Prevention of Fetal Alcohol Spectrum Disorder: Current Canadian Efforts and Analysis of Gaps

Effective prevention of risky alcohol use in pregnancy involves much more than providing information about the risk of potential birth defects and developmental disabilities in children. To categorize the breadth of possible initiatives, Canadian experts have identified a four-part framework for fetal alcohol spectrum disorder (FASD) prevention: Level 1, public awareness and broad health promotion; Level 2, conversations about alcohol with women of childbearing age and their partners; Level 3, specialized support for pregnant women; and Level 4, postpartum support for new mothers. In order to describe the level of services across Canada, 50 Canadian service providers, civil servants, and researchers working in the area of FASD prevention were involved in an online Delphi survey process to create a snapshot of current FASD prevention efforts, identify gaps, and provide ideas on how to close these gaps to improve FASD prevention. Promising Canadian practices and key areas for future action are described. Overall, Canadian FASD prevention programming reflects evidence-based practices; however, there are many opportunities to improve scope and availability of these initiatives.

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Fetal Alcohol Spectrum Disorder: What does Public Awareness Tell Us about Prevention Programming?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16214229 ◽

2019 ◽

Vol 16 (21) ◽

pp. 4229

Author(s):

Peter Choate ◽

Dorothy Badry ◽

Bruce MacLaurin ◽

Kehinde Ariyo ◽

Dorsa Sobhani

Keyword(s):

Health Care Providers ◽

Fetal Alcohol Spectrum Disorder ◽

Public Awareness ◽

Secondary Data ◽

Spectrum Disorder ◽

Health Concern ◽

Care Providers ◽

Childbearing Age ◽

Fetal Alcohol ◽

Fetal Alcohol Spectrum

The prevalence of Fetal Alcohol Spectrum Disorder (FASD) does not appear to be diminishing over time. Indeed, recent data suggests that the disorder may be more prevalent than previously thought. A variety of public education programs developed over the last 20 years have promoted alcohol abstention during pregnancy, yet FASD remains a serious public health concern. This paper reports on a secondary data analysis of public awareness in one Canadian province looking at possible creative pathways to consider for future prevention efforts. The data indicates that the focus on women of childbearing age continues to make sense. The data also suggests that targeting formal (health care providers for examples) and informal support (partner, spouse, family, and friends) might also be valuable. They are seen as sources of encouragement, so ensuring they understand the risks, as well as effective ways to encourage abstinence or harm reduction, may be beneficial for both the woman and the pregnancy. Educating people who might support a woman in pregnancy may be as important as programs targeted towards women who may become or are pregnant. The data also suggests that there is already a significant level of awareness of FASD, thus highlighting the need to explore the effectiveness and value of current prevention approaches.

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Elements for developing community-based interventions for adults with fetal alcohol spectrum disorder: A scoping review

British Journal of Occupational Therapy ◽

10.1177/0308022618790206 ◽

2018 ◽

Vol 82 (4) ◽

pp. 201-212

Author(s):

Ryan Quan ◽

E Sharon Brintnell ◽

Ada WS Leung

Keyword(s):

Scoping Review ◽

Fetal Alcohol Spectrum Disorder ◽

Service Providers ◽

Spectrum Disorder ◽

Fetal Alcohol ◽

Community Based Interventions ◽

Community Based ◽

Daily Lives ◽

High Prevalence ◽

Fetal Alcohol Spectrum

Introduction Current literature about interventions for adults with fetal alcohol spectrum disorder (FASD) is limited, which is a concern, due to the high prevalence of FASD. FASD creates lifelong physical, mental, cognitive and behavioral deficits, which impacts many aspects of daily living. Community-based interventions are necessary to better support adults with FASD and provide them with the opportunity to achieve success in their daily lives and social participation. This scoping review aimed to identify elements for developing successful community-based interventions for these individuals. Method A search was conducted in the MEDLINE, PsycINFO, CINAHL, and EMBASE databases and supplementary gray literature was resourced. Articles were selected based on inclusion–exclusion criteria, and a thematic analysis was completed to identify and present relevant findings. Results Seven articles met selection criteria and were included in this review. Six emerging themes were identified: inclusion of a functional context, individualized support, education for service providers, structure and routine, utilizing a strengths-based approach, and environmental adaptations. These themes were used to present the findings related to the elements necessary for developing interventions for adults with FASD. Conclusion The results indicate that the identified elements may be necessary to develop successful interventions, especially community-based interventions, for adults with FASD.

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Women of Childbearing Age and Fetal Alcohol Spectrum Disorder Prevention

Journal of Addictions Nursing ◽

10.1097/jan.0000000000000371 ◽

2020 ◽

Vol 31 (4) ◽

pp. 302-306

Author(s):

Khadejah F. Mahmoud ◽

Kira J. Griffith ◽

Annie Hayden ◽

Susanne A. Fogger ◽

Brayden N. Kameg ◽

...

