Changes in health professionals' knowledge, attitudes and practice following provision of educational resources about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder

We provided health professionals in Western Australia (WA) with educational resources about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder and assessed changes in their knowledge, attitudes and practice concerning fetal alcohol syndrome (FAS) and alcohol consumption in pregnancy. Following our 2002 survey of health professionals in WA, we developed and distributed educational resources to 3348 health professionals in WA in 2007. Six months later we surveyed 1483 of these health professionals. Prevalence rate ratios [PRR] and 95% confidence intervals [CI] were calculated to compare 2007 results with results from the 2002 survey. Of the 1001 responding health professionals, 69.8% had seen the educational resources; of these 77.1% have used them and 48.5% said the resources had assisted them to change their practice or their intention to change their practice. Compared with 2002, there was an increase in the proportion who knew all the essential features of FAS from 11.7% to 15.8% [PRR 1.35; 95% CI 1.09, 1.67] and had diagnosed FAS, from 4.8% to 7.3% [PRR 1.52; 95% CI 1.08, 2.13]. In 2007, 98.1% of health professionals stated they would advise pregnant women to consider not drinking at all or advise them that no alcohol in pregnancy is the safest choice. Health professionals surveyed in 2007 have increased their knowledge, changed their attitudes and practice about FAS, and altered the advice they give to pregnant women about alcohol consumption since our survey in 2002. It is essential that we build on this change and continue to support health professionals' knowledge, attitudes and practice about the prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder. The educational resources for health professionals may be ordered as hard copies and downloaded from the internet http://www.ichr.uwa.edu.au/alcoholandpregnancy.     

Fetal alcohol syndrome: knowledge and attitudes of family medicine clerkship and residency directors

Fetal alcohol spectrum disorders (FASD) are the leading preventable causes of developmental disabilities with serious permanent consequences. Regardless of the increased awareness of fetal alcohol syndrome (FAS), 13% of women in the United States drink alcohol during pregnancy. Health care professionals do not routinely assess the frequency and quantity of alcohol use by their patients. This study examined the knowledge, skills, and practices of family medicine residency and clerkship directors and assessed the time devoted and format of FAS curricula in the programs. A self-administered anonymous survey was sent to the residency and clerkship directors (N = 571). Response rate of clerkship directors was 52% and residency directors 46%. Both groups showed high level of knowledge of FASD and of alcohol counseling practices for pregnant women. Although almost two thirds of the residency programs had FASD integrated in the curriculum, an equivalent fraction of predoctoral programs did not. More than half of the clerkship directors without FASD in their curriculum agreed that a need exists for its inclusion. These findings raise important medical education and policy issues and provide insight into the disparity in FASD content of curricula between predoctoral and family medicine residency programs in the United States. The role of physician counseling in primary prevention of FAS should continue to be stressed in predoctoral and residency education.     

RE-AIM evaluation of the Alcohol and Pregnancy Project: educational resources to inform health professionals about prenatal alcohol exposure and fetal alcohol spectrum disorder

The objective was to evaluate the Alcohol and Pregnancy Project that provided health professionals in Western Australia (WA) with educational resources to inform them about prevention of prenatal alcohol exposure and fetal alcohol spectrum disorder (FASD). The authors developed, produced, and distributed educational resources to 3,348 health professionals in WA. Six months later, they surveyed 1,483 of these health professionals. The authors used the RE-AIM framework (reach, effectiveness, adoption, implementation, and maintenance) to evaluate the project. The educational resources were effective in producing a 31% increase in the proportion of health professionals who routinely provided pregnant women with information about the consequences of drinking alcohol during pregnancy. One hundred percent of the settings adopted the project, it reached 96.3% of the target population, it was implemented as intended, and the resources were maintained (http://www.ichr.uwa.edu.au/alcoholandpregnancy). The educational resources for health professionals have potential to contribute to reducing prenatal alcohol exposure and FASD.     

The effectiveness of a multimedia program to prevent fetal alcohol syndrome

Fetal alcohol syndrome (FAS) continues to be the leading preventable cause of mental retardation in the United States. Because abstaining from alcohol prior to and throughout pregnancy is the only way to prevent FAS, some prevention programs try to target women before they become pregnant. The Fetal Alcohol Spectrum Teaching and Research Awareness Campaign (FASTRAC) is a multimedia, peer-delivered educational presentation designed to reduce the incidence of FAS. Results from an ethnically diverse sample of high school students indicate that the program increased participants' knowledge regarding FAS but had no significant effect on participants' attitudes, beliefs about the dangers of FAS or intention to use alcohol during pregnancy. The FASTRAC program failed partly because of its didactic approach and the lack of health education principles that have been shown to be effective in changing other substance use behaviors. Suggestions for improving FAS prevention education programs are offered.     

