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An Overview of CDC’s FASD
Prevention & Intervention Efforts:
Resources You Can Use
FASD: Best Practices in the Last Frontier
Anchorage, Alaska
May 23, 2013
Claire M. Marchetta, MPH
Nancy Cheal, MS, PhD
Elizabeth P. Dang, MPH
National Center on Birth Defects and Developmental Disabilities
Fetal Alcohol Syndrome Prevention Team
What ’s new?
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Data
Prevention and Intervention
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Health promotion/education
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Data
NSFG
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National fertility survey for the US
 Women 18-44 years old
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NCBDDD is a supporting agency of the National Survey of
Family Growth and serves as one of its funders
The collaboration with the NSFG Team (National Center for
Health Statistics—NCHS) gives NCBDDD an opportunity to
assess AEP risk among U.S. women of childbearing age
Questions are based off of BRFSS core alcohol questions
Currently being collected
BRFSS
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Development of new question module
 2014 BRFSS
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Questions focus on alcohol screening and brief
intervention
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If a doctor/HC professional asked about alcohol use
If you were asked how much you drink (in general/per occasion)
If you were offered advice about what’s harmful/risky
If you were advised to reduce your drinking
Public use data
 By state
 Aggregated to represent the US population
Alcohol Use and Binge Drinking among Women of
Childbearing Age - United States, 2006-2010
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7.6% of pregnant women and 51% of nonpregnant
women reported drinking alcohol in the past 30 days
Among pregnant women, the highest estimates
of use were among those who were:
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Aged 35-44 years (14.3%)
White (8.3%)
College graduates (10.0%)
Employed (9.6%)
1.4% of pregnant women and 15.0% of nonpregnant women
reported binge drinking in the past 30 days
Among pregnant and nonpregnant binge drinkers:
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Average frequency: ~ 3 times per month
Average intensity: ~ 6 drinks per occasion
Vital Signs: Binge Drinking Among Women and
High School Girls — United States, 2011
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Among w om en ≥18 years
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Among high school girls
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Prevalence:12.5% (1 in 8)
Frequency: 3.2 episodes/month
Intensity: 5.7 drinks on occasion
Prevalence: 20% (1 in 5)
Who is most likely to binge drink?
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Women aged 18-34 years and high school girls
Whites and Hispanics
Women with household incomes about $75,000
FASNet II Surveillance
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3 funded sites (2009-2015)
 Western New York
 Metropolitan Denver
 Arizona
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Records based system
 Hospital
 Medical
 FASD diagnostic clinics
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Point prevalence (2010)
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Ages 7-9 years of age
 Prevalence estimates anticipated 2014
Prevention Status Report: Excessive Alcohol Use
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10 important health topics
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JULY: Healthcare-associated Infections, Tobacco Use
AUGUST: Prescription Drug Overdose, Food Safety
SEPTEMBER: Heart Disease and Stroke
OCTOBER: Excessive Alcohol Use; HIV; Motor Vehicle Injuries;
Nutrition, Physical Activity, and Obesity; Teen Pregnancy
The Public Health Problem
Policy and Practice Solutions
Status of Policy and Practice Solutions, by state
 Rating: Green, Yellow, Red
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Indicator definitions
Prevention & Intervention
CHOICES Implementation Efforts
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Sexually Transmitted Diseases (STD) clinics
 Baltimore City Health Department
 CO Department of Health & Environment/Denver Health
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Family Planning/Community Health Centers
 AltaMed Corporation in LA (3 clinics)
 New York Health and Hospital Corporation in NYC (4 clinics)
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Oglala Sioux Tribe in South Dakota
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Choices Plus (Choices + smoking cessation)
 University of Texas at Austin
CHOICES: Expanding Availabilit y of Resources
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www.cdc.gov/fasd “Free Materials” link
Counselor Manual
Client Workbook
Assessment Tools
Training Curriculum
Training videos
Web page (TBD)
ToT curriculum
Making (and Understanding) the Case
for Alcohol Screening
and Brief Intervention (SBI)
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Initial “Demand” meeting on August 14, 2012 in Atlanta GA
Meeting Purposes:
 Better understand how best to “make the case” for alcohol SBI
 Identify which organizations would support implementation of a
new policy/health program advancing alcohol SBI within primary
care settings and find out what they would need
 Is a public-private partnership the right approach?
