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Parker M, May PA, Marais AS, de Vries M, Kalberg WO, Buckley D, Hasken J, Hoyme HE, Seedat S. Influence of childhood trauma and traumatic stress on a woman's risk of having a child with a fetal alcohol spectrum disorder. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1176-1188. [PMID: 38702143 PMCID: PMC11178454 DOI: 10.1111/acer.15334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/22/2024] [Accepted: 04/07/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Maternal risk factors for having a child diagnosed on the fetal alcohol spectrum disorders (FASD) continuum are complex and include not only the quantity, frequency, and timing of alcohol use but also a woman's physical stature, socio-economic status, and pregnancy-related factors. Exposure to trauma may predispose women to a range of physiological and mental disorders. A woman's mental and physical health may in turn influence her probability of having a child with FASD. This study investigated the role of maternal childhood trauma and lifetime traumatic stress on prenatal alcohol consumption and on the risk of having a child with FASD. METHODS A nested, case-control study was conducted for maternal risk assessment. Study participants were mothers of first-grade learners from five rural communities in the Western Cape Province of South Africa who were assessed for FASD. Face-to-face surveys were conducted, which included mental health and trauma assessment questionnaires. RESULTS In logistic regression analyses, higher maternal childhood trauma scores were associated with an increased likelihood of having a child diagnosed with FASD, although the increase in risk was modest (OR = 1.014, p = 0.015). In addition, structural equation modeling investigated relationships between maternal drinking, childhood trauma, traumatic stress, and a child's FASD diagnosis. Traumatic stress and drinking during pregnancy, but not lifetime alcohol use, were associated with maternal childhood trauma. Lifetime alcohol use influenced drinking during pregnancy, which in turn was significantly associated with having a child diagnosed on the continuum of FASD. CONCLUSION No direct influence of maternal childhood trauma on FASD diagnosis could be demonstrated. However, maternal trauma may indirectly contribute to the risk of having a child diagnosed with FASD.
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Affiliation(s)
- Michelle Parker
- Department of Psychiatry and SAMRC Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Philip A May
- Department of Psychiatry and SAMRC Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico, USA
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA
| | - Anna-Susan Marais
- Department of Psychiatry and SAMRC Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Marlene de Vries
- Department of Psychiatry and SAMRC Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
| | - Wendy O Kalberg
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico, USA
| | - David Buckley
- Center on Alcohol, Substance Abuse and Addictions, The University of New Mexico, Albuquerque, New Mexico, USA
| | - Julie Hasken
- Nutrition Research Institute, The University of North Carolina at Chapel Hill, Kannapolis, North Carolina, USA
| | - H Eugene Hoyme
- Department of Psychiatry and SAMRC Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
- Sanford Children's Genomic Medicine Consortium, Sanford Health, Sioux Falls, South Dakota, USA
| | - Soraya Seedat
- Department of Psychiatry and SAMRC Genomics of Brain Disorders Research Unit, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, Cape Town, South Africa
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Boerner KE, Keogh E, Inkster AM, Nahman-Averbuch H, Oberlander TF. A developmental framework for understanding the influence of sex and gender on health: Pediatric pain as an exemplar. Neurosci Biobehav Rev 2024; 158:105546. [PMID: 38272336 DOI: 10.1016/j.neubiorev.2024.105546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 07/07/2023] [Accepted: 11/06/2023] [Indexed: 01/27/2024]
Abstract
Sex differences are a robust finding in many areas of adult health, including cardiovascular disease, psychiatric disorders, and chronic pain. However, many sex differences are not consistently observed until after the onset of puberty. This has led to the hypothesis that hormones are primary contributors to sex differences in health outcomes, largely ignoring the relative contributions of early developmental influences, emerging psychosocial factors, gender, and the interaction between these variables. In this paper, we argue that a comprehensive understanding of sex and gender contributions to health outcomes should start as early as conception and take an iterative biopsychosocial-developmental perspective that considers intersecting social positions. We present a conceptual framework, informed by a review of the literature in basic, clinical, and social science that captures how critical developmental stages for both sex and gender can affect children's health and longer-term outcomes. The literature on pediatric chronic pain is used as a worked example of how the framework can be applied to understanding different chronic conditions.
