Preventing Alcohol-Exposed Pregnancies

State-Based FASD Prevention Programs

From 2003 to 2009, CDC funded seven state-based FASD prevention programs. The purpose of these programs was to develop, implement, and evaluate programs to help prevent FASDs. This included prevention programs for women of childbearing age who are at high risk for drinking alcohol during pregnancy.

Funded sites

• Colorado Department of Public Health & Environment
• Michigan Department of Community Health
• Minnesota Department of Health
• Missouri Department of Health and Senior Services
• Oregon Department of Human Services
• University of South Dakota (in collaboration with the North Dakota Fetal Alcohol Syndrome Center), as a bona fide agent for the South Dakota Department of Health
• University of Wisconsin Medical School, as a bona fide agent for the Wisconsin Department of Health and Family Services

Reducing Alcohol-Exposed Pregnancies Through the Use of Community-Level Guided Self-Change Programs

Community resources for assisting individuals who are problem drinkers but who are not alcohol-dependent are limited in most communities. Over the past decade, increasing attention has been directed toward programs focused on engaging the individual's own capacity for self-change as a means of achieving recovery from alcohol problems. This approach is supported by findings that up to 75% of individuals who change their problem drinking habits do so without the use of formal treatment programs. Guided self-change (GSC) programs tend to be of low intensity as compared with traditional treatments, targeted toward the community at large, and focused on problem drinkers as opposed to severely alcohol-dependent drinkers. The goal of these programs is to attract and assist motivated individuals in the early stages of alcohol abuse to take part in an intervention aimed at facilitating a client-driven, self-change process of alcohol reduction or abstinence. GSC intervention components are similar to those of brief interventions and include personal feedback, advice, goal-setting, and self-monitoring of behavior reformatted into self-administered materials that can be completed at home.

In 2004, CDC funded two universities to 1) develop, implement, and evaluate community-level, self-guided change projects targeting women 18 to 44 years of age who are at risk for an alcohol-exposed pregnancy; and 2) demonstrate a 15% reduction in the proportion of women at risk for an alcohol-exposed pregnancy in community-based intervention sites as compared with non-intervention community-based sites.

Funded Projects

Nova Southeastern University—Ft. Lauderdale, Florida
An intervention was designed for a sample of women 18 to 44 years of age at risk for an alcohol-exposed pregnancy in three counties in south Florida. Participants were recruited through the media (e.g., newspaper advertisements, mail flyers, television, billboards, and radio public service announcements). Once respondents were screened and determined to be eligible, they were randomly assigned either to a motivational intervention promoting self-change, or to a control intervention that will provide information only about the risk of fetal alcohol syndrome. The intervention group received a one-time mailing about how to either reduce alcohol consumption or increase use of effective birth control. Women who were unsuccessful at reducing their risk were able to access professional services for help. The specific goals of the study were to 1) determine the degree to which participants decrease their risk for an alcohol-exposed pregnancy, and 2) determine the level of use of professional resources for self-change. The efficacy of the intervention was evaluated and the results were disseminated to health care providers in the local community. Visit Nova Southeastern University's Websitefor more information about their Guided Self-Change Clinic.

St. Louis University—St. Louis, Missouri
A community-based self-change project was conducted with the goal of reducing the risk of alcohol-exposed pregnancies by 15% among African-American women in St. Louis. St. Louis has a high number of childbearing age women in an at-risk community, with a high prevalence of binge drinking that continues during pregnancy. Kansas City was the comparison community. Baseline risk for alcohol-exposed pregnancies in both St. Louis and Kansas City were assessed using a random digit dial survey. Behaviors relating to both alcohol use and contraceptive use were assessed. Recruitment of participants took place through advertisements in the media, through the random digit dial survey, and through health care provider offices and WIC clinics. Educational materials about reducing at-risk drinking or increasing proper use of birth control were mailed to participants, but were also available through the Internet. These materials guided participants through a self-change process. Follow-up occurred 4 months after enrollment.

Project BALANCE

(Birth Control and ALcohol Awareness: Negotiating Choices Effectively)

Many young women in the United States who drink alcohol and have unprotected sex are putting themselves at risk for an alcohol-exposed pregnancy. Not much is known about the relationship between moderate-to-heavy alcohol use, unprotected sex, and unplanned pregnancies in young women. Well-designed epidemiological and behavioral studies are needed to better understand and intervene with this population. The following project explored these issues.

Funded Project

Virginia Commonwealth University—Richmond, Virginia
Project BALANCE consisted of (1) a brief epidemiologic survey, (2) focus groups, and (3) a randomized, controlled trial of a motivational intervention directed at Virginia Commonwealth University (VCU) college students from 18 to 24 years of age. The intervention was a modified form of Project CHOICES, a preconceptional, motivational intervention designed collaboratively with CDC and three institutions, of which VCU was one. Project BALANCE's objectives were to identify the prevalence of risky drinking and contraceptive behaviors in this population, and to test the efficacy of an intervention in a randomized trial comparing a group receiving both assessment and one face-to-face session with a group receiving assessment only. A brief survey was administered to college women to identify those eligible for intervention and to further characterize the population. Focus groups with college women also explored qualitative issues related to drinking, contraception, and sexual behavior. The intervention focused both on drinking and unprotected sex, allowing a woman to modify either or both behaviors. Follow-up occurred at 1 month and 4 months.