 Next steps for ongoing dialogue about how to advance alcohol SBI
Insights from the Demand Side
Key Themes
Potential Next Steps
Awareness about risky drinking
Explore issues around
communication/messaging
Integration/bundling of services
Address data issues
Better data needed
Not just physicians/electronic
SBI
Demonstration projects
(provider/insurer/business)
Engage professional groups
Coordinated efforts
Support SBI demonstration
projects from the
insurer/business perspective
Increase engagement of
professional groups
Strengthen federal linkages
related to SBI
Alcohol Screening and Brief Intervention:
Practice Implications
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Work with Providers
 October 29, 2012 meeting with SAMHSA’s
SBIRT Residency Program Representatives
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Work with RTCs
 Funded pilot projects
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Develop Implementation Guides
Alcohol SBI Implementation Guides
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Primary Care
 Adapted from SBI for Unhealthy Alcohol Use: A Step-by-Step
Implementation Guide for Trauma Centers
 Currently being piloted/evaluated through FASD Regional Training
Centers
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Ob-gyn settings
 Through ACOG contract
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Pediatric settings serving adolescents
 Exploring with AAP
Advancing Alcohol SBI & CHOICES in
American Indian and Alaska Native Populations
through Training & Technical Assistance
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Focus is on building capacity in 2 organizations to provide
Training and TA to clinics serving AI/AN clients
Clinics will offer CHOICES and alcohol SBI
Each funded organization will work with 3 primary care
clinics
Clinics will screen all men and women and provide
appropriate intervention
Intervention Activities for Children & Youth
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Interventions for Children with FASDs
Intervening with Youth and Young Adults with FASDs
Collaboration with ACF
Interventions for Children with FASDs
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MILE
Emory University
www.psychiatry.emory.edu/PROGRAMS/GADrug
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PACT
Children’s Research Triangle
www.childstudy.org
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Good Buddies
U. of California, Los Angeles
www.semel.ucla.edu/fas/
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Families Moving Forward
Children’s Hospital, Seattle
http://depts.washington.edu/fmffasd
Intervening with Youth
and Young Adults with FASDs
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Purpose: to support innovative research of
interventions for youth and young adults (aged 12-25
years) with FASDs
 Randomized control design (at least 50 per group)
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Funded: UCLA and Saint Louis University
 UCLA – targets alcohol misuse/abuse
 SLU – targets externalizing behaviors & life skills
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Studies wrapping up
Collaboration with
Administration for Children & Families
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Identification of national datasets that may facilitate determining
the burden of FASDs and DDs in foster/adoptive care settings
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Capitalize on ACF informational channels to disseminate
information on FASDs and LTSAE to foster/adoptive and child
welfare agencies and regions
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Assistance with electronic version (and subsequent validation of )
the Survey of Wellbeing in Young Children (SWYC), a public use
(i.e., no cost) developmental screener. Working to include
questions on prenatal exposures.
