FAS Prevention: A Trial of the IOM Model

世界上胎儿酒精综合征（FAS）发病率最高的国家是南非（SA）， 这座小镇是预防研究的目标在第一波和第二波中，FAS的发生率分别为46/1000和75/1000。 研究和初步率在第三波是79。南非其他地区FAS患病率较高。 预防研究对南非、美国和发展中国家的项目有着广泛的影响。 这是一项综合性、公共卫生模式、社区范围、FAS的多中心、疗效试验 医学研究所（IOM）制定的预防计划。它既利用了比较社区， 预防前/预防后设计，通过对儿童和婴儿FAS的严格诊断进行评估， 随机抽样饮酒习惯调查的措施变化。严格的项目评估将 还评估土著居民采用的具体的、选定的和普遍的预防技术， 工人预防点（城乡组成部分）与四个对比社区相匹配 将作为不同的实体进行总体分析，以评估混杂影响。利用 IOM推荐的研究和预防技术以前在美洲印第安人中应用 社区，这项研究将确定在SA中社区范围内预防FAS的有效性， 特定的组件是最可行的。预防设计中的嵌套研究还涉及基本的 进一步研究以下疾病的流行病学和临床特征的特异性：FAS、成人饮酒和 FAS的母体风险因素。 具体目标是：（1）评估IOM、FAS预防计划的有效性; 2.）直接测量 流行病学“仅研究”阶段通过年龄特异性FAS率的变化的预防功效; 3.） 测量成人知识，态度，信仰和饮酒行为（KABB）以及社区的变化 准备好改变; 4.）将预防活动的参与程度与具体成果联系起来， 过程评价; 5.）进一步定义FAS的母体风险因素;以及6.）探讨风险的基本问题， 通过嵌套研究进行保护。为每个目标提供了一个广泛的多变量数据分析计划。 预防实施人员：7名现场预防人员，以开普敦大学为主 工作人员，以及美国和南非的调查员/培训员。在指定的预防中，通过以下方式降低孕产妇风险： 高危人群的管理、节育和营养强化;短期干预 使用动机访谈和社区强化方法的原则;和个人 赋权/技能建设。选择性和普遍预防用途：酒精滥用筛查;有针对性 改变规范和KABB的信息;政策宣传;社区教育和对话。

The highest rates of fetal alcohol syndrome (FAS) in the world have been found in South Africa (SA) in this town targeted for prevention research. Rates of FAS were 46 and 75 per 1,000 in waves I and II of research and a preliminary rate in Wave III is 79. A high prevalence of FAS exists in other parts of SA. Prevention research has broad implications for programs in SA, the US, and developing populations. This is a multi-site, efficacy trial of a comprehensive, public health model, community-wide, FAS prevention program defined by the Institute of Medicine (IOM). It utilizes both comparative community and pre/post prevention designs with assessment via rigorous diagnosis of FAS in children and infants and also change in measures from a random sample drinking practices survey. Rigorous program evaluation will also assess specific indicated, selected, and universal prevention techniques applied by indigenous workers. The prevention site (urban and rural components) is matched with four comparison communities which will be analyzed in aggregate and as distinct entities to assess confounding influences. Utilizing lOM-recommended techniques of research and prevention applied previously in American Indian communities, this study will determine the efficacy of community-wide prevention of FAS in SA, and which specific components are most viable. Nested studies within the prevention design also address basic research for further specificity of epidemiologic and clinical characteristics of: FAS, adult drinking, and maternal risk factors for FAS. Specific aims are to: 1.) assess the efficacy of the IOM, FAS prevention program; 2.) directly measure the prevention efficacy of the epidemiology "research only" phase via change in age-specific FAS rates; 3.) measure change in adult knowledge, attitudes, beliefs, and drinking behavior (KABB) as well as community readiness for change; 4.) link the level of participation in prevention activities to specific outcomes through process evaluation; 5.) further define maternal risk factors for FAS; and 6.) explore basic issues of risk and protection via nested studies. An extensive multivariate data analysis plan is provided for each aim. Prevention is implemented by: seven on-site prevention personnel, University of Cape Town-based staff, and U.S. and SA investigators/trainers. In indicated prevention, maternal risk is reduced via: case management of high risk individuals, access to birth control, and enhanced nutrition; brief interventions using principles of motivational interviewing and community reinforcement approach; and individual empowerment/skills building. Selective and universal prevention use: screening for alcohol abuse; targeted messages to change norms and KABB; policy advocacy; and community education and dialogue.