1) 2002, 58-65.
Abstract
Discusses fetal alcohol syndrome (FAS) prevention activities. The intervention spectrum
for FAS described by the Institute of Medicine of the National Academy of Sciences
comprises the 3 components of universal, selective, and indicated prevention. Research
pertaining to universal efforts have focused on media attention to drinking during
pregnancy, the value of warning posters and alcohol beverage warning labels, and
increases in FAS knowledge. Brief interventions for pregnant women can successfully
reduce alcohol intake during pregnancy. [PsycINFO]
Fetal alcohol syndrome/fetal alcohol effects: A survey of Alaskan educators.
Binns, W.R. Dissertation Abstracts International. Vol 61(7-A), Feb 2001, 2589, US:
University Microfilms International.
Abstract
Fetal alcohol syndrome (FAS) is one the leading causes of mental retardation and often
results in significant social, learning, and behavioral challenges. Early identification and
interventions for students with FAS and fetal alcohol effects (FAE) serves an especially
critical function in rural Alaskan settings. This study reports educators' level of
knowledge/awareness of issues surrounding FAS/FAE in educational settings in Alaska.
The primary method used in the study was a 64-item, self-administered mail survey,
completed by 271 (49%) of the 550 educators in the sample. The survey attempted to
identify predictors of educators' knowledge/awareness, perceived skill level, and ability to
access resources for working with students with FAS/FAE. It also identified previous
training experiences and possible preferred methods for future training opportunities. Data
collected through the survey instrument were augmented and supported by qualitative
data collected from two subsequent focus groups. There was a high degree of consistency
between the survey data and the qualitative findings generated by the study's focus
groups. Educators who had more direct, personal experience with students with FAS/FAE
were more knowledgeable, had better perceived skills, and had more confidence in these
skills than educators who had worked with fewer students with FAS/FAE. Participation in
the special education process, self-directed training efforts, and identifying FAS/FAE as a
significant problem in one's home community were also significant positive predictors.
Several predictor variables had significant negative predictive relationships with the
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
41
dependent variables. Educators who were of Alaska Native ethnicity scored significantly
lower on the knowledge/awareness and skill level factors on the survey. Over 68% of
Alaska Native respondents had a high school diploma as their highest educational degree.
Most of the Alaska Native respondents worked primarily with the preschool population in
rural and remote preschool programs. This combination of predictors identified
paraprofessionals with no college degree who worked in rural preschool settings as prime
candidates for future training efforts on FAS/FAE. [PsycINFO]
Variable structure/variable performance: Parent and teacher perspectives on a
school-age child with FAS.
Timler, G.R. & Olswang, L.B. Journal of Positive Behavior Interventions. Vol 3(1) Win
2001, 48-56.
Abstract
A case study of a school-age boy with a diagnosis of fetal alcohol syndrome is presented
to explore the parent's and teacher's viewpoints about the best educational program for
him. During open-ended interviews, the child's mother and teacher described his strengths
and challenges differently, ultimately leading to disagreement about the most appropriate
educational placement and supports for this child. Analysis of these interviews indicated
that differences in environmental structure and adult expectations for child behavior
across the home and school settings are one likely source for these diverse viewpoints.
These results suggest that intervention planning must take into account this child's
variations in performance across contexts. Recommendations for positive behavioral
supports are provided to facilitate the child's performance across home and school
settings. [PsycINFO]
Twelve-year follow-up of children exposed to alcohol in utero.
Autti-Raemoe, I. Developmental Medicine & Child Neurology. Vol 42(6) Jun 2000,
406-411.
Abstract
82 women who were consuming alcohol while pregnant attended a special clinic at the
University Central Hospital, Helsinki with the aim of reducing heavy drinking during
pregnancy. The children born to these women were followed up regularly. During their
preschool years the children were assessed to have fetal alcohol syndrome, fetal alcohol
effects, alcohol-related neurodevelopmental disorder, pre- and/or postnatal growth
retardation, or normal cognitive and somatic growth. Of the original children, 70 of 82
could be traced at the age of 12 yrs. Through semi-structured interview and contact with
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
42
the health and social care authorities, information was gathered about schooling, family
structure, whether help had been sought for behavioral difficulties and major adverse
events in the family. The longer the intrauterine alcohol exposure and the more severe the
diagnosis related to prenatal alcohol exposure, the more often the children required
special education, were temporarily or permanently taken into care, and had behavioral
problems. There is a considerable need for prolonged multidisciplinary follow-up and
support of all children whose mothers have not been able to reduce drinking in early
pregnancy, whether or not cognitive disturbances are evident in early childhood.
[PsycINFO]
Fetal alcohol syndrome (FAS) primary prevention through FAS diagnosis: I.
Identification of high-risk birth mothers through the diagnosis of their children.
Astley, S.J.; Bailey, D.; Talbot, C. & Clarren, S.K. Alcohol & Alcoholism. Vol 35(5)
Sep-Oct 2000, 499-508. Oxford Univ Press, United Kingdom
Abstract
Conducted a 5-yr, fetal alcohol syndrome (FAS) primary prevention study to: (1) assess
the feasibility of using a FAS diagnostic and prevention clinic as a center for identifying
and targeting primary prevention intervention to high-risk women; (2) generate a
comprehensive, lifetime profile of these women; (3) identify factors that have enhanced
and/or hindered their ability to achieve abstinence. Two sources of patients with FAS
were used to address the 3 objectives. The results of this study are presented in 2 parts:
work on objective 1 is summarized in the present paper; whereas that on objectives 2 and
3 is summarized in the accompanying paper (see record 2000-00931-010). One out of
every 3 patients evaluated in the FAS Diagnostic and Prevention Network (DPN) clinics
was diagnosed with FAS or static encephalopathy/alcohol exposed. The birth mothers of
1 out of every 3 of these children diagnosed with FAS or static encephalopathy/alcohol
exposed could be located and directly contacted. Half of the birth mothers directly
contacted were still at risk for producing more children damaged by prenatal alcohol
exposure. Thus, 1 out of every 18 children evaluated in the FAS DPN clinics had a birth
mother who could be found and was at risk of producing more children damaged by
prenatal alcohol exposure. [PsycINFO]
Fetal alcohol syndrome (FAS) primary prevention through FAS diagnosis: II. A
comprehensive profile of 80 birth mothers of children with FAS.
Astley, S.J.; Bailey, D.; Talbot, C. & Clarren, S.K. Alcohol & Alcoholism. Vol 35(5)
Sep-Oct 2000, 509-519. Oxford Univ Press, United Kingdom
Abstract
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
43
Conducted a 5-yr, fetal alcohol syndrome (FAS) primary prevention study to: (1) assess
the feasibility of using a FAS diagnostic and prevention clinic as a center for identifying
and targeting primary prevention intervention to high-risk women; (2) generate a
comprehensive, lifetime profile of these women; (3) identify factors that have enhanced
and/or hindered their ability to achieve abstinence. Comprehensive interviews were
conducted with 80 women (aged 23.1-55.4 yrs), who had given birth to child diagnosed
with FAS, to document their sociodemographics, reproductive and family planning
history, social and healthcare utilization patterns, adverse social experiences, social
support network, alcohol use and treatment history, mental health, and intelligence IQ.
Relative to the women who had not achieved abstinence, the women who had achieved
abstinence had significantly higher IQs, higher household incomes, larger more
satisfactory social support networks, were more likely to report a religious affiliation, and
were more likely to be receiving mental health treatment for their mental health disorders.
The rate of unintended pregnancies and alcohol-exposed pregnancies was substantial.
[PsycINFO]
Reducing the risk of alcohol-exposed pregnancies: a study of a motivational
intervention in community settings.
Ingersoll, K.; Floyd, L.; Sobell, M.; Velasquez, M.M.; Project CHOICES Intervention
Research Group. Pediatrics. 111(5 Part 2):1131-5, 2003 May.
Abstract
OBJECTIVES: To test the feasibility and impact of a motivational intervention in
reducing drinking and/or increasing effective contraception in women who are at risk for
an alcohol-exposed pregnancy. METHODS: A multisite single-arm pilot study was
conducted in 6 community settings in 3 large cities. A total of 2384 women were screened
for eligibility; 230 were eligible on the basis of their alcohol use and lack of
contraception. Of the eligible women, 190 consented and were enrolled, and 143 (75.3%)
completed the 6-month follow-up. The intervention consisted of 4 manual-guided
motivational counseling sessions delivered by mental health clinicians and 1
contraceptive counseling session delivered by a family planning clinician. Outcome
measures include intervention completion rates, alcohol use (frequency, quantity, and
bingeing), contraceptive use and effectiveness, and risk for alcohol-exposed pregnancy.
RESULTS: Among women who completed the 6-month follow-up, 68.5% were no longer
at risk of having an alcohol-exposed pregnancy; 12.6% of women who completed the
program reduced drinking only; 23.1% used effective contraception only; and 32.9%
reported both. Results were consistent across the 6 diverse high-risk settings.
CONCLUSIONS: This study provides evidence that providing 4 sessions of motivational
interviewing plus a contraception counseling session is feasible and strongly suggests that
this intervention can decrease the risk of alcohol-exposed pregnancy in women in highFetal Alcohol Spectrum Disorder - International Research and Practice Inventory
44
risk settings. Additional investigation in a randomized controlled trial is warranted.
[Medline]
A brief intervention for prenatal alcohol use: an in-depth look.
Chang, G.; Goetz, M.A.; Wilkins-Haug, L.; Berman, S. Journal of Substance Abuse
Treatment. 18(4):365-9, 2000 Jun.
Abstract
About 20% of pregnant women will drink alcohol, even though no universally safe level
of prenatal alcohol consumption has been established. This study of 123 alcohol screenpositive pregnant women receiving a brief intervention in the 16th week of gestation
examines the relationship of drinking goals, reasons for the goals, recognition of
situations increasing risk of drinking, and subsequent antepartum consumption. While
women who named abstinence as their antepartum drinking goal were more likely not to
be consuming alcohol at the time of study enrollment (chi(2) = 16.80, df = 1, p =.001),
current drinkers who named abstinence as their goal did reduce subsequent prenatal
alcohol use (chi(2) = 10.04, df = 1, p =.002). All current drinkers who indicated fetal
alcohol syndrome as a reason not to drink reduced their subsequent alcohol consumption
(chi(2) = 11.04, df = 1, p =.001). Future efforts may include the partners and support
systems of pregnant women in education or intervention programs to reduce prenatal
alcohol consumption to enhance their effectiveness. [Medline]
Is there evidence to show that fetal alcohol syndrome can be prevented?
Murphy-Brennan, M.G.; Oei, T.P. Journal of Drug Education. 29(1):5-24, 1999.
Abstract
Fetal Alcohol Syndrome (FAS) is currently the major cause of mental retardation in the
Western world. Since FAS is not a natural phenomenon and is created by mixing alcohol
and pregnancy, the solution to decreasing the incidence of all alcohol-related birth defects
is therefore entirely preventable. To date, little is known about the effectiveness of
prevention programs in reducing the incidence of FAS. Therefore, it is the intention of
this article to review the effectiveness of prevention programs in lowering the incidence
of FAS. The present review revealed that prevention programs, to date, have been
successful in raising awareness of FAS levels across the groups examined. However, this
awareness has not been translated into behavioral changes in "high risk" drinkers as
consumption levels in this group have decreased only marginally, indicating prevention
programs have had minimal or no impact in lowering the incidence of FAS. Urgent steps
must now be taken to fully test prevention programs, and find new strategies involving
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
45
both sexes, to reduce and ultimately eliminate the incidence of FAS. [Medline]
Identification of children with fetal alcohol syndrome and opportunity for referral of
their mothers for primary prevention--Washington, 1993-1997.
Anonymous. MMWR - Morbidity & Mortality Weekly Report. 47(40):861-4, 1998 Oct
16.
Abstract
Heavy maternal use of alcohol during pregnancy can cause permanent birth defects,
including fetal alcohol syndrome (FAS). Although these alcohol-related defects are
entirely preventable, the factors associated with maternal use of alcohol during pregnancy
are complex and often resistant to change. In addition, not all women who drink heavily
will produce children with FAS. Although targeting primary prevention efforts to all
women at risk for drinking during pregnancy is ideal, limited resources require targeting
women at the highest risk for producing children affected by prenatal alcohol exposure.
One such population is women who have already given birth to an alcohol-affected child.
This high-risk population is not easily identified because not all children with FAS have
their condition diagnosed, and these birth mothers are often separated from their children
during the first few years of the child's life, often before a diagnosis of FAS has been
considered. However, once identified, these women are receptive to intervention. To
identify a population of women at highest risk for a future alcohol-exposed pregnancy
through diagnosing a previously affected birth child, researchers at the University of
Washington developed the Fetal Alcohol Syndrome Diagnostic and Prevention Network
(FAS DPN). This report summarizes the results of this program and documents the
feasibility of identifying persons who may have FAS so their condition can be diagnosed
and their birth mothers can be identified and referred to prevention services. [Medline]
Attitudes and knowledge about drinking: relationships with drinking behavior
among pregnant teenagers.
