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Washio Y, E. Martin C, Goldstein ND, Terplan M. Characteristics of pregnant women who reported alcohol use at admission to substance use treatment. J Subst Abuse Treat 2017; 82:82-86. [DOI: 10.1016/j.jsat.2017.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 09/13/2017] [Accepted: 09/14/2017] [Indexed: 11/29/2022]
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102
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Alcohol Use Disorders in Argentinian Girls and Women 12 Months Before Delivery: Comparison of DSM-IV, DSM-5, and ICD-10 Diagnostic Criteria. J Addict Med 2017; 11:106-113. [PMID: 28067756 DOI: 10.1097/adm.0000000000000285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The evidence of important problems related to prenatal alcohol exposure has faced researchers with the problem of understanding and screening alcohol use in this population. Although any alcohol use should be considered risky during pregnancy, identifying alcohol-drinking problems (ADPs) could be especially important because women with ADPs could not benefit from a simple advice of abstinence and because their offsprings are subjected to a higher risk of problems related with prenatal alcohol exposure. In this context, we aim to study the prevalence and characteristics of ADPs in pregnant women, evaluating the performance of different diagnostic systems in this population. OBJECTIVES The aims of the study were to describe the prevalence of ADPs obtained with the criteria of the Diagnostic and Statistical Manual of Mental Disorders in its fourth (DSM-IV) and fifth edition (DSM-5), and the International Classification of Diseases (ICD)-10, in Argentinean females aged 13 to 44 years, 12 months before delivery; to evaluate the level of agreement between these classification systems; and to analyze the performance of each diagnosis criterion in this population. METHODS Data were collected through personal interviews of a probability sample of puerperal women (N = 641) in the city of Santa Fe (Argentina), between October 2010 and February 2011. Diagnoses compatible with DSM-IV, DSM-5, and ICD-10 were obtained through the Composite International Diagnostic Interview. Agreement among diagnostic systems was measured through Cohen kappa. Diagnosis criteria performance were analyzed considering their prevalence and discriminating ability (D value). RESULTS Total ADP prevalence was 6.4% for DSM-IV (4.2% abuse and 2.2% dependence), 8.1% for DSM-5 (6.4% mild, 0.8% moderate, and 0.9% severe alcohol use disorder), and 14.1% for the ICD-10 (11.9% harmful use and 2.2% dependence). DSM-5 modifications improved agreement between DSM and ICD. The least prevalent and worst discriminating ability diagnostic criterion was "legal problems." The most prevalent and 1 of the best discriminating ability diagnostic criterion was '"health issues." CONCLUSIONS DSM-IV and ICD-10 dependence prevalence was similar to that of previous studies in pregnant women, whereas abuse prevalence was surprisingly higher. Our results indicate a better performance of the DSM-5 alcohol use disorder category relative to the DSM-IV dual categorization. Nevertheless, the poor diagnostic performance of some DSM-5 criteria in this population could evidence their intercultural variability.
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103
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Tearne E, Cox K, Giglia R. Patterns of Alcohol Intake of Pregnant and Lactating Women in Rural Western Australia. Matern Child Health J 2017; 21:2068-2077. [DOI: 10.1007/s10995-017-2318-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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104
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Singal D, Brownell M, Chateau D, Wall-Wieler E, Longstaffe S, Hanlon-Dearman A, Roos LL. Suicide and suicide attempts among women in the Manitoba Mothers and Fetal Alcohol Spectrum Disorder cohort: a retrospective matched analysis using linked administrative data. CMAJ Open 2017; 5:E646-E652. [PMID: 28830865 PMCID: PMC5621956 DOI: 10.9778/cmajo.20160127] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Women who give birth to children with fetal alcohol spectrum disorder (FASD) may be at increased risk for suicide; however, there are few data in this area. The objective of this study was to compare rates of suicide between women who had given birth to children with FASD and women who had not given birth to children with FASD during critical periods in their lives, including before pregnancy, during pregnancy, during the postpartum period (maternal death) and until the end of the study period. METHODS We conducted a retrospective cohort analysis of women with children born in Manitoba between Apr. 1, 1984, and Mar. 31, 2012 in whom FASD was diagnosed between Apr. 1, 1999, and Mar. 31, 2012, with follow-up until Dec. 1, 2013 (FASD group; n = 702). We generated a comparison group of women who had not given birth to children with FASD (n = 2097), matched up to 1:3 on date of birth of the index child, socioeconomic status and region of residence. We used linked administrative data to investigate suicide attempt and completion rates in the 2 groups. Regression modelling produced relative rates (RRs) adjusted for socioeconomic status and age at birth of the index child and was used to assess suicide risk. RESULTS The 2799 participants produced 40 390.21 person-years until the end of the study period. Compared to the comparison group, the FASD group had higher rates of suicide completion (adjusted RR 6.20 [95% confidence interval (CI) 2.36-16.31]), a higher number of women who attempted suicide after the postpartum period until the end of the study period (adjusted RR 4.62 [95% CI 2.53-8.43]) and a higher number of attempts after the postpartum period until the end of the study period (adjusted RR 3.92 [95% CI 2.30-6.09]). INTERPRETATION This study identified a group of women with increased rates of social complexities, mental disorders and alcohol use, which places them at risk for suicide. Interventions are needed that screen for suicidal behaviour in women who are at high risk to consume alcohol during pregnancy and have mental disorders.
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Affiliation(s)
- Deepa Singal
- Affiliations: Department of Community Health Sciences and the Manitoba Centre for Health Policy (Singal, Brownell, Chateau, Wall-Wieler, Roos) and Department of Pediatrics and Child Health (Longstaffe, Hanlon-Dearman), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Marni Brownell
- Affiliations: Department of Community Health Sciences and the Manitoba Centre for Health Policy (Singal, Brownell, Chateau, Wall-Wieler, Roos) and Department of Pediatrics and Child Health (Longstaffe, Hanlon-Dearman), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Dan Chateau
- Affiliations: Department of Community Health Sciences and the Manitoba Centre for Health Policy (Singal, Brownell, Chateau, Wall-Wieler, Roos) and Department of Pediatrics and Child Health (Longstaffe, Hanlon-Dearman), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Elizabeth Wall-Wieler
- Affiliations: Department of Community Health Sciences and the Manitoba Centre for Health Policy (Singal, Brownell, Chateau, Wall-Wieler, Roos) and Department of Pediatrics and Child Health (Longstaffe, Hanlon-Dearman), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Sally Longstaffe
- Affiliations: Department of Community Health Sciences and the Manitoba Centre for Health Policy (Singal, Brownell, Chateau, Wall-Wieler, Roos) and Department of Pediatrics and Child Health (Longstaffe, Hanlon-Dearman), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Ana Hanlon-Dearman
- Affiliations: Department of Community Health Sciences and the Manitoba Centre for Health Policy (Singal, Brownell, Chateau, Wall-Wieler, Roos) and Department of Pediatrics and Child Health (Longstaffe, Hanlon-Dearman), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
| | - Leslie L Roos
- Affiliations: Department of Community Health Sciences and the Manitoba Centre for Health Policy (Singal, Brownell, Chateau, Wall-Wieler, Roos) and Department of Pediatrics and Child Health (Longstaffe, Hanlon-Dearman), Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Man
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105
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Coathup V, Smith L, Boulton M. Exploration of dietary patterns and alcohol consumption in pregnant women in the UK: A mixed methods study. Midwifery 2017; 51:24-32. [DOI: 10.1016/j.midw.2017.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/20/2017] [Accepted: 04/25/2017] [Indexed: 12/24/2022]
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106
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How have the lives of pregnant women changed in the last 30 years? Women Birth 2017; 30:342-349. [DOI: 10.1016/j.wombi.2017.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 01/20/2017] [Accepted: 01/22/2017] [Indexed: 01/15/2023]
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107
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Consumption of alcohol during pregnancy—A multinational European study. Women Birth 2017; 30:e207-e213. [DOI: 10.1016/j.wombi.2017.01.003] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 01/02/2017] [Accepted: 01/03/2017] [Indexed: 11/20/2022]
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108
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Konkolÿ Thege B, Horwood L, Slater L, Tan MC, Hodgins DC, Wild TC. Relationship between interpersonal trauma exposure and addictive behaviors: a systematic review. BMC Psychiatry 2017; 17:164. [PMID: 28472931 PMCID: PMC5418764 DOI: 10.1186/s12888-017-1323-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 04/24/2017] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The aim of this study was to systematically summarize knowledge on the association between exposure to interpersonal trauma and addictive behaviors. Extant reviews on this association focused on a restricted range of substance-related addictions, and/or used a narrative instead of a systematic approach. METHODS Systematic searches of 8 databases yielded 29,841 studies, of which 3054 studies were included and subsequently classified in relation to study design (scoping review). A subset of observational studies (N = 181) prospectively investigating the relationship between exposure to interpersonal traumata and subsequent behavioral or substance-related addiction problems were characterized. Heterogeneity in study methodologies and types of addictive behaviors and traumatic experiences assessed precluded meta-analysis. Instead, the proportions of associations tested in this literature that revealed positive, negative, or null relationships between trauma exposure and subsequent addictive behaviors were recorded, along with other methodological features. RESULTS Of 3054 included studies, 70.7% (n = 2160) used a cross-sectional design. In the 181 prospective observational studies (407,041 participants, 98.8% recruited from developed countries), 35.1% of the tested associations between trauma exposure and later addictive behaviors was positive, 1.3% was negative, and 63.6% was non-significant. These results were primarily obtained among non-treatment seeking samples (80.7% of studies; n = 146), using single and multi-item measures of addictive behaviors of unknown psychometric quality (46.4% of studies). Positive associations were more frequently observed in studies examining childhood versus adult traumatization (39.7% vs. 29.7%). CONCLUSIONS Longitudinal research in this area emphasizes alcohol abuse, and almost no research has examined behavioral addictions. Results provide some support for a positive association between exposure to interpersonal trauma and subsequent addictive behaviors but this relationship was not consistently reported. Longitudinal studies typically assessed trauma exposure retrospectively, often after addictive behavior onset, thus precluding robust inferences about whether traumatization affects initial onset of addictive behaviors.
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Affiliation(s)
- Barna Konkolÿ Thege
- Department of Psychology, University of Calgary, 2500 University Drive, Calgary, T2N 1N4 Canada
- Research and Academics Division, Waypoint Centre for Mental Health Care, 500 Church Street, Penetanguishene, ON L9M 1G3 Canada
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, M5T 1R8 Canada
| | - Lewis Horwood
- Department of Psychology, University of Calgary, 2500 University Drive, Calgary, T2N 1N4 Canada
| | - Linda Slater
- John W. Scott Health Sciences Library, University of Alberta, 2K312 WMC University of Alberta, Edmonton, T6G 2R7 Canada
| | - Maria C. Tan
- Knowledge Resource Service - Abdul Khaliq Library, Alberta Health Services Cross Cancer Institute, 11560 University Avenue, Edmonton, T6G 1Z2 Canada
| | - David C. Hodgins
- Department of Psychology, University of Calgary, 2500 University Drive, Calgary, T2N 1N4 Canada
| | - T. Cameron Wild
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405-97 Avenue, Edmonton, T6G 1C9 Canada
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McAllister-Williams RH, Baldwin DS, Cantwell R, Easter A, Gilvarry E, Glover V, Green L, Gregoire A, Howard LM, Jones I, Khalifeh H, Lingford-Hughes A, McDonald E, Micali N, Pariante CM, Peters L, Roberts A, Smith NC, Taylor D, Wieck A, Yates LM, Young AH. British Association for Psychopharmacology consensus guidance on the use of psychotropic medication preconception, in pregnancy and postpartum 2017. J Psychopharmacol 2017; 31:519-552. [PMID: 28440103 DOI: 10.1177/0269881117699361] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Decisions about the use of psychotropic medication in pregnancy are an ongoing challenge for clinicians and women with mental health problems, owing to the uncertainties around risks of the illness itself to mother and fetus/infant, effectiveness of medications in pregnancy and risks to the fetus/infant from in utero exposure or via breast milk. These consensus guidelines aim to provide pragmatic advice regarding these issues. They are divided into sections on risks of untreated illness in pregnancy; general principles of using drugs in the perinatal period; benefits and harms associated with individual drugs; and recommendations for the management of specific disorders.
