FASD Prevention: Evidence of Success in WA State.    

 

A recent publication (Astley, SJ. Fetal alcohol syndrome prevention in Washington State: Evidence of Success. Paediatric and Perinatal Epidemiology. 2004;18:344-351) of data from two ongoing population-based surveillance and screening programs:

    1. The Pregnancy Risk Assessment Monitoring System (PRAMS); a statewide surveillance program conducted by the Department of Health documenting maternal behaviors (including alcohol use) during pregnancy, and

    2. The FAS Screening Program in the King County Foster Care Passport Program (FCPP) conducted jointly by the University of Washington FAS Diagnostic & Prevention Network (FAS DPN) and the FCPP.

documented the following outcomes:

    1. The prevalence of maternal drinking during pregnancy in Washington State declined significantly (p < 0.001) from 1993 to 1998. (1999 PRAMS Surveillance Report, page 81). See Table 1 below. (Click here to go to the CDC PRAMS website)

    2. The prevalence of FAS among foster children, born in the same years (1993 to 1998) also declined significantly (p <0.03). (FAS DPN and FCPP)

These observations strongly support that FASD prevention efforts in Washington State are working.

Table 1

Prevalence of Drinking Alcohol 3 Months Before Pregnancy &, 1993-1999

CDC PRAMS 1999 Surveillance Report (2003)

State
1999 (%)
1994
(%)
1995
(%)
1996
(%)
1997
(%)
1998
(%)
1999
(%)
P-value for trend*
Alabama
38.2
33.2
35.3
38.1
39.1
31.8
36.1
0.52
Alaska
50.5
50.0
50.4
49.7
50.0
48.3
50.0
0.50
Arkansas
--
--
--
--
36.6
32.6
34.2
0.31
Colorado
--
--
--
--
--
51.5
51.6
0.98
Florida
45.0
44.7
43.5
39.9
41.6
41.8
41.6
0.06
Illinois
--
--
--
--
45.8
46.2
43.0
0.18
Louisiana
--
--
--
--
--
43.3
43.8
0.76
Maine
54.8
57.3
52.6
55.1
56.8
54.5
55.6
0.91
New Mexico
--
--
--
--
--
^43.9
44.7
0.70
New York $
56.6
#55.8
56.1
54.9
53.6
51.5
53.5
0.06
North Carolina
--
--
--
--
}37.3
38.3
36.0
0.50
Oklahoma
39.4
41.8
46.1
41.9
38.6
41.9
39.7
0.45
South Carolina
40.6
37.0
35.7
40.7
37.5
38.3
38.2
0.76
Washington
--
57.3
49.8
49.6
46.5
44.3
49.2
@ 0.00
West Virginia
33.4
34.4
37.3
35.6
34.9
36.2
32.8
0.97
* Based on a test for linear trend using logistic regression
$ Data do not include New York City
# Missing >= 10% data.
} 1997 data represent only July-December births.
@ P-value is statistically significant at the 0.05 level
^ 1998 data represent July 1997- December 1998 births.
& Because women are more likely to report first trimester substance use as their use after they knew they were pregnant, alcohol use just before pregnancy may measure early pregnancy use more accurately than measuring alcohol use in the first trimester.

 


History of FASD Prevention Efforts in Washington State

The adverse impact of prenatal alcohol exposure on infant outcome was first identified at the University of Washington in 1968 by Christy Ulleland M.D. (Ulleland et. al., 1970; Ulleland 1972). Washington State prevention efforts that ensued over the next three decades have reflected the full continuum of strategies from public health education (e.g., Surgeon General's Advisory, Alcohol Beverage Labeling, etc.) to direct intervention with high-risk women.

The 2004 population-based surveillance study described above provides compelling evidence that FASD prevention efforts in Washington State are working. While this study was not designed to determine which prevention efforts were most effective, the prevention literature strongly supports that a comprehensive approach, that utilizes the full spectrum of effort from public health education to targeted intervention, has the greatest impact.

To review the comprehensive approach taken by Washington State since 1968, an annotated historical record (Fetal Alcohol Spectrum Disorders: Washington State History) of FASD-related programs and policies has been compiled. Included in the document are brief descriptions of each program/policy with references to publications and/or websites where more detailed information can be obtained.

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