Health Promotion and Education
FASD Regional Training Centers (RTCs)
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Purpose: to educate medical and allied health students and
practitioners in the prevention, identification, and treatment of FASDs
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Current funding cycle (2011-2014)
 5 cooperative agreements
 Core training activities
 3 RTCs implementing alcohol SBI in primary
care systems
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Data Collection
 2008-2011
• Conducted 724 trainings/events
• Reached 7,140 students/residents and 10,631 health care professionals
 Knowledge, comfort, self-efficacy, practice behaviors
FASD Regional Training Centers,
2011-2014
Washington
Montana
Vermont
Minnesota
North Dakota
Maine
Michigan
Oregon
New
Hampshire
Wisconsin
Massachusetts
South Dakota
Idaho
New York
Wyoming
Michigan
Rhode Island
Pennsylvania
Iowa
Nebraska
New Jersey
Nevada
Indiana
Ohio
DC
Delaware
Illinois
Utah
West
Virginia
Colorado
California
Kansas
Missouri
Maryland
Virginia
Kentucky
North Carolina
Tennessee
Oklahoma
Arizona
Arkansas
South
Carolina
New Mexico
Mississippi
Georgia
Alabama
Texas
Louisiana
Alaska
Florida
Arctic RTC, Univ of Alaska Anchorage
Midwestern RTC, Univ of Missouri
Hawaii
Connecticut
Great Lakes RTC, Univ of Wisconsin
Southeastern RTC, Meharry Medical College
Frontier RTC, Univ of Nevada Reno
FASD RTCs: SBI implementation projects
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Southeast FASD RTC (Tennessee)
 2 Meharry Medical College Family Medicine Clinics (FMCs)
• Skyline and Meharry FMCs
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Frontier FASD RTC (Nevada)
 University Health System, University of Nevada School of Medicine
• Women’s Health Care Center & Patient Care Center (Las Vegas)
• Family Medical Center, Student Health Center,
Student Outreach Center (Reno)
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Arctic FASD RTC (Alaska)
 State of Alaska, Section of Public Health Nursing
• Fairbanks
• Ketchikan
• Mat-Su/Wasilla
FASD RTCs : SBI implementation projects (cont ’d)
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Incorporate alcohol SBI into day-to-day clinical
practice
Identify barriers and facilitators to implementation
Identify methods to overcome/create solutions to
barriers
Evaluate uptake of alcohol SBI in the
implementation sites
Evaluate the primary care SBI implementation
guide
American Academy of Pediatrics
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CDC is working with AAP on a variety of activities:
 Professional education materials to inform pediatricians about
prevention, identification, and treatment of children with FASDs
 PediaLink online training course
 AAP FASD Toolkit – www.aap.org/fasd
 Visiting Professorship Program – connection with FASD Regional
Training Centers (5 AAP chapters in 2013)
 FASD Risk Communication Workshop / Joint Call to Action
 Information dissemination to members through AAP OnCall,
AAP SmartBriefs, and AAP News
 ARND work group
 Alcohol SBI for adolescents work group
American College of
Obstetricians and Gynecologists
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2010-2011: Worked with ACOG to:
 Assess the 2006 FASD Prevention Toolkit
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Resulted in new resources for women’s
health care providers
 New website: www.womenandalcohol.org
 Resources include:
• Pocket card
• Cell phone app on screening/brief intervention
• ACOG Committee Opinion on At Risk Alcohol Use
 Tips for working with women who drink….and more
NOFAS Clearinghouse & Media Center
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Four-year cooperative agreement (2010-2014) with
NOFAS:
 Enhance/expand the NOFAS National & State Resource Directory
 Engage/enhance affiliate and stakeholder networks
 Enhance/expand the NOFAS Information Clearinghouse and
disseminate resources/materials
 Conduct media outreach
 New in 2013:
• Develop plan to engage AI/AN
communities re: dissemination of CHOICES
• Promote evidence-based interventions for
children with FASDs
Messages & Materials for Women:
Alcohol Use in Pregnancy
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Conducted formative research to explore women’s
knowledge and beliefs about alcohol use and
pregnancy
 20 focus groups
 Manuscript in press at American Journal of Health Education
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Inform development of new CDC materials on alcohol
use in pregnancy and FASDs
 Developed and tested concepts/messages/materials for women of
childbearing age
 8 focus groups
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Next Steps
 Finalizing new messages/materials
Recently Tested….
Multimedia & Tools
Questions?
www.cdc.gov/fasd
Thank you!
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: [email protected]
Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
National Center on Birth Defects and Developmental Disabilities
Fetal Alcohol Syndrome Prevention Team