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Transcript
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 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 Maternal Age at Key Events (n = 80) 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 Age (years) of Mother at Birth of Child with FAS (n = 80) 60 60 40 26 30 20 11 10 3 0 0 17-19 20-29 30-39 40 50-55 Age (years) Age (years) of Birth Mother at Interview (n = 80) 60 51 50 Percent Percent 50 40 30 20 10 22 18 9 0 0 17-19 20-29 30-39 Age (years) 40-49 50-55 Maternal Race, Education Race / Ethnicity (n = 80) 60 54 40 30 19 20 6 10 1 0 Caucasian Amer/Can Native Afr. Amer. Hispanic Education (n = 80) 40 31 Number Number 50 30 20 18 17 11 10 3 0 <= 8 9-11 12 13-16 Highest Grade Completed >16 Maternal IQ Etimated IQ from Shipley (WAIS-R) (n = 72) 40 33 28 Percent 30 24 20 10 10 4 1 0 57-60 61-69 70-85 86-100 101-115 116-120 IQ Lifetime Abuse of Mother Childhood, Adult and Lifetime Abuse (n = 80) any abuse emotional Lifetime Adult Child physical sexual 0 20 40 60 Percent 80 100 Maternal Mental Health Lifetime Mental Health Disorders and Age at Onset (n = 79) Alcohol Dependence 19 yrs Post Traumatic Stress 18 yrs 18 Major Depression Phobia - Simple 11 Phobia - Social 13 Antisocial Personality 14 Phobia - Agora 22 Generalized Anxiety 20 Manic 18 Panic 21 Bulimia 22 Schizophrenia 2 20 0 10 20 30 40 50 Percent 60 70 80 90 Maternal Mental Health 20 17 16 15 Percent 15 11 10 10 8 7 5 0 4 0 4 1 2 3 4 5 6 7 8 4 4 9 10 Number of Mental Health Disorders per Woman Earliest Age of Onset of Mental Health Disorder N % Childhood (0 - 8 years) 33 (45 %) Adolescent (9 - 17 years) 31 (42 %) Adult (18+ years) 10 (14 %) Maternal Drug Use Maternal Lifetime Drug Use (n = 80) None 8 Methadone 11 Quaaludes 16 PCP 20 heroin/opiates 23 barbituates Drugs 35 tranquilizers 39 LSD 44 pain killers 49 Speed/amphetamines 64 cocaine/crack 63 Marijuana 80 0 20 40 Percent 60 80 Why she did not want to reduce alcohol use Reasons For Not Wanting To Reduce Alcohol Use (n = 80) Alc helped her cope Too depressed Uncomfortable about alc problem In abusive relationship Alcohol not a problem Did not think it would help Partner unsupportive Family unsupportive 0 10 20 30 40 50 60 Percent 70 80 90 100 Why she did not seek Alcohol Treatment Reasons for not Seeking Treatment (n = 44) Did not want to stop No one to care for kids Afraid she'd lose kids Partner not supportive Too expensive No insurance No access Heard bad things about treat. Pregnant, lose custody Too far to travel Afraid of losing house Bad past experience Family not supportive 0 10 20 30 40 50 60 Percent 70 80 90 100 Reproductive History Proportion of Pregnancies/woman Unplanned No birth control Exposed to alcohol mean maximum 77 % 81 % 73 % 100 % 100 % 100 % Maternal Contraceptive Preference Preferred Method of Birth Control (n = 80) abortion diaphragm rhythm vasectomy cervical cap foam IUD condom no method the pill tubal ligation Norplant Depo provera 0 5 10 15 20 Proportion 25 30 35 Children At Risk Parity at time of Interview (n = 80) 22 24 Total of 272 children born 18 15 10 12 6 6 3 3 6 7 2 0 1 2 3 4 5 8 Parity Number of Children Born after Index Child with FAS (n = 80) 50 Number of Women Number of Women 19 Total of 61 children born 75% alcohol exposed 80% no birth control 6+ with FAS 45 40 30 20 14 14 10 5 1 0 0 1 2 3 4 Number of Children born after Index Child with FAS Parity of Child with FAS Parity of Index Child with FAS (n = 80) 40 35 Percent 30 23 21 20 9 10 0 5 1 2 3 4 5 Parity 3 6 3 7 1 8 Significant Contrasts Between Women Who Had And Had Not Achieved Abstinence Abstinent at Time of Interview Yes (n=50) No (n=25) Mean IQ Married 96 52 % 82 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 52 % 26 % Received mental health treatment* Unintended Pregnancies 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 Treatment for Alcoholism 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.