Fetal Alcohol Spectrum Disorder in Adults: Health and Neurobehavior

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The 5-year award, for which this would be an administrative supplement in response to NOT-AA-20-011, focuses on the impact of prenatal alcohol exposure (PAE) on physical and mental health within the context of social and environmental factors that may contribute to outcomes in adulthood. There are two important, and related, reasons to include attention to COVID-19 and the medical and social implications of the pandemic in this ongoing study of alcohol-affected adults. First, there is evidence that the adults in the longitudinal cohorts being followed in Atlanta and Seattle are particularly vulnerable to the impact of the pandemic. Second, given this vulnerability, the pandemic represents a historic threat to the validity of study outcomes that must be addressed. In the parent study, 500 volunteers, half from each site will be seen for Tier 1, that includes remote collection of self-reported health and demographic information. In Tier 2, 240 individuals are being seen for more comprehensive assessment of health risk, immune status, neurocognition, and social functioning. To date, 226 individuals have completed Tier 1. Preliminary data, from Years 1-3, indicates that, in these samples, PAE is associated with higher risk for cardiovascular compromise, intellectual and social dysfunction, and higher rates of substance use. The majority of individuals in these cohorts are from populations that have been identified nationally as more impacted by COVID-19 infection and mortality (i.e., African-American; Native-American) and many in these groups are highly anxious about the effects of the virus. Given these factors, we will collect information on the impact of COVID-19 on health (e.g..,medical records), social outcomes (e.g., job loss, homelessness), and mental health status as well as substance use. COVID-relevant questionnaires will be administered remotely to both those who have previously participated and to future participants allow measurement of the effects of the pandemic on these outcomes. In Atlanta only, an extra tube of blood will be obtained during existing blood draw for antibody testing. Finally, we will employ the National Death Index (NDI) to determine mortality rates over the past 10 years in the parent cohorts from which these samples are being drawn, allowing an estimate of mortality in these 902 individuals who have previously participated in research. We anticipate that individuals with PAE will show more impact on health during this emergency and they may have a higher mortality rate than nonexposed individuals. Further, we anticipate that PAE will be associated with greater anxiety related to COVID-Exposure and increased substance use. We also hypothesize that social and environmental factors will contribute to the severity of effects.