Fetal alcohol syndrome prevention using community-based narrowcasting campaigns

Preventing fetal alcohol syndrome (FAS) by encouraging pregnant women to abstain from drinking alcohol competes with commercial alcohol marketing. Two FAS-prevention campaigns using a narrowcast approach among young women of childbearing age in two disadvantaged Southern California communities are compared. The design, implementation process, and degree to which campaigns reached the priority populations are the focus of this article. Formative research shows that young women in disadvantaged communities receive mixed messages about dangers of drinking during pregnancy. A social norms approach using positive role models was the most acceptable message strategy based on materials pretesting. Differences in campaign implementation and distribution strategies between communities were documented through program monitoring. Survey research indicated the more viable messaging and implementation strategies. Findings show that low-cost community campaigns are feasible; however, variations in messaging, distribution strategies, and saturation levels determine whether such campaigns succeed or fail to reach priority populations.     

Fetal deaths and proximity to hazardous waste sites in Washington State

BACKGROUND: The in utero period is one of increased susceptibility to environmental effects. The effects of prenatal exposure to environmental toxicants on various adverse pregnancy outcomes, including fetal death, are not well understood. OBJECTIVE: We examined the risk of fetal death in relation to maternal residential proximity to hazardous waste sites. METHODS: We conducted a population-based case-control study using Washington State vital records for 1987-2001. Cases were women with fetal deaths at > or = 20 weeks (n = 7,054). Ten controls per case were randomly selected from live births. Locations of 939 hazardous waste sites were identified from the Department of Ecology registry. We measured distance from maternal residence at delivery to the nearest hazardous waste site, and calculated odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS: The risk of fetal death for women residing < or = 0.5 miles, relative to > 5 miles, from a hazardous waste site was not increased (adjusted OR = 1.06; 95% CI, 0.90-1.25). No associations were observed for any proximity categories < or = 5 miles from sites with contaminated air, soil, water, solvents, or metals; however, fetal death risk increased among women residing < or = 1 mile from pesticide-containing sites (OR = 1.28; 95% CI, 1.13-1.46). CONCLUSION: These results do not suggest that fetal death is associated with residential proximity to hazardous waste sites overall; however, close proximity to pesticide-containing sites may increase the risk of fetal death.     

Fetal alcohol syndrome: dashed hopes, damaged lives

Since the term was coined about 40 years ago, fetal alcohol syndrome has slowly become recognized as a public health issue. Alicestine October reports from South Africa's Western Cape province, which has the highest reported rate in the world.     

Fetal alcohol syndrome: the origins of a moral panic

Since its discovery almost 30 years ago, the fetal alcohol syndrome (FAS) has been characterized in the USA, as a major threat to public health. In part because FAS resonated with broader social concerns in the 1970s and 1980s about alcohol's deleterious effect on American society and about a perceived increase in child abuse and neglect, it quickly achieved prominence as a social problem. In this paper, we demonstrate that, as concern about this social problem escalated beyond the level warranted by the existing evidence, FAS took on the status of a moral panic. Through examples taken from both the biomedical literature and the media about drinking during pregnancy, we illustrate the evolution of this development, and we describe its implications, particularly how it has contributed to a vapid public policy response.     

Fetal alcohol spectrum disorders: a Native American journey to prevention

Fetal alcohol spectrum disorders, the most common preventable cause for mental retardation, is the result of prenatal alcohol exposure. There is no safe amount of alcohol during pregnancy. Native Americans have a higher risk of alcohol abuse than the general U.S. population. The fetal alcohol spectrum disorders prevalence rates for Native Americans range from 1.0 to 8.97 per 1000 births. Nurses and health care providers working in collaboration with tribal fetal alcohol spectrum disorders prevention specialists can greatly, and positively, impact the physical and mental health and well-being of children in Native American communities.     

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.     

Completion rates of clients discharged from drug and alcohol treatment programs in Washington State.

OBJECTIVES. The primary goal of this study was to analyze completion rates of clients in drug and alcohol abuse treatment programs in Washington State and to assess the factors associated with treatment completion. A secondary goal was to examine the utility of a state information system as a source of evaluative data. METHODS. Analyses were conducted of 5827 client records contained in the Washington State Substance Abuse Monitoring System, representing a census of public clients discharged during the last quarter of 1990 from all state-funded alcohol and drug treatment programs in four treatment modalities. Logistic regression was performed to determine the independent predictors of treatment completion. RESULTS. Completion rates were highest for intensive inpatient alcohol treatment (75%) and lowest for intensive outpatient drug programs (18%). Factors associated with treatment completion included screening at a referral assessment center, education, age, ethnicity, and existence of a secondary drug problem. CONCLUSIONS. The fit between clients and treatment programs may be an important factor explaining why some clients complete treatment and others drop out. State client information systems are an important source of data for analyzing treatment completion and other outcomes.     