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Affiliation(s)
- R Hamish McAllister-Williams
- 1 Institute of Neuroscience, Newcastle University, Newcastle, UK.,2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK
| | - David S Baldwin
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,4 University Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | | | - Abby Easter
- 6 Centre for Implementation Science, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Eilish Gilvarry
- 2 Northumberland Tyne and Wear NHS Foundation Trust, Newcastle upon Tyne, UK.,7 Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Vivette Glover
- 8 Institute of Reproductive and Developmental Biology, Imperial College London, London, UK
| | - Lucian Green
- 9 Ealing, Hounslow, Hammersmith & Fulham Perinatal Mental Health Service, West London Mental Health Trust, London, UK
| | - Alain Gregoire
- 3 Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK.,10 Hampshire Perinatal Mental Health Service, Winchester, UK
| | - Louise M Howard
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | - Ian Jones
- 13 National Centre for Mental Health, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, UK
| | - Hind Khalifeh
- 11 Section of Women's Mental Health, Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK.,12 South London and Maudsley NHS Foundation Trust, London, UK
| | | | - Elizabeth McDonald
- 15 Royal College of Psychiatrists, London, UK.,16 East London Foundation Trust, London, UK.,17 Tavistock and Portman NHS Foundation Trust, London, UK
| | - Nadia Micali
- 18 Behavioural and Brain Sciences Unit, GOSH Institute of Child Health, University College London, London, UK
| | - Carmine M Pariante
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Ann Roberts
- 20 St Martin's Healthcare Services CIC, Leeds, UK.,21 Hertfordshire Partnership University NHS Foundation Trust, Hatfield, Hertfordshire, UK.,22 Postgraduate School of Medicine, University of Hertfordshire, Hatfield, Hertfordshire, UK
| | - Natalie C Smith
- 23 Tees, Esk and Wear Valleys NHS Foundation Trust, Darlington, County Durham, UK
| | - David Taylor
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,24 Institute of Pharmaceutical Science, King's College London, London, UK
| | - Angelika Wieck
- 25 Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK.,26 University of Manchester, Manchester, UK
| | - Laura M Yates
- 27 UK Teratology Information Service, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK.,28 Institute of Genetic Medicine, Newcastle University, Newcastle, UK
| | - Allan H Young
- 12 South London and Maudsley NHS Foundation Trust, London, UK.,19 Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Coathup V, Northstone K, Gray R, Wheeler S, Smith L. Dietary Patterns and Alcohol Consumption During Pregnancy: Secondary Analysis of Avon Longitudinal Study of Parents and Children. Alcohol Clin Exp Res 2017; 41:1120-1128. [PMID: 28423476 DOI: 10.1111/acer.13379] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 03/13/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Large general population surveys show that heavy regular and episodic alcohol consumption are associated with lower intakes of fruits and vegetables, and higher intakes of processed and fried meat. This is of particular concern regarding pregnant women, as both alcohol intake and inadequate maternal nutrition are independently associated with adverse fetal outcomes. The current study aimed to determine associations between maternal dietary patterns and alcohol consumption during pregnancy. METHODS Women were participating in the Avon Longitudinal Study of Parents and Children, and provided details of alcohol consumption at 18 weeks' gestation and diet at 32 weeks' gestation (n = 9,839). Dietary patterns were derived from the food frequency questionnaire data using principal components analysis. Associations between alcohol consumption and dietary patterns were determined using multiple linear regression, adjusted for various sociodemographic and lifestyle factors. RESULTS After adjustment, drinking ≥1 unit/d during the first trimester (β = 0.23 [95% CI: 0.08, 0.38]; p = 0.002) and binge drinking (≥4 units in 1 day) during the first half of pregnancy (β = 0.14 [95% CI: 0.07, 0.21]; p < 0.0001) were associated with greater adherence to the "Processed" dietary pattern (high intakes of processed meat and low intakes of fruit and vegetables). Light-to-moderate alcohol consumption (≤1 drink/d) during the first trimester was associated with greater adherence to the "Health conscious" dietary pattern (high intakes of fruit, vegetables, whole grains, and fish) (β = 0.09 [95% CI: 0.04, 0.14]; p < 0.0001). CONCLUSIONS Two important components of health behavior during pregnancy appear to be related: greater consumption of processed foods associated with heavier alcohol consumption, and healthier dietary choices associated with light-to-moderate alcohol intake. Potential synergistic effects of these behaviors may have implications for maternal and fetal health and warrant further investigation. A more holistic approach to addressing health behaviors in women of reproductive age is required.
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Affiliation(s)
- Victoria Coathup
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom.,National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kate Northstone
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom.,The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care West (NIHR CLAHRC West), University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Ron Gray
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Simon Wheeler
- School of Life & Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Lesley Smith
- Department of Health and Life Sciences, Oxford Brookes University, Oxford, United Kingdom
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111
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Brittain K, Remien RH, Phillips T, Zerbe A, Abrams EJ, Myer L, Mellins CA. Factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa. Drug Alcohol Depend 2017; 173:69-77. [PMID: 28199918 PMCID: PMC5429399 DOI: 10.1016/j.drugalcdep.2016.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 11/21/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Alcohol use during pregnancy is prevalent in South Africa, but there are few prospectively-collected data exploring patterns of consumption among HIV-infected women, which may be important to improve maternal and child health outcomes. We examined patterns of and factors associated with alcohol use prior to and during pregnancy among HIV-infected pregnant women in Cape Town, South Africa. METHODS Participants were enrolled when entering antenatal care at a large primary care clinic, and alcohol use was assessed using the AUDIT (Alcohol Use Disorders Identification Test). In analysis, the AUDIT-C scoring was used as a measure of hazardous drinking, and we examined factors associated with patterns of alcohol use in logistic regression models. RESULTS Among 580 women (median age: 28.1 years), 40% reported alcohol use during the 12 months prior to pregnancy, with alcohol use characterised by binge drinking and associated with single relationship status, experience of intimate partner violence (IPV), and lower levels of HIV-related stigma. Of this group, 65% had AUDIT-C scores suggesting hazardous alcohol use, with hazardous alcohol users more likely to report having experienced IPV and having higher levels of education. Among hazardous alcohol users, 70% subsequently reported reduced levels of consumption during pregnancy. Factors independently associated with reduced consumption included earlier gestation when entering antenatal care and report of a better patient-healthcare provider relationship. CONCLUSIONS These unique data provide important insights into alcohol use trajectories in this context, and highlight the urgent need for an increased focus on screening and intervention at primary care level.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa.
| | - Robert H. Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Tamsin Phillips
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa,Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Allison Zerbe
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Elaine J. Abrams
- ICAP, Columbia University, Mailman School of Public Health, New York, NY, USA,College of Physicians & Surgeons, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, South Africa,Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, South Africa
| | - Claude A. Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
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112
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Tough SC, McDonald SW, Collisson BA, Graham SA, Kehler H, Kingston D, Benzies K. Cohort Profile: The All Our Babies pregnancy cohort (AOB). Int J Epidemiol 2017; 46:1389-1390k. [DOI: 10.1093/ije/dyw363] [Citation(s) in RCA: 63] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/13/2016] [Indexed: 11/15/2022] Open
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113
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Symon A, Rankin J, Sinclair H, Butcher G, Smith L, Gordon R, Cochrane L. Peri-Conceptual and Mid-Pregnancy Alcohol Consumption: A Comparison between Areas of High and Low Deprivation in Scotland. Birth 2016; 43:320-327. [PMID: 27620000 DOI: 10.1111/birt.12252] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Alcohol-related mortality and morbidity among women has increased over recent decades, especially in areas of higher deprivation. Pre-pregnancy alcohol use is associated with continued consumption in pregnancy. We assessed whether general population alcohol consumption patterns were reflected among pregnant women in two Scottish areas with different deprivation levels. METHODS Cross-sectional study in two health boards (HB1, lower deprivation levels, n = 274; HB2, higher deprivation levels, n = 236), using face-to-face 7-day Retrospective Diary estimation of peri-conceptual and mid-pregnancy alcohol consumption. RESULTS A greater proportion of women in HB2 (higher deprivation area) sometimes drank peri-conceptually, but women in HB1 (lower deprivation area) were more likely to drink every week (49.6 vs 29.7%; p < 0.001) and to exceed daily limits (6 units) at least once each week (32.1 vs 14.8%; p < 0.001). After pregnancy recognition, consumption levels fell sharply, but women in HB2 were more likely to drink above recommended daily limits (2 units) each week (2.5 vs 0.0%; p < 0.05). However, women in HB1 were more likely to drink frequently. Women with the highest deprivation scores in each area drank on average less than women with the lowest deprivation scores. CONCLUSIONS Heavy episodic and frequent consumption was more common in the lower deprivation area, in contrast with general population data. Eliciting a detailed alcohol history at the antenatal booking visit, and not simply establishing whether the woman is currently drinking, is essential. Inconsistent messages about the effects of alcohol in pregnancy may have contributed to the mixed picture we found concerning peri-conceptual and mid-pregnancy alcohol consumption.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Jean Rankin
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | | | | | - Lesley Smith
- Department of Psychology, Social Work & Public Health, Oxford Brookes University, Marston, UK
| | - Rhona Gordon
- School of Nursing & Health Sciences, University of Dundee, Dundee, UK
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114
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Guttmannova K, Hill KG, Bailey JA, Hartigan L, Small CM, Hawkins JD. Parental Alcohol Use, Parenting, and Child On-Time Development. INFANT AND CHILD DEVELOPMENT 2016; 26. [PMID: 29062266 DOI: 10.1002/icd.2013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
This study examined whether parental alcohol use in adolescence, adulthood, and, for mothers, during pregnancy was related to their young children's functioning in terms of their on-time development as indicated by the number of developmental areas in which children experienced delay. Observed parenting practices and family socioeconomic status were tested as potential explanatory mechanisms of these links. Data came from the surveys and videotaped observations of a community sample of 123 biological parents and their 1-5 year old children followed longitudinally. Results suggest that the negative association between parental alcohol use and children's development operates primarily through fathers' alcohol use. Additionally, father's adolescent regular alcohol use predicted the family's low SES, which in turn predicted less-skilled maternal parenting practices and children's developmental delay.
