Preventing Alcohol, Tobacco, and Other Substance-exposed Pregnancies: a community Affair Hosted by: Interagency Coordinating Committee on Fetal Alcohol Syndrome Work Group on Women,




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Preventing Alcohol, Tobacco, and Other Substance-exposed Pregnancies:
A Community Affair
Hosted by:

Interagency Coordinating Committee on Fetal Alcohol Syndrome

Work Group on Women, Drinking, and Pregnancy

Sponsored by:

National Institute on Alcohol Abuse and Alcoholism, NIH

and

American Legacy Foundation

September 23-24, 2008
Rockville, Maryland
Report from the Conference

This report is based on the proceedings of the September 23 and 24, 2008, symposium hosted by the Women, Drinking, and Pregnancy Work Group of the Interagency Coordinating Committee on Fetal Alcohol Syndrome. The symposium: Preventing Alcohol, Tobacco, and Other Substance-exposed Pregnancies was held in Rockville, Maryland, and sponsored by the National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, and American Legacy Foundation.


About the development of the report: The initial draft of the report, based on verbatim transcripts from the symposium, was written by Linda Richardson, a science writer for Lewis-Williams Conference and Logistics Management, LLC, who attended the symposium. Each formal symposium participant was invited to correct errors in the text describing his/her presentation. The final report was edited by Dr. Deidra Roach, Division of Treatment and Recovery Research, NIAAA, and Leader of the Women, Drinking, and Pregnancy Work Group of the Interagency Coordinating Committee on Fetal Alcohol Syndrome and by Dr. Sally M. Anderson, Coordinator and Executive Secretary of the Interagency Coordinating Committee on Fetal Alcohol Syndrome.
The U.S. Government does not endorse or favor any specific commercial products (or commodity, service, or company). Trade or proprietary names (or company names) appearing in this publication are used only because they are considered essential in the context of the presentation reported herein.
The opinions expressed herein are those of the participants in the symposium and do not necessarily reflect an official position of NIAAA, NIH, any other part of the United States Government, or American Legacy Foundation.
All material in this report is in the public domain and may be reproduced without permission from NIAAA, American Legacy Foundation, or the authors. Citation of the source is appreciated.

Table of Contents

Executive Summary 7

MEETING PROCEEDINGS 13

Welcome and Introductory Comments 13

Historical Background 14

The Evidence – Substance Use among Women of Childbearing Age 16

Prevalence of Substance Use among Women of Childbearing Age 16

Women and Substance Abuse: Risk Factors and Health Impacts 18

Prenatal Exposure: Effects of Commonly Used Substances 20

Panel Discussion on At-Risk Populations, and Treatment and Preventions 22

Some Federal Agency Activities on Identification of At-Risk Alcohol and other Substance Use and Intervening With Women of Childbearing Age 24

Centers for Disease Control and Prevention (CDC) 24

Substance Abuse and Mental Health Services Administration (SAMHSA) 25

Health Resources and Services Administration (HRSA) 27

National Institute on Alcohol Abuse and Alcoholism (NIAAA) 28

Intervention Research 29

Intervening in the Preconception Period 29

Intervening with Pregnant Women 32

Intervening with Women with/or At-Risk for HIV Infection 34

Reaching out to Special Populations 35

The Mississippi Experience 35

An Urban California Experience 36

The Cheyenne River and Turtle Mountain Chippewa Reservation Experience 37

Health Services Delivery and Marketing 38

Measuring the Cost-Effectiveness of Interventions in the Health Care System: Making the Business Case 38

Marketing the Message: Lessons Learned from the National Center for Health Marketing 40

Marketing the Message: Lessons Learned from the Office on Smoking and Health 41

Marketing the Message: American Legacy Foundation 43

Panel Discussion: the Role of the Media in Promoting and Reducing Tobacco Use 44

Reaching-out – Best Approaches and Global Strategies 45

Reaching out to Women at Risk: A Mother’s Perspective 45

Keynote Address I: Best Approaches to Marketing the Message “Drinking, Smoking, and Pregnancy Do Not Mix” 47

