Substance-Exposed Pregnancy Prevention: An Environmental Scan of Local Health Department Practices...
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Transcript of Substance-Exposed Pregnancy Prevention: An Environmental Scan of Local Health Department Practices...
Substance-Exposed Pregnancy Prevention:
An Environmental Scan of Local Health Department Practices
Molly Schlife, MPH
Floyd RL, Jack BW, Cefalo R, Atrash H, Mahoney J, Herron A, Husten C, Sokol RJ. The clinical content of preconception care: Alcohol, tobacco, and illicit drug exposures.
American Journal of Obstetrics and Gynecology 2008; 199(6):S333-S339.
• 16.5% of pregnant women (and 29.5% of non-pregnant women of reproductive age) reported tobacco use
• 11.8% of pregnant women (and 53% non-pregnant women of reproductive age) reported alcohol use
• 4% of pregnant women (and 10% of non-pregnant women of reproductive age) reported using illicit drugs
Key Questions
• What are local health departments and their community partners doing to address the problem of substance-exposed pregnancies?
• What opportunities exist to expand the use of existing effective interventions and develop new interventions?
Definitions
"Substance-exposed pregnancies” (SEPs) are defined as those that include prenatal exposure to:
• alcohol • tobacco • illicit drugs and/or • prescription drugs (misused/abused)
• increasing community knowledge and awareness of the risks of substance use before and during pregnancy;
• decreasing unintended pregnancies among women who use substances;
• increasing health care and social service provider knowledge and improving practices around substance use screening and brief intervention;
• increasing public health department involvement in prevention activities.
SEP Prevention activities include those aimed at:
Methods
• An environmental scan/survey was developed• 136 MCH leaders in urban local health
departments contacted (April-May 2011)• 59 responses received• Response rate = 43%
Who responded?
Is SEP a problem in your community?
70%
19%
11%
Yes, a big problem
Yes, a small problem
No, not a problem
Don't know
Considers SEP Prevention a priority
55%31%
9%5%
Top 5
Top 10
Top 20
Not on radar
Perceived Readiness to Prevent SEPs
5%
15%
39%
41% Not ready at all
Not very ready
Somewhat ready
Very ready
What substances are you addressing?
9689
7873
64 6460
0
20
40
60
80
100
120
Tobacco Alcohol Marijuana Cocaine/crack cocaine
Heroin/other narcotics
Meth Perscription drugs (misused)
%
Funding Sources Used for SEP Prevention Activities?
64
4540
2519
11 9 7 6 6 50
10
20
30
40
50
60
70
%
*Respondent can check all that apply
Consumer groups targeted
93
61 59
45
36 34
70
10
20
30
40
50
60
70
80
90
100
Pregnant women
Women of reproductive
age at high risk
All women of Reproductive
age
Adolescents General Public Men/fathers Other
%
*Respondent can check all that apply
SEP Prevention Activities
• Individual Interventions with Women at Risk for SEPs – Project CHOICES, Intensive Case Management, counseling services provided by
LCSWs, Community Health Workers and Substance Abuse Counselors
• Pre/inter-conceptual Programs– Education for high risk newly delivered (interconceptual) women, preconception
peer education, birth control for at risk youth; tobacco and substance abuse screening in school-based health centers
• Collaboration/Coordination– Working with providers/hospitals who serve higher risk groups, Human Services,
family planning, Children Services, community SA treatment providers– Coordination of referrals (especially with high risk women seen by WIC or in STD
clinics) coordinating/participating on multiple Task Forces/Coalitions
Are you well-equipped in terms of…
2
8
10
20
42
46
60
50
56
46
30
30
0 10 20 30 40 50 60 70
Training
Time
Funding
Data
Yes No Don't know
%
Which programs include SEP prevention activities?
84
6055
42
15
90
10
20
30
40
50
60
70
80
90
Prenatal/maternal health services
Family planning/Reproductive
health
Teen pregnancy prevention/adolescent
sexual health
STD clinic services Other (SA recovery programs, WIC, NFP)
Don't know
%
*Respondent can check all that apply
Who is the lead organization coordinating SEP prevention activities?
13%
62%
23%
2%
Your agency
There is no lead
Another organization
Don't know
Implications (overall)
•Better understanding of current public health practice in the area of substance exposed pregnancies;
•Understanding priorities in this area at the local level
•Identification of needs in this area
•Help inform planning of future collaborative efforts
Implications for Preconception Health
• Opportunity for LHD leadership coordination role (e.g., data needs, programs, policy levers)
• Potential for bundling of substance use screening and intervention activities
• How to incorporate these issues into a broad women’s health umbrella?
Limitations
• Low response rate
• Self-reporting
• Geographic limitations
•Development of capacity-building opportunities for local health departments
•Promotion of increased community and clinical collaboration to reduce substance-exposed pregnancies
•Additional data analysis performed and a summary report disseminated (Fall 2011)
Acknowledgements
R. Louise Floyd, DSN, RNTeam Leader, FAS Prevention Team
Joe Sniezek, MD, MPHChief, Prevention Research Branch
Mary Kate Weber, MPHPublic Health AnalystPrevention Research Branch
Molly Schlife, MPHProject Coordinator
Katie Brandert, MPH, CHESActing Associate Director of Programs
Laurin Kasehagen Robinson, MA, PhDSenior CDC MCH EpidemiologistAssignee to CityMatCHAdjunct Assistant Professor in Pediatrics
Contact for more information
Molly Schlife, MPHProject Coordinator, CityMatCH
(402)[email protected]