Cornelius, M.D.; Lebow, H.A.; Day, N.L.
1997.
Journal of Drug Education. 27(3):231-43,
Abstract
Data were collected on the drinking behavior of 415 pregnant adolescents from 1990 to
1994. The relationships between knowledge and attitudes about drinking and drinking
behavior were examined. Knowledge about drinking was not related to average daily
volume of alcohol before or during pregnancy. Those with specific knowledge about fetal
alcohol effects drank less before pregnancy, and in the first trimester, and were also less
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
46
likely to drink to intoxication. Among drinkers, general knowledge about drinking was
significantly related to a decrease in drinking between pre-pregnancy and first trimester,
as well as between first and third trimesters. Those with more intolerant attitudes about
drinking drank less before and during pregnancy. They had fewer episodes of binge
drinking, intoxication, negative consequences, and problem drinking during pregnancy.
They were more likely to decrease drinking from the first to third trimesters. These
relationships are relevant to developing effective education programs for the high-risk
group of pregnant teenagers who drink. [Medline]
A multiple-level, comprehensive approach to the prevention of fetal alcohol
syndrome (FAS) and other alcohol-related birth defects (ARBD).
May, P.A. International Journal of the Addictions. 30(12):1549-602, 1995.
Abstract
A comprehensive program for the prevention of fetal alcohol syndrome (FAS) and
alcohol-related birth defects (ARBD) must consider multiple approaches and utilize
knowledge from a variety of academic disciplines. Issues related to culture, society,
behavior, belief systems, and medicine must all be considered for both etiology and
solutions. A broad paradigm such as a public health model integrates various elements of
approach. Because FAS and other levels of ARBD form a spectrum, from severe to
negligible damage, a variety of drinking patterns with various characteristics and
etiologies have to be addressed. This paper describes a multiple-level, comprehensive
program with primary, secondary, and tertiary prevention components. Practical
recommendations are proposed for addressing ARBD in a variety of arenas. While
secondary and tertiary prevention hold promise for short-term reduction of FAS and
ARBD prevalence, comprehensive prevention serves both short- and long-term effects.
Multiple level prevention efforts are well served by clear and compelling vision and
mission statements, and require careful evaluation. [Medline]
Alcohol-related knowledge, attitude, belief and behavior (KABB) surveys of Alaskan
health professionals. The Alaska Fetal Alcohol Syndrome Prevention Steering
Committee.
Anonymous. Alaska Medicine. 37(1):5-9, 1995 Jan-Mar.
Abstract
Surveys were conducted to identify alcohol-related and fetal alcohol syndrome training
and resource needs of health care providers in the state of Alaska. Surveys were mailed to
all obstetrician/gynecologists, pediatricians, family practitioners, and public health nurses
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
47
in 1992 and 1993. The majority of respondents (95-100%) agreed it was their role to
address alcohol abuse problems among their patients and their patient's families. The
health care providers feeling very or somewhat prepared to deal with alcohol issues were
more likely to report that they always refer alcohol-abusing patients to alcohol treatment
programs (52% of 158) than those feeling unprepared (24% of 68) (Prevalence ratio 2.2,
95% CI and 2 over black square]; [1 and 2 over black square].4, 3.5]). The survey results
identify a need to facilitate referrals from health care providers. Training to improve
provider's level of preparation in dealing with patients in the area of alcohol abuse is
indicated and may enhance referrals to treatment services. [Medline]
Evaluation of a self-help program to reduce alcohol consumption among pregnant
women.
Reynolds, K.D.; Coombs, D.W.; Lowe, J.B.; Peterson, P.L. & Gayoso, E.
Journal of the Addictions. 30(4):427-43, 1995 Mar.
International
Abstract
This study tested a cognitive-behavioral intervention for reducing alcohol consumption
among economically disadvantaged pregnant women. The intervention included a 10minute educational session and a nine-step self-help manual. Women attending public
health maternity clinics completed a screening questionnaire, a pretest questionnaire, were
randomly assigned to receive the self-help intervention or usual clinic care, and completed
a posttest questionnaire. A higher alcohol quit rate was observed among the intervention
participants (88%) than controls (69%). The effect was strongest for "light" drinkers,
African-Americans, and non-Protestants. This approach may be useful in clinics where
staff time is limited. [Medline]
Alaska/Russian Far East behavioral health projects: a progress report on recent
activities.
Richards, B.; Lowe, M. & Starlings, M.J.
Alaska Medicine. 36(3):137-43, 1994 Jul-Sep.
Abstract
A number of "behavioral health" exchange activities between Alaska and the Russian Far
East took place during 1992-93. These included visits by a psychiatrist running one of the
first "private polyclinics" in Magadan and by a narcologist to discuss the latest
developments in alcohol services; a Behavioral Health Conference where Native health
workers from Russia and Alaska shared experiences; beginning a multi-year
epidemiology project; and a project to assess needs for a fetal alcohol syndrome (FAS)
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
48
prevention program in Magadan. [Medline]
The prevention of prenatal alcohol use: a critical analysis of intervention studies.
Schorling, J.B.
Journal of Studies on Alcohol. 54(3):261-7, 1993 May.
Abstract
Alcohol is a major cause of birth defects and mental retardation in the U.S. The yearly
cost to care for those affected has been estimated to be over $300 million. Prenatal
education and counseling have been advocated as techniques to reduce alcohol use in
pregnancy. The purpose of this study was to critically review investigations that used
these methods in order to determine their effectiveness. Reports of relevant studies were
found by searching Medline, the ETOH database and bibliographies of primary sources.
Only five studies were identified that met predetermined selection criteria. As judged by
usual methodologic standards for intervention programs, only one was of acceptable
quality. None employed a randomized design, and only two compared the treatment group
to a control group. Both these studies found no difference in alcohol use between control
and intervention groups. An ethical argument was used by several authors to justify
performing inadequately controlled studies. Since no intervention has proven to be
superior to the usual care delivered to pregnant women, this problem can be overcome
through the use of controls who receive this level of care. Despite the public health
importance of prenatal alcohol use, interventions to alter this behavior have not been
rigorously evaluated, and the benefits of any specific approach are unclear. Randomized
trials are ethically justified and guidelines for undertaking such studies are proposed.
[Medline]
Residential programs for persons with FAS: Programming and economics.
Hess, J.J.Jr. & Niemann, G.W. In: The challenge of Fetal Alcohol Syndrome:
Overcoming secondary disabilities. Streissguth, Ann (Ed); Kanter, Jonathan (Ed). (1997).
(pp. 189-197).
Abstract
(from the chapter) Providing effective treatment programs for individuals with Fetal
Alcohol Syndrome (FAS) requires the development of environments conducive to
positive treatment outcomes. This chapter will discuss both the programmatic and
economic pros and cons associated with congregate (i.e., institutional) and communitybased models of residential programs and advocate for the development of a continuum of
services for individuals with FAS. [PsycINFO]
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
49
An advocacy program for mothers with FAS/FAE.
Grant, T.; Ernst, C.; Streissburg, A.; Porter, J. In: The challenge of Fetal Alcohol
Syndrome: Overcoming secondary disabilities. Streissguth, Ann (Ed); Kanter, Jonathan
(Ed). (1997). (pp. 102-112).
Abstract
(from the chapter) Pregnancy and childbirth among mothers who themselves have Fetal
Alcohol Syndrome/Fetal Alcohol Effects is a topic that has not been adequately
addressed, yet it is a problem with which clinicians who work with fetal alcohol affected
patients are all too familiar. In this chapter, we review data from a recent study of this
topic and describe an existing advocacy program that we believe is promising for working
with these high-risk mothers during a critical time in their lives.
This chapter examines the birth to 3 advocacy model. This model was developed to work
with the highest risk mothers who abused alcohol and/or drugs during pregnancy and
received little or no prenatal care. [PsycINFO]
Case managers and independent living instructors: Practical hints and suggestions
for adults with FAS.
Schmucker, C.A. In: The challenge of Fetal Alcohol Syndrome: Overcoming secondary
disabilities. Streissguth, Ann (Ed); Kanter, Jonathan (Ed). (1997). (pp. 96-101).
Abstract
(from the preface) This chapter gives specific tips on how a privately paid case manager
and independent living instructor can assist adult patients with Fetal Alcohol
Syndrome/Fetal Alcohol Effects.
(from the chapter) Topics discussed include: guardianship and housing; financial
management; immediate gratification/impulse control; forgetfulness, routine, and
generalization; and socialization. [PsycINFO]
A demonstration classroom for young children with FAS.
Tanner-Halverson, P. In: The challenge of Fetal Alcohol Syndrome: Overcoming
secondary disabilities. Streissguth, Ann (Ed); Kanter, Jonathan (Ed). (1997), (pp. 78-88).
Abstract
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
50
(from the preface) The author describes techniques developed for early intervention
within the classroom setting over the past 6 yrs when she ran a demonstration classroom
for young children (6-9 yr old males) with Fetal Alcohol Syndrome/Fetal Alcohol Effects
which began with a small pilot program from the Arizona State Department of Education.
Ss exhibited slow academic gains and disruptive behavior when entering the
demonstration classroom. [PsycINFO]
Development of the FAS Diagnostic and Prevention Network in Washington State.
Clarren, S. & Astley, S. In: The challenge of Fetal Alcohol Syndrome: Overcoming
secondary disabilities. Streissguth, Ann (Ed); Kanter, Jonathan (Ed). (1997), (pp. 40-51).
Abstract
(from the preface) The authors present a comprehensive report on how they developed a
fetal alcohol diagnostic and prevention network in Washington State that is underway at 7
sites, serving the Fetal Alcohol Syndrome (FAS) diagnostic and prevention needs of
communities. Developing these clinics within a community context where local
professionals are involved at the outset in the diagnostic examination and
recommendations means that the diagnosis leads directly to workable intervention and
treatment recommendations. Experience with the 1st 511 patients (0.3-46.3 yrs old)
evaluated at the Washington clinic site is described as well as methods for development,
funding and staffing of such statewide networks. [PsycINFO]
"If It Burns Going Down...": How Focus Groups Can Shape Fetal Alcohol
Syndrome (FAS) Prevention
Branco, E-I. & Kaskutas, L-A. Substance Use and Misuse; 2001, Vol 36 (3), 333-345.
Abstract
Despite public health campaigns & clinical interventions that encourage women to abstain
from alcohol during pregnancy, some women continue to drink while pregnant. To
provide a more in-depth understanding of how at-risk women regard - & emotionally
react to - warnings about drinking alcohol during pregnancy, we conducted focus groups
in 1997 with 11 pregnant & recent postpartum Native American & African American
women in Los Angeles, CA. The main objective of these groups was to uncover relevant
aspects of women's beliefs & opinions about drinking during pregnancy that may not have
been elicited by other research instruments. Results would then be used to shape a large
survey of pregnant at-risk women. Analysis of the transcripts revealed three emergent
themes, which had the greatest impact on our subsequent survey. These were women's
exposure to & perceived believability of messages, their perception of risk associated with
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
51
drinking, & the barriers to cutting down on alcohol consumption during pregnancy.
Questions added to our survey instrument because of these findings included whether
women think that some alcohol beverages are safer to drink than others; how they value
cutting back alcohol use; their views on the irreversibility of fetal alcohol syndrome; &
what pressures they feel from peers & family to drink during pregnancy. Given the small
sample size associated with focus groups, these results cannot be generalized to larger
populations; however, these women's words revealed important underlying issues &
barriers that should be considered in studying & intervening with larger representative
samples. [Sociological Abstracts 1986-2002/12]
Findings of a Pilot Study of Motivational Interviewing with Pregnant Drinkers.
Handmaker, N.S; Miller, W.R..; Manicke, M. Journal of Studies on Alcohol; 1999, 60, 2,
Mar, 285-287.
Abstract
Cost-effective interventions are needed for counseling pregnant drinkers to reduce risk of
fetal alcohol effects. Described here is a pilot study of a motivational interviewing
intervention in which 42 pregnant women in NM who reported alcohol consumption
participated. Following a comprehensive alcohol use assessment, subjects (Ss) were
randomly assigned to receive either written information about risks related to drinking
during pregnancy or a 1-hour motivational interview - an empathetic, client-centered, but
directive session focusing on the health of the participant's unborn baby. At the 2-month
follow-up, all 34 women (81%) who remained in the study showed significant reductions
in alcohol consumption & intoxication, but these reductions were greater among Ss who
had received the test intervention. Motivational interviewing shows promise as a specific
intervention for reducing drinking among pregnant women who are at greatest risk.