Keyword(s):

Fetal Alcohol Spectrum Disorder ◽

Spectrum Disorder ◽

Women Of Childbearing Age ◽

Childbearing Age ◽

Fetal Alcohol ◽

Fetal Alcohol Spectrum ◽

Disorder Prevention

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A guideline for the prevention and management of Fetal Alcohol Spectrum Disorder in South Africa

BMC Health Services Research ◽

10.1186/s12913-019-4677-x ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Babatope O. Adebiyi ◽

Ferdinand C. Mukumbang ◽

Anna-Marie Beytell

Keyword(s):

South Africa ◽

Fetal Alcohol Spectrum Disorder ◽

Service Providers ◽

Alcohol Problems ◽

Spectrum Disorder ◽

World Health ◽

Fetal Alcohol ◽

Specific Policy ◽

Delphi Approach ◽

Fetal Alcohol Spectrum

Abstract Background Fetal Alcohol Spectrum Disorder (FASD) is a public health problem globally, with South Africa having the highest recorded prevalence of all countries. Government programmes to prevent and manage FASD remain limited because of the lack of a specific policy. Herein, we developed a guideline to inform policy on the prevention and management of FASD in South Africa. Methods We applied a modified version of the World Health Organization’s approach to guideline development in three phases. In the first phase, we designed the initial guideline prototype. To do this, we conducted an in-depth interview with policymakers and a focus group with relevant service providers on policy requirements for FASD, a document review of policies on FASD and a scoping review of various interventions for FASD. In phase 2, we refined the initially formulated guideline prototype through a discursive approach with seven local and international experts on FASD. Phase 3 involved refining the prototype using a modified Delphi approach. Forty-three and forty-one experts participated in rounds 1 and 2 of the Delphi approach, respectively. The acceptable consensus for each included policy statement was 85%. Results We identified three aspects of the proposed guideline, which are the approaches and guiding principles, the prevention measures and the management measures. The guideline proposes that a FASD policy should consider lifespan needs, be culturally diverse, collaborative, evidence-based, multi-sectoral and address social determinants of health contributing to FASD. The essential components of FASD prevention policy consist of awareness and education of the dangers of drinking alcohol, access to treatment for alcohol problems and training of service providers. The management components include capacity building related to diagnosis, educating parents regarding the needs and management, appropriate referral pathways, training of teachers regarding classroom management and support for parents and individuals with FASD. Conclusion FASD in South Africa deserves urgent attention. Developing a specific policy to guide programmes could enhance and coordinate the efforts towards preventing and managing FASD. The guideline has the potential to assist policymakers in the development of a comprehensive and multi-sectoral policy for prevention and management of FASD, considering the consensus obtained from the experts.

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Unrealistic optimism with regard to drinking during pregnancy among women of childbearing age in a South African community

South African Journal of Psychology ◽

10.1177/0081246317717105 ◽

2017 ◽

Vol 48 (2) ◽

pp. 219-229

Author(s):

Jacobus G Louw ◽

Mark Tomlinson ◽

Leana Olivier

Keyword(s):

At Risk ◽

Fetal Alcohol Spectrum Disorder ◽

Spectrum Disorder ◽

Health Concern ◽

Unrealistic Optimism ◽

Childbearing Age ◽

Fetal Alcohol ◽

Personal Risk ◽

Significant Difference ◽

Fetal Alcohol Spectrum

Drinking alcohol during pregnancy is a risk factor in a range of adverse birth outcomes, including fetal alcohol spectrum disorders, and is a major health concern. For this behaviour to change one of the necessary conditions is for women to have an accurate perception of the risks drinking during pregnancy poses. A major obstacle to this is the presence of unrealistic optimism which leads to women believing they are less at risk than others. This study examined a sample of women ( N = 129) from a community in the Northern Cape Province in South Africa with a high prevalence of fetal alcohol spectrum disorder for signs of unrealistic optimism. A questionnaire about the perception of personal and general risk was administered during a one-on-one interview and responses compared. Neither a Student’s t-test ( t(115) = −1.720, p = .088, 95% confidence interval [−0.180, 0.013]) nor a Wilcoxon matched-pairs signed-rank test ( z = −1.72, p = .285) showed a significant difference. The perception of risk posed by drinking during pregnancy to others, knowledge of fetal alcohol spectrum disorder, and the perception of how easy it would be for the participant to quit drinking were significant predictors of the perception of personal risk. Only the perception of personal risk predicted the perception of general risk. There was no evidence that participants believed themselves to be less at risk than their peers when it came to the risks of drinking during pregnancy. Future directions for research into unrealistic optimism and drinking during pregnancy are discussed.

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Reframing Fetal Alcohol Spectrum Disorder: Studying Culture to Identify Communication Challenges and Opportunities

Studies in Media and Communication ◽

10.11114/smc.v5i2.2687 ◽

2017 ◽

Vol 5 (2) ◽

pp. 105

Author(s):

Nathaniel Kendall-Taylor ◽

Marissa Fond

Keyword(s):

Public Health ◽

Fetal Alcohol Spectrum Disorder ◽

Public Awareness ◽

Cultural Beliefs ◽

Cultural Models ◽

Spectrum Disorder ◽

Public Health Issue ◽

Issue Salience ◽

Fetal Alcohol ◽

Fetal Alcohol Spectrum

Implicit cultural understandings challenge those working to increase public awareness and support for programs to prevent and address fetal alcohol spectrum disorder (FASD). Understanding these cultural beliefs reveals key challenges that communicators face; it also helps identify opportunities to foster public engagement and build support for policies and programs that are important for reducing the prevalence of FASD as a public health issue. Through a series of interviews with members of the public in Manitoba, Canada, we identify the cultural models that members of the Manitoban public draw on to make sense of this issue. These models and their implications are used to create a set of recommendations that can improve understanding of the issue, increase issue salience, and generate support for solutions. While the research presented is specific to Manitoba, findings have significance for those working on FASD in other areas and for those working on other public health and science translation projects.

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