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Affiliation(s)
- Katelynn E Boerner
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada.
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | - Amy M Inkster
- Department of Medical Genetics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Hadas Nahman-Averbuch
- Department of Anesthesiology, Washington University in St. Louis, St. Louis, MO, USA
| | - Tim F Oberlander
- Department of Pediatrics, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, and BC Children's Hospital Research Institute, Vancouver, BC, Canada
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Macgregor C, Walumbe J, Tulle E, Seenan C, Blane DN. Intersectionality as a theoretical framework for researching health inequities in chronic pain. Br J Pain 2023; 17:479-490. [PMID: 38107758 PMCID: PMC10722103 DOI: 10.1177/20494637231188583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Chronic pain is experienced unequally by different population groups; we outline examples from the pain literature of inequities related to gender, ethnicity, socioeconomic and migration status. Health inequities are systematic, avoidable and unfair differences in health outcomes between groups of people, with the fundamental 'causes of causes' recognised as unequal distribution of income, power and wealth. Intersectionality can add further theory to health inequities literature; collective social identities including class/socioeconomic status, race/ethnicity, gender, migration status, age, sexuality and disabled status intersect in multiple interconnected systems of power leading to differing experiences of privilege and oppression which can be understood as axes of health inequities. The process of knowledge creation in pain research is shaped by these interconnected systems of power, and may perpetuate inequities in pain care as it is largely based on majority white, middle class, Eurocentric populations. Intersectionality can inform research epistemology (ways of knowing), priorities, methodology and methods. We give examples from the literature where intersectionality has informed a justice oriented approach across different research methods and we offer suggestions for further development. The use of a reductionist frame can force unachievable objectivity on to complex health concepts, and we note increasing realisation in the field of the need to understand the individuals within their social world, and recognise the fluid and contextual nature of this.
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Affiliation(s)
- Cassandra Macgregor
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- NHS Lanarkshire Chronic Pain Service, Buchanan Centre, Coatbridge, UK
| | - Jackie Walumbe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Emmanuelle Tulle
- Department of Social Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Christopher Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - David N Blane
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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Brittain K, Pellowski J, Noholoza S, Mellins CA, Bekker LG, Kagee A, Remien RH, Abrams EJ, Myer L. Perinatal alcohol use among young women living with HIV in South Africa: Context, experiences, and implications for interventions. Glob Public Health 2023; 18:2221732. [PMID: 37302089 PMCID: PMC10413958 DOI: 10.1080/17441692.2023.2221732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
Perinatal alcohol use is common in South Africa, including among young women living with HIV (WLHIV), but there are few insights into the drivers of alcohol use in this population. Following the completion of a pilot trial of a peer support intervention for WLHIV aged 16-24 years in Cape Town, we purposively selected participants who had reported perinatal alcohol use at ≥1 study visits to complete a qualitative in-depth interview exploring their experiences of substance use. Of 119 women enrolled, 28 reported alcohol use, and 24 were interviewed, with ≥1/3 reporting drinking throughout their pregnancy. Women described living in a community where heavy perinatal alcohol consumption is normalised, including among their peers, leading to social pressure. Despite being aware of the risks of perinatal alcohol use, women described a disconnect between public health messaging and their experiences. Although most acknowledged the negative effects of alcohol in their lives, self-efficacy to reduce consumption was diminished by peer influences and the lack of formal employment and opportunities for recreation. These findings provide insights into the drivers of perinatal alcohol use in this setting, and suggest that without meaningful community-level changes, including employment opportunities and alternatives for socialising, interventions may have limited impact.