[Sociological Abstracts 1986-2002/12]
Prevention of Alcohol Abuse-Related Birth Effects-I. Public Education Efforts
Abel, .E.L. Alcohol-and-Alcoholism; 1998, 33, 4, July-Aug, 411-416.
Abstract
After considering the relevant literature, it is contended that universal public education
efforts will only be effective in reducing fetal alcohol abuse syndrome & alcohol-abuserelated birth defects if they focus on the cause of these disorders, which is alcohol abuse
rather than the currently open-ended message that any amount of alcohol consumption
during pregnancy constitutes a danger to an unborn child. This argument lays the
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
52
groundwork for an alternative & more pragmatic prevention strategy set forth in Part II
(1998). [Sociological Abstracts 1986-2002/12]
Protecting fetuses from certain harm.
Abel EL.
Politics Life Sciences. 1998 Sep;17(2):113-7.
Abstract
Deborah Mathieu's proposal for state intervention in the lives of pregnant substance
abusers in order to prevent serious harm to their future children sparked a lively debate in
this journal. The present discussion characterizes the three main arguments offered
against her proposal as (a) the "uncertainty principle"--the inability to predict which
fetuses will be affected, (b) the "father factor"--gender bias with respect to prenatal
damage, and (c) "critical periods"--the vulnerability of the embryo/fetus at different times
of pregnancy. Each of these arguments is examined in the specific context of fetal alcohol
syndrome (FAS). Since the birth of a child with FAS is a virtual certainty if a woman has
previously given birth to a child with FAS, since no father has ever sired a child with FAS
unless his spouse is an alcoholic, and since the most damaging effects are those associated
with exposure throughout and especially late in pregnancy, none of the arguments offered
against Mathieu's proposal are relevant in this particularly narrow set of circumstances.
While Mathieu's proposal seems pertinent in this situation, her proposal would be even
more effective if modified as suggested here. [Pubmed]
Diagnosing Moral Disorder: The Discovery and Evolution of Fetal Alcohol
Syndrome
Armstrong, E..M. Social-Science-and-Medicine; 1998, 47, 12, Dec, 2025-2042.
Abstract
Investigates the process by which a cluster of birth defects associated with exposure to
alcohol in utero came to be a distinct medical diagnosis, focusing on the first 10 years of
the medical literature on fetal alcohol syndrome (FAS) following its "discovery" in 1973
by a group of US dysmorphologists who published the first case reports & coined the
term. The nature of the diagnosis & its salient symptoms were determined collectively
over time by the medical profession as a whole. The natural history of the diagnosis in the
US is traced through five stages: introduction, confirmation & corroboration, dissent,
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
53
expansion, & diffusion. FAS serves as an example of the social construction of clinical
diagnosis; moral entrepreneurship plays a key role, & the medical literature is infused
with moral rhetoric, including passages from classical mythology, philosophy, & the
Bible. FAS is a moral, as well as a medical diagnosis, reflecting the broader cultural
concerns of the era in which it was discovered, including a greater awareness of
environmental threats to health, the development of fetal medicine, an emphasis on "the
perfect child," & a growing paradigm of maternal-fetal conflict. [Sociological Abstracts
1986-2002/12]
Prenatal alcohol exposure: advancing knowledge through international
collaborations.
Riley EP, Guerri C, Calhoun F, Charness ME, Foroud TM, Li TK, Mattson SN, May PA,
Warren KR. Alcohol Clin Exp Res. 2003 Jan;27(1):118-35.
Abstract
Fetal alcohol syndrome (FAS) is a major public health issue that is evident on an
international scale. The current article summarizes a meeting that was held in Valencia,
Spain, in September 2001, that reviewed ongoing international collaborations and the
prospects for new collaborative research. The attendees represented nine different
countries and many different specialties. Following overviews of existing international
collaborations in South Africa, Russia, and Chile, a number of topics for future work were
discussed. Issues related to the diagnosis of FAS, its prevalence and how measures might
be enhanced and standardized were presented, as obtaining consistency across populations
is of prime importance. Another session discussed the current state of basic research and
how collaborations in this area might be initiated. The neurobehavioral profile of FAS and
how work in this area could be advanced and interpreted in light of findings with different
populations generated considerable discussion. There was a review of brain imaging data
in FAS and how this might be utilized in assisting the diagnosis of FAS and alcoholrelated neurodevelopmental disorder (ARND). A presentation on the utilization of
international collaborations in defining the role of genetics in the etiology of FAS was
included. Finally, issues related to the prevention of FAS and how these issues might be
modified based upon different populations were presented. International collaborations
provide a wealth of resources for the study of FAS, and it was hoped that this meeting
might better enhance the work ongoing in this area, and provide opportunities for future
work. [Pubmed]
Prevention of Alcohol Abuse-Related Birth Effects-I. Public Education Efforts
Abel, E.L. Alcohol and Alcoholism, 1998, 33, 4, July-Aug, 411-416.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
54
Abstract
After considering the relevant literature, it is contended that universal public education
efforts will only be effective in reducing fetal alcohol abuse syndrome & alcohol-abuserelated birth defects if they focus on the cause of these disorders, which is alcohol abuse
rather than the currently open-ended message that any amount of alcohol consumption
during pregnancy constitutes a danger to an unborn child. This argument lays the
groundwork for an alternative & more pragmatic prevention strategy set forth in Part II
(1998). [Sociological Abstracts 1986-2002/12]
Prevention of Alcohol Abuse-Related Birth Effects-II. Targeting and Pricing
Abel, E.L. Alcohol and Alcoholism, 1998, 33, 4, July-Aug, 417-420.
Abstract
It is argued that current public health measures to reduce the occurrence of fetal alcohol
abuse syndrome & alcohol-abuse-related birth effects have been ineffective because they
target alcohol consumption, rather than alcohol abuse. It is contended that the most
effective public health strategy entails a combination of more specific public health
messages that target alcohol abuse, coupled with higher taxes on alcohol beverages.
Although alcohol consumption by alcohol abusers has been thought to be inelastic to
price changes, recent studies have found that both heavy consumption & binge drinking
are sensitive to alcohol price changes, & price elasticities are relatively high for heavy
drinkers aware of the consequences of their drinking. Although price increases may have
a disproportionate impact on lower socioeconomic groups, it is concluded that they are
justifiable from both utilitarian & categorical imperative perspectives. [Sociological
Abstracts 1986-2002/12]
Treatment Programming for Alcohol and Drug-Dependent Pregnant Women
Finkelstein, N. International Journal of the Addictions; 1993, 28, 13, Nov, 1275-1308.
Abstract
In light of national concern regarding the problem of alcohol & drug use during
pregnancy, many agencies are seeking guidance in establishing services for pregnant
women. A review of relevant research suggests that programs providing comprehensive,
coordinated, & holistic treatment are better able to draw pregnant women into care & treat
them more effectively. An overview of written guidelines & protocols for treating
pregnant chemically dependent women is presented, including an elaboration of guiding
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
55
principles for care. Unresolved policy issues are identified, & recommendations made for
future research directions. [Sociological Abstracts 1986-2002/12]
Substance Abuse by Pregnant Women: A Survey of Iowa's Treatment Providers.
Butler, M.A.; Saunders, J.A.; Saunders, E.J. Alcoholism Treatment Quarterly, 1993, 10,
1-2, 157-169.
Abstract
Presents findings from a statewide survey of treatment providers (N = 50) in IA
questioned about the treatment programs for pregnant substance abusers. Providers were
asked about the incidence of pregnant women seeking treatment, drugs of preference of
pregnant women, & services offered these clients. A call is made for treatment approaches
that recognize the special needs of pregnant women. [Sociological Abstracts 19862002/12]
Treatment issues for alcohol- and drug-dependent pregnant and parenting women.
Finkelstein, N. Health & Social Work. Vol. 19(1) Feb 1994, 7-15.
Abstract
Research suggests that programs that provide coordinated, comprehensive, and familycentered care are better at attracting pregnant and parenting substance-abusing women
into treatment and provide more effective treatment. The author examines the history of
substance abuse treatment for women; identifies barriers to treatment access; and explores
the socioeconomic, clinical, and systemic issues in the treatment of alcohol- and drugdependent women. Special attention is given to the effects of substance abuse on women's
relationships as daughters, partners, and parents and to its role in violence against women.
[PsycINFO]
A comparison of pregnant women presenting for alcohol and other drug treatment
by CPS status.
Hohman M.M., Shillington A.M., Baxter H.G. Child Abuse Negl. 2003 Mar;27(3):30317.
Abstract
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
56
OBJECTIVE: The purpose of this study was to describe the demographic, substance use,
and treatment variables of alcohol and other drug (AOD) treatment seeking pregnant
women. This study also compared women on these variables based on Child Protective
Service (CPS) status. METHOD: Secondary data of all pregnant women with at least one
child entering all publicly funded AOD treatment programs (N=678), in a southwest
county, over a 3-year period were analyzed to examine the differences between pregnant
women also involved with CPS and those not involved with CPS. RESULTS: Pregnant
women reporting CPS involvement were similar to non-CPS women on demographic
variables but differed on drug use and treatment variables. CPS women were more likely
to report marijuana use as their primary problem drug, be mandated to treatment, attend
day treatment and be released from treatment unsatisfactorily compared to the non-CPS
pregnant women. Those without CPS involvement were more likely to report cocaine or
crack as their primary drug, attend outpatient treatment and be found to have a
satisfactory release from treatment compared to those with CPS involvement. Results
from the multiple logistic regression analysis found that the significant predictors of CPS
involvement were mandated status and unsatisfactory treatment release.
CONCLUSIONS: Differences in treatment outcomes may be based on AOD agencies'
difficulty in working with mandated clients and/or with the multiple demands placed by
CPS on clients as part of their treatment plans. Further research is needed to determine
reasons for CPS clients' high failure rates in AOD treatment. [PubMed]
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
57
3.3
Surveillance / Screening
A multiple source methodology for the surveillance of fetal alcohol syndrome--The
Fetal Alcohol Syndrome Surveillance Network (FASSNet).
Hymbaugh, K.; Miller, L.A.; Druschel, C.M.; Podvin, D.W.; Meaney, F.J.; Boyle, C.A.;
The FASSNet Team. Teratology. 66 Suppl 1:S41-9, 2002.
[Medline]
Implementation of substance use screening in prenatal clinics.
Li, C.; Olsen, Y. Kvigne, V. & Welty, T. South Dakota Journal of Medicine. 52(2):59-64,
1999 Feb.
Abstract
BACKGROUND AND OBJECTIVES: To reduce women's consumption of alcohol and
other drugs during pregnancy, the Department of Epidemiology for the Aberdeen Area
Indian Health Service (AAIHS) promoted a maternal substance use screening program for
prenatal clinics in 1992. This report describes the adherence to the screening protocol at
AAIHS facilities and barriers to such screening. METHODS: Prenatal clinic staff
members at 20 AAIHS health care facilities were surveyed to determine the extent of
prenatal substance use screening and the barriers to its implementation. The medical
records of a random sample of 235 women who sought prenatal care at five hospitals were
reviewed to determine whether prenatal clinic staff adhered to the screening protocol.
RESULTS: Of the 20 health care facilities, 13 (65%) had implemented the screening. The
major barriers to implementing screening were lack of training in prenatal substance use
screening and lack of clinic staff designated to administer the screening protocol. Though
not statistically significant, our data suggest that women not administered the screening
questionnaire were more likely to be multiparous (prevalence ratio = 2.1; 95% confidence
interval = 0.9, 4.5). CONCLUSIONS: To improve screening of pregnant women for
substance use, prenatal clinic staff members should address administrative barriers and
assess adherence of health care providers and patients to the screening protocol. Training
of prenatal clinic personnel is essential to implement optimal maternal substance use
screening in prenatal clinics. [Medline]
Title Fetal alcohol syndrome in Alaska, 1977 through 1992: an administrative
prevalence derived from multiple data sources.
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
58
Egeland, G.M., Perham-Hester, K.A.; Gessner, B.D.; Ingle, D.; Berner, J.E.; Middaugh,
J.P. American Journal of Public Health. 88(5):781-6, 1998 May.
