FAS Primary Prevention In a FAS Diagnostic Clinic
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Transcript of FAS Primary Prevention In a FAS Diagnostic Clinic
FAS Primary Prevention
In a FAS Diagnostic Clinic
Susan J. Astley, Ph.D.
Sterling K. Clarren, M.D.
Diane Bailey, M.N.
Christina Talbot, M.S.W.
Washington State
FAS Diagnostic and Prevention Network
(FAS DPN)
Primary Questions
1. What is the profile of this high-risk population?
2. What factors enhanced / hindered their ability to achieve sobriety and practice effective birth control?
Maternal Interview
3-4 hour personal interview (87% enrollment success)
Key topics
Sociodemographics (age, race, education)
Social support network
Lifetime adverse events
Mental health profile
Alcohol use and treatment history
Family planning history and preferences
Primary Questions
Age Mean Min-Max
At first drink 15 7 - 30
At maximum drinking 23 10 - 41
At first attempt to stop 26 14 - 47
At birth of child with FAS 27 18 - 41
At most successful sobriety 31 20 - 52
At diagnosis of child with FAS 35 21 - 52
At interview 38 23 - 55
Maternal Age at Key Events (n = 80)
11
60
26
3 00
10
20
30
40
50
60
Pe
rce
nt
17-19 20-29 30-39 40 50-55
Age (years)
Age (years) of Mother at Birth of Child with FAS (n = 80)
0
18
51
22
9
0
10
20
30
40
50
60
Pe
rce
nt
17-19 20-29 30-39 40-49 50-55
Age (years)
Age (years) of Birth Mother at Interview (n = 80)
Maternal Age
54
19
61
0
10
20
30
40
50
60
Nu
mb
er
Caucasian Amer/CanNative
Afr. Amer. Hispanic
Race / Ethnicity (n = 80)
18
31
11
17
3
0
10
20
30
40
Nu
mb
er
<= 8 9-11 12 13-16 >16
Highest Grade Completed
Education (n = 80)
Maternal Race, Education
1
10
28
33
24
4
0
10
20
30
40
Per
cen
t
57-60 61-69 70-85 86-100 101-115 116-120
IQ
Etimated IQ from Shipley (WAIS-R) (n = 72)
Maternal IQ
Childhood, Adult and Lifetime Abuse (n = 80)
0 20 40 60 80 100
sexual
physical
emotional
any abuse
Percent
Lifetime
Adult
Child
Lifetime Abuse of Mother
Lifetime Mental Health Disorders and Age at Onset (n = 79)
0 10 20 30 40 50 60 70 80 90
Schizophrenia
Bulimia
Panic
Manic
Generalized Anxiety
Phobia - Agora
Antisocial Personality
Phobia - Social
Phobia - Simple
Major Depression
Post Traumatic Stress
Alcohol Dependence
Percent
19 yrs
18 yrs
18
11
13
14
22
20
18
21
22
220
Maternal Mental Health
4 4
11
1716
7
15
10
8
4 4
0
5
10
15
20
Per
cen
t
0 1 2 3 4 5 6 7 8 9 10
Number of Mental Health Disorders per Woman
Maternal Mental Health
N %
Childhood (0 - 8 years) 33 (45 %)
Adolescent (9 - 17 years) 31 (42 %)
Adult (18+ years) 10 (14 %)
Earliest Age of Onset of Mental Health Disorder
Maternal Lifetime Drug Use (n = 80)
80
63
64
44
39
35
23
20
16
11
8
49
0 20 40 60 80
Marijuana
cocaine/crack
Speed/amphetamines
pain killers
LSD
tranquilizers
barbituates
heroin/opiates
PCP
Quaaludes
Methadone
None
Drugs
Percent
Maternal Drug Use
Reasons For Not Wanting To Reduce Alcohol Use (n = 80)
0 10 20 30 40 50 60 70 80 90 100
Family unsupportive
Partner unsupportive
Did not think it would help
Alcohol not a problem
In abusive relationship
Uncomfortable about alc problem
Too depressed
Alc helped her cope
Percent
Why she did not want to reduce alcohol use
Reasons for not Seeking Treatment (n = 44)
0 10 20 30 40 50 60 70 80 90 100
Family not supportive
Bad past experience
Afraid of losing house
Too far to travel
Pregnant, lose custody
Heard bad things about treat.
No access
No insurance
Too expensive
Partner not supportive
Afraid she'd lose kids
No one to care for kids
Did not want to stop
Percent
Why she did not seek Alcohol Treatment
mean maximum
Proportion of Pregnancies/woman
Unplanned 77 % 100 %
No birth control 81 % 100 %
Exposed to alcohol 73 % 100 %
Reproductive History
Preferred Method of Birth Control (n = 80)
0 5 10 15 20 25 30 35
Depo provera
Norplant
tubal ligation
the pill
no method
condom
IUD
foam
cervical cap
vasectomy
rhythm
diaphragm
abortion
Proportion
Maternal Contraceptive Preference
45
14 14
5
1
0
10
20
30
40
50N
um
be
r o
f W
om
en
Number of Children born after Index Child with FAS
Number of Children Born after Index Child with FAS (n = 80)
Total of 61 children born75% alcohol exposed80% no birth control
6+ with FAS
6
22
19
15
10
3 32
0
6
12
18
24
Nu
mb
er
of
Wo
me
n
Parity
Parity at time of Interview (n = 80)
Total of 272 children born
Children At Risk
21
35
23
9
53 3
1
0
10
20
30
40P
erc
en
t
1 2 3 4 5 6 7 8
Parity
Parity of Index Child with FAS (n = 80)
Parity of Child with FAS
Abstinent at Time of Interview
Yes (n=50) No (n=25)
Mean IQ 96 82Married 52 % 44 %
Low Income: yearly income less than $10,000 50 % 76 %
Reported a religious affiliation 72 % 44 %
Parents had a problem with alcohol use 88 % 64 %
Most # of drinks/occasion prior to pregnancy 34 17
Mean # of individuals in social support network 17 11
Mean # of mental health disorders per woman 5 5
Received mental health treatment* 52 % 26 %
Significant Contrasts Between Women Who Had And Had Not Achieved Abstinence
This study suggested women were more successful at
stopping drinking ( 75 %) than avoiding unintended pregnancy ( 22 %).
30 years after US Supreme Court legalized contraception
• 57 % of U.S. pregnancies unintended (Forrest ‘94)
• 78 % pregnancies unintended in women with FAS kids
May be due in part to lack of access to contraception.
1998 WA State Survey of Health Insurance Plans
• Only 30 % paid for contraception.
• 77 % paid for abortions
• 4 out of 5 women did not have contraceptive coverage
Unintended Pregnancies
1992 Survey of 79 King County Alcohol/Drug Treatment Agencies
33 % of clientele were women
54 % had no medical or MH services
84 % had no on-site child care
44 % had no on-site recovery support groups
Among 80 birth mothers of children with FAS
• 96 % had mental health disorders.
• Those who received MH treatment more likely to achieve abstinence.
• 70 % had children.
• Those who entered support groups more likely to achieve abstinence.
Treatment for Alcoholism