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Affiliation(s)
- Katarina Guttmannova
- Center for the Study of Health and Risk Behaviors (CSHRB), Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Karl G Hill
- Social Development Research Group (SDRG), School of Social Work, University of Washington, Seattle, Washington, USA
| | - Jennifer A Bailey
- Social Development Research Group (SDRG), School of Social Work, University of Washington, Seattle, Washington, USA
| | - Lacey Hartigan
- Social Development Research Group (SDRG), School of Social Work, University of Washington, Seattle, Washington, USA
| | - Candice M Small
- Social Development Research Group (SDRG), School of Social Work, University of Washington, Seattle, Washington, USA
| | - J David Hawkins
- Social Development Research Group (SDRG), School of Social Work, University of Washington, Seattle, Washington, USA
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115
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Ulrich F, Petermann F. Consequences and Possible Predictors of Health-damaging Behaviors and Mental Health Problems in Pregnancy - A Review. Geburtshilfe Frauenheilkd 2016; 76:1136-1156. [PMID: 27904164 PMCID: PMC5123885 DOI: 10.1055/s-0042-118180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 09/13/2016] [Accepted: 09/25/2016] [Indexed: 12/29/2022] Open
Abstract
In recent decades, the understanding of the short and longer term effects of health-damaging behaviors and mental health problems in pregnant women and the underlying mechanisms of these behaviors and illnesses has significantly increased. In contrast, little is known about the factors affecting individual pregnant women which contribute to health-damaging behaviors and mental illness. The aim of this paper was therefore to summarize the current state of research into the consequences of nicotine and alcohol consumption, malnutrition, excessive weight gain or obesity, and impaired mental health (depression and anxiety) during pregnancy. In addition, the characteristics of pregnant women which increase their risk of developing such behaviors or mental disorders are described. A better knowledge of these risks should make it easier for clinicians to identify cases at risk early on and put measures of support in place. A review of the literature has shown that certain characteristics of pregnant women (e.g. her relationship with her partner, a previous history of mental illness prior to pregnancy) are associated with various health-damaging behaviors as well as with impaired mental health. Affected women often show an accumulated psychosocial stress which was already present prior to the pregnancy and which may persist even after the birth of the child.
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Affiliation(s)
- F. Ulrich
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen, Bremen, Germany
| | - F. Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen, Bremen, Germany
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Symon A, Rankin J, Butcher G, Smith L, Cochrane L. Evaluation of a retrospective diary for peri-conceptual and mid-pregnancy drinking in Scotland: a cross-sectional study. Acta Obstet Gynecol Scand 2016; 96:53-60. [PMID: 27792241 DOI: 10.1111/aogs.13050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 10/19/2016] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Heavy episodic ("binge") drinking among women in Scotland is commonplace; prepregnancy drinking is associated with continued antenatal drinking. Evidence for effectiveness of standardized antenatal alcohol assessment is lacking. Alcohol-exposed pregnancies may be missed. We assessed peri-conceptual and mid-pregnancy consumption using a week-long retrospective diary and standard alcohol questionnaires, and evaluated the agreement between these instruments. MATERIAL AND METHODS Cross-sectional study in two Scottish health board areas involving 510 women attending mid-pregnancy ultrasound scan clinics. Face-to-face administration of alcohol retrospective diary and AUDIT or AUDIT-C assessed weekly and daily alcohol consumption levels and patterns. Depression-Anxiety-Stress Scale (DASS-21) assessed maternal wellbeing. A sub-sample (n = 30) provided hair for alcohol metabolite analysis. Pearson's correlation coefficient investigated associations between questionnaires and alcohol metabolite data. RESULTS The response rate was 73.8%. The retrospective diary correlated moderately with AUDIT-C and AUDIT but elicited reports of significantly higher peri-conceptual consumption, (median unit consumption on "drinking days" 6.8; range 0.4-63.8). Additional "special occasions" consumption ranged from 1 to 125 units per week. Correlations between DASS-21 and retrospective diary were weak. Biomarker analysis identified three instances of hazardous peri-conceptual drinking. CONCLUSIONS Women reported higher consumption levels when completing the retrospective diary, especially regarding peri-conceptual "binge" drinking. Routine clinical practice methods may not capture potentially harmful or irregular drinking patterns. Given the association between prepregnancy and antenatal drinking, and alcohol's known teratogenic effects, particularly in the first trimester, the retrospective diary may be a useful low-tech tool to gather information on alcohol intake patterns and levels.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Jean Rankin
- School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | | | - Lesley Smith
- Department of Social Work and Public Health, Oxford Brookes University, Oxford, UK
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Yazici AB, Uslu Yuvaci H, Yazici E, Halimoglu Caliskan E, Cevrioglu AS, Erol A. Smoking, alcohol, and substance use and rates of quitting during pregnancy: is it hard to quit? Int J Womens Health 2016; 8:549-556. [PMID: 27785104 PMCID: PMC5063552 DOI: 10.2147/ijwh.s116170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Alcohol and substance use is a major health challenge in Turkey, as it is worldwide. Recently, there has been a rapid increase in the number of females using substances and although usage tends to reduce during pregnancy, it is of critical importance to determine its exact level as substance use negatively impacts on the health of both the mother and infant. Aim The aim of the present study was to investigate the frequency of smoking, alcohol, and substance use, and quitting rates during pregnancy. Method This study was conducted on pregnant females in Sakarya, Turkey. A total of 1,082 consecutively presenting females who agreed to participate in the study were evaluated. The study team prepared a sociodemographic data form and adapted the “Introduction” section, derived from the Addiction Profile Index, to cover substance use during pregnancy. Results The substances most frequently used by pregnant females in their previous pregnancies and current pregnancies were cigarettes/tobacco products (11% and 11.8%, respectively), alcohol (0.6% and 0.4%, respectively), and rarely, synthetic cannabinoids (0.3% and 0.2%, respectively). Daily tobacco smokers continued to smoke during pregnancy, with a rate of 42.5%. Based on research into predictors of smoking (cigarettes) in pregnancy, a correlation was found between lifetime smoking and smoking during a previous pregnancy. A similar link was found with respect to alcohol. Conclusion Cigarettes are the most frequently used substance in pregnancy, and to a lesser extent, alcohol and synthetic cannabinoids, also considered to be risky substances. A high incidence of smoking regularly during pregnancy was found in daily smokers. It is recommended that physicians should sensitively ask pregnant females presenting at clinics about all forms of substance use, including alcohol and synthetic cannabinoids, and to include such questions in their routine enquiries.
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Affiliation(s)
| | | | - Esra Yazici
- Faculty of Medicine, Department of Psychiatry
| | - Ebru Halimoglu Caliskan
- Department of Obstetrics and Gynaecology, Training and Research Hospital, Sakarya University, Sakarya, Turkey
| | | | - Atila Erol
- Faculty of Medicine, Department of Psychiatry
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Dinsdale S, Azevedo LB, Shucksmith J, Newham J, Ells LJ, Jones D, Heslehurst N. Effectiveness of weight management, smoking cessation and alcohol reduction interventions in changing behaviors during pregnancy. ACTA ACUST UNITED AC 2016; 14:29-47. [DOI: 10.11124/jbisrir-2016-003162] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Symon A, Rankin J, Sinclair H, Butcher G, Barclay K, Gordon R, MacDonald M, Smith L. Peri-conceptual and mid-pregnancy drinking: a cross-sectional assessment in two Scottish health board areas using a 7-day Retrospective Diary. J Adv Nurs 2016; 73:375-385. [PMID: 27555470 DOI: 10.1111/jan.13112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2016] [Indexed: 11/29/2022]
Abstract
AIMS The aim of this study was to evaluate the use of a 7-day Retrospective Diary to assess peri-conceptual and mid-pregnancy alcohol consumption. BACKGROUND Alcohol consumption among women has increased significantly and is of international concern. Heavy episodic ('binge') drinking is commonplace and is associated with unintended pregnancy. Pre-pregnancy drinking is strongly associated with continued drinking in pregnancy. Routine antenatal assessment of alcohol history and current drinking is variable; potentially harmful peri-conceptual drinking may be missed if a woman reports low or no drinking during pregnancy. DESIGN Cross-sectional study (n = 510) in two Scottish health board areas. METHODS Face-to-face Retrospective Diary administration from February to June 2015 assessing alcohol consumption in peri-conceptual and mid-pregnancy periods. Women were recruited at the mid-pregnancy ultrasound clinic. RESULTS Of 510 women, 470 (92·0%) drank alcohol before their pregnancy; 187 (39·9%) drank every week. Retrospective assessment of peri-conceptual consumption identified heavy episodic drinking (more than six units on one occasion) in 52·2% (n = 266); 19·6% (n = 100) reported drinking more than 14 units per week, mostly at the weekend; 'mixing' of drinks was associated with significantly higher consumption. While consumption tailed off following pregnancy recognition, 5·5% (n = 28) still exceeded the recommended daily two-unit limit in pregnancy. Multivariable logistic regression identified that women who 'binged' peri-conceptually were 3·2 times more likely to do this. CONCLUSION Statistically significant peri-conceptual consumption levels suggest a substantial proportion of alcohol-exposed pregnancies before pregnancy recognition. Not taking a detailed alcohol history, including patterns of consumption, will result in under-detection of alcohol-exposed pregnancies. The Retrospective Diary offers practitioners a detailed way of enquiring about alcohol history for this population.
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Affiliation(s)
- Andrew Symon
- Mother and Infant Research Unit, University of Dundee, UK
| | - Jean Rankin
- Maternal, Child and Family Health, School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | | | | | - Kylie Barclay
- School of Nursing and Health Sciences, University of Dundee, UK
| | - Rhona Gordon
- School of Nursing and Health Sciences, University of Dundee, UK
| | | | - Lesley Smith
- Department of Psychology, Social Work and Public Health, Oxford Brookes University, Marston, UK
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Onwuka CI, Ugwu EO, Dim CC, Menuba IE, Iloghalu EI, Onwuka CI. Prevalence and Predictors of Alcohol Consumption during Pregnancy in South-Eastern Nigeria. J Clin Diagn Res 2016; 10:QC10-QC13. [PMID: 27790525 DOI: 10.7860/jcdr/2016/21036.8449] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Accepted: 07/04/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Alcohol consumption during pregnancy is a major public health problem because of the enormous deleterious effects on a developing fetus. Sub-Saharan Africa (SSA) is among the highest per capita rates of alcohol consumption in the world, thus suggesting a high burden of Fetal Alcohol Syndrome Disorder (FASD) in the sub-region. Despite this, there is limited data on alcohol exposed pregnancies for most SSA countries including Nigeria. AIM To determine the prevalence and predictors of alcohol consumption during pregnancy in Enugu, South-Eastern Nigeria. MATERIALS AND METHODS It was a cross-sectional study of 380 consecutive consenting parturients accessing antenatal care at the University of Nigeria Teaching Hospital, Enugu, Nigeria. The information sought for, included the women's socio-demographic characteristics, alcohol use in pregnancy, awareness of the harmful effects of alcohol on the babies including FASD, sources of initial information on awareness, type and quantity of alcohol ingested, reasons for taking alcohol and willingness to stop alcohol ingestion in pregnancy after counseling on the risk of alcohol use in pregnancy. Statistical analysis was both descriptive and inferential at 95% confidence level. A p-value of less than 0.05 was considered statistically significant. RESULTS The prevalence of alcohol consumption in pregnancy was 22.6%. The most common brand of alcoholic beverage consumed was stout beer (62.8%, 54/86). A total of 135 (35.5%) respondents were aware that alcohol is harmful to the fetus. Maternal age 30 years or less, nulliparity, less than tertiary education, pre-pregnancy alcohol consumption and lack of awareness of the harmful effect of alcohol on the fetus, were associated with alcohol consumption during pregnancy (p< 0.05). CONCLUSION The prevalence of alcohol consumption during pregnancy among women in Enugu, South-Eastern Nigeria is high and lack of awareness of harmful effect of alcohol on fetus was a major predictor. There is need for a concerted public health campaign to improve the awareness of harmful effects of alcohol on the fetus.