Abstract
OBJECTIVES: The prevalence and characteristics of fetal alcohol syndrome cases and
the usefulness of various data sources in surveillance were examined in Alaska to guide
prevention and future surveillance efforts. METHODS: Sixteen data sources in Alaska
were used to identify children with fetal alcohol syndrome. Medical charts were reviewed
to verify cases, and records were reviewed to provide descriptive data. RESULTS: Fetal
alcohol syndrome rates varied markedly by birth year and race, with the highest
prevalence (4.1 per 1000 live births) found among Alaska Natives born between 1985 and
1988. Screening and referral programs to diagnostic clinics identified 70% of all recorded
cases. The intervention program for children 0 to 3 years of age detected 29% of ageappropriate cases, and Medicaid data identified 11% of all cases; birth certificates
detected only 9% of the age-appropriate cases. CONCLUSIONS: Our findings indicate a
high prevalence of fetal alcohol syndrome in Alaska and illustrate that reliance on any one
data source would lead to underestimates of the extent of fetal alcohol syndrome in a
population. [Medline]
Surveillance for fetal alcohol syndrome using multiple sources -- Atlanta, Georgia,
1981-1989.
Anonymous. MMWR - Morbidity & Mortality Weekly Report. 46(47):1118-20, 1997
Nov 28.
Abstract
Fetal alcohol syndrome (FAS) is caused by heavy alcohol consumption during pregnancy
and is characterized by specific anomalies of the face; prenatal and postnatal growth
deficits; and a variety of central nervous system (CNS) abnormalities, including mental
retardation. Children with either full or partial FAS often incur severe and costly
secondary disabilities. Despite the importance of surveillance for establishing the
magnitude of FAS and in monitoring trends in the occurrence of this disease, populationbased surveillance for FAS has been difficult because the syndrome can be diagnosed
only by clinical observation and often is not recognized until after the child reaches
school age. Although most FAS surveillance has been based on diagnoses among
newborns, most (89%) cases (full FAS and partial FAS) are diagnosed after the age of 6
years. To develop a more accurate estimate of the prevalence of FAS in a defined
population, in 1997 CDC linked data from the Metropolitan Atlanta Congenital Defects
Program (MACDP) and the Metropolitan Atlanta Developmental Disabilities Surveillance
Program (MADDSP) for children born in Atlanta during 1981-1989 (the most recent birth
year for which data were available for 3-10-year-olds). This report presents a multipleFetal Alcohol Spectrum Disorder - International Research and Practice Inventory
59
source method for FAS surveillance that is more complete than previous methods and that
enables comparison of rates between states. [Medline]
Barriers to screening and counseling pregnant women for alcohol use.
Miner, K.J.; Holtan, N.; Braddock, M.E.; Cooper, H. & Kloehn, D. Minnesota Medicine.
79(10):43-7, 1996 Oct.
Abstract
The consequences of fetal alcohol exposure are far-reaching and preventable. Health care
providers are uniquely positioned to promote alcohol-free pregnancy, yet an array of
factors inhibit routine screening, counseling, and referral. This descriptive, qualitative
study explored experiences and perceived barriers related to prenatal screening for alcohol
use. The study included eight focus groups (71 participants) and 41 key informant
interviews with health care professionals representing a mix of disciplines. Nearly 40% of
the providers were physicians who regularly encounter women in their practices. While
most providers ask about alcohol use, few probe in depth or follow up. The findings
should alert program planners and medical educators to strengthen their preventive
medical and public health practices. [Medline]
Surveillance for fetal alcohol syndrome in Colorado.
Miller, L.A.; Shaikh, T.; Stanton, C.; Montgomery, A.; Rickard, R.; Keefer, S.; Hoffman,
R. Public Health Reports. 110(6):690-7, 1995 Nov-Dec.
Abstract
The authors performed surveillance for fetal alcohol syndrome with an existing birth
defects registry. Fetal alcohol syndrome cases were identified from multiple sources using
passive surveillance and from two selected medical sites using enhanced surveillance.
Between May 1992 and March 1994, a total of 173 cases were identified, and the medical
records of the cases were reviewed to determine whether the cases met a surveillance case
definition for fetal alcohol syndrome. Of these cases, 37 (21 percent) met either definite
(28) or probable (9) criteria for fetal alcohol syndrome, 76 met possible criteria (44
percent), and 60 (35 percent) were defined as not fetal alcohol syndrome. Enhanced
surveillance had the highest sensitivity for definite or probable cases, 31 of 37 (84
percent), followed by hospital discharge data, 14 of 37 (38 percent). The authors also
compared birth certificate information for 22 definite or probable cases in children born
between 1989 and 1992 to birth certificate information for all Colorado births for that
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
60
period. The proportion of mothers of children with fetal alcohol syndrome was
statistically significantly greater (as determined by exact binomial 95 percent confidence
limits) than the proportion of all mothers for the following characteristics: black race
(0.23 versus 0.05), unmarried (0.55 versus 0.22), not employed during pregnancy (0.86
versus 0.43), and started prenatal care in the third trimester (0.18 versus 0.04).
Surveillance for fetal alcohol syndrome can be accomplished with an existing registry
system in combination with additional case finding and verification activities. Through
followup investigation of reported cases, data can be gathered on the mothers of children
with fetal alcohol syndrome. These data could be used to target fetal alcohol syndrome
prevention programs. [Medline]
Current screening instruments related to alcohol consumption in pregnancy and a
proposed alternative method.
Savage C, Wray J, Ritchey PN, Sommers M, Dyehouse J, Fulmer M.
Neonatal Nurs. 2003 Jul-Aug;32(4):437-46.
J Obstet Gynecol
Abstract
Because alcohol is a known teratogenic substance that negatively affects the fetus,
screening for alcohol use is included in maternal child texts for nurses. They present no
standard screening approach, however. In the general literature, a multitude of screening
instruments exist for the purpose of detecting maternal alcohol dependence but few allow
the nurse to detect fetal alcohol exposure in the absence of maternal alcohol dependence.
After a comparative analysis of existing screening instruments, we concluded that the
Timeline Followback method has the most utility as a screening instrument to detect fetal
exposure to alcohol. The purpose of this article is to present a critical review of current
screening instruments related to alcohol consumption in pregnant women and to propose
the use of the Timeline Followback method as the preferred approach. [Pubmed]
Application of the fetal alcohol syndrome facial photographic screening tool in a
foster care population.
Astley SJ, Stachowiak J, Clarren SK, Clausen C. J Pediatr. 2002 Nov;141(5):712-7.
Abstract
We determined the prevalence of fetal alcohol syndrome (FAS) in a foster care population
and evaluated the performance of the FAS Facial Photographic Screening Tool. All
children enrolled in a Washington State Foster Care Passport Program were screened for
three conditions: (1) the FAS facial phenotype from a photograph, (2) evidence of brain
damage with prenatal alcohol exposure from their Health and Education passport, and/or
(3) other syndromes identifiable from a facial photograph. Screen-positives received
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
61
diagnostic evaluations at a FAS Diagnostic and Prevention Network clinic. The
prevalence of FAS in this foster care population was 10 to 15/1000, or 10 to 15 times
greater than in the general population. The screening tool performed with 100%
sensitivity, 99.8% specificity, 85.7% predictive value positive, and 100% predictive value
negative. We conclude that the foster care population is a high-risk population for FAS.
The screening tool performed with very high accuracy and could be used to track FAS
prevalence over time in foster care to accurately assess the effectiveness of primary
prevention efforts. [Pubmed]
Biochemical markers of alcohol use in pregnant women.
Cook JD. Clin Biochem. 2003 Feb;36(1):9-19.
Abstract
OBJECTIVES: To describe the serious health consequences of alcohol (ethanol) use,
especially as they relate to pregnancy and the development of fetal alcohol syndrome
(FAS) and fetal alcohol effects (FAE). The classic markers of alcohol exposure, including
blood/breath alcohol, gamma-glutamyl transferase (gammaGT), mean corpuscular volume
(MCV), hemoglobin-associated acetaldehyde (HAA) and carbohydrate deficient
transferrin (CDT), are valuable and their methods of analysis are reviewed.
CONCLUSIONS: Since both FAS and FAE represent two of the leading preventable
causes of mental retardation and birth defects, identification of alcohol use early in
pregnancy is important to avoid adverse fetal outcomes. Unfortunately, the diagnosis of
FAS and FAE is usually made after birth, when alcohol damage has become irreversible
and permanent. The clinical laboratory can help prevent this damage and make a valuable
contribution in assessing prenatal alcohol use. The clinical utility of blood/breath alcohol,
gammaGT, MCV, HAA and CDT in alcohol use identification, especially in pregnancy, is
substantial. Although none of the markers singularly has adequate sensitivity and
specificity for screening, their diagnostic utility increases when measured as a panel. This
is especially true in detecting alcohol use in pregnancy where the presence of several
positive markers was correlated with the presence of alcohol-related fetal effects.
[Pubmed]
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3.4
Medical (Pertaining to interventions)
A survey of medication responses in children and adolescents with fetal alcohol
syndrome.
Coe, J.; Sidders, J.; Riley, K.; Waltermire, J.& Hagerman, R.. Mental Health Aspects of
Developmental Disabilities. Vol 4(4) Oct-Dec 2001, 148-155.
Abstract
This paper describes the psychopharmacological interventions in patients with Fetal
Alcohol Syndrome (FAS), Partial Fetal Alcohol Syndrome (PFAS) or Alcohol-related
Neurodevelopmental Disorder (ARND). The pharmacological histories of patients who
had a confirmed inutero exposure to alcohol and were between the ages of 3.5 and 17 yrs
were collected from a chart review of children seen in a child development unit over the
previous seven years. Medications were grouped under 6 categories: stimulants, alpha2presynaptic agonists, selective serotonin reuptake inhibitors, mood stabilizers,
antipsychotics, and tricyclics. Twenty-two patients had 66 medications trials: 63%
responded well to stimulants. 82% responded well to selective serotonin reuptake
inhibitors, 88% responded well to a mood stabilizer and 83% responded well to an
antipsychotic. Aggressive treatment, including medication, should beneficially influence
the broad range of secondary disabilities seen in these patients. [PsycINFO]
Clinical implications of a link between fetal alcohol spectrum disorder and attentiondeficit hyperactivity disorder.
O’Malley, K.D. & Nanson, J. Canadian Journal of Psychiatry - Revue Canadienne de
Psychiatrie. 47(4):349-54, 2002 May.
Abstract
OBJECTIVE: To provide an overview of the animal and human research literature on the
link between fetal alcohol spectrum disorder (FASD) and attention-deficit hyperactivity
disorder (ADHD). METHOD: We conducted a comprehensive literature review that
addressed the history of, and current research on, fetal alcohol syndrome (FAS) and
FASD, as well as that on ADHD in children. RESULTS: In animal and human research,
there is emerging clinical, neuropsychological, and neurochemical evidence of a link
between FASD and ADHD. CONCLUSIONS: The evidence of the link between these 2
conditions has implications for clinical management. The clinical quality of ADHD in
children with FASD often differs from that of children without FASD. For children with
FASD, ADHD is more likely to be the earlier-onset, inattention subtype, with comorbid
developmental, psychiatric, and medical conditions. Children with FASD are commonly
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not mentally retarded but present complex learning disabilities, especially a mixed
receptive-expressive language disorder with deficits in social cognition and
communication (reminiscent of sensory aphasia and apraxia), working memory problems,
and frequently, a mathematics disorder. Comorbid psychiatric conditions include anxiety,
mood, conduct, or explosive disorders. As well, cardiac, renal, or skeletal problems are
more likely to be present. Because these children have a disturbance in brain
neurochemistry, or even brain structure (that is, in the corpus callosum), their response to
standard psychostimulant medication can be quite unpredictable. [Medline]
The role of acetaldehyde in pregnancy outcome after prenatal alcohol exposure.
Hard, M.L., Einarson, T.R., Koren, G. Therapeutic Drug Monitoring. 23(4):427-34, 2001
Aug.
Abstract It is not known why some heavy-drinking women give birth to children with
alcohol-related birth defects (ARBD) whereas others do not. The objective of this study
was to determine whether the frequency of elevated maternal blood acetaldehyde levels
among alcoholics is in the range of ARBD among alcoholic women. MEDLINE was
searched from 1980 to 2000 using the key words acetaldehyde, pharmacokinetics, and
alcoholism for controlled trials reporting blood or breath acetaldehyde levels in alcoholics
and nonalcoholics. Separately, using the key words fetal alcohol syndrome, epidemiology,
prevalence, incidence, and frequency, articles were identified reporting ARBD incidences
among the offspring of heavy drinkers. Of 23 articles reporting acetaldehyde levels in
alcoholics, four met the inclusion criteria. Forty-three studies reported on the rate of
ARBD in heavy drinkers, and 14 were accepted. Thirty-four percent of heavy drinkers
had a child with ARBD, and 43% of chronic alcoholics had high acetaldehyde levels. The
similar frequencies of high acetaldehyde levels among alcoholics and the rates of ARBD
among alcoholic women provide epidemiologic support to the hypothesis that
acetaldehyde may play a major role in the cause of ARBD. [Embase]
Antioxidants and fetal protection against ethanol teratogenicity. I. Review of the
experimental data and implications to humans.
Cohen-Kerem R, Koren G.