Related Publications

Risk drinking and contraception effectiveness among college women
Psychology & Health; 2008, 23(8):965-981
Ingersoll KS, Ceperich SD, Nettleman MD, Johnson BA
[Read summary]

Reducing alcohol-exposed pregnancy risk in college women: Initial outcomes of a clinical trial of a motivational intervention
Journal of Substance Abuse Treatment 2005;29:173-180
Ingersoll KS, Ceperich SD, Nettleman MD, Karanda K, Brocksen S, Johnson BA
[Read summary]

Preventing Alcohol-Exposed Pregnancies in Diverse Populations

Rates of harmful drinking among women from diverse populations and the characteristics of those at greatest risk are not well understood. Well-designed epidemiologic studies are needed to better understand these populations of women. Likewise, intervention studies aimed at reducing the risk of alcohol-exposed pregnancies need to be designed and evaluated to determine the most effective approaches for high-risk women from diverse populations. The following projects were funded to address this issue.

Funded Projects

San Diego State University—San Diego, California
This project's goal was to (1) determine the frequency of self-reported alcohol consumption in a sample of low-income pregnant and non-pregnant Latinas of childbearing age and examine risk factors for alcohol use, and (2) test the effectiveness of an educational feedback intervention among non-pregnant Latinas on intent to change alcohol consumption behaviors in a future pregnancy. Screening questionnaires and in-person interviews provided information on the women and their use of alcohol. The intervention group received educational feedback on their self-reported current consumption. The intervention assessed intention to reduce current alcohol consumption and/or avoid alcohol use in a future pregnancy. Outcomes regarding future intentions were measured through a post-intervention telephone interview 3 months following the baseline interview.

University of Texas at San Antonio—San Antonio, Texas
This project explored characteristics regarding alcohol use and pregnancy, and tested the effectiveness of a social action approach to prevent alcohol-exposed pregnancies among Latinas in San Antonio. The project investigated the values, attitudes, and behaviors of Latinas regarding motherhood and pregnancy, patterns of alcohol use and familial patterns, sexual activity, and knowledge of fetal alcohol syndrome. The study pilot tested a social action intervention model that aims to alter normative drinking behavior and/or sexual behavior. Quantitative measures were used to determine differences in knowledge, attitudes, and behaviors and qualitative methods were used to understand the interplay between individual and social change. Follow-up was conducted 6 months after the intervention.

Related Publications

Alcohol consumption among low-income pregnant Latinas
Alcoholism: Clinical and Experimental Research 2005;29(11):2022-2028
Chambers CD, Hughes S, Meltzer SB, Wahlgren D, Kassem N, Larson S, Riley EP, Hovell MF
[Read summary]

Increasing Public Awareness of the Risks of Alcohol Use During Pregnancy Through Targeted Media Campaigns

Effective media campaigns create awareness, change attitudes, and motivate individuals and communities to engage in healthy behaviors. Successful campaigns target specific audiences taking into account the unique preferences and needs of particular groups. The targeted media campaign is one strategy to enhance current prevention efforts related to fetal alcohol syndrome (FAS) and other prenatal alcohol-related effects. Evidence-based approaches on the design, implementation, and evaluation of these types of projects are needed to determine the most effective strategies for use in media campaigns aimed at reducing prenatal alcohol use.

Funded Projects

St. Louis University—St. Louis, Missouri
This project designed, implemented, and evaluated a media campaign targeting African-American women, aged 18 through 35 years, at risk for pregnancy. The primary purpose of the campaign was to increase knowledge and change attitudes about alcohol use during pregnancy. A comprehensive media campaign was developed using a variety of strategies including visual, audio, and print advertisements, direct marketing, media interviews with experts, and community event exposure. The campaign was built around four core messages: (1) drinking alcohol during pregnancy harms unborn babies, (2) pregnant women should abstain from alcohol, (3) sexually active women should not drink if they could be pregnant, and (4) women at risk for an alcohol-exposed pregnancy should see a physician. Evaluation of the intervention consisted of pre- and post-intervention random-digit dialing surveys of the African-American community both in St. Louis and Kansas City (control group).

University of California at Los Angeles—Los Angeles, California
This project developed, implemented, and evaluated a social marketing campaign using a “narrowcasting approach” that warned women about the dangers of drinking alcohol during pregnancy. Narrowcasting refers to information that is directed to a highly specific segment of the public. The purpose of the project was to change norms and perceptions of women who are light or moderate drinkers both prior to and during pregnancy. The target groups included White, Hispanic, and African-American women, aged 18 through 30 years. Print materials were developed and disseminated, saturating specific neighborhoods in two communities of southern California over a 12-month period, with a third community serving as a comparison group. Project partners worked with community participants and professional agencies to create high-quality campaign messages and materials. Evaluation consisted of a repeated cross-sectional survey design.