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Affiliation(s)
- Chidinma Ifechi Onwuka
- Lecturer 1/Honorary Consultant, Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital , Ituku/Ozalla, Enugu, Nigeria
| | - Emmanuel Onyebuchi Ugwu
- Senior Lecturer/Honorary Consultant, Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria , Enugu Campus, Enugu, Nigeria
| | - Cyril Chukwudi Dim
- Professor/Honorary Consultant, Department of Obstetrics and Gynaecology, Faculty of Medical Sciences, College of Medicine, University of Nigeria , Enugu Campus, Enugu, Nigeria
| | - Ifeanyi Emmanuel Menuba
- Lecturer 1/Honorary Consultant, Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital , Ituku/Ozalla, Enugu, Nigeria
| | - Emeka Ifeanyi Iloghalu
- Post-Fellowship Senior Registrar, Department of Obstetrics and Gynaecology, University of Nigeria Teaching Hospital , Ituku/Ozalla, Enugu, Nigeria
| | - Chidozie Ifechi Onwuka
- Lecturer 1/Honorary Consultant Oral & Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, University of Nigeria Teaching Hospital , Ituku/Ozalla, Enugu, Nigeria
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Högberg H, Skagerström J, Spak F, Nilsen P, Larsson M. Alcohol consumption among partners of pregnant women in Sweden: a cross sectional study. BMC Public Health 2016; 16:694. [PMID: 27484750 PMCID: PMC4971635 DOI: 10.1186/s12889-016-3338-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 07/21/2016] [Indexed: 11/29/2022] Open
Abstract
Background Antenatal care in Sweden involves a visit in pregnancy week 6–7 for counseling about lifestyle issues, including alcohol. The aim of this study was to investigate alcohol consumption among partners of pregnant women, their motives for changing drinking patterns when becoming a parent and their perceptions of the midwife’s counseling about alcohol. Method The study was conducted at 30 antenatal care centers across Sweden in 2009–2010. All partners who accompanied a pregnant women in pregnancy week >17 were asked to participate. The questionnaire included questions on alcohol consumption. Results Questionnaires from 444 partners were analyzed. Most, 95 %, of the partners reported alcohol consumption before pregnancy; 18 % were binge drinking (6 standard drinks or more per occasion, each drink containing 12 grams of pure alcohol) at least once every month during the last year. More than half, 58 %, of all partners had decreased their alcohol consumption following pregnancy recognition and a higher proportion of binge drinkers decreased their consumption compared to non-frequent binge drinkers (p = 0.025). Their motives varied; the pregnancy itself, fewer social gatherings (potentially involving alcohol consumption) and a sense of responsibility for the pregnant partner were reported. Of the partners, 37 % reported support for decreased drinking from others (pregnant partner, parents, friend or workmates). Further, most partners appreciated the midwife’s counseling on alcohol. Conclusion A majority of partners decreased their alcohol consumption in transition to parenthood, which also appears to be a crucial time for changing alcohol-drinking patterns. The partners with higher AUDIT-C scores reported more support for decreased drinking. Most partners appreciated the midwife’s talk about alcohol and pregnancy and those who filled out AUDIT in early pregnancy reported that the counseling was more engaging. During pregnancy it is possible to detect partners with high alcohol consumption, and promote interventions for decreased drinking, also for the partners. Written information addressing alcohol use and directed to partners is needed.
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Affiliation(s)
- Hjördis Högberg
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden. .,Psykiatri Skåne, Divisionsledningen, Baravägen 1, S-22185, Lund, Sweden.
| | - Janna Skagerström
- Department of Health and Medical Science, Division of Community Medicine, Linköping University, Linköping, Sweden
| | - Fredrik Spak
- Social medicine, University of Gothenburg, Göteborg, Sweden
| | - Per Nilsen
- Department of Health and Medical Science, Division of Community Medicine, Linköping University, Linköping, Sweden
| | - Margareta Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Muggli E, O'Leary C, Donath S, Orsini F, Forster D, Anderson PJ, Lewis S, Nagle C, Craig JM, Elliott E, Halliday J. "Did you ever drink more?" A detailed description of pregnant women's drinking patterns. BMC Public Health 2016; 16:683. [PMID: 27485120 PMCID: PMC4969642 DOI: 10.1186/s12889-016-3354-9] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 07/22/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This paper presents drinking patterns in a prospective study of a population-based cohort of 1570 pregnant women using a combination of dose and timing to give best estimates of prenatal alcohol exposure (PAE). Novel assessments include women's special occasion drinking and alcohol use prior to pregnancy recognition. METHODS Information on up to nine types of alcoholic drink, with separate frequencies and volumes, including drinking on special occasions outside a 'usual' pattern, was collected for the periconceptional period and at four pregnancy time points. Weekly total and maximum alcohol consumption on any one occasion was calculated and categorised. Drinking patterns are described in the context of predictive maternal characteristics. RESULTS 41.3 % of women did not drink during pregnancy, 27 % drank in first trimester only; most of whom stopped once they realised they were pregnant (87 %). When compared to women who abstained from alcohol when pregnant, those who drank in the first trimester only were more likely to have an unplanned pregnancy and not feel the effects of alcohol quickly. Almost a third of women continued to drink alcohol at some level throughout pregnancy (27 %), around half of whom never drank more than at low or moderate levels. When compared with abstainers and to women who only drank in trimester one, those who drank throughout pregnancy tended to be in their early to mid-thirties, smoke, have a higher income and educational attainment. Overall, almost one in five women (18.5 %) binge drank prior to pregnancy recognition, a third of whom were identified with a question about 'special occasion' drinking. Women whose age at first intoxication was less than 18 years (the legal drinking age in Australia), were significantly more likely to drink in pregnancy and at binge levels prior to pregnancy recognition. CONCLUSIONS We have identified characteristics of pregnant women who either abstain, drink until pregnancy awareness or drink throughout pregnancy. These may assist in targeting strategies to enhance adherence to an abstinence policy and ultimately allow for appropriate follow-up and interpretation of adverse child outcomes. Our methodology also produced important information to reduce misclassification of occasional binge drinking episodes and ensure clearly defined comparison groups.
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Affiliation(s)
- Evelyne Muggli
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia. .,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia.
| | | | - Susan Donath
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia
| | - Francesca Orsini
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia
| | - Della Forster
- Judith Lumley Centre, School of Nursing and Midwifery, SHE College, La Trobe University, Melbourne, 3000, VIC, Australia.,The Royal Women's Hospital, Parkville, 3052, VIC, Australia
| | - Peter J Anderson
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia
| | - Sharon Lewis
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia
| | - Catherine Nagle
- Quality and Patient Safety Strategic Research Centre, Deakin University, Geelong, 3220, VIC, Australia.,Women's and Children's Division, Western Health, St Albans, 3021, VIC, Australia
| | - Jeffrey M Craig
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia
| | - Elizabeth Elliott
- Paediatrics & Child Health, Children's Hospital Westmead, The University of Sydney, Sydney, 2006, NSW, Australia
| | - Jane Halliday
- Murdoch Childrens Research Institute, Parkville, 3052, VIC, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, 3052, VIC, Australia
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Thapa N, Aryal KK, Puri R, Shrestha S, Shrestha S, Thapa P, Mehata S, Thapa P, Banjara MR, Stray-Pedersen B. Alcohol Consumption Practices among Married Women of Reproductive Age in Nepal: A Population Based Household Survey. PLoS One 2016; 11:e0152535. [PMID: 27035722 PMCID: PMC4818085 DOI: 10.1371/journal.pone.0152535] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 03/15/2016] [Indexed: 12/03/2022] Open
Abstract
Background Alcohol chemically known as ethanol, causes several health, economic and social consequences across the world. Literatures suggest potential harm of alcohol drinking by pregnant women especially to the fetus and the mother. Despite anumber of significant public health problems related to alcohol consumption, this area has been ignored in Nepal and information at the national level is limited. Thus this study aimed at finding the prevalence of alcohol consumption among married women of reproductive age. Methods A nationally representative household survey was carried out from April to August 2013 by taking 16 districts across all 15 eco administrative regions. From the selected districts, 86 village development committees and 14 municipalities were selected as primary sampling units using probability proportionate to size, followed by random selection of 3 wards from each primary sampling unit. Finally, 30 households within each ward were selected using systematic random sampling, and one married women of reproductive age from each household. A total of 9000 married women of reproductive age were interviewed using a semi-structured questionnaire, on alcohol consumption practices including environmental factors and socio demographic characteristics and were included in the analysis. Results National prevalence of alcohol consumption ever among married women of reproductive age was 24.7% (95% CI:21.7–28.0), last 12 months 17.9% (95% CI:15.3–20.7) and last 30 days (current drinking) 11.8% (95% CI:9.8–14.1). There was substantial variation among the districts ranging from 2% to 60%. Multivariable analysis suggests women with no education or within formal education, dalit and janajatis ethnicity, whose husbands drink alcohol, who brew alcohol at home and women from mountains were significantly at higher risk of consuming alcohol. Among the women who drank alcohol in last 12 months, a substantial proportion of them drank home brewed alcoholic beverages (95.9%, 95% CI:94.3–97.4). Conclusion Alcohol consumption was common practice among married women of reproductive age in Nepal with variation among the subgroups of population. Thus, further investigation and behavior change communication interventions to reduce alcohol consumption especially among the women with higher risk of drinking is essential.
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Affiliation(s)
- Narbada Thapa
- Nepalese Army Institute of Health Sciences, Kathmandu, Nepal
- * E-mail:
| | - Krishna Kumar Aryal
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Nepal Health Research Council (NHRC), Government of Nepal, Kathmandu, Nepal
| | - Rupendra Puri
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- District Ayurveda Health Centre, Department of Ayurveda, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | - Saraswoti Shrestha
- Initiative for Research Education and Community Health—Nepal (InREACH Nepal), Kathmandu, Nepal
| | - Sheela Shrestha
- National Health Education, Information and Communication Centre, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal
| | | | | | - Pushpa Thapa
- Nepal Health Research Council (NHRC), Government of Nepal, Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal
| | - Babill Stray-Pedersen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Women and Children, Rikshospitalet, Oslo University Hospital, Oslo, Norway
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Alhusen JL, Ayres L, DePriest K. Effects of Maternal Mental Health on Engagement in Favorable Health Practices During Pregnancy. J Midwifery Womens Health 2016; 61:210-6. [PMID: 26849176 DOI: 10.1111/jmwh.12407] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
INTRODUCTION A woman's health practices during pregnancy are associated with maternal and neonatal outcomes. Yet limited research has examined predictors of a woman's engagement in favorable health practices, particularly in pregnant women at greatest risk for adverse outcomes. We examined the role of mental health on engagement in favorable health practices during pregnancy in a sample of pregnant, low-income, predominantly African American women. METHODS A convenience sample of pregnant women was obtained from 3 obstetric clinics within a large Mid-Atlantic academic health system. Pregnant women (N = 166) completed measures of depression, social support, and engagement in favorable health practices during their second trimester. Six domains of health practices (ie, balance of rest and exercise, safety measures, nutrition, substance use, health care access, access to pregnancy-related information) were assessed by the Health Practices in Pregnancy Questionnaire-II. Multiple linear regression was used to examine predictors of engagement in favorable health practices. RESULTS Fifty-nine percent of the study participants experienced depressive symptomatology during pregnancy. Multivariate linear regression modeling demonstrated that increased depressive symptoms, decreased social support, young age, and prepregnancy overweight or obesity were significant predictors of nonengagement in favorable health practices during pregnancy. DISCUSSION Findings suggest that pregnant women with poor mental health (eg, depressive symptomatology, poor social support) and specific sociodemographic characteristics (eg, young age, prepregnancy overweight or obesity) were less likely to engage in favorable health practices during pregnancy. Health care providers are uniquely positioned to assess a woman's mental health and related indicators to optimize pregnancy and neonatal outcomes.
