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Transcript of Larissa Tsvetkova, PhD Vice Dean, St. Petersburg State University The First U.S.-Russia Scientific...
Prevention of alcohol exposed pregnancies
Larissa Tsvetkova, PhDVice Dean, St. Petersburg State University
The First U.S.-Russia Scientific Forum for Biomedical and Behavioral Research
TheUniversity of OklahomaHealth Sciences Center
OU St. Petersburg State UniversityNizhny Novgorod State Pedagogical University
Nizhny Novgorod State Pedagogical University
Supported by Research Grants R21 TW006745 Brain Disorders in the Developing World: Research Across the Lifespan and R01AA016234, NIH/NIAAA/Fogarty Center and AUCD/CDC Grants RTOI 2005-999-01 and RTOI 2007-999-02 to Bonner and Balachova, OUHSC
Prevent FAS Research Team
University of Oklahoma Health Sciences CenterTatiana Balachova, PhDBarbara Bonner, PhDMark Chaffin, PhD
St. Petersburg State University, Russia
Larissa Tsvetkova, PhD
Galina Isurina, PhD
Vladimir Shapkaitz, MD, PhD, Academy of Pediatrics
Alexander Palchik , MD, PhD, Academy of Pediatrics
Nizhny Novgorod State Pedagogical University
Elena Volkova, PhD
Data Collectors in St. Petersburg and Nizhniy Novgorod
Consultants
Karen Beckman, MD, OUHSC
Jacquelyn Bertrand, PhD, CDC
Vladimir Shapkaitz, MD, PhD, Academy of Pediatrics
Oleg Erishev, MD, PhD, Bekhterev Institute, St. Petersburg
Alexander Palchick, MD, PhD, Academy of Pediatrics
Edward Riley, PhD, San Diego State University
Vladimir Shapkaitz, MD, PhD, Academy of Pediatrics
Linda Sobell, PhD, Nova Southeastern University
Michael Fleming, MD, MPH, University of Wisconsin
Advisory Board
Sheldon Levy, MPH, PhD, University of Miami
John Mulvihill, MD, OUHSC
Edward Riley, PhD, San Diego State University
Kevin Rudeen, PhD, OUHSC
Mark Wolraich, MD, OUHSC
Elena Varavikova, MD, PhD, MPH,,CNIOIZ, Russia
Developing FASD prevention: International collaboration
Phase I: Preventing FAS/ARND in Russian Children, 2003-2007Supported by Grant R21 TW006745 Brain Disorders in the
Developing World: Research Across the Lifespan, NIH Fogarty International Center/NAAA to Barbara Bonner at OUHSC
Phase II: Development of Education Materials for Prevention of FAS in Russia, 2005-2007, supported by Research Grant RTOI 2005-999-01 AUCD/CDC to Barbara Bonner at OUHSC
Health of Children in Russia: Providing Education on FAS/FASD, 2007-2008, supported by Research Grant RTOI
2007-999-02 AUCD/CDC, to Tatiana Balachova at OUHSC
Phase III: Preventing FAS/ARND in Russian Children, 2007-2012 supported by Research Grant R01AA016234 NIAAA/Fogarty International Center to Tatiana Balachova at OUHSC
Phase I
Objective
Assess knowledge, attitudes, drinking behaviors,
and receptivity to prevention necessary for
developing a FAS/ARND primary prevention
program in Russia
Phase I: study design
Sample Focus groups in spring 2004
7 groups of women, partners, women with alcohol dependency substance abuse treatment physicians, OBGs, Pediatricians (N=51)
Survey with 851 participants from St. Petersburg (SPB)and the Nizhniy Novgorod region (NNR) in fall 2004 - spring 2005 648 women recruited at women’s clinics:
301 pregnant and 347 non-pregnant 203 physicians recruited at continuing education
courses: 100 OBGs and 103 pediatricians
Results: Any alcohol use
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Nonpregnant,N=347
Pregnant, N=301 Might becomepregnant, N=469
Trying toconceive, N=222
Proportion
SPB
NNR
(Balachova et al., 2007)
Russia: Binge drinking
0.55
0.660.61
0.28
0.77 0.770.72
0.47
0.060.021
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
Nonpregnant,N=347
Pregnant,N=301
Might becomepregnant,N=469
Trying toconceive,N=222
Proportion SPB, any last 3 monthsSPB, once/month & more NNR, any last 3 monthNNR, once/month & more
p<0.05 (Balachova et al., 2007)
Women At-risk for AEP
13%
21%24%
9%5%
8%2%
32%
54%
0%
10%
20%
30%
40%
50%
60%
Total Jail RecoveryCenters
GYNClinic
HealthCenters
MediaSample
General Population
Russia,SPB
Russia,NNR
(Project CHOICES Research Group, 2002)(Prevent FAS in Russia Research group, 2007)
Alarmingly high risk for AEP among nonpregnant women
After pregnancy recognition, a decline in consumption
Interventions by OBGs may be influential in preventing AEP
Physicians have limited knowledge and
Training for physicians and education materials for women were not available
Phase I: Results
Photo courtesy of Dr. Bertrand
Phase II: Developing education materials for FASD prevention
Objectives
Develop education materials for women and training for health professionals in Russia
Evaluate training materials in randomized trials
