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:
- 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
- The FAS Screening Program in the King County Foster Care Passport Program (FCPP) was conducted jointly by the University of Washington FAS Diagnostic & Prevention Network (FAS DPN) and the FCPP from 1999 through 2009
documented the following outcomes:
- The prevalence of maternal drinking during pregnancy in Washington State declined significantly (p < 0.001) from 1993 to 1998. (1999 PRAMS Surveillance Report, p 81). See Table 1 below.
- 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 |
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|---|---|---|---|---|---|---|---|---|
State |
1993
(%) |
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 through December 1998 births. |
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& 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. |
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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. 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 progam/policy with references to publications and/or websites where more detailed information can be obtained.
Current FASD Prevention Efforts Include:
- Parent Child Assistance Program (PCAP).
PCAP is a model of intensive, long-term, paraprofessional advocacy with high-risk mothers who abuse alcohol or drugs heavily during pregnancy and are estranged from community service providers. The primary goal of PCAP is to prevent alcohol and drug exposure among the future children of these mothers. PCAP was established in 1991 and is a program within the Fetal Alcohol and Drug Unit at the University of Washington.
- Division of Behavioral Health and Recovery (DBHR).
DBHR is a state Agency within the Department of Health and Human Services (DSHS). DBHR promotes strategies that support healthy lifestyles by preventing the misuse of alcohol, tobacco, and other drugs, and support recovery from the disease of chemical dependency. This is achieved through prevention, research, training, and treatment. DBHR has voluntarily served as the program chair of the Fetal Alcohol Syndrome Interagency Workgroup (FASIAWG) since it's inception in 1995, to ensure continued development and implementation of FASD services statewide. To view a powerpoint slide presentation entitled "Division of Alcohol and Substance Abuse Services in the Prevention of FASD: January 2005" click here.