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van der Wulp NY, Hoving C, de Vries H. Partner's influences and other correlates of prenatal alcohol use. Matern Child Health J 2015; 19:908-16. [PMID: 25087003 DOI: 10.1007/s10995-014-1592-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To investigate the influence of partners on alcohol consumption in pregnant women within the context of other factors. A Dutch nationwide online cross-sectional study among 158 pregnant women and their partners was conducted. To identify correlates of prenatal alcohol use, including perceived and reported partner norm (i.e. partner's belief regarding acceptability of prenatal alcohol use), partner modeling (i.e. partner's alcohol use during the woman's pregnancy) and partner support (i.e. partner's help in abstaining from alcohol during pregnancy), independent sample T-tests and Chi square tests were conducted. Correlation analyses tested the relationship between perceived and reported partner influence. Multivariate logistic hierarchical regression analyses tested the independent impact of partner's perceived and reported influence next to other correlates from the I-Change Model. Pregnant women who consumed alcohol perceived a weaker partner norm (p < 0.001) and less partner modeling (p < 0.05), with the partner reporting a weaker norm (p < 0.001), more drinking days per week (p < 0.05) and weaker support (p < 0.05). Perceived and reported partner norm, modeling and support were positively related (respectively p < 0.01, p < 0.01 and p < 0.05). The multivariate analyses demonstrated that pregnant women with a higher education who perceived lower severity of harm due to prenatal alcohol use and a weaker partner norm were more likely to use alcohol (R(2) = 0.42). This study demonstrated that perceived partner norm was the most critical of the constructs of perceived and reported partner influences in explaining prenatal alcohol use.
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Affiliation(s)
- Nickie Y van der Wulp
- Dutch Institute for Alcohol Policy STAP, P.O. Box 9769, 3506 GT, Utrecht, The Netherlands,
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Skagerström J, Häggström-Nordin E, Alehagen S. The voice of non-pregnant women on alcohol consumption during pregnancy: a focus group study among women in Sweden. BMC Public Health 2015; 15:1193. [PMID: 26621365 PMCID: PMC4666188 DOI: 10.1186/s12889-015-2519-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 11/18/2015] [Indexed: 12/02/2022] Open
Abstract
Background Consensus is that fetal exposure to alcohol is harmful. Abstinence while trying to conceive and throughout pregnancy is recommended. Despite this, there are many women who consume alcohol around conception and until pregnancy recognition. The aim of this study was to explore the voice of non-pregnant women concerning alcohol consumption and its relation to pregnancy. Methods Data were collected through seven focus groups interviews with 34 women of fertile age, who were neither pregnant nor mothers. Semi-structured interviews were undertaken, recorded and transcribed verbatim and then analysed using thematic analysis. Results Three main themes were identified in the analysis: an issue that cannot be ignored; awareness and uncertainty concerning alcohol and pregnancy; and transition to parenthood. Alcohol was an integral part of the women’s lives. A societal expectation to drink alcohol was prevalent and the women used different strategies to handle this expectation. Most women agreed not to drink alcohol during pregnancy although their knowledge on the specific consequences was scanty and they expressed a need for more information. Most of the participants found drinking alcohol during pregnancy to be irresponsible and saw pregnancy as a start of a new way of life. Conclusions Social expectations concerning women’s alcohol use change with pregnancy when women are suddenly expected to abstain. Although most study participants shared an opinion for zero tolerance during pregnancy, their knowledge regarding consequences of drinking during pregnancy were sparse. In order for prospective mothers to make informed choices, there is a need for public health initiatives providing information on the relationship between alcohol consumption and reproduction.
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Affiliation(s)
- Janna Skagerström
- Department of Medical and Health Sciences, Division of Community Medicine, Linköping University, SE-581 83, Linköping, Sweden.
| | - Elisabet Häggström-Nordin
- Department of Women's and Children's Health, Uppsala University, SE-751 85, Uppsala, Sweden. .,School of Health, Care and Social Welfare, Mälardalen University, SE-721 23, Västerås, Sweden.
| | - Siw Alehagen
- Department of Medical and Health Sciences, Division of Nursing, Linköping University, SE-581 85, Linköping, Sweden.
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Lange S, Probst C, Quere M, Rehm J, Popova S. Alcohol use, smoking and their co-occurrence during pregnancy among Canadian women, 2003 to 2011/12. Addict Behav 2015; 50:102-9. [PMID: 26117214 DOI: 10.1016/j.addbeh.2015.06.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 04/27/2015] [Accepted: 06/04/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The co-occurrence of alcohol use and smoking during pregnancy has been shown to have a negative synergistic effect on fetal and perinatal risks. The objectives were to: 1) obtain an estimate of the prevalence of smoking during pregnancy in Canada by province and territory from 2003 to 2011/12; 2) determine if the prevalence of smoking during pregnancy has increased or decreased over time; 3) investigate whether smoking status is differentially associated with alcohol use during pregnancy; and 4) examine the risk factors predictive of alcohol use only, smoking only, and the co-occurrence of alcohol use and smoking during pregnancy. METHODS Secondary data analysis was conducted using five cycles of the Canadian Community Health Survey (CCHS; 2003, 2005, 2007/08, 2009/10 and 2011/12). The prevalence of smoking during pregnancy, and 95% confidence interval (CI) was calculated by province and territory and by year. The likelihood ratio test was used to determine if the prevalence of smoking during pregnancy has increased or decreased over time. The relationship between smoking status and alcohol use during pregnancy was explored using a quasi-Poisson regression model. A multinomial logistic regression model was utilized to determine which factors were predictive of alcohol use only, smoking only, and the co-occurrence of alcohol use and smoking during pregnancy. RESULTS In Canada, between 2003 and 2011/12, the weighted pooled prevalence of smoking during pregnancy was 14.3% (95% CI: 13.6%-15.0%). Women who smoked daily during pregnancy, occasionally during pregnancy, or had a lifetime history of smoking (but did not smoke while pregnant) were 2.54 (95% CI: 2.11-3.06, P < 0.0001), 2.71 (95% CI: 2.25-3.27, P < 0.0001), and 2.09 (95% CI: 1.85-2.37, P < 0.0001), respectively, times more likely to have consumed alcohol during pregnancy, compared to pregnant women who were lifetime non-smokers when controlling for age, household income, ethnicity and CCHS cycle. Risk factors that predicted alcohol use only, smoking only, and the co-occurrence of alcohol use and smoking during pregnancy differed. CONCLUSION It is apparent that smoking in any capacity, whether during pregnancy or not, increases the likelihood that a woman consumed alcohol while pregnant. Ascertaining smoking status among pregnant women and women of childbearing age could be a useful screening method for identifying those at-risk of consuming alcohol during pregnancy, and vice versa.
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Affiliation(s)
- Shannon Lange
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada
| | - Charlotte Probst
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada; Epidemiological Research Unit, Klinische Psychologie and Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46. 01187 Dresden, Germany
| | - Mathilde Quere
- Institut de Santé Publique d'Épiémiologie et de Développement, l'Université Bordeaux Segalen, 146 Rue Léo Saignat, 33076 Bordeaux cedex, France
| | - Jürgen Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Epidemiological Research Unit, Klinische Psychologie and Psychotherapie, Technische Universität Dresden, Chemnitzer Str. 46. 01187 Dresden, Germany; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada
| | - Svetlana Popova
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, 33 Russell Street, Toronto, ON M5S 2S1, Canada; Institute of Medical Science, University of Toronto, Faculty of Medicine, Medical Sciences Building, 1 King's College Circle, Toronto, ON M5S 1A8, Canada; Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada; Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street W., Toronto, ON M5S 1V4, Canada.
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128
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Liu W, Mumford EA, Petras H. Maternal Alcohol Consumption During the Perinatal and Early Parenting Period: A Longitudinal Analysis. Matern Child Health J 2015; 20:376-85. [DOI: 10.1007/s10995-015-1836-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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129
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Factors associated with family resilience during pregnancy among inner-city women. Midwifery 2015; 31:957-64. [DOI: 10.1016/j.midw.2015.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 05/22/2015] [Accepted: 05/25/2015] [Indexed: 11/20/2022]
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130
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Lange S, Quere M, Shield K, Rehm J, Popova S. Alcohol use and self-perceived mental health status among pregnant and breastfeeding women in Canada: a secondary data analysis. BJOG 2015; 123:900-9. [PMID: 26344418 DOI: 10.1111/1471-0528.13525] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To estimate the prevalence of alcohol consumption during pregnancy and while breastfeeding in Canada from 2003 to 2010, and to test the relation between self-perceived mental health status and alcohol consumption during pregnancy and while breastfeeding. DESIGN Secondary analysis of four cycles of the Canadian Community Health Survey, a population-based cross-sectional survey. SETTING Canada. SAMPLE A total of 18 612 pregnant and 15 836 breastfeeding women. METHODS The prevalence of alcohol consumption during pregnancy and while breastfeeding and 95% confidence intervals (CI) were calculated by province and territory, and cycle. The relation between self-perceived mental health status and alcohol consumption during pregnancy and while breastfeeding was explored using quasi-Poisson regression models. MAIN OUTCOME MEASURES Alcohol consumption during pregnancy and while breastfeeding, and self-perceived mental health status. RESULTS In Canada, between 2003 and 2010, approximately one in every ten pregnant women (9.9%; 95%CI 9.2-10.5%) and two in every ten breastfeeding women (20.3%; 95%CI 19.4-21.2%) women consumed alcohol. Women with a lower self-perceived mental health status (i.e. 'good') were 1.40 (95%CI 1.18-1.67, P < 0.001) times more likely to have consumed alcohol during pregnancy, compared with women with an 'excellent' self-perceived mental health. There were no notable differences between the categories of mental health status in regard to alcohol consumption while breastfeeding. CONCLUSION Despite public health efforts in Canada, a significant proportion of pregnant and breastfeeding women consume alcohol. It is imperative that a standard screening protocol be initiated among pregnant and breastfeeding women, especially in high-risk populations (e.g. women utilising substance abuse treatment programs). TWEETABLE ABSTRACT In Canada in 2003-2010, approximately 10% of pregnant and 20% of breastfeeding women consumed alcohol.
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Affiliation(s)
- S Lange
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | - M Quere
- Institut de Santé Publique d'Épidémiologie et de Développement, l'Université Bordeaux Segalen, Bordeaux Cedex, France
| | - K Shield
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | - J Rehm
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Epidemiological Research Unit, Klinische Psychologie and Psychotherapie, Technische Universität Dresden, Dresden, Germany
| | - S Popova
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Faculty of Medicine, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Factor-Inwentash Faculty of Social Work, University of Toronto, ON, Canada
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Hettema J, Cockrell S, Russo J, Corder-Mabe J, Yowell-Many A, Chisholm C, Ingersoll K. Missed Opportunities: Screening and Brief Intervention for Risky Alcohol Use in Women's Health Settings. J Womens Health (Larchmt) 2015; 24:648-54. [PMID: 26230758 PMCID: PMC4628227 DOI: 10.1089/jwh.2014.4961] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although women's health settings could provide access to women for screening, brief intervention, and referral to treatment (SBIRT) for risky alcohol use, little is known about rates of alcohol use or associated risk for alcohol-exposed pregnancy (AEP) among women's health patients, receipt of SBIRT services in these settings, or patient attitudes towards SBIRT services. METHODS This study reports the results of a self-administered survey to a convenience sample of women's health patients attending public clinics for family planning or sexually transmitted infection visits. RESULTS Surveys were analyzed for 199 reproductive-aged women who had visited the clinic within the past year. The rate of risky drinking among the sample was (44%) and risk for AEP was (17%). Despite this, many patients did not receive SBIRT services, with more than half of risky drinking patients reporting that they were not advised about safe drinking limits (59%) and similar rates of patients at risk for AEP reporting that their medical provider did not discuss risk factors of AEP (53%). Patient attitudes towards receipt of SBIRT services were favorable; more than 90% of women agreed or strongly agreed that if their drinking was affecting their health, their women's health provider should advise them to cut down. CONCLUSIONS Women's health clinics may be an ideal setting to implement SBIRT and future research should address treatment efficacy in these settings.
