Transcript Image Analysis

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.