University of Iowa—Iowa City, Iowa 
The goals of the project were to design, implement, and evaluate the effectiveness of a broad-based and localized media campaign aimed at reducing prenatal alcohol use in rural areas, targeting women enrolled in the Women, Infants, and Children (WIC) program. After formative research, project staff produced commercial-quality materials for dissemination in three channels (a broad based 30-second television commercial, an eight minute video for localized distribution in WIC clinics, and a printed pamphlet for distribution in WIC clinics) to increase awareness about the dangers of alcohol use during pregnancy. WIC clinics in rural Iowa were paired and randomly assigned to usual-care or intervention groups. The usual-care group was exposed to the 30-second commercial and printed pamphlet, while the intervention group was exposed to messages in all three channels. Evaluation consisted of pre- and post-test surveys assessing changes in knowledge, interactions with health care professionals, reported alcohol use, and perceptions of normative expectations in the social network regarding consumption of alcohol during pregnancy.

Related Publications

Fetal alcohol syndrome prevention using community-based narrowcasting campaigns
Health Promotion Practice 2008;9(1):93-103
Glik D, Prelip M, Myerson A, Eilers K
[Read summary]

Increasing FASD knowledge by a targeted media campaign: Outcome determined by message frequency
Journal of FAS International 2005;3(e13):1-14
Mengel MB, Ulione M, Wedding D, Jones ET, Shurn D
[Read summary]

Narrowcasting campaign for community programs: creating health messages for targeted media campaign
Glik DC, Prelip M, Myerson A, Eilers K. Los Angeles, CA: UCLA Health and Media Research Group; 2004
[Read summary]

Dialogic voices in talk about drinking and pregnancy
Journal of Applied Communication Research 2004;32(3):224-248
Baxter LA, Hirokawa R, Lowe JB, Nathan P, Pearce L
[Read summary]

Enhancing Clinical Practices to Prevent Alcohol-Exposed Pregnancies

In 2004, 11.2% of pregnant women aged 15 to 44 reported alcohol use and 4.5% reported binge drinking. Among nonpregnant women of childbearing age, 52.8% reported alcohol use and 23.3% reported binge drinking. Half of all pregnancies are unplanned, and many women will not know they are pregnant during the early weeks of gestation and may continue drinking. Identifying women who are at high risk for an alcohol-exposed pregnancy and intervening with them before conception (or at least as early as possible thereafter) is an essential strategy for preventing alcohol-exposed pregnancies.

Funded Project

American College of Obstetricians and Gynecologists—Washington, D.C.
To address the prevention of alcohol-exposed pregnancies, the American College of Obstetricians and Gynecologists (ACOG), in collaboration with CDC's Fetal Alcohol Syndrome Prevention Team, has developed a tool kit, Drinking and Reproductive Health: A Fetal Alcohol Spectrum Disorders Prevention Tool Kit, for women's health care providers. The primary component in the tool kit is a CD-ROM that aims to teach women's health care providers how to properly screen and advise all of their patients of reproductive age about risky drinking and encourage the use of effective contraception among patients who continue to engage in risky drinking. It also addresses drinking during pregnancy. With information on screening, education, and counseling, this publication will help women's health care clinicians prevent FASDs when they encounter risky drinking, regardless of pregnancy status. This tool kit contains a brief guide, a laminated screening instrument for providers, resource information, and patient handouts that can be downloaded and printed. Continuing medical education credits are also available. The tool kit is available to download or to order from the ACOG website.

Improving Community-Based Fetal Alcohol Syndrome Prevention Efforts Using the Fetal and Infant Mortality Review Methodology

Prenatal exposure to alcohol is one of the leading preventable causes of birth defects, mental retardation, and neurodevelopmental disorders in the United States. One of the national health objectives for 2010 is to increase the percentage of pregnant women abstaining from alcohol from 86% to 94%. According to national data collected in 2002 by the Behavioral Risk Factor Surveillance System, 10% of women reported drinking alcohol during pregnancy. CDC studies have documented fetal alcohol syndrome (FAS) prevalence rates ranging from 0.2 to 1.5 per 1,000 live births.

Funded Project

American College of Obstetricians and Gynecologists—Washington, D.C.
The National Fetal and Infant Mortality Review Program (FIMR) is a collaborative effort between the American College of Obstetricians and Gynecologists and the Maternal and Child Health Bureau, Health Resources and Services Administration. FIMR is a community-based program to improve the health and well-being of women, infants, and families. The goal of this project was to use the established FIMR process to expand the knowledge base about service systems, specifically the personal knowledge, attitudes, and beliefs of women who have experienced a loss that might be associated with infant morbidity and mortality due to prenatal alcohol exposure, and to suggest areas where service system improvements, or enhanced health education, might improve outcomes for future families.