Keynote Address II: Global Strategies in Health Marketing 48

International Birth Mothers Network 50

Legislative Update 52

Future Directions and Framing an Action Agenda 53

Breakout Sessions: Future Directions 53

Framing an Action Agenda: Next Steps 54

Reports from Breakout Sessions 56

Preventing Prenatal Exposure to Alcohol, Tobacco, and other Substances of Abuse in (Universal and Selected) Populations 56

Intervening with Women with Problem Drinking and other Substances Misuse (Indicated Populations) 57

Engaging Partners, Parents, Peers, and Policymakers 58

Wrap-Up and Closing Remarks 59

References 61

Appendix 65

AGENDA 67

Speakers and Formal Discussants 71

List of other Participants 75

Abbreviation/Acronym List


ACOG

American College of Obstetrics and Gynecology

AEP

Alcohol-exposed Pregnancies

ARBD

Alcohol-related Birth Defects

ARND

Alcohol-related Neurodevelopmental Disorder

AUDIT-C

Alcohol Use Disorders Identification Test-C

BI

Brief Intervention

BMN

Birth Mothers Network

BPH

Bureau of Primary Health

BRFSS

Behavioral Risk Factor Surveillance System

CDC

Centers for Disease Control and Prevention

CHCs

Community Health Centers

CHOICES

Changing High-risk Alcohol Use and Increasing Contraception

Effectiveness Study



CIFASD

Collaborative Initiative on Fetal Alcohol Spectrum Disorders

CMS

Centers for Medicare and Medicaid Services

CSPI

Center for Science in the Public Interest

DEER

Determining Effective Educational Resources

DHHS

United States Department of Health & Human Services

DSM-IV

Diagnostic and Statistics Manual IV

FAE

Fetal Alcohol Effects

FAS

Fetal Alcohol Syndrome

FASD

Fetal Alcohol Spectrum Disorders

FASER

FAS Epidemiology Research Center

FRAMES

Feedback; Responsibility; Advice; Menu; Empathy; Self-efficacy

GED

General Equivalency Diploma

HAART

Highly Active Antiretroviral Therapy

HMO

HRSA


Health Maintenance Organization

Health Resources and Services Administration



ICCFAS

Interagency Coordinating Committee on Fetal Alcohol Syndrome

ICD

International Classification of Diseases

KPNC

Kaiser Permanente Northern California

MCHB

Maternal and Child Health Bureau

NCAA

National Collegiate Athletic Association

NCBDDD

National Center on Birth Defects and Developmental Disabilities

NCI

National Cancer Institute

NESARC

National Epidemiologic Survey on Alcohol and Related Conditions

NHIS

National Health Interview Survey

NIAAA

National Institute on Alcohol Abuse and Alcoholism

NICHD

National Institute of Child Health and Human Development

NICU

Neonatal Intensive Care Unit

NIH

National Institutes of Health

NOFAS

NSDUH


National Organization on Fetal Alcohol Syndrome

National Survey of Drug Use and Health



NTFFAS/FAE

National Task Force on Fetal Alcohol Syndrome and Fetal Alcohol Effect

PASS

PCAP


Prenatal Alcohol and SIDS and Stillbirth Network

Parent-Child Assistance Programs



PHFE

Public Health Foundation Enterprises

RCT

Randomized Control Trial

RTCs

Regional Training Centers

SAMHSA

Substance Abuse and Mental Health Services Administration

SAT

Screened, Assessed, and Treated

SBILT

Screening, Brief Intervention, and Linkage to Treatment

SBIRT

Screening, Brief Intervention and Referral to Treatment

SBIR

Screening, Brief Intervention, Referral

SEM

Socioecological Marketing

SES

Socioeconomic Status

SIDS

Sudden Infant Death Syndrome

SSB

Safer Sex Skills Building

STD

Sexually Transmitted Disease

T-ACE

Alcohol Use Screening Tools - Tolerance; Annoyed; Cut down; Eye-opener

TIP

Treatment Improvement Protocols

TWEAK

Alcohol Use Screening Tool - Tolerance; Worried; Eye Opener; Amnesia

WHO

WIC


World Health Organization

Women, Infants, and Children Program





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