Neurotoxicol Teratol. 2003 Jan-Feb;25(1):1-9.
Abstract
Ethanol is the most common human teratogen, and heavy drinking during pregnancy can
result in serious adverse outcomes to the fetus. The cellular mechanisms by which ethanol
induces damage in utero are not well understood, while induction of oxidative stress is
believed to be one putative mechanism. Our objective is to review the data of antioxidant
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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effects in experimental models of fetal alcohol syndrome. Prior to the description of the
available experimental data, we will briefly review the mechanisms leading to ethanolinduced oxidative stress. Ethanol-induced oxidative damage to the fetus could be
attenuated by a variety of antioxidants as was documented in whole animal and tissue
culture studies. Experiments, retrieved from the literature search, are described and
criticized. Although experimental data are still limited, the application of a treatment
strategy that includes antioxidants is justified since antioxidant treatment in human
pregnancy for pre-eclampsia was demonstrated to be safe and effective. The available
experimental evidence and the safety of vitamins C and E in pregnancy suggest that
experimental use of antioxidants in alcohol-consuming mothers should be seriously
considered to reduce fetal alcohol damage. [Pubmed]
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3.5 Alcoholism and Pregnancy: Social Implications related to
Prevention
Therapeutical characteristics of alcohol dependent women - A case study.
Beutel, M.
Sucht. Vol 45(5) (pp 346-350), 1999.
Abstract
The characteristics of the therapy of alcohol dependent women during pregnancy are
presented in a case study. Only relatively few women join an inpatient rehabilitation
programme for substance abuse during pregnancy. Possible causes are discussed. For
many female addicts pregnancy is experienced as a psychological relief. This enables
them to live without alcohol or to reduce drinking levels during pregnancy. Unfortunately
this advantage becomes effective only when the woman knows about her pregnancy and
that is often rather late for women with substance abuse. Pregnant women need special
support during rehabilitation. They need intensive medical and gynaecological care.
Psychotherapy during pregnancy is possible and effective. Especially women with serious
personality disorders need special support caring for their newborn child. [Embase]
'A tempest in a cocktail glass': Mothers, alcohol, and television, 1977- 1996.
Golden, J. Journal of Health Politics, Policy & Law. Vol 25(3) (pp 473-498), 2000.
Abstract
This article examines the portrayal of pregnancy and alcohol in thirty- six national
network evening news broadcasts (ABC, CBS, NBC). Early coverage focused on white,
middle-class women, as scientific-authorities and government officials warned against
drinking during pregnancy. After 1987, however, women who drank during pregnancy
were depicted as members of minority groups and as a danger to society. The thematic
transition began before warning labels appeared on alcoholic beverages and gained
strength from official government efforts to prevent fetal alcohol syndrome. The greatest
impetus for the revised discourse, however, was the eruption of a 'moral panic' over crack
cocaine use. By linking fetal harm to substance abuse, the panic suggested it was in the
public's interest to control the behavior of pregnant women. [Embase]
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Pregnant, alcohol-abusing women.
Hankin, J.; McCaul, M.E.; Heussner, J. Alcoholism: Clinical & Experimental Research.
Vol 24(8) (pp 1276-1286), 2000.
Abstract
Background: This paper reviews the literature on the identification and treatment of
pregnant, alcohol-abusing women, with special emphasis on poor women who have
access to treatment through Medicaid. Methods: The paper discusses the gaps and
controversies in the literature and suggests five priorities for future research. Results:
Studies that attempt to identify pregnant women who drink conclude that heavier drinkers
enter prenatal care later than other women, that many health care providers fail to
recognize alcohol abuse by pregnant women, and that research on screening techniques is
still in the early stages. Treatment research suggests that comprehensive, holistic
treatment approaches, as well as brief interventions and case management, have been
successful in reducing prenatal alcohol use. Debate continues over whether treatment
should be voluntary. Conclusions: The five areas identified as priorities for future
research include (1) developing reliable and valid measures to identify alcohol abuse in
pregnant women, (2) creating training programs for providers, (3) generating programs to
reduce barriers to care, (4) determining which treatment programs are most successful,
and (5) estimating the costs and benefits of various treatment approaches. [Embase]
Thoughts on poverty and inequality.
Widmer, M. Journal of Poverty, 1(2): 95-100, 1997.
Abstract
What is it like to be a single mother? It is like performing a high wire act with no net
underneath to catch you when you fall. According to this single mother, the fall is
imminent. Women arrive at single motherhood for a variety of reasons--generational
poverty, unwed teen pregnancy, divorce, spousal abuse, alcoholism or drug addiction--the
list is a long one. Regardless of how they arrive, when they get there it becomes a
balancing act unlike any other. This essay tells of a single mother's struggles of caring for
her sons with a near poverty line income. [Social Work Abstracts 1977-2003/06]
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Ethnic Differences in the Substance Use Patterns of Low-Income Pregnant Women
Zambrana, R.E.; Hernandez, M.; Dunkel-Schetter, C. Scrimshaw, S.C.M. Family and
Community Health 1991, 13, 4, Jan, 1-11.
Abstract
Sociodemographic & psychological factors that distinguish pregnant women who
continue to use substances from women who abstain from all substances during their
pregnancy are examined, based on structured interviews conducted with a sample of 107
primiparous Afro-American, recent Mexican immigrant, & Mexican-American women
attending Los Angeles County (Calif) prenatal care clinics. Information was obtained on:
alcohol consumption, smoking behavior, use of hard & prescription drugs, & use of the
over-the-counter (OTC) medications. Also explored were psychosocial factors &
differences by ethnicity on use of substances before pregnancy: black women were more
likely than recent Mexican immigrant or Mexican-American women to use all substances
before pregnancy; further, Mexican-American women were less likely to use OTC
medications & prescription drugs before pregnancy than recent Mexican immigrant
women. However, no significant ethnic differences in substance use patterns during
pregnancy were identified. In general, women who continued to use substances during
pregnancy were significantly older & had not planned the pregnancy. [Sociological
Abstracts 1986-2002/12]
Gender Roles and Alcohol Consumption across the Transition to Parenthood.
Richman, J.A.; Zeisz, J.M.; Rospenda, K.M.; Kelley, M.A. asp Association-Paper
International Sociological Association (ISA). 1994.
Abstract
The transition to parenthood now occurs within the context of major gender-role changes
involving the greatly increased labor force participation of women with young children. A
substantial literature has depicted stress-related costs of both traditional & nontraditional
gender-role choices of husbands & wives with young children, one being heavy drinking
for stress-reduction purposes. Self-report questionnaire data were obtained from 51
married couples expecting their first child during the second trimester of pregnancy, &
again 6 months following childbirth. Results are used to examine both wives' & husbands'
changes in problem-related drinking, & to contrast problem- with nonproblem drinkers
following parenthood with regard to role overload (competing demands from work &
family roles), role deprivation (loss of the work role following parenthood), & role
deterioration (decreased support from social relationships). Empirical results fail to
support either the role overload or role deprivation thesis for either men or women, but are
congruent with a role deterioration model.[Embase]
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Issues of Violence and Abuse among Low-Income, Substance-Involved Pregnant
Women
Zahnd, E.G.; Klein, D. asp Association-Paper, Society for the Study of Social Problems
(SSSP). 1994.
Abstract
To determine the extent of violence permeating the lives of low-income, pregnant women
who are problem alcohol or other drug (AOD) users, variables related to violence & abuse
were examined among 401 such women & adolescents in 2 CA counties, with a
comparison group of 746. About half the respondents (Rs) reported childhood problems,
most frequently, a family member's AOD use closely followed by a family member's
abuse or discipline, & fighting or violence. This response was more frequent among
heavier AOD users. About half the Rs want their children to be disciplined differently
than they were, wanting more talk, patience, & understanding/less punishment, strictness,
& violence, which many connected to drug use or dealing. Discussing their own AODrelated problems, Rs frequently mentioned getting into a serious argument or fight. These
findings show that violence strongly affects such women's lives, both as part of their
earlier & childhood experiences, & in the context of their everyday neighborhood
experiences. [Embase]
Individual Differences in Perceived Riskiness of Drinking in Pregnancy: Antecedents
and Consequences
Testa, M.; Reifman, A.
Abstract
Empirically explores (1) whether differences in perceived riskiness of alcohol
consumption during pregnancy were related to self-reported alcohol consumption among
a community sample of 159 pregnant women in Buffalo, NY, & (2) the impact of prior
experiences on risk perceptions, focusing on previous pregnancy experiences & alcoholrelated problems. Structural equation modeling revealed that perceived riskiness of
drinking during pregnancy was lower among women who had previously given birth to a
healthy child & among women with greater numbers of previous alcohol problems. Prior
adverse pregnancy experience did not predict perceived risk. Perceived risk negatively
predicted actual alcohol consumption during pregnancy, suggesting that previous healthy
pregnancy experiences & alcohol problems increase drinking in pregnancy indirectly
through perceived risk. A direct positive effect from previous alcohol problems to
drinking in pregnancy also was observed. Findings suggest that risk perceptions play a
role in drinking behavior among pregnant women & help to illuminate the relationship
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between parity & alcohol consumption. Interventions designed to reduce drinking among
pregnant women, which have generally relied on providing information, may be improved
by considering the impact of previous experiences & addressing erroneous beliefs.
[Embase]
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4.
Programs – Prevention and Intervention
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4.1 Partnership to Prevent Fetal Alcohol Syndrome
(http://prevention.samhsa.gov/faspartners/default.asp)
The Partnership to Prevent Fetal Alcohol Spectrum Disorders was established by the
Substance Abuse and Mental Health Services Administration's (SAMHSA), Center for
Substance Abuse Prevention (CSAP), in July 2001. The goal of the Partnership is to unite
communities nationwide in a public health response to prevent Fetal Alcohol Spectrum
Disorders (FASD). The Partnership aims to empower mothers to deliver healthy babies by
encouraging women who are planning a pregnancy or already pregnant to avoid alcohol.
It also strives to foster social support among their significant others.
CSAP recognizes that prevention works best at the community level. With a network of
local partners who understand the needs of specific areas, CSAP will initially implement
the program in four community sites and later share these models with the national public
health community.
Community Sites
CSAP will initially implement the program in four community sites and later share these
models with the national public health community. The lead organization in each
community site will work with CSAP to coordinate partnership development at a local
level.
Doña Ana County, New Mexico
Lead Organization
Ben Archer Health Center
255 Highway 187, P.O. Box 370
Hatch, NM 87937
Tel: 505-267-3088, Fax: 505-267-4606
Web: http://www.zianet.com/bahcmed/HATCHSTAFF.html
Contact: Mary Alice Garay, Executive Director
Contact: Trudy G. Gallegos, BCH
The Ben Archer Health Center (BAHC) was established in 1972. Its mission is to
significantly improve the health status of its population through the prevention of illness,
the promotion of health education, and the provision of quality primary care, access to the
underserved and a strong commitment to chronic disease and pain management. BAHC is
fully accredited by the Joint Commission on Accreditation of Health Care and is the only
primary care provider for Northern Doña Ana County.
East Baton Rouge Parish, Louisiana
Lead Organization
Capital Area Human Services District (CAHSD)
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4615 Government Street, Baton Rouge, LA 70806
Tel: 225-922-2700, Fax: 225-925-1987
Web: http://www.cahsd.org
Contact: Jan Kasofsky, Ph.D., Executive Director
Contact: Debby Cartwright, BCSW, Director of Prevention and Outreach
CAHSD provides the publicly funded mental health, developmental disabilities, and
addictions services in a 7-parish region. Some of the services pertinent to the FASD
Partnership are: child/adolescent prevention and treatment, adult treatment including
detox, education groups, outpatient treatment, residential treatment for women with
dependent children, inpatient treatment, addictions screening for pregnant women, and
treatment for sexual abuse, dual diagnosis, and gambling addiction.
Erie County, New York
Lead Organization
Erie County Council for the Prevention of Alcohol and Substance Abuse (ECCPASA)
1625 Hertel Avenue, Buffalo, NY 14216
Tel: 716-831-2298, Fax: 716-831-9580
Web: http://www.eccpasa.info
Contact: Jan Duffey, Executive Director
Contact: Helen Weinstein
ECCPASA is an affiliate member of the National Council of Alcoholism and Drug
Dependence (NCADD) and is committed to building safe, healthy and resilient
communities free from alcohol and drug use. ECCPASA is a proven provider of quality
prevention and intervention services utilizing research-based strategies and programs.