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Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Jennifer Pellowski
- Department of Behavioral & Social Sciences, Brown University School of Public Health, Providence, RI, USA
- International Health Institute, Brown University School of Public Health, Providence, RI, USA
| | - Sandisiwe Noholoza
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Claude A. Mellins
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Linda-Gail Bekker
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Robert H. Remien
- HIV Center for Clinical & Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Elaine J. Abrams
- ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Pediatrics, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology & Biostatistics, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
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Miller AP, Shoptaw S, Mvududu R, Mashele N, Coates TJ, Bekker LG, Essack Z, Groenewald C, Petersen Z, Gorbach PM, Myer L, Joseph Davey DL. Sexual Risk among Pregnant Women at Risk of HIV Infection in Cape Town, South Africa: What Does Alcohol Have to Do with It? AIDS Behav 2023; 27:37-50. [PMID: 35737280 PMCID: PMC9780404 DOI: 10.1007/s10461-022-03742-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 01/24/2023]
Abstract
This study examines baseline associations between alcohol use and HIV sexual risk among a cohort of HIV-uninfected pregnant women (n = 1201) residing in a high HIV burdened community in Cape Town, South Africa. Alcohol use was measured using a modified version of the Alcohol Use Disorder Identification Test (AUDIT). HIV sexual risk was measured through a composite variable of four risk factors: diagnosis with a STI, self-report of > 1 recent sex partners, partner HIV serostatus (unknown or HIV+) and condomless sex at last sex. Any past year alcohol use prior to pregnancy was reported by half of participants (50%); 6.0% reported alcohol use during pregnancy. Alcohol use prior to pregnancy was associated with increased odds of being at high risk of HIV (aOR = 1.33, 95% CI 1.05-1.68, for 2 risks and aOR = 1.47, 95% CI 0.95-2.27 for 3 risks). In addition to reducing alcohol use, several other strategies to address HIV sexual risk were identified. Evidence-based interventions to address alcohol use and other HIV sexual risk behaviors during pregnancy in South Africa are desperately needed. Qualitative work exploring individual and community level drivers of alcohol use among pregnant and breastfeeding women in this setting could support development of a culturally tailored intervention to address these issues in this population.
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Affiliation(s)
- Amanda P Miller
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
- Department of Epidemiology, Fielding School of Public Health, 650 Charles E. Young Drive South, Room #41-295CHS, Los Angeles, CA, 90095-1772, USA.
| | - Steven Shoptaw
- Department of Family Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Rufaro Mvududu
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Nyiko Mashele
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Thomas J Coates
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, Faculty of Health Science, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Zaynab Essack
- Centre for Community-Based Research, Human Sciences Research Council, Pretoria, South Africa
| | - Candice Groenewald
- Centre for Community-Based Research, Human Sciences Research Council, Pretoria, South Africa
- Psychology Department, Rhodes University, Makhanda, South Africa
| | - Zaino Petersen
- Impact and Research Development, Human Sciences Research Council, Pretoria, South Africa
| | - Pamina M Gorbach
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
| | - Dvora L Joseph Davey
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA, USA
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Observatory, Cape Town, South Africa
- Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- The Desmond Tutu HIV Centre, Faculty of Health Science, Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
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Greaves L, Poole N, Brabete AC. Sex, Gender, and Alcohol Use: Implications for Women and Low-Risk Drinking Guidelines. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084523. [PMID: 35457389 PMCID: PMC9028341 DOI: 10.3390/ijerph19084523] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/05/2022] [Accepted: 04/06/2022] [Indexed: 02/06/2023]
Abstract
Alcohol use is coming under increasing scrutiny with respect to its health impacts on the body. In this vein, several high-income countries have issued low-risk drinking guidelines in the past decade, aiming to educate the public on safer levels of alcohol use. Research on the sex-specific health effects of alcohol has indicated higher damage with lower amounts of alcohol for females as well as overall sex differences in the pharmacokinetics of alcohol in male and female bodies. Research on gender-related factors, while culturally dependent, indicates increased susceptibility to sexual assault and intimate partner violence as well as more negative gender norms and stereotypes about alcohol use for women. Sex- and gender-specific guidelines have been issued in some countries, suggesting lower amounts of alcohol consumption for women than men; however, in other countries, sex- and gender-blind advice has been issued. This article reports on a synthesis of the evidence on both sex- and gender-related factors affecting safer levels of drinking alcohol with an emphasis on women’s use. We conclude that supporting and expanding the development of sex- and gender-specific low-risk drinking guidelines offers more nuanced and educative information to clinicians and consumers and will particularly benefit women and girls.
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Affiliation(s)
- Lorraine Greaves
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Correspondence: (L.G.); (A.C.B.)
| | - Nancy Poole
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
| | - Andreea C. Brabete
- Centre of Excellence for Women’s Health, Vancouver, BC V6H 3N1, Canada;
- Correspondence: (L.G.); (A.C.B.)
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