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Affiliation(s)
- Jennifer Hettema
- 1 Department of Family and Community Medicine, University of New Mexico , Albuquerque, New Mexico
| | - Stephanie Cockrell
- 1 Department of Family and Community Medicine, University of New Mexico , Albuquerque, New Mexico
| | - Jennifer Russo
- 2 Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine , Charlottesville, Virginia
| | - Joan Corder-Mabe
- 3 Office of Family Health , Virginia Department of Health, Richmond, Virginia
| | - Alycia Yowell-Many
- 3 Office of Family Health , Virginia Department of Health, Richmond, Virginia
| | - Christian Chisholm
- 2 Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine , Charlottesville, Virginia
| | - Karen Ingersoll
- 2 Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine , Charlottesville, Virginia
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Rushmer RK, Cheetham M, Cox L, Crosland A, Gray J, Hughes L, Hunter DJ, McCabe K, Seaman P, Tannahill C, Van Der Graaf P. Research utilisation and knowledge mobilisation in the commissioning and joint planning of public health interventions to reduce alcohol-related harms: a qualitative case design using a cocreation approach. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03330] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BackgroundConsiderable resources are spent on research to establish what works to improve the nation’s health. If the findings from this research are used, better health outcomes can follow, but we know that these findings are not always used. In public health, evidence of what works may not ‘fit’ everywhere, making it difficult to know what to do locally. Research suggests that evidence use is a social and dynamic process, not a simple application of research findings. It is unclear whether it is easier to get evidence used via a legal contracting process or within unified organisational arrangements with shared responsibilities.ObjectiveTo work in cocreation with research participants to investigate how research is utilised and knowledge mobilised in the commissioning and planning of public health services to reduce alcohol-related harms.Design, setting and participantsTwo in-depth, largely qualitative, cross-comparison case studies were undertaken to compare real-time research utilisation in commissioning across a purchaser–provider split (England) and in joint planning under unified organisational arrangements (Scotland) to reduce alcohol-related harms. Using an overarching realist approach and working in cocreation, case study partners (stakeholders in the process) picked the topic and helped to interpret the findings. In Scotland, the topic picked was licensing; in England, it was reducing maternal alcohol consumption.MethodsSixty-nine interviews, two focus groups, 14 observations of decision-making meetings, two local feedback workshops (n = 23 andn = 15) and one national workshop (n = 10) were undertaken. A questionnaire (n = 73) using a Behaviourally Anchored Rating Scale was issued to test the transferability of the 10 main findings. Given the small numbers, care must be taken in interpreting the findings.FindingsNot all practitioners have the time, skills or interest to work in cocreation, but when there was collaboration, much was learned. Evidence included professional and tacit knowledge, and anecdotes, as well as findings from rigorous research designs. It was difficult to identify evidence in use and decisions were sometimes progressed in informal ways and in places we did not get to see. There are few formal evidence entry points. Evidence (prevalence and trends in public health issues) enters the process and is embedded in strategic documents to set priorities, but local data were collected in both sites to provide actionable messages (sometimes replicating the evidence base).ConclusionsTwo mid-range theories explain the findings. If evidence hassaliency(relates to ‘here and now’ as opposed to ‘there and then’) andimmediacy(short, presented verbally or visually and with emotional appeal) it is more likely to be used in both settings. A second mid-range theory explains how differing tensions pull and compete as feasible and acceptable local solutions are pursued across stakeholders. Answering what works depends on answering for whom and where simultaneously to find workable (if temporary) ‘blends’. Gaining this agreement across stakeholders appeared more difficult across the purchaser–provider split, because opportunities to interact were curtailed; however, more research is needed.FundingThis study was funded by the Health Services and Delivery Research programme of the National Institute for Health Research.
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Affiliation(s)
- Rosemary K Rushmer
- School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Mandy Cheetham
- School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
| | - Lynda Cox
- Clinical Directorates, NHS England, Newcastle upon Tyne, UK
| | - Ann Crosland
- Department of Pharmacy, Health and Wellbeing, University of Sunderland, Sunderland, UK
| | - Joanne Gray
- Department of Public Health and Wellbeing, Northumbria University, Newcastle upon Tyne, UK
| | | | - David J Hunter
- Centre for Public Policy and Health, School of Medicine, Pharmacy and Health, Wolfsan Research Institute, Durham University, Durham, UK
| | - Karen McCabe
- Department of Pharmacy, Health and Wellbeing, University of Sunderland, Sunderland, UK
| | - Pete Seaman
- Glasgow Centre for Population Health, Glasgow, UK
| | | | - Peter Van Der Graaf
- School of Health and Social Care, Health and Social Care Institute, Teesside University, Middlesbrough, UK
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Frankenberger DJ, Clements-Nolle K, Yang W. The Association between Adverse Childhood Experiences and Alcohol Use during Pregnancy in a Representative Sample of Adult Women. Womens Health Issues 2015; 25:688-95. [PMID: 26227209 DOI: 10.1016/j.whi.2015.06.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 06/17/2015] [Accepted: 06/22/2015] [Indexed: 01/28/2023]
Abstract
BACKGROUND The impact of adverse childhood experiences (ACEs) on adult alcohol consumption is well-established, but little is known about the association with alcohol use during pregnancy. METHODS Using data from the 2010 Nevada Behavioral Risk Factor Surveillance System, we assessed the relationship between ACEs and alcohol use during pregnancy in a representative sample of 1,987 adult women. An established ACEs scale was used to assess a range of childhood physical, emotional, and sexual abuse and household dysfunction (range, 0-8). Weighted logistic regression was used to assess the relationship between ACE scores and alcohol use during pregnancy after controlling for drinking before pregnancy and other covariates. RESULTS Six percent of participants reported drinking alcohol during pregnancy. After controlling for race/ethnicity, age, employment status, smoking status, and prepregnancy alcohol use, increasing ACEs were positively associated with higher odds of alcohol use during pregnancy (1 ACE: adjusted odds ratio [AOR], 2.92; 95% CI, 1.08-7.87), (2-3 ACEs: AOR, 3.52; 95% CI, 1.46-8.48), and (≥4 ACEs: AOR, 4.79; 95% CI, 2.14-10.72). Prepregnancy drinking was also strongly associated with alcohol use during pregnancy (AOR, 11.95; 95% CI, 5.02-28.43). CONCLUSIONS We found evidence of a dose-response relationship between ACEs and alcohol use during pregnancy that remained even after controlling for prepregnancy drinking and other covariates. Screening women of childbearing age as well as pregnant women for ACEs may be an effective way to identify and address many of the emotional, behavioral, and physical sequelae of childhood adversity.
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Affiliation(s)
- David J Frankenberger
- Department of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada
| | - Kristen Clements-Nolle
- Department of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada.
| | - Wei Yang
- Department of Epidemiology, School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada
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O'Keeffe LM, Kearney PM, McCarthy FP, Khashan AS, Greene RA, North RA, Poston L, McCowan LME, Baker PN, Dekker GA, Walker JJ, Taylor R, Kenny LC. Prevalence and predictors of alcohol use during pregnancy: findings from international multicentre cohort studies. BMJ Open 2015; 5:e006323. [PMID: 26152324 PMCID: PMC4499685 DOI: 10.1136/bmjopen-2014-006323] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare the prevalence and predictors of alcohol use in multiple cohorts. DESIGN Cross-cohort comparison of retrospective and prospective studies. SETTING Population-based studies in Ireland, the UK, Australia and New Zealand. PARTICIPANTS 17,244 women of predominantly Caucasian origin from two Irish retrospective studies (Growing up in Ireland (GUI) and Pregnancy Risk Assessment Monitoring System Ireland (PRAMS Ireland)), and one multicentre prospective international cohort, Screening for Pregnancy Endpoints (SCOPE) study. PRIMARY AND SECONDARY OUTCOME MEASURES Prevalence of alcohol use pre-pregnancy and during pregnancy across cohorts. Sociodemographic factors associated with alcohol consumption in each cohort. RESULTS Alcohol consumption during pregnancy in Ireland ranged from 20% in GUI to 80% in SCOPE, and from 40% to 80% in Australia, New Zealand and the UK. Levels of exposure also varied substantially among drinkers in each cohort ranging from 70% consuming more than 1-2 units/week in the first trimester in SCOPE Ireland, to 46% and 15% in the retrospective studies. Smoking during pregnancy was the most consistent predictor of gestational alcohol use in all three cohorts, and smokers were 17% more likely to drink during pregnancy in SCOPE, relative risk (RR)=1.17 (95% CI 1.12 to 1.22), 50% more likely to drink during pregnancy in GUI, RR=1.50 (95% CI 1.36 to 1.65), and 42% more likely to drink in PRAMS, RR=1.42 (95% CI 1.18 to 1.70). CONCLUSIONS Our data suggest that alcohol use during pregnancy is prevalent and socially pervasive in the UK, Ireland, New Zealand and Australia. New policy and interventions are required to reduce alcohol prevalence both prior to and during pregnancy. Further research on biological markers and conventions for measuring alcohol use in pregnancy is required to improve the validity and reliability of prevalence estimates.