Occupational carpal tunnel syndrome in Washington State, 1984-1988.

BACKGROUND: There are no published population-based studies of occupational carpal tunnel syndrome (OCTS) using a strict case definition. Most studies are either industry specific or present patient self-report of symptoms. METHODS: We conducted a population-based incidence study of OCTS using the Washington State Workers' Compensation database. Incident OCTS claims were identified with paid bills for physician reported ICD codes 354.0 and 354.1. RESULTS: There were 7,926 incident OCTS claims identified for the years 1984-1988, which yields an industry-wide incidence rate of 1.74 claims/1,000 FTEs. The mean age (37.4 years) and female/male ratio (1.2:1) in this population differ from those reported in nonoccupational carpal tunnel studies (mean age, 51 years; female/male ratio, 3:1). The female-specific OCTS incidence rate increased significantly during the study period. The highest industry specific OCTS rates were found in the food processing, carpentry, egg production, wood products, and logging industries. CONCLUSION: Demographic differences and industry-specific rates consistent with workplace exposures suggest that OCTS is distinct from CTS occurring in nonoccupational settings. Workers' compensation data proved useful in identifying high risk industries.     

The economic burden of carpal tunnel syndrome: long-term earnings of CTS claimants in Washington State

BACKGROUND: The long-term earnings losses borne by injured workers, beyond those covered by workers' compensation insurance, are rarely estimated. The post-claim earnings of a cohort of carpal tunnel syndrome (CTS) claimants are tracked over a period of 6 years and compared to the earnings of claimants with either upper extremity fractures or dermatitis. METHODS: Quarterly earnings records of 4,443 workers in Washington State who filed claims with the State Fund in 1993 or 1994 for CTS are compared to those of 2,544 with upper-extremity fracture claims and 1,773 with medical-only dermatitis claims. Multivariate regression was used to identify the effect of injury type on earnings from that of other potential predictors. RESULTS: CTS claimants recover to about half of their pre-injury earnings level relative to that of comparison groups after 6 years; they also endured periods on time-loss three times longer than claimants with upper extremity fractures. CTS surgery claimants had better outcomes than those who did not have surgery. Earnings recovery fractions among CTS claimants were better for workers who: (1) were younger; (2) had stable pre-claim employment; (3) lived in the Puget sound area; (4) worked for large businesses; (5) worked in non-construction/transportation industries; or (6) were in the higher pre-injury earnings categories. Cumulative excess loss of earnings of the 4,443 CTS claimants was 197 million dollars to 382 million dollars over 6 years, a loss of 45,000-89,000 dollars per claimant. This underscores the importance of prevention, early diagnosis, and accommodation for return to work.     

Fetal alcohol syndrome (FAS) primary prevention through FAS diagnosis: I. Identification of high-risk birth mothers through the diagnosis of their children

A 5-year, fetal alcohol syndrome (FAS) primary prevention study was conducted in Washington State to: (1) assess the feasibility of using a FAS diagnostic and prevention clinic as a centre for identifying and targeting primary prevention intervention to high-risk women (namely women who had given birth to a child with FAS); (2) generate a comprehensive, lifetime profile of these women; (3) identify factors that have enhanced and/or hindered their ability to achieve abstinence. The results of this study are presented in two parts: work on objective 1 is summarized in the present paper; whereas that on objectives 2 and 3 is summarized in the accompanying paper. This project demonstrated that a multidisciplinary FAS Diagnostic and Prevention Network (FAS DPN) clinic could successfully attract and meet the diagnostic and treatment planning needs of patients presenting with prenatal alcohol exposure. One out of every three patients evaluated in the FAS DPN clinics was diagnosed with FAS or static encephalopathy/alcohol exposed. The birth mothers of one out of every three 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, one 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. Primary prevention programmes targeted to this high-risk population could lead to measurable, cost-effective reductions in the incidence of FAS. Using this approach, the cost of raising a child with FAS would be roughly 30 times the cost of preventing FAS in the child. The benefit to the children, their mothers, and society would be immeasurable.