Sumter County, South Carolina
Lead Organization
The Prevention Center, a division of the Sumter Commission on Alcohol and Drug Abuse
(SCADA)
115 North Harvin Street, 4th Floor
P.O. Box 39, Sumter, SC 29150
Tel: 803-778-2835, Fax: 803-778-4017
Web: http://www.preventioncenter.netfirms.com
Email: thepreventioncenter@yahoo.com
Contact: Glenn Peagler, M.Ed., CSPP, Director of Prevention
Contact: Patricia A. Colclough, MS, CPP, Women's Issues Coordinator
Site Visit: May 30-31, 2002
The Prevention Center, a division of the Sumter Commission on Alcohol and Drug Abuse
in South Carolina, provides a full range of prevention services, including presentations,
trainings/workshops, and Outdoor Adventure (ropes).
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4.2
Fetal Alcohol Education Program (FAEP)
Boston University School of Medicine
1975 Main Street
Concord, MA 01742
Phone: 978-369-7713
Fax: 978-287-4993
The Fetal Alcohol Education Program is dedicated to research and education for the
prevention, identification and treatment of alcohol-related neurodevelopmental disorders.
They have a number of educational materials available for sale, including two teaching
packages, one for professional education entitled Alcohol, Drugs, and the Fetus: A
Teaching Package (84 slides, a 65-page manual) and Here's to Healthy Babies for
education of parents and community groups (call or write for details). They have also
developed a handbook for parents, FAS: Parent and Child ($7.50 per single copy; bulk
rates available), and make a reprint list available. Call or write for further information.
When time permits, FAEP will do brief consultation and referral. They also maintain a list
of families interested in participating in research studies.
4.3
The National Organization on Fetal Alcohol Syndrome [NOFAS]
418 "C" Street, NE
Washington, DC 20002
1-800-666-6327
202-785-4585
Fax: 202-466-6456
Web: http://www.nofas.org/
NOFAS is committed to raising public awareness about Fetal Alcohol Syndrome, the
leading cause of mental retardation, and seeks to implement innovative ideas in
prevention, education, intervention and advocacy. NOFAS takes a multicultural approach
to prevention and healing among individuals, families and communities, because FAS
touches people in all walks of life.
NOFAS publishes a quarterly newsletter, Notes on NOFAS, which is free, and has
brochures available. They also have a state-by-state resource directory developed in
conjunction with the Centers of Disease Control and Prevention, that can be purchased or
can be requested from their own state. This comprehensive listing of services contains
valuable information for physicians, health care workers, FAS program counselors,
teachers, parents and others seeking quick and accurate information NOFAS sponsors
community seminars, and a national conference; call for further details.
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4.4
International Birth Defects Information Systems (IBIS)
http://www.ibis-birthdefects.org/start/index.htm
Provides:
 Access to a not-for-profit information consortium.
 A Web site dedicated to Birth Defects, Genetics and Teratology.
 Information for patients, public, professionals and investigators.
 Sources of information selected by specialists.
 A conduit for experts to strengthen the contents of IBIS.
 A global reach toward multi-lingual and culturally diverse sources.
 A medium for authors/owners to disseminate their works
 A medium for contributions to prevent and ameliorate birth defects
4.5
National Council on Alcohol and Drug Dependence, Inc.
Juneau Affiliate
211 Fourth St. Suite 102
Juneau, AK 99801
Ph: (907) 463-3755 | Fax: 463-2539
Fetal Alcohol Syndrome (FAS) prevention: Adolescents who are referred to the
Juvenile ASAP department take part in a FAS prevention program. These youth have
been charged by the Alaska court system with some type of high-risk behavior such as
minor consumption of alcohol or underage smoking. Upon their initial appointment with
ASAP, the youth takes a 10 question pre-test about fetal alcohol exposure and its effects.
He and the ASAP staff person go over the answers so the teen has correct information.
The teen and his parent then watch a 10-minute video about FAS and take a post-test. The
goal of the program is to educate minors who are engaging in high-risk behaviors about
Fetal Alcohol Syndrome and to ultimately lower its incidence.
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4.6
Statewide Fetal Alcohol Syndrome Prevention Program
1650 Yale Blvd SE
Albuquerque, NM 87106
Principal Investigator
Jerome Romero
505-925-2302
Fax – 505-925-2313
Aggie@unm.edu
The Fetal Alcohol Syndrome Prevention Project was established in 1996. The New
Mexico Strategic Plan for Disability Prevention recognized the need for a Statewide Lead
Agency to coordinate the FAS/ARBD prevention efforts in New Mexico. This
coordination includes; public education campaigns, community projects, social change
and advocacy efforts at multiple levels of intervention. A statewide FAS Advisory
Committee provides guidance to the project coordinator. The Committee is comprised of
individuals who have an interest in FAS prevention and women having healthy
pregnancies. The project staff have expertise in FAS/ARBD prevention and intervention,
experience in primary and secondary prevention programs, media marketing, program
development, continuing education for health and human services providers, educators
and the community. The program is funded by the Disability and Health Program, New
Mexico Department of Health.
4.7
Colorado Area Health Education Centre (AHEC) Program
http://www.uchsc.edu/ahec/fas/index.htm
The Colorado AHEC system is a community/academic partnership involving the
University of Colorado Health Sciences Center (UCHSC) with its five schools (Medicine,
Dentistry, Nursing, Pharmacy, Graduate) and five AHEC’s, each serving a designated
region of the state. Four of the AHEC's are rural, community-based independent
organizations. The fifth AHEC is predominantly urban, with a community-based advisory
board. This long-standing partnership has generated numerous linkages between academic
resources and local health care facilities and providers, assuring that a variety of
educational and support services are available throughout Colorado.
Fetal Alcohol Syndrome Prevention Program
Strategies and Goals
Information and Dissemination - to increase overall awareness of the nature and scope of
the FAS/ATOD problem and effective strategies to prevent the problem.
Education - to increase the knowledge, skills of individuals who work in high-risk
populations in the area of effective FAS/ATOD prevention.
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Community Based Process - to increase FAS/ATOD knowledge and problem
identification and referral skills of health and human service providers who work with
high risk individuals and to develop/strengthen the capacity of local community
groups/agencies to address FAS/ATOD issues in their area and to increase the knowledge,
skills of individuals who work in high risk populations in the area of effective
FAS/ATOD prevention, and to increase overall knowledge of effective FAS/ATOD
policies and help change current attitudes in the communities.
4.8
National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol
Effect
http://www.cdc.gov/ncbddd/fas/taskforce.htm
The National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect is a
congressionally mandated task force charged with:
 Advising all governmental agencies, academic bodies, and community groups that
conduct or support fetal alcohol syndrome and fetal alcohol effect research, programs, and
surveillance, and
 Meeting the general needs of populations actually or potentially impacted by fetal
alcohol syndrome and fetal alcohol effect.
Purpose
The Secretary is mandated under Section 399H of the Public Health Service Act, as
amended (42 U.S.C. Section 280f, as added by Public Law 105-392), to establish a
National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect: (1) to foster
coordination among all governmental agencies, academic bodies, and community groups
that conduct or support fetal alcohol syndrome and fetal alcohol effect research,
programs, and surveillance; and (2) to otherwise meet the general needs of populations
actually or potentially impacted by fetal alcohol syndrome and fetal alcohol effect.
Function
The National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect shall (a)
advise Federal, State, and local programs and research concerning fetal alcohol syndrome
(FAS) and fetal alcohol effect (FAE), including programs and research concerning
education and public awareness for relevant service providers, school-age children,
women at risk, and the general public, medical diagnosis, interventions for women at risk
of giving birth to children with FAS and FAE, and beneficial services for individuals with
FAS and FAE and their families; (b) coordinate its efforts with the Interagency
Coordinating Committee on Fetal Alcohol Syndrome of the Department of Health and
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Human Services; and (c) report, on a biennial basis, to the Secretary and relevant
committees of Congress on the current and planned activities of the participating
agencies.
4.9
Brief Alcohol Intervention: The Healthy Moms Project
Faculty of Medicine, University of Wisconsin
Funding: National Institute on Alcohol Abuse and Alcoholism
Michael Fleming, MD – Principal Investigator
http://www.fammed.wisc.edu/research/alcoholintervention.html
Abstract:
Background: The prevention of Fetal Alcohol Syndrome and fetal alcohol exposure is an
important national priority. A 1995 national survey conducted by the Centers for Disease
Control estimates that as many as 140,000 children born in the US are exposed to
potentially harmful effects of alcohol during fetal development (3.5% of 4 million live
births). One prevention strategy is to establish screening and intervention procedures that
can be administered in primary care settings to womn who are drinking above
recommended limits.
Goal: The study is designed to test the efficiency of a primary care-vased brief
intervention for women who resume heavy drinking during the post-partum period who
used alcohol during their last pregnancy. The ultimate goal is to reduce alcohol use,
alcohol related harm, and fetal alcohol exposuer in subsequent pregnancies.
Method: The trial will utilize methods successfully employed by the PI in three brief
intervention trials (Project TrEAT, Project GOAL, and an ongoing trial in Poland).
Women will be asked to complete an embedded alcohol questionnaire (Health Screening
Survey) whil seeing their obstetrician for a routine post partum visit. Women who screen
positive for heavy drinking (>7 drinks/week in the past month, 4 or more drinks/occasion,
or two or more positive responses on the T-ACE) will be invited by a researcher to
participate in a health interview. Women who meet eligibility criteria for the trial will be
randomized to a usual care control group or a physician/nurse brief intervention group.
The intervention will consist of two 10-15 minute physician/nurse visits and two 2-minute
follow-up phone calls. All subjects will be contacted at 6, 12, 18 and 24 months by
telephone to assess outcomes of interest which include alcohol use, quality of life, mental
health problems, accidents, and heath care utilization. Power analysis suggests that 250
women in each arm of the trial will have sufficient power to detect a difference for the
main outcome variables of interest.
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Significance: The proposed study would significantly increase our understanding of how
to reduce alcohol use in post partum patients and how to limit FAS and fetal alcohol
exposure.
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5.
Funding Opportunities – FASD/FAE Prevention
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5.1
Maternal Alcohol Use & Prenatal Alcohol Exposure
Prevention/Intervention Initiative
Minnesota Department of Health
Division of Family Health-Fetal Alcohol Syndrome
Request for Proposals (RFP) for Maternal Alcohol Use and Prenatal Alcohol
Exposure Prevention/Intervention Initiative
To: All Interested Applicants
Date Due: September 12, 2003
http://www.health.state.mn.us/divs/fh/FAS/FAS-rfp2003.html
NOTICE IS HEREBY GIVEN that the Minnesota Department of Health (MDH), Family
Health Division is requesting proposals from community organizations and coalitions to
collaborate on strategies and activities to prevent maternal alcohol use and prenatal
alcohol exposure that could result in fetal alcohol syndrome and alcohol related effects.
The Minnesota Department of Health plans to fund at least one project in each of the
following categories: (1) maternal alcohol screening; (2) interventions with women at
high-risk; (3) community prevention and integration partnerships; and (4) interventions
with adolescents and adults with fetal alcohol syndrome and alcohol related effects.
Eligible applicants include Community Boards of Health, non-profit health and human
service organizations, tribal governments and entities, health care organizations, and other
interested agencies.
$850,000 in State funds are available for each year of this grant initiative. The two-year
grants will begin on or about January 1, 2004, and will be subject to annual review by
MDH.
The completed proposal must be submitted no later than 4:30 p.m. on Friday, September
12, 2003 to Sheila Blackman at the Minnesota Department of Health, Family Health
Division,
85 E 7th Place, Suite 400 P.O. Box 64882, St. Paul, MN 55416-0882.
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5.2
March of Dimes - Biomedical research funding
http://www.marchofdimes.com/professionals/691_1447.asp
RFP for 2004 Research Program
We invite all qualified scientists with faculty appointments or the equivalent, at
universities, hospitals and research institutions, to submit applications for research grants
directed at the prevention of birth defects. Research subjects appropriate for support by
the March of Dimes include basic biological processes governing development, genetics,
clinical studies, studies of reproductive health, environmental toxicology, and social and
behavioral studies.
Please note: In Social and Behavioral Sciences, we are interested in applications
proposing research that advances our understanding of – and therefore our ability to
prevent – the cognitive and behavioral risks that affect outcomes of pregnancy, the
perinatal period, and subsequent child development. Because change in behavior is an
important component of several of our campaigns, we are interested in studies that
address this method of prevention.
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6.
FASD Family and Practitioners Resources
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6.1
Fetal Alcohol Syndrome Family Resource Institute (FAS*FRI)
http://www.fetalalcoholsyndrome.org/
PO Box 2525
Lynnwood, Washington, USA 98036
(253) 531-2878
Fax: (253) 640-9155
E-mail: vicfas@hotmail.com
The Fetal Alcohol Syndrome Family Resource Institute is dedicated to the preservation of
families through the identification, understanding and compassionate care of individuals
disabled by prenatal alcohol exposure. The institute helps by sharing the grief, healing the
pain, and directing parents to agencies and programs that will give hope and help.