Perceptions of Nut Consumption amongst Australian Nutrition and Health Professionals: An Online Survey

Habitual nut consumption is associated with reduced risk of chronic diseases; however, consumption levels in Australia are below recommendations. This study examined perceptions and knowledge regarding nut consumption among Australian healthcare professionals and their provision of nut consumption recommendations. A cross-sectional online survey of Australian health professionals was conducted in February–April 2020. Questions in the survey included demographic details, participants’ perceptions of nut consumption, and nut consumption recommendations they may make to clients and patients. A total of 204 health professionals completed the survey, of which 84% were dietitians or nutritionists. Health professionals demonstrated basic nutritional knowledge regarding nut consumption; however, non-dietitians/nutritionists lacked knowledge of long-term benefits of nut consumption. Dietitians/nutritionists were more likely to agree that nuts are healthy and do not cause weight gain when compared to non-dietitians/nutritionists (p = 0.021). A total of 63% of health professionals advised at least some of their clients to eat more nuts, and this was higher among dietitians/nutritionists (68%) than non-dietitians/nutritionists (31%). While basic nutritional knowledge regarding nut consumption was observed among all health professionals, there is scope for further education, particularly for non-dietitians/nutritionists, to ensure that nutrition information provided to patients and clients is accurate and reflects the current evidence base.     

Alcohol consumption among women who are pregnant or who might become pregnant--United States, 2002

Alcohol use during pregnancy is associated with health problems that adversely affect the mother and fetus; no level of alcohol consumption during pregnancy has been determined safe. Fetal alcohol syndrome (FAS) is recognized as the foremost preventable condition involving neurobehavioral and developmental abnormalities. Women who drink during pregnancy place themselves at risk for having a child with FAS or fetal alcohol spectrum disorders (FASD). To determine the alcohol consumption patterns among all women of childbearing age, including those who are pregnant or might become pregnant, CDC analyzed data for women aged 18-44 years from the 2002 Behavioral Risk Factor Surveillance System (BRFSS) survey. The results of that analysis indicated that approximately 10% of pregnant women used alcohol, and approximately 2% engaged in binge drinking or frequent use of alcohol. The results further indicated that more than half of women who did not use birth control (and therefore might become pregnant) reported alcohol use and 12.4% reported binge drinking. Women who are pregnant or who might become pregnant should abstain from alcohol use.     

The use of alcohol and medicines among Australian adults

OBJECTIVE: To collect Australian population-based data on concurrent use of conventional medicines, complementary/alternative medicines (CAM), and alcohol. METHOD: National survey administered in December 2005 to 816 Australian adults. RESULTS: 71% of respondents reported recent (last 24 hour) use of conventional medicine or CAM. 24% had recently consumed alcohol and conventional medicine, 17% alcohol and CAM and 13% alcohol and both types of medicines. Use of blood pressure and arthritis medicines was significantly more likely among daily drinkers than less than daily drinkers and non-drinkers. CONCLUSIONS: Concurrent use of medicines and alcohol is common, particularly among older people. IMPLICATIONS: Use of alcohol may have an impact on the stability of chronic illness managed by medicines or other types of interactions with medicines, such as sedation. Health care professionals should routinely inquire about such use to be able to incorporate appropriate safety strategies into clinical management.     

Emergency contraception – knowledge and attitudes in a group of Australian university students

Objective: To explore first year Australian university students' knowledge and attitudes about emergency contraception and their understanding of the risk for pregnancy.
Method: A self-report questionnaire was completed by a convenience sample of 627 first year on-campus students from both health and non-health disciplines.
Results: Knowledge about emergency contraception (EC) was generally poor including misunderstanding that it can only be used the 'morning after', as well as where it may be accessed. Its potential use was, however, more highly accepted as a preventative measure after unprotected sexual intercourse than abortion in the event of unplanned pregnancy. Women had better knowledge than men, and on a number of measures there were significant differences between these groups.
Conclusions: Poor knowledge about the timing, accessibility, action and side effects of EC may act as a barrier to its use in the event of unprotected sexual intercourse. Although EC has been available in Australia as a Schedule 3 medication since 2004, its availability from pharmacies is not well known, nor is access from other primary health care providers.
Implications: The lack of knowledge about EC may lead to its underutilisation and underlines the need for future educational strategies about EC as well as the need for health professionals who provide contraceptive services to discuss EC with clients. Health promotion campaigns which are both general as well as gender-specific may improve overall community knowledge about this method of contraception.     