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Affiliation(s)
- Linda M O'Keeffe
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
| | - Fergus P McCarthy
- The Irish Centre for Foetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
| | - Ali S Khashan
- Department of Epidemiology and Public Health, University College Cork, Cork, Ireland
- The Irish Centre for Foetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
| | - Richard A Greene
- National Perinatal Epidemiology Centre, Cork University Maternity Hospital, Wilton, Cork, Ireland
| | - Robyn A North
- Division of Women's Health, Women's Health Academic Centre, King's College London, and King's Health Partners, London, UK
| | - Lucilla Poston
- Division of Women's Health, Women's Health Academic Centre, King's College London, and King's Health Partners, London, UK
| | - Lesley M E McCowan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, South Auckland Clinical School, University of Auckland, Auckland, New Zealand
| | - Philip N Baker
- National Centre for Growth & Development and Maternal and Fetal Health, Liggins Institute, University of Auckland, Auckland District Health Board and Counties Manukau District Health Board, Auckland, New Zealand
| | - Gus A Dekker
- Women's and Children's Division Lyell McEwin Hospital, University of Adelaide, Adelaide, South Australia
| | | | - Rennae Taylor
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Louise C Kenny
- The Irish Centre for Foetal and Neonatal Translational Research (INFANT), University College Cork, Cork, Ireland
- Department of Obstetrics and Gynecology, University College Cork, Cork, Ireland
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Kingsbury AM, Hayatbakhsh R, Gibbons K, Flenady V, Najman JM. Women's frequency of alcohol consumption prior to pregnancy and at their pregnancy-booking visit 2001–2006: A cohort study. Women Birth 2015; 28:160-5. [DOI: 10.1016/j.wombi.2014.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 11/07/2014] [Accepted: 11/14/2014] [Indexed: 11/25/2022]
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Montag AC, Brodine SK, Alcaraz JE, Clapp JD, Allison MA, Calac DJ, Hull AD, Gorman JR, Jones KL, Chambers CD. Preventing Alcohol-Exposed Pregnancy Among an American Indian/Alaska Native Population: Effect of a Screening, Brief Intervention, and Referral to Treatment Intervention. Alcohol Clin Exp Res 2015; 39:126-35. [DOI: 10.1111/acer.12607] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 10/17/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Annika C. Montag
- Department of Pediatrics; University of California, San Diego; San Diego California
- Department of Family and Preventive Medicine; University of California, San Diego; San Diego California
| | - Stephanie K. Brodine
- Division of Epidemiology and Biostatistics; San Diego State University; San Diego California
| | - John E. Alcaraz
- Division of Epidemiology and Biostatistics; San Diego State University; San Diego California
| | - John D. Clapp
- Department of Social Work ; The Ohio State University; Columbus Ohio
| | - Matthew A. Allison
- Department of Family and Preventive Medicine; University of California, San Diego; San Diego California
| | - Daniel J. Calac
- Southern California Tribal Health Clinic; San Diego California
| | - Andrew D. Hull
- Department of Reproductive Medicine; University of California, San Diego; San Diego California
| | - Jessica R. Gorman
- Moores Cancer Center; University of California, San Diego; San Diego California
| | - Kenneth L. Jones
- Department of Pediatrics; University of California, San Diego; San Diego California
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McDonald SW, Hicks M, Rasmussen C, Nagulesapillai T, Cook J, Tough SC. Characteristics of Women Who Consume Alcohol Before and After Pregnancy Recognition in a Canadian Sample: A Prospective Cohort Study. Alcohol Clin Exp Res 2015; 38:3008-16. [DOI: 10.1111/acer.12579] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/13/2014] [Indexed: 10/24/2022]
Affiliation(s)
| | - Matthew Hicks
- Department of Pediatrics; University of Calgary; Calgary Alberta Canada
| | - Carmen Rasmussen
- Department of Pediatrics; University of Alberta; Edmonton Alberta Canada
| | | | | | - Suzanne C. Tough
- Department of Pediatrics; University of Calgary; Calgary Alberta Canada
- Department of Community Health Sciences; University of Calgary; Calgary Alberta Canada
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Bortes C, Geidne S, Eriksson C. Preventing Alcohol Consumption during Pregnancy: A Randomized Controlled Trial. Health (London) 2015. [DOI: 10.4236/health.2015.73033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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139
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Högberg H, Spak F, Larsson M. Dialogue between Midwives and Parents-to-Be about Alcohol, from a Life Cycle Perspective—An Intervention Study. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/ce.2015.65049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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140
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Kitsantas P, Gaffney KF, Wu H. Identifying high-risk subgroups for alcohol consumption among younger and older pregnant women. J Perinat Med 2015; 43:43-52. [PMID: 24791820 DOI: 10.1515/jpm-2013-0323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 04/04/2014] [Indexed: 11/15/2022]
Abstract
AIMS Recent studies indicate that older women are more likely to consume alcohol during pregnancy, but subgroups at highest risk within the context of maternal age have not been identified. This study identifies subgroups at risk for alcohol use during pregnancy among three age categories using classification and regression trees (CART) analysis. METHODS Using the 2002-2009 Pregnancy Risk Assessment Monitoring System (PRAMS) dataset (311,428 records of U.S. women), logistic regression and classification trees were constructed separately for age groups, ≤24, 25-29, and ≥30 years. RESULTS Overall, 6.5% of women reported drinking alcohol during the last trimester of pregnancy. Alcohol consumption by age group was: 3.7% for ≤24, 5.7% for 25-29, and 10.1% for ≥30 years of age. Women ≤24 years were at greater risk of consuming alcohol if they also smoked (5.8%). Among nonsmokers, higher levels of education and being Hispanic were associated with a 35% increase in alcohol use. Distinct high-risk subgroups emerged for the 25-29-year-old group. Specifically, 12.8% of non-obese women who reported having experienced abuse during pregnancy also reported drinking alcohol in the last trimester. About 16% of women ≥30 years with at least 16 years of education, White or Hispanic with normal or underweight BMI, drank alcohol during their last trimester. CONCLUSIONS Given limited health care resources for prevention and treatment, the early identification of high-risk groups for prenatal alcohol use is critical. This study provides evidence that risk factors contributing to alcohol consumption during pregnancy may differ by maternal age.
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Wilhelmova R, Hruba D, Vesela L. Key Determinants Influencing the Health Literacy of Pregnant Women in the Czech Republic. Zdr Varst 2014; 54:27-36. [PMID: 27646619 PMCID: PMC4820146 DOI: 10.1515/sjph-2015-0004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/14/2014] [Indexed: 12/17/2022] Open
Abstract
Background Health literacy is a critical determinant of women’s and children’s health and therefore has immense consequences for the health of society as well. Evidence from epidemiological, clinical and experimental studies indicates that unhealthy lifestyles and risky behavioural habits of parents before conception and during pregnancy influence the etiology of various health defects. Decreasing primary risk factors, practicing physical wellness, monitoring physiological markers and preparing for labour, breastfeeding and newborn care should be the main parental responsibilities during the prenatal period. Methods Our study focused on specifying the main determinants of health literacy among 360 pregnant Czech women by using an anonymous questionnaire and selected anthropometric data of mothers. The criteria for study participation produced a sample representing 1.41% of Czech women in labour during a given 2012 reference period. Results Despite quite adequate knowledge of both risks and supporting factors for pregnancy and foetal development, the lifestyles of a majority of the women surveyed were far from optimum: only 30% reported good dietary and physical activity habits, 24% were active or passive smokers and one third of the women occasionally drank alcohol, more often among those who were university educated. Conclusion Our results have confirmed previously published data noting that health literacy and a healthier lifestyle of pregnant women are associated with a higher level of education (except for alcohol drinking) and with contact with a midwife (in some examined parameters) in prenatal courses.
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Affiliation(s)
- Radka Wilhelmova
- Masaryk University, Faculty of Medicine, Department of Midwifery, Komenskeho nam. 2, 66243 Brno, Czech Republic; Masaryk University, Faculty of Medicine, Department of Preventive Medicine, Kamenice 5, 62500 Brno, Czech Republic
| | - Drahoslava Hruba
- Masaryk University, Faculty of Medicine, Department of Preventive Medicine, Kamenice 5, 62500 Brno, Czech Republic
| | - Lenka Vesela
- Masaryk University, Faculty of Medicine, Department of Midwifery, Komenskeho nam. 2, 66243 Brno, Czech Republic
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Tran NT, Najman JM, Hayatbakhsh R. Predictors of maternal drinking trajectories before and after pregnancy: evidence from a longitudinal study. Aust N Z J Obstet Gynaecol 2014; 55:123-30. [DOI: 10.1111/ajo.12294] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 10/28/2014] [Indexed: 01/07/2023]
Affiliation(s)
- Nam T. Tran
- School of Social Sciences; The University of Queensland; Brisbane Australia
| | - Jake M. Najman
- School of Social Sciences; The University of Queensland; Brisbane Australia
- School of Population Health; The University of Queensland; Brisbane Australia
- Queensland Alcohol and Drug Research and Education Centre; Brisbane Australia
| | - Reza Hayatbakhsh
- School of Population Health; The University of Queensland; Brisbane Australia
- Queensland Alcohol and Drug Research and Education Centre; Brisbane Australia
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143
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Alcohol consumption during pregnancy: Cross-sectional survey. Midwifery 2014; 30:1173-8. [DOI: 10.1016/j.midw.2014.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 04/01/2014] [Accepted: 04/10/2014] [Indexed: 11/18/2022]
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The effectiveness of a brief intervention to reduce alcohol consumption in pregnancy: a controlled trial. Ir J Psychol Med 2014; 31:175-189. [PMID: 30189489 DOI: 10.1017/ipm.2014.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Alcohol consumption during pregnancy potentially has significant effects on both mother and baby. The aim of the study was to determine the effectiveness of a brief intervention to reduce alcohol consumption during pregnancy. METHODS This study was performed at the outpatient antenatal clinics of a large academic maternity teaching hospital in Dublin city centre. Six hundred and fifty-six women who drank alcohol before pregnancy were recruited at their first antenatal clinic visit. Drinking patterns before pregnancy, since becoming pregnant, and in later pregnancy (at ~32 weeks of gestation) were assessed using the Alcohol Use Disorders Identification Test (AUDIT). A controlled study was conducted - participants were allocated to either the brief intervention group (screening and 5 minutes of non-directive discussion of their drinking pattern) or a control group (screening and treatment as usual). RESULTS Before pregnancy, 57% of women consumed five or more units of alcohol per drinking occasion (i.e. binge drinking); during pregnancy, the rate of binge drinking fell to 4.8%. Sixty per cent of women who drank before pregnancy ceased drinking when pregnant, and a further 9% reduced their intake substantially. Four hundred and ninety-nine women were followed up in later pregnancy. The brief intervention did not produce any significant reduction in alcohol consumption above that attributable to pregnancy and comprehensive screening in antenatal care. Larger reductions in alcohol intake during pregnancy were associated with younger age, non-Irish nationality and greater intake of alcohol before first antenatal clinic visit. CONCLUSION Pregnancy itself produces abstinence and large reductions in alcohol consumption, even among women who drink relatively heavily. Consequently, a universal screening and brief intervention programme is not warranted but screening and targeted interventions could be appropriate such as repeated interventions for those who continue to binge drink. Future research could include evaluating interventions for those women who continue to binge drink during pregnancy and exploring ways of maintaining reductions in alcohol consumption among women who decreased consumption during pregnancy.
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145
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Meurk CS, Broom A, Adams J, Hall W, Lucke J. Factors influencing women's decisions to drink alcohol during pregnancy: findings of a qualitative study with implications for health communication. BMC Pregnancy Childbirth 2014; 14:246. [PMID: 25060554 PMCID: PMC4122767 DOI: 10.1186/1471-2393-14-246] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 07/15/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite Australian guidelines advising abstinence from alcohol during pregnancy, a relatively high number of Australian women continue to drink alcohol while pregnant. While some call for greater advocacy of the need for abstinence, others have expressed concern that abstinence messages may be harmful to pregnant women and their unborn babies due to the anxiety they could provoke. We present findings on women's deliberations over drinking alcohol during pregnancy, particularly their emotional dimensions, to inform debates about public health messages and practitioner-patient discussions regarding alcohol use during pregnancy. METHODS Semi-structured face-to-face interviews were conducted with 40 women in their homes. Our sample comprised women aged 34-39, drawn from the Australian Longitudinal Study on Women's Health, living in the Greater Brisbane Area who were pregnant, or had recently given birth, in 2009. An inductive qualitative framework analysis approach was used to identify and interpret themes explaining why pregnant women choose to drink or not. RESULTS Women generally described drinking small amounts of alcohol during pregnancy as being a low risk activity and talked about the importance of alcohol to their social lives as a reason for continuing to drink or finding abstinence a burden; sensitisation to the judgements of others was not widespread. Women predominantly assessed the risk of their drinking in terms of the kinds of alcoholic beverages consumed rather than alcohol content. In reflecting on the advice they recalled receiving, women described their healthcare practitioners as being relaxed about the risks of alcohol consumption. CONCLUSIONS The significance of alcohol to women's identity appeared to be an important reason for continued alcohol use during pregnancy among otherwise risk averse women. Anxiety about alcohol consumption during pregnancy was not widespread. However, obstetricians were an important mediator of this. Health messages that dispel the notion that wine is a "healthy" choice of alcoholic beverage, that provide women with strategies to help them avoid drinking, that advise the broader public not to pressure women to drink if they do not want to, and educate women about the effects of ethanol on maternal and fetal bodies, should be considered.