FAS*FRI has local support groups with a directory that is included in their information
packet and will give assistance to anyone wishing to start a group in their locality.
The Institute publishes a quarterly newsletter, FAS Times, that in included in membership
fees, and brochures including, "Fetal Alcohol Syndrome," "Help Hope Healing for Birth
Parents of Children with FAS/FAE," and "We Love Children with Special Needs, and We
Vote." The Institute offers a new parent information packet that contains, Fetal Alcohol
Fact Sheet, a copy of the newsletter, letters from parents and a listing of regional support
resources. They have a reading list of articles and books that are available to members and
collect information on physicians and researchers who treat/study the condition. This
information is made accessible to members. They have a state wide 800 referral line.
6.2
Family Empowerment Network: Supporting Families affected by
FAS/E
http://www.familyvillage.wisc.edu/lib_fas.htm
610 Langdon Street
Room 523
Madison, WI 53703-1195
1-800-462-5254
608/262-6590
608/265-2329 (Fax)
Email: fen@mail.dcs.wisc.edu
Family Empowerment Network (FEN): Supporting Families Affected by Fetal Alcohol
Syndrome and Fetal Alcohol Effects. FEN is an international organization serving
families and professionals. They provide: free informational packets on FAS/FAE;
international resource/referral directory catalogued by state/province; quaterly newsletter,
the FEN Pen; extensive loan library (videos, audio training tapes, books, fact sheets, etc.);
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trainings for parents and professionals; educational opportunities; annual retreat for
families; and an annual national conference.
FEN is a program of the University of Wisconsin-Madison, Department of Professional
Development and Applied Studies.
6.3
FAS Community Resource Center
Information about Fetal Alcohol Syndrome (FAS) and Fetal Alcohol
Spectrum Disorders (FASD) http://come-over.to/FASCRC/
A Web site sponsored by the Pima Council on Developmental Disabilities in Tucson,
Arizona. Resources, articles, photos, and stories for students, parents, and professionals.
6.4
Educational Resources:
The Arc’s Fetal Alcohol Resource Guide, online at: http://thearc.org/misc/faslist.html
March of Dimes 2002 Product Catalog "Saving Babies Together"
This product catalog contains FAS-related resources; other resources for alcohol, tobacco,
and other drug prevention and intervention; and healthy pregnancy and baby resources.
Materials listed include pamphlets, fact sheets, videos, slide shows, reports, publications,
and books on pregnancy planning, healthy pregnancy, baby care, preterm labor,
bereavement, prenatal care, smoking and pregnancy, parenting, caring for the new baby,
the importance of folic acid during pregnancy, teen pregnancy, and perinatal and genetic
data. All materials are also available in Spanish.
Organization: March of Dimes Birth Defects Foundation
Year: 2002
Format: Resource
Target Audience: Families, women of childbearing age, pregnant women, prevention
specialists, fathers-to-be, female teens, and social service and health care providers
Availability:
March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
888-MODIMES (888-663-4637)
TTY: 914-997-4764
Fax: 914-997-4763
Internet: http://www.marchofdimes.com/professionals/2222.asp
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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Cost: Free
You Can Help Prevent Fetal Alcohol Syndrome and Fetal Alcohol Effects
This action kit offers facts about FAS, action steps for the prevention of FAS, and
valuable resource links, as well as a link to a model FAS prevention program. It includes
templates for writing to politicians and liquor companies to encourage them to fund
education, research, and prevention programs. Instructions are provided for starting a
letter-writing campaign.
Organization: League for the Prevention of Alcohol-Related Fetal Brain Injury
Year: 2001
Format: Online action kit
Target Audience: Families, communities, and prevention specialists and organizations
Availability:
Available online only.
Internet: http://www.worldprofit.com/ mafas.htm
Cost: Free
A Mother's Choice
This video examines the root causes of FAS from the perspective of an Aboriginal
mother. The video provides strong messages about consuming alcohol while pregnant.
The video targets Aboriginal men and women who are thinking about having a child but
may still be dealing with their substance abuse problems. A discussion guide is provided
with the video.
Organization: Gryphon Production, Ltd.
Year: 1999
Format: Video (26 minutes)
Target Audience: Aboriginal families and men and women who use alcohol and are
considering having a child
Availability:
Gryphon Productions, Ltd.
P.O. Box 93009
5331 Headland Drive
West Vancouver, BC
Canada V7W 3CO
604-921-7627
Fax: 604-921-7626
E-mail: gryphon@telus.net
Internet: http://www3.bc.sympatico.ca/ gryphon/
Cost: $148 (U.S. dollars)
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Community Action Guide: Working Together for the Prevention of Fetal Alcohol
Syndrome
This guide is intended to support those interested in working on the prevention of FAS in
communities. It provides clear, up-to-date information on FAS; interventions that work
for children, youth, and adults affected by FAS; information that supports increased
understanding of women's use of alcohol and other drugs; information on working with
women to prevent FAS; and information on planning effective community-based
initiatives to prevent FASD.
Organization: British Columbia Ministry for Children and Families and British
Columbia Fetal Alcohol Syndrome Resource Society
Year: 1998
Format: Guide (111 pages)
Target Audience: Families, community leaders, and social service professionals who
work on community prevention initiatives, and prevention specialists
Availability:
British Columbia Ministry of Children and Family Development
P.O. Box 9721
Stn. Prov. Govt.
Victoria, BC
Canada V8W 9S2
250-387-2023
Fax: 250-356-3007
Free download available online.
Internet: http://www.mcf.gov.bc.ca/child_protection/fas/
Cost: Free
Fetal Alcohol Syndrome and Effects: Stories of Help and Hope
This FAS prevention video provides young people, parents, and others with the facts
about FAS/ARBD and its causes. Through the stories told by parents, professionals, and
adoptive parents, the viewer can come to understand the effects of alcohol abuse on
children and the importance of getting help with alcohol problems.
Organization: Hazelden Publishing and Education
Year: 1998
Format: Video (45 minutes)
Target Audience: Adolescents, parents, women of childbearing age, and pregnant
women who use alcohol
Availability:
Hazelden Publishing and Education
Pleasant Valley Road
P.O. Box 176
Center City, MN 55012-0176
800-328-9000
or
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Office of FAS
Alaska Department of Health and Social Services
P.O. Box 110609
Juneau, AK 99811-0609
907-465-3033
877-393-2287
(toll-free in Alaska)
Fax: 907-465-1189
Internet: http://www.hss.state.ak.us/fas/
Cost: Contact Hazelden Publishing and Education or Alaska DHSS/Office of FAS for
current pricing.
Drinking and Your Pregnancy
This brochure explains in simple language why pregnant women should not drink alcohol
and the possible damage to their babies if they do.
Organization: National Institute on Alcohol Abuse and Alcoholism, National Institutes
of Health (NIH), and National Organization on Fetal Alcohol Syndrome
Year: 1997
Format: Brochure (2 pages)
Target Audience:Pregnant women and their families and women of childbearing age
Availability:
Health Resources and Services Administration Publications
888-ASK-HRSA
(888-275-4772)
Order by phone or online only.
Publication No. MCHK040
Internet: http://www.ask.hrsa.gov/detail.cfm?id=mchk040
Cost: Free
Fetal Alcohol Syndrome
This brochure explains FAS, what it is, how it can be prevented, and how a mother's
drinking affects her unborn child. It explains that although there is no cure for FAS, it is
100 percent preventable. The brochure lists the learning and developmental problems of
FAS children, and effective strategies and discipline for them.
Organization: National Organization on Fetal Alcohol Syndrome
Year: 1997
Format: Brochure
Target Audience: Families of pregnant women and of FAS-affected children
Availability:
National Organization on Fetal Alcohol Syndrome
1819 H Street, NW, Suite 750
Washington, DC 20006
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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202-785-4585 or
800-66-NOFAS
Internet: http://www.nofas.org
Cost: Free
A Layman's Guide to Fetal Alcohol Syndrome and Possible Fetal Alcohol Effects
This guide answers many frequently asked questions about FAS and fetal alcohol effects
(FAE), including history, causes, diagnosis, and characteristics of children with FAS/FAE
at different stages of their lives.
Organization: FAS/E Support Network of British Columbia
Year: 1997
Format: Guide
Target Audience: Families of preconceptional and pregnant women and FAS-affected
adolescents and young adults and their families
Availability:
FAS Bookshelf, Inc.
#438-6540 E. Hastings Street
Burnaby, BC
Canada V5B 4Z5
604-942-2024
Fax: 604-942-2041
Item No. B-105
Internet: http://www.fasbookshelf.com/buyit.html
Cost: $17
The Walk of Our Grandmother: A Manual for Alaska Native Girls & Women
edited by Valerie Naquin and Clarice Dickess
This FAS prevention manual is written for Alaska Native girls and women. It provides
messages of prevention, cultural stories, and lessons on living an alcohol- and drug-free
life by following the advice of Alaskan elders.
Organization: Fairbanks Native Association
Year: 1996
Format: Manual
Target Audience: Alaska Native girls and women and their families
Availability:
Office of FAS
Alaska Department of Health and Social Services
150 Third Street, Suite 310
P.O. Box 110609
Juneau, AK 99811-0609
907-465-3033
877-393-2287
(toll-free in Alaska)
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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Fax: 907-465-1189
E-mail: fas@health.state.ak.us
Internet: http://www.hss.state.ak.us/fas/Resources/default.htm
Cost: Contact Office of FAS, Alaska DHSS, for current pricing and availability.
6.5 Online Resources for Practitioners
Fetal Alcohol Syndrome Prevention, Minnesota Department of Health.
http://www.health.state.mn.us/fas/professionalpractice.html
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7.
International Activities and On-line Resources
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Information obtained from: Fetal Alcohol and Drug Unit, University of Washington, web:
http://depts.washington.edu/fadu/
Most resources are in native language, and do not provide English translation
Australia
 National Organisation for Foetal Alcohol Syndrome and Related Disorders. Canadian
Reports cited on this page. http://users.chariot.net.au/~miers/
Brazil
 Consumo de álcool durante a gravidex altera a função da tireóide;
http://www.emedix.com.br/not2002/02jan15acer-acd-alcool.shtml
 Síndrome Alcoólica Fetal; an excellent article on SAF which includes many pictures.
http://200.152.193.252/novosite/complicacoes_gravidez_sindrome.htm
Central America
 El consumo de alcohol durante el embarazo;
http://www.bebescr.com/embarazo/emba0005.shtml
Chile
 Alcohol y Embarazo; information about FAS from the Maternidad Clinica Santa Maria.
http://www.csm.cl/maternidad/alcohol_embarazo.htm
 Efecto del alcohol durante el embarazo;
http://educacion.123.cl/ciencia/articulos/efecto_alcohol_embarazo.htm
 Síndrome alcohol fetal; Département de Pédiatrie de l'Université du Chili.
http://www.rms.cl/Numeros_anteriores/rmszz_11/H%20Temas%20de%20Pediatr%C3%
ADa/s%C3%ADndrome_alcohol_fetal.htm
China
 Unfortuately, this is not on-line, but Peggy Oba has translated some of Dr. Streissguth's
work into Mainland Chinese and Hong Kong/Taiwan Traditional Chinese. She would be
happy to her translations to you. Please email her at: PSOBA@aol.com.
Croatia
 Fetusni Alkohoni Sindrom (FAS); an article by Doc. dr. Danijel Buljan, prof. dr. Vlatko
Thaller. http://www.moravek.net/kla/26-002.html
 Alkohol i droge u trudnoc'i http://www.poliklinika-harni.hr/teme/trudnoca/07_alkohol.asp
Cuba
 Centro de Referencia para el Diagnóstico de Malformaciones Congénitas
Asesoramiento genético del stico del síndrome fetal alcohólico.