Develop and evaluate a web-based FASD education resource in the Russian language- for public (target women of childbearing age) and - for health professionals
Phase II: Developing training for health professionals
Review medical schools and CME curricula to identify existing FASD training
Translate the FAS Curriculum Framework and the Instructional Resource Handbook
Review FASD materials available in Russia
Select and translate additional training and reading materials on FASD
Adapt and modify available materials to develop a curriculum for health professionals in Russia
Train the trainers: Train the Russian project faculty
Education materials: FAS Diagnosis
Astley, 2004
Russian translation by Balachova & Palchik (Prevent FAS in Russia Research Group)
http://depts.washington.edu/fadu/International.html
Lip-Philtrum Guide
Education materials: Dual-focused Brief Physician Intervention (DFBPI)
Adaptation of two evidence-based FASD prevention approaches: Brief physician intervention (Fleming & Mundt, 2006;
NIAAA1999, 2005) and Project CHOICES a motivational dual-focused
intervention (Floyd et al., 2007) If a woman is pregnant or planning pregnancy:
The goal is abstaining from alcohol If a woman is not contracepting consistently:
the goal depends on the woman’s choice:1) reducing alcohol consumption or/and2) delaying pregnancy/contraception
“If you wish to have a baby, don’t drink; if you drink, don’t have a baby!”
(FAS-Russia study participant , 2005)
Randomized trials
Sample 138 physicians (73 pediatricians and 65 OBGYN)
from throughout Russia were recruited at a CME program at St. Petersburg Pediatric Academy in 2006-2008
Procedures Groups of physicians (6 groups of pediatricians
and 8 groups of OBGYN) were randomly assigned to intervention or control conditions Participants in the experimental groups (EG)
received a 3-hour training module on FASD Participants in the control groups (CG) received a
regular CME course both groups received the same number of CME
Training included 1) presentations on FASD foundation competencies and 2) practicum in FAS diagnosis (pediatricians) or training in a brief intervention protocol (OBGYN)
Phase II: Developing education materials for women
Focus groups to design brochures
Sample: 35 women of childbearing age were recruited from public women’s clinics in St. Petersburg and Nizhniy Novgorod
Evaluate brochures in a randomized trial
Randomly assigned to 1 of 3 groups:
Review the FAS prevention brochure with positive images (N=140),
Review the FAS prevention brochure with negative images (N=140),
Review a health material that is available at local clinics (N=140).
Following the intervention, women complete a brief questionnaire
One-month follow-up
Fetal Alcohol Syndrome Fasstar Information Series Brochure 0201B1
FAS and the
Brain
(Photo courtesy of Sterling Clarren, MD)
Brain of normal baby Brain of baby with FAS
How Prenatal Alcohol Exposure Affects
Development of the Brain By Teresa Kellerman
Fasstar Enterprises Fetal Alcohol Syndrome: Support, Training, Advocacy, & Resources
www.fasstar.com
Conclusions
The 3-hour FASD education modules included in CME for OBGYN and pediatricians were effective in improving physicians’ knowledge, attitudes, and targeted skills
OBGYN significantly increased their competence and skills in conducting the dual-focused brief intervention
FASD education brochures were effective in improving women’s knowledge and attitudes
Phase II : FASD Education website in Russian
The FASD education website for the general public
Internet-based FASD education for health professionals
http://NetFas.net/pro
http://NetFAS.net
Phase III: Reducing risk of alcohol-exposed pregnancies in childbearing age women
764 participants in two regions
enrollment completed ongoing follow-up:
3,6, and 12 months
A two-arm, 20-site, site-randomized clinical trial
Evaluate DFBPI at OBGYN clinics
Building Research Capacity
Research seminars, lectures for faculty and students, train-the-trainer workshops
Human Subject Protection Training to SPSU and NNSPU faculty and students Established Behavioral IRB at SPSU Training and consultation to the IRB
Ongoing research supervision; weekly SKYPE meeting
Graduate psychology students participate in research activities
PhD students serve as coordinators on the study Five PHD dissertations are in progress Master thesis are being completed Presentations at professional meetings Publications are in progress New collaborations with researchers from
other universities have been initiated
Conclusions
FAS/ARND is a major public health problem in Russia
Women and professionals readily participate in research
International collaboration in research is challenging but productive