Native American Adolescents' Views of Fetal Alcohol Syndrome Prevention in Schools

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 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. (J Sch Health. 1998; 68(4): 131-136)     

Fetal alcohol syndrome--Alaska,Arizona, Colorado,and New York, 1995-1997

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 in the United States. FAS is diagnosed on the basis of a combination of growth deficiency (pre- or postnatal), central nervous system (CNS) dysfunction, facial dysmorphology, and maternal alcohol use during pregnancy. Estimates of the prevalence of FAS vary from 0.2 to 1.0 per 1,000 live-born infants. This variation is due, in part, to the small size of the populations studied, varying case definitions, and different surveillance methods. In addition, differences have been noted among racial/ethnic populations. To monitor the occurrence of FAS, CDC collaborated with five states (Alaska, Arizona, Colorado, New York, and Wisconsin*) to develop the Fetal Alcohol Syndrome Surveillance Network (FASSNet). This report summarizes the results of an analysis of FASSNet data on children born during 1995-1997, which indicate that FAS rates in Alaska, Arizona, Colorado, and New York ranged from 0.3 to 1.5 per 1,000 live-born infants and were highest for black and American Indian/Alaska Native populations. This study demonstrates that FASSNet is a useful tool that enables health care professionals to monitor the occurrence of FAS and to evaluate the impact of prevention, education, and intervention efforts.     

Barriers and facilitators for health professionals referring Aboriginal and Torres Strait Islander tobacco smokers to the Quitline

Objective: To examine the barriers and facilitators among health professionals to providing referrals to Quitline for Aboriginal and Torres Strait Islander clients who smoke. Methods: A brief online survey, based on the Theoretical Domains Framework, was completed by 34 health professionals who work with Aboriginal and Torres Strait Islander people in South Australia and the Northern Territory. Results: Respondents who frequently made referrals had higher domain scores than less frequent referrers for ‘Skills and knowledge’ (M=4.44 SD=0.39 vs. M=4.09 SD=0.47, p<0.05) and ‘beliefs about capabilities’ (M=4.33 SD=0.44 vs. M=3.88 SD=0.42, p<0.01). Barriers to providing referrals to Quitline were lack of client access to a phone, cost of a phone call, preference for face‐to‐face interventions, and low client motivation to quit. Conclusions: Health professionals working with Aboriginal and Torres Strait Islander clients should be supported to build their skills and confidence to provide referrals to Quitline and other brief cessation interventions. Building capacity for face‐to‐face support locally would be beneficial where phone support is not preferable. Implications for public health: Engaging with health professionals who work with Aboriginal and Torres Strait Islander people to increase referrals to Quitline is strategic as it builds on their existing capacity to provide cessation support.     

Characteristics of mothers who have children with fetal alcohol syndrome or some characteristics of fetal alcohol syndrome

BACKGROUND: Health care providers can more effectively prevent fetal alcohol syndrome and prenatal alcohol exposure if they know more about mothers who have children with fetal alcohol syndrome (FAS) or some characteristics of FAS. METHODS: We conducted two retrospective case-control studies of Northern Plains Indian children with FAS and some characteristics of FAS diagnosed from 1981 to 1993 by using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 760.71. We compared mothers who had children with FAS or some characteristics of FAS with mothers who had children that did not have FAS. RESULTS: Compared with control mothers, 43 mothers who had children with FAS and 35 mothers who had children with some characteristics of FAS were older, had fewer prenatal visits, more pregnancies, more mental health problems, and more injuries (both total and alcohol-related). Although the prevalence of drinking was high in both case and control mothers, case mothers had more alcohol-related medical problems, drank heavily, in binges, and daily more often than control mothers. CONCLUSIONS: Women with injuries and mental health problems should be screened for substance use. Mothers of children with FAS or of some characteristics of FAS have numerous needs that must be addressed to prevent future prenatal alcohol exposure.     