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Affiliation(s)
- Carla S Meurk
- />Postdoctoral Research Fellow, The University of Queensland, UQ Centre for Clinical Research, Royal Brisbane and Women’s Hospital Site, Herston, Queensland 4029 Australia
| | - Alex Broom
- />Sociology, Australian Research Council Future Fellow, The University of Queensland, School of Social Science, St Lucia, Queensland 4072 Australia
| | - Jon Adams
- />Public Health, National Health and Medical Research Council Career Development Fellow, University of Technology Sydney, Faculty of Health, PO Box 123, Broadway, NSW 2007 Australia
| | - Wayne Hall
- />Australia Fellow, The University of Queensland, UQ Centre for Clinical Research, Royal Brisbane and Women’s Hospital Site, Herston, 4029 Queensland
| | - Jayne Lucke
- />Principal Research Fellow, The University of Queensland, UQ Centre for Clinical Research, Royal Brisbane and Women’s Hospital Site, Herston, 4029 Queensland
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Watt MH, Eaton LA, Choi KW, Velloza J, Kalichman SC, Skinner D, Sikkema KJ. "It's better for me to drink, at least the stress is going away": perspectives on alcohol use during pregnancy among South African women attending drinking establishments. Soc Sci Med 2014; 116:119-25. [PMID: 24997441 DOI: 10.1016/j.socscimed.2014.06.048] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/25/2014] [Accepted: 06/26/2014] [Indexed: 11/16/2022]
Abstract
The Western Cape of South Africa has one of the highest rates of fetal alcohol spectrum disorders (FASD) globally. Reducing alcohol use during pregnancy is a pressing public health priority for this region, but insight into the experiences of women who drink during pregnancy is lacking. Convenience sampling in alcohol-serving venues was used to identify women who were currently pregnant (n = 12) or recently post-partum (n = 12) and reported drinking during the pregnancy period. In-depth qualitative interviews were conducted between April and August 2013. Interviews explored drinking narratives, with textual data analyzed for themes related to factors that contributed to drinking during pregnancy. All but one woman reported her pregnancy as unplanned. The majority sustained or increased drinking after pregnancy recognition, with patterns typically including multiple days of binge drinking per week. Analysis of the textual data revealed five primary factors that contributed to drinking during pregnancy: 1) women used alcohol as a strategy to cope with stressors and negative emotions, including those associated with pregnancy; 2) women drank as a way to retain social connection, often during a difficult period of life transition; 3) social norms in women's peer groups supported drinking during pregnancy; 4) women lacked attachment to the pregnancy or were resistant to motherhood; and 5) women were driven physiologically by alcohol addiction. Our data suggest that alcohol-serving settings are important sites to identify and target women at risk of drinking during pregnancy. Intervention approaches to reduce alcohol use during pregnancy should include counseling and contraception to prevent unwanted pregnancies, mental health and coping interventions targeting pregnant women, peer-based interventions to change norms around perinatal drinking, and treatment for alcohol dependence during pregnancy. Our findings suggest that innovative interventions that go beyond the boundaries of the health care system are urgently needed to address FASD in this region.
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Affiliation(s)
- Melissa H Watt
- Duke University, Duke Global Health Institute, Durham, NC 27708, USA.
| | - Lisa A Eaton
- University of Connecticut, Department of Human Development and Family Studies, Storrs, CT, USA
| | - Karmel W Choi
- Duke University, Department of Psychology and Neuroscience, Durham, NC, USA
| | - Jennifer Velloza
- Duke University, Duke Global Health Institute, Durham, NC 27708, USA
| | - Seth C Kalichman
- University of Connecticut, Department of Psychology, Storrs, CT, USA
| | - Donald Skinner
- Stellenbosch University, Unit for Research on Health and Society, Tygerberg, South Africa
| | - Kathleen J Sikkema
- Duke University, Duke Global Health Institute, Durham, NC 27708, USA; Duke University, Department of Psychology and Neuroscience, Durham, NC, USA
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Eaton LA, Pitpitan EV, Kalichman SC, Sikkema KJ, Skinner D, Watt MH, Pieterse D, Cain DN. Food insecurity and alcohol use among pregnant women at alcohol-serving establishments in South Africa. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2014; 15:309-17. [PMID: 23526080 PMCID: PMC3760986 DOI: 10.1007/s11121-013-0386-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
South Africa has the highest rate of fetal alcohol syndrome (FAS) in the world. While efforts have been made to curb the high rate of FAS, little is known about situational factors that may contribute to alcohol use during pregnancy. In the current paper, we focus on the role of food insecurity and its relationship to alcohol use among pregnant women. Women completed computer-assisted interviews. Generalized linear modeling was used in all analyses. Women attending alcohol-serving establishments in a township in Cape Town, South Africa were recruited for the study. Five hundred sixty women were sampled and 95 women reported being pregnant. High levels of alcohol use were reported among pregnant women: 65 % of women consumed alcohol at least every month and 29 % consumed alcohol as often as two to three times per week. Thirty-four percent of the women reported having six or more drinks per occasion on at least a weekly basis. The majority (87 %) of pregnant women reported experiencing some form of food insecurity (e.g., food unavailable, eating less) in the past month. Alcohol use was significantly associated with food insecurity, even when controlling for relevant demographic variables. Intervention with pregnant women who consume alcohol is urgently needed. Future research should focus on understanding the intersection of food insecurity and alcohol, and how the experience of food insecurity may contribute to greater rates of alcohol use and abuse among pregnant women.
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Affiliation(s)
- Lisa A Eaton
- Center for Health, Intervention and Prevention, University of Connecticut, 2006 Hillside Rd, Storrs, CT, 06269-1020, USA,
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Beijers C, Burger H, Verbeek T, Bockting CLH, Ormel J. Continued smoking and continued alcohol consumption during early pregnancy distinctively associated with personality. Addict Behav 2014; 39:980-6. [PMID: 24556156 DOI: 10.1016/j.addbeh.2014.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 01/17/2014] [Accepted: 01/29/2014] [Indexed: 12/15/2022]
Abstract
Pregnancy is a unique period to quit smoking and alcohol consumption and although motivated, not all women succeed at this. We investigated the associations of personality with continued smoking and continued alcohol consumption during early pregnancy. In addition, we studied whether antenatal anxiety and depressive symptoms can explain these associations. Two antenatal measurements from the population-based Pregnancy Anxiety and Depression cohort study were used. Pregnant women in their first trimester were recruited via midwifery practices and hospitals. We analyzed a sample of women who continued (n=101) or quit smoking (n=254), and a sample of women who continued (n=110) or quit alcohol consumption (n=1230). Measures included questions about smoking, alcohol consumption, the NEO-Five Factor Inventory (personality), the State Trait Anxiety Inventory, and the Edinburgh Postnatal Depression Scale. We found associations between continued alcohol consumption and higher levels of openness to experience, and lower levels of conscientiousness (p<0.05). The association between conscientiousness and continued alcohol consumption was partly explained by both anxiety and depressive symptoms. No associations between personality and continued smoking emerged. This study contributes to the limited literature on personality differences between women who continue and quit smoking and alcohol consumption during early pregnancy. General population studies have not confirmed the association between openness to experience and alcohol consumption which implies that pregnancy is indeed a unique period. Increased insight in how personality influences continued smoking and alcohol consumption during pregnancy can help health professionals to improve lifestyle interventions targeted at pregnant women.
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Affiliation(s)
- Chantal Beijers
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion Regulation, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Huibert Burger
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion Regulation, Hanzeplein 1, 9713 GZ Groningen, The Netherlands; University of Groningen, University Medical Center Groningen, Department of General Practice, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Tjitte Verbeek
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Claudi L H Bockting
- University of Groningen, Department of Clinical Psychology, Grote Kruisstraat 2/1, 9712 TS Groningen, The Netherlands
| | - Johan Ormel
- University of Groningen, University Medical Center Groningen, Interdisciplinary Center of Psychopathology and Emotion Regulation, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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150
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Choi KW, Abler LA, Watt MH, Eaton LA, Kalichman SC, Skinner D, Pieterse D, Sikkema KJ. Drinking before and after pregnancy recognition among South African women: the moderating role of traumatic experiences. BMC Pregnancy Childbirth 2014; 14:97. [PMID: 24593175 PMCID: PMC3975846 DOI: 10.1186/1471-2393-14-97] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 02/26/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND South Africa has one of the world's highest rates of fetal alcohol spectrum disorder (FASD) and interpersonal trauma. These co-occurring public health problems raise the need to understand alcohol consumption among trauma-exposed pregnant women in this setting. Since a known predictor of drinking during pregnancy is drinking behavior before pregnancy, this study explored the relationship between women's drinking levels before and after pregnancy recognition, and whether traumatic experiences - childhood abuse or recent intimate partner violence (IPV) - moderated this relationship. METHODS Women with incident pregnancies (N = 66) were identified from a longitudinal cohort of 560 female drinkers in a township of Cape Town, South Africa. Participants were included if they reported no pregnancy at one assessment and then reported pregnancy four months later at the next assessment. Alcohol use was measured by the Alcohol Use Disorders Identification Test (AUDIT), and traumatic experiences of childhood abuse and recent IPV were also assessed. Hierarchical linear regressions controlling for race and age examined childhood abuse and recent IPV as moderators of the effect of pre-pregnancy recognition drinking on post-pregnancy recognition AUDIT scores. RESULTS Following pregnancy recognition, 73% of women reported drinking at hazardous levels (AUDIT ≥ 8). Sixty-four percent reported early and/or recent exposure to trauma. While drinking levels before pregnancy significantly predicted drinking levels after pregnancy recognition, t(64) = 3.50, p < .01, this relationship was moderated by experiences of childhood abuse, B = -.577, t(60) = -2.58, p = .01, and recent IPV, B = -.477, t(60) = -2.16, p = .04. Pregnant women without traumatic experiences reported drinking at levels consistent with levels before pregnancy recognition. However, women with traumatic experiences tended to report elevated AUDIT scores following pregnancy recognition, even if low-risk drinkers previously. CONCLUSION This study explored how female drinkers in South Africa may differentially modulate their drinking patterns upon pregnancy recognition, depending on trauma history. Our results suggest that women with traumatic experiences are more likely to exhibit risky alcohol consumption when they become pregnant, regardless of prior risk. These findings illuminate the relevance of trauma-informed efforts to reduce FASD in South Africa.
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Affiliation(s)
- Karmel W Choi
- Department of Psychology and Neuroscience, Duke University, Box 90086, Durham, NC 27708, USA
| | - Laurie A Abler
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Melissa H Watt
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Lisa A Eaton
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Seth C Kalichman
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Donald Skinner
- Stellenbosch University, Unit for Research on Health and Society, Tygerberg, South Africa
| | - Desiree Pieterse
- Stellenbosch University, Unit for Research on Health and Society, Tygerberg, South Africa
| | - Kathleen J Sikkema
- Department of Psychology and Neuroscience, Duke University, Box 90086, Durham, NC 27708, USA
- Duke Global Health Institute, Duke University, Durham, NC, USA
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