Denmark
 Føtalt alkoholsyndrom; info on FAS in Danish.
http://www.sst.dk/publ/publ1999/alkgrav/defa0011.htm
 Føtalt alkoholsyndrom og eruptionsafvigelser; an article on FAS with some pictures.
http://www.tnl.dk/tidsskrift/arkiv/artikler/0702inger_kjaer.html
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
Videncenter om Alkohol; the Danish Resource and Information Centre on Alcohol is a
national institution within the Danish Ministry of Social Affairs.
http://www.alkoholviden.dk/
Click here for their page on FAS. http://www.alkoholviden.dk/default.asp?ID=166
England
 Fetal Alcohol Syndrome Trust Resources for parents/families.
http://www.medicouncilalcol.demon.co.uk/FAST/fast.htm
 FAS-UK Group of parents and professionals dedicated to raising awareness.
http://www.fasstar.com/UK/
Europe
 Eurocare; advocacy for the prevention of alcohol related harm in Europe.
http://www.eurocare.org/
 International Federation of the Blue Cross; its objectives are to assist those who are
battling with alcohol-related problems, using every available modern means, to inform
about the dangers of alcohol and all other drug abuse, to encourage prevention amongst
young people, by promoting a drug free lifestyle, and to support an alcohol policy,
promoting health for all. http://www.eurocare.org/bluecross/
Finland
 FAS-oireyhtymä http://www.sci.fi/~kup/syndroma/fas.htm
France
 Alcool : le fœtus préfère l'abstinence; from Doctissimo.fr.
http://www.doctissimo.fr/html/grossesse/pendant/facteurs_risque/gr_3953_alcool_foetus.
htm
 Centre Hospitalier Universitaire de Rouen, Hopitaux de Rouen's FAS page
http://www.chu-rouen.fr/ssf/pathol/alcoolismefoetalsyndrome.html
 Grossesse, alcool et tabac : le tiercé perdant; from Doctissimo.fr.
http://www.doctissimo.fr/html/grossesse/mag_2002/0125/gr_5081_alcool_tabac_grossess
e.htm
 Le syndrome d'alcoolisme foetal: une tragédie évitable; article by Dr Philippe Dehaene.
 Book: P. Dehaene, La Grossesse Et L'Alcool. Presses Universitaires De France, 1995.
http://www.anpa.asso.fr/htmlfr/milieu/alcool_ou_sante_articles/f_milieu_recherche_syndrome.html
Germany
 Alkohol In der Schwangerschaft: Kein Gläschen in Ehren!
http://www.unverdorben.org/info/schwangerschaft/ernaehrung/alkohol.html
 FASworld Germany. http://fasae.freeservers.com/web3.html
Click here for the English version of this site.
http://fasalkoholembryopathie.freeservers.com/
 Fetales Alkohol Syndrom. http://home.arcor.de/no/norbert.mallik/miscell/fas.htm
Click here for the English version of this site.
http://home.arcor.de/no/norbert.mallik/miscell/fas_engl.htm
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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
Info on FAS from DRK Kliniken Berlin, Westend. http://www.drk-klinikenbln.de/westend/kinderheilkunde/sprechstunde.htm
 More info on FAS in Germany. http://www.uni-essen.de/~ibp010/alkemb/
 Neue Erkenntnisse zum foetalen Alkoholsyndrom - Implikationen fuer Diagnostik,
Behandlung und Praevention (Recent advances in fetal alcohol syndrome: Implications
for diagnosis, intervention, and prevention); by Karen Kopera-Frye, Paul Connor, and
Ann Streissguth. Articles are in German only. Part One.
http://www.agsp.de/UB_Veroffentlichungen/Aufsatze/Aufsatz_12/hauptteil_aufsatz_12.h
tml Part Two.
http://www.agsp.de/UB_Veroffentlichungen/Aufsatze/Aufsatz_12/Aufsatz_12b/hauptteil
_aufsatz_12b.html
 Book: H. Löser, Alkohol-embryopathie und Alkoholeffekte. Gustav Fisher Verlag, 1995.
http://medweb.uni-muenster.de/institute/paedcard/forschung/f_alkohol.html
 Book: H. Merzenich & P. Lang Alkohol in der Schwangerschaft. Forschung und Praxis
der Gesundheitsförderung, 2002. http://www.bzga.de/bzga_stat/fachpubl/dfh/dfh-171.html
Click here to read it in pdf format. http://www.bzga.de/bzga_stat/fachpubl/pdfdatei/dfh17.pdf
Hungary
 A magzati alkohol szindróma (MAS); an article on MAS,
http://www.babapont.hu/egesz/alt/mas.html
 Magzati Alkohol Szindróma, an article from KIDS nyitóoldal.
http://www.szulo.hu/kids/k01/exkl01.htm
 Book: Koenyv, A Magzati Alcohol-Szindróma. Medicina, 1981.
Iceland
 Alkóhól, from Vísindavefurinn. http://visindavefur.hi.is/?id=2280
 Áhrif áfengis á fóstur og Þroska barna
http://www.saa.is/fraedsluefni/vimuefni/afengiII#Ahrif_afengis_a_fostur_og_throska_bar
na
International
 Journal of FAS International; a peer reviewed scientific journal on FAS.
http://www.motherisk.org/JFAS/
Ireland
 Drugs Awareness Programme; a division of Crosscare, the Social Care Agency of he
Dublin Diocese. http://www.dap.ie/
 Foetal Alcohol Support Ireland http://www.fasireland.org/
 Pregnancy alcohol limits 'too high'; an article on Dr. Jennifer Little's research in Ireland,
published by BBC. http://news.bbc.co.uk/1/hi/health/619840.stm
Italy
 La Sindrome Alcolica Fetale
http://fit.supereva.it/associazionedivolont.freeweb/FAS.htm?p
Japan
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
FAS in Japan; resources and articles in Japanese. http://www.geocities.co.jp/SweetHomeGreen/4808/
Click here to read a story about FAS in Japan, written in English.
http://hometown.aol.com/psoba/myhomepage/family.html
Luxembourg
 FASworld Luxembourg; website is mostly in French and German.
http://www.fasaelu.com/
Netherlands
 FAS Stichting http://www.fasstichting.nl/
 FAS: Expert Opinions; Dr. Ulf Rydberg and Dr. Ann Streissguth answer questions about
FAS and its related conditions. Radio Netherlands; September 12, 2001 (in English).
http://www.rnw.nl/science/html/fashome010912.html
Norway
 200 alkoholskadde barn fødes hvert år-Kvinners misbruk av alkohol under svangerskapet
er den største kjente enkeltårsak til at barn fødes med hjerneskade, article from
Dagsavisen.no. http://www.dagsavisen.no/innenriks/2001/10/613206.shtml
 Aline Foreningen http://www.alineforeningen.no/barna.htm
 Det føtale alkoholsyndrom - belyst ved litteratur og kasuistikk.
http://www.alkoholfornuft.org/Bakgrunn/918061219.html
 Rask diagnose hjelper FAS-barn. http://www.folket.no/fasdiagn.htm
 Skadet i mors liv; a Norwegian documentary about children born with FAS/E and other
birth injuries caused by their mother's drug abuse.
http://www.nrk.no/kanal/nrk1/brennpunkt/1384639.html
 Anbefaler avhold; a continuation of that documentary. Click on "Anbefaler
avhold" to hear Ann Streissguth talk about FAS (in English).
http://www.nrk.no/programmer/tv/brennpunkt/1386290.html
New Zealand
 The Alcohol Advisory Council of New Zealand http://www.alcohol.org.nz/
Drinking and Your Baby http://www.alcohol.org.nz/effects/fas/index.html
Te Inu Waipiro Me Tö Pëpë (in Maöri)
http://www.alcohol.org.nz/effects/fas/maori-index.html
 Alcohol Healthwatch; reducing alcohol related harm. http://www.ahw.co.nz/
 Alcohol and Pregnancy: Foetal Alcohol Syndrome
http://homepages.ihug.co.nz/~dcandmkw/fas/fas.htm
 Fetal Alcohol New Zealand (FANZ) Trust http://www.fanz.org.nz/
Poland
 alkoholowy zespól plodowy; an article on FAS in Polish.
http://www.ipz.edu.pl/centrum/alerty/alkoholowy_zespol_plodowy.html
Portugal
 Síndrome Alcoólica Fetal; a short summary of SAF.
http://www.iec.uminho.pt/telmie/PT/Level3/content/Mental/alcoholi.htm
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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Puerto Rico
 Psicología Forense: Sobre Las Causas De La Conducta Criminal; scroll down to
"Condiciones Congénitas: Síndrome fetal alcohólico."
http://www.psicologiacientifica.com/articulos/ar-ang_vazquez01.htm
Russia
 FAS and FAE Issues in Russia: Alcohol Related Birth Defects and International
Adoption; article by Dr. Jane Aronson. Russian Adoption Resources can be found on the
navigational bar. http://www.russianadoption.org/fas.htm
 Resource #1, http://www.narcom.ru/cabinet/online/17.html
 Resource #2,
http://www.psychiatry.ru/library/lib/article.php4?booknumber=32&article_id=21
 Resource #3, http://pregnancy.h1.ru/health/pregnancy/other/alco.htm
 Resource #4, http://www.bsmu.anrb.ru/publ/lec/index.asp?publ=fl1
 Resource #5, http://razdolie.tomsk.ru/index.php?menu=4&article=43
Scotland
 FAS Scotland http://www.fas_scotland.homestead.com/
South Africa
 A new screening method for fetal alcohol syndrome; a blip located at the bottom of the
Medical Research Council of South Africa's current projects page, that provides a little bit
of info on the incidence of FAS in South Africa.
http://momslife.com/directory/pregnancy.shtml
Spain
 El alcohol en el embarazo;
http://www.consumer.es/web/es/nutricion/salud_y_alimentacion/embarazo_y_lactancia/5
1162.jsp
 Estudio De La Motilidad Ocular En El Síndrome Alcohólico Fetal; an article on FAS with
a few pictures. http://www.oftalmo.com/estrabologia/rev-98/98-06.htm
 Fetopatía alcohólica; information on FAS.
http://www.insm.es/glosariogr/glosarionsm/terminos/ficha_terminos.php3?c_termino=36
0
 Las Rutas Nocivas Del Alcohol Sobre El Feto; from the Facultad de Medicina,
Universidad Complutense de Madrid.
http://www.ucm.es/info/fmed/medicina.edu/Pediatria/nocivas.htm
 Pediatras del Hospital de La Candelaria advierten que el alcohol es uno de los principales
factores de malformación fetal durante el embarazo
http://www.comtf.es/doc/Pediatras%20Alcohol%20Feto.htm
 Síndrome alcohólico fetal; a report on SAF with lots of pictures.
http://wellpath.uniovi.es/es/contenidos/seminario/pediatria/temas/html/tema9/clinica.htm
 Síndrome alcohólico fetal; information about SAF. http://www.unizar.es/gine/fas.htm
 Book: Sindrome Alcoholico Fetal, Jonrnadas Internacionales. Funación Valgrande, 1985.
Sweden
Fetal Alcohol Spectrum Disorder - International Research and Practice Inventory
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

Alkohol och graviditet; http://www.medicallink.se/news/showNews.cfm?newsID=1517
Fetalt Alkoholsyndrom; http://user.tninet.se/~fxg297r/nep_fetalt_alkoholsyndrom.htm
 Det kom ett brev om FAS; http://user.tninet.se/~fxg297r/fas.htm
 FAS-foreningen http://www.fasforeningen.nu/
Switzerland
 Fetalen Alkoholsyndroms; an article on FAS in German. http://www.sfaispa.ch/ServicePresse/allemand/Abhangigkeiten/Fetal.htm
 Ce qu'il faut savoir pour éviter les risques liés à la consommation d'alcool durant la
grossesse; Institut suisse de prévention de l'alcoolisme et autres toxicomanies (in
French).
http://www.prevention.ch/offrez_a_votre_enfant_un_bon_depart_dans_la_vie.html
Turkey
 Alkohol Pada Janin Sebabkan Masalah Perilaku http://www.jagajaga.com/anIhatiyook.php?ida=282
Ukraine
 Resource #1, http://www.jaga-jaga.com/anIhatiyook.php?ida=282
United Kingdom
 Alcoholism and Addiction; prevention, treatment and recovery resources.
http://www.alchemyproject.net/
 ALCOWEB, site for professionals, http://www.alcoweb.com/
 Fetal Alcohol Syndrome; this is a good article on FAS by the Addiction Network. For
faster reading, go up to "view" and click on "text zoom", then on "50%".
http://www.addictionnetwork.co.uk/FAS.htm
 Qualitative European Drug Research Network http://www.qed.org.uk/
United States
 Alcohol y embarazo: Sindrome de alcohol en el feto y efectos de alcohol en el feto; a
video about FAS in Spanish, produced by AIMS Multimedia.
http://www.aimsmultimedia.com/title.php3?code=8494-SP-VID
 El Uso Perinatal de Sustancias: ¿Se está arriesgando ella?; from Idaho CareLine.
http://www2.state.id.us/dhw/ecic/spanish/PPC/perinatalSub_Abuse.htm
 Eu sou o Viscom a Invisível Adolescente com a Invisível Deficiência; an article on
invisible disabilities translated into Portuguese. http://comeover.to/FAS/brochures/visibleteenP.htm
 La bebida y su embarazo; an article on FAS in Spanish. http://comeover.to/FAS/brochures/visibleteenP.htm
 Síndrome de alcoholismo fetal; an article in Spanish, from KidsHealth.org.
http://www.kidshealth.org/parent/en_espanol/fas_esp.html
Uruguay
 Alcohol y embarazo; information on SFA from Alburg S.A. New Media Producer.
http://www.latinsalud.com/articulos/00046.asp
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