Report from the CDC. Physician and allied health professionals' training and fetal alcohol syndrome

Maternal prenatal alcohol use is one of the leading preventable causes of birth defects and developmental disabilities. On the severe end of the spectrum of conditions related to drinking during pregnancy is fetal alcohol syndrome (FAS). Physicians and other health practitioners play a critical role in diagnosing FAS and in screening women of childbearing age for alcohol use during pregnancy. The Fetal Alcohol Syndrome Prevention Team at CDC's National Center on Birth Defects and Developmental Disabilities awarded funds to four medical school partners (Meharry and Morehouse Medical Colleges, St. Louis University, the University of Medicine and Dentistry of New Jersey, and the University of California at Los Angeles) to develop FAS regional training centers (RTCs). The RTCs are developing, implementing, evaluating, and disseminating educational curricula for medical and allied health students and practitioners that incorporate evidence-based diagnostic guidelines for FAS and other prenatal alcohol-related disorders.     

Identifying and helping alcohol abusers attending general health care services

Studies conducted in Canada and elsewhere show a high prevalence of alcohol-related problems among general practice patients, users of accident and emergency services, and patients in some community-based and hospital-based outpatient and residential settings. However, many users of general health care services with alcohol problems are not recognized as such. Also, even when identified, alcohol abusers are not always treated for alcohol abuse per se. Interest in prevention and in early identification of alcohol problems is also low among many health care professionals. Alcohol problems can be prevented and treated. Health care professionals should thus try to identify clients with alcohol-related problems and those at risk. These clients should then be provided with appropriate information and advice and, if necessary, referred to a specialized addiction service. The routine use of simple, structured questions concerning drinking will facilitate the identification process.     

Travel counsellors and travel health advice

BACKGROUND: Travel Counsellors may be a source of health advice to travellers and might influence travellers' decisions to seek consultation from health professionals. We examined the travel health advice that Alberta travel counsellors currently provide their clients and assessed their health knowledge and practices. METHODS: Cross-sectional postal survey of travel counsellors who book international trips identified from a random sample of Alberta travel agencies in 2000. RESULTS: The response rate was 54.4%. Over 80% of respondents routinely provide clients with general health advice, and approximately 70% advise on malaria risk and vaccines required for travel. The risk of malaria was correctly identified by 72% of the respondents who frequently book clients to malarious destinations. Most respondents (79%) thought they should be involved in promoting the health of international travellers. Their preference was to provide health advice to their clients (90%) rather than refer them to a health professional (67%). CONCLUSIONS: A large proportion of Alberta travel counsellors provided travel-related health advice to clients. Their preferred role of counselling rather than referring conflicts with the recommendations of the International Society of Travel Medicine.     

‘Partnerships are crucial’: an evaluation of the Aboriginal Family Birthing Program in South Australia

Objectives: To evaluate implementation and outcomes of the Aboriginal Family Birthing Program (AFBP), which provides culturally competent antenatal, intrapartum and early postnatal care for Aboriginal families across South Australia (SA). Methods: Analysis of births to Aboriginal women in SA 2010–2012; interviews with health professionals and AFBP clients. Results: Around a third of all Aboriginal women giving birth in SA 2010–2012 (n=486) attended AFBP services. AFBP women were more likely to be more socially disadvantaged, have poorer pregnancy health and to have inadequate numbers of antenatal visits than Aboriginal women attending other services. Even with greater social disadvantage and higher clinical complexity, pregnancy outcomes were similar for AFBP and other Aboriginal women. Interviews with 107 health professionals (including 20 Aboriginal Maternal and Infant Care (AMIC) workers) indicated differing levels of commitment to the model, with some lack of clarity about AMIC workers and midwives roles. Interviews with 20 AFBP clients showed they highly valued care from another Aboriginal woman. Conclusions: Despite challenges, the AFBP reaches out to women with the greatest need, providing culturally appropriate, effective care through partnerships. Implications for Public Health: Programs like the AFBP need to be expanded and supported to improve maternal and child health outcomes for Aboriginal families.     

Estimating the prevalence of fetal alcohol syndrome in Victoria using routinely collected administrative data

OBJECTIVE: To establish the prevalence of fetal alcohol syndrome (FAS) in Victoria through the Victorian Birth Defects Register (VBDR). METHODS: A sample of live births from 1995-2002 was selected from the Victorian Perinatal Data Collection and VBDR based on reported microcephaly, FAS or maternal use of alcohol during pregnancy. Following ethics approval, medical records of mother and child were requested for 117 births. One hundred and nine of these were accessed and examined for factors related to FAS. Records were categorised as FAS, possible FAS, unable to categorise, or not FAS. RESULTS: From the VBDR the prevalence was calculated at 0.006 per 1,000 live births. Four additional possible cases of FAS increased this to 0.014 per 1,000 live births. Six cases were defined as 'unable to categorise' as alcohol use was unknown but other features of FAS were evident. Including these cases, plus five where some low-level alcohol use was reported, increased the prevalence to 0.03 per 1,000 live births. Twenty-eight per cent of the audit population and 39% of the microcephalic cases had no information about maternal alcohol use recorded in the antenatal or babies' records. CONCLUSION AND IMPLICATIONS: The audit of medical records provided additional information regarding FAS prevalence in Victoria. This prevalence ranges from 0.01 to 0.03 per 1,000 live births. To accurately assess the extent of the problem, there needs to be improved reporting of alcohol use in pregnancy and a system in place to report cases diagnosed during and beyond the perinatal period to the VBDR.     

Maternal risk factors for fetal alcohol syndrome in the Western cape province of South Africa: a population-based study

OBJECTIVES: We defined risk factors for fetal alcohol syndrome (FAS) in a region with the highest documented prevalence of FAS in the world. METHODS: We compared mothers of 53 first-grade students with FAS (cases) with 116 randomly selected mothers of first-grade students without FAS (controls). RESULTS: Differences between case and control mothers in our study population existed regarding socioeconomic status, religiosity, education, gravidity, parity, and marital status. Mothers of children with FAS came from alcohol-abusing families in which heavy drinking was almost universal; control mothers drank little to no alcohol. Current and past alcohol use by case mothers was characterized by heavy binge drinking on weekends, with no reduction of use during pregnancy in 87% of the mothers. Twenty percent of control mothers drank during pregnancy, a rate that declined to 12.7% by the third trimester. The percentage who smoked during pregnancy was higher for case mothers than for control mothers (75.5% vs 30.3%), but the number of cigarettes smoked was low among case mothers. The incidence of FAS in offspring of relatively young women (28 years) was not explained by early drinking onset or years of drinking (mean, 7.6 years among case mothers). In addition to traditional FAS risk factors, case mothers were smaller in height, weight, head circumference, and body mass index, all anthropomorphic measures that indicate poor nutrition and second-generation fetal alcohol exposure. CONCLUSIONS: Preventive interventions are needed to address maternal risk factors for FAS.     

A survey of physicians knowledge regarding awareness of maternal alcohol use and the diagnosis of FAS.

Background

Alcohol is the most widely used drug in the world that is a human teratogen whose use among women of childbearing age has been steadily increasing. It is also probable that Fetal Alcohol Syndrome is under diagnosed by physicians. The objectives of this study were twofold: 1) to evaluate the experience, knowledge and confidence of family physicians with respect to the diagnosis of FAS and 2) to evaluate physicians awareness of maternal drinking patterns.

Methods and Participants

A multiple choice anonymous questionnaire was sent to a randomly selected group of family physicians in the Metropolitan Toronto area.

Results

There was a 73% (75/103) total response rate; Overall, 6/75 (8%) of family physicians reported that they had actually diagnosed a child with FAS. 17.9% had suspicions but did not make a diagnosis and 12.7% reported making a referral to confirm the diagnosis. Physician rated confidence in the ability to diagnosis FAS was low, with 49% feeling they had very little confidence. 75% reported counselling pregnant women and 60.8% reported counselling childbearing women in general on the use of alcohol. When asked what screening test they used to detect the use of alcohol, 75% described frequency/quantity. Not a single respondent identified using the current accepted screening method for alcohol use (TWEAK) which is recommended by The Centre for Addiction and Mental Health.

Conclusions

Family physicians do not feel confident about diagnosing FAS. None of the physicians were aware of the current screening methods to accurately gage alcohol use in pregnant and childbearing women

     

Prevention research on the teratogenic effects of alcohol

This paper presents findings from an October 1979 mail survey of women who gave live birth in Los Angeles county during a 3-month period. Ninety-six percent of the sample had been exposed to messages about the teratogenic effects of alcohol, and the mass media played a central role in this exposure. About one-fifth of the sample reported risky drinking practices during their most recent pregnancy. On average, those women who did not discuss drinking alcohol with their doctor or nurse were about one and a half times more likely to have risky drinking practices during pregnancy. These results imply that future fetal alcohol syndrome (FAS) prevention efforts, at least in Los Angeles county, should focus more on the interaction between pregnant women and their health care providers and less on public awareness campaigns. Three directions for FAS prevention research are discussed.