FAS Prevention: A Trial of the IOM Model

南非 (SA) 是世界上胎儿酒精综合症 (FAS) 发病率最高的国家 这个镇是预防研究的目标。在第一波和第二波中，FAS 发生率分别为每 1000 人 46 例和 75 例。 研究显示，第三波的初步发病率为 79。南澳其他地区 FAS 患病率很高。 预防研究对南澳、美国和发展中国家的项目具有广泛的影响。 这是一项针对社区范围内的综合公共卫生模型 FAS 的多地点功效试验 由医学研究所 (IOM) 制定的预防计划。它利用比较社区和 通过对儿童和婴儿的 FAS 进行严格诊断进行评估的前/后预防设计 随机抽样饮酒习惯调查的措施发生变化。严格的计划评估将 还评估土著人应用的具体指定、选定和普遍预防技术 工人。预防点（城乡部分）与四个对照社区进行匹配 将对其进行总体分析并作为不同的实体进行分析，以评估混杂影响。利用 lOM 推荐的研究和预防技术先前在美洲印第安人中应用 社区，本研究将确定南澳社区范围内预防 FAS 的效果，以及 特定的组件是最可行的。预防设计中的嵌套研究还解决了基本问题 研究进一步明确以下疾病的流行病学和临床特征：FAS、成人饮酒和 FAS 的孕产妇危险因素。 具体目标是： 1.) 评估 IOM、FAS 预防计划的有效性； 2.) 直接测量 通过改变特定年龄的 FAS 率来评估流行病学“仅研究”阶段的预防效果； 3.) 衡量成人知识、态度、信仰和饮酒行为 (KABB) 以及社区的变化 准备改变； 4.) 将预防活动的参与程度与具体成果联系起来 过程评估； 5.) 进一步明确 FAS 的孕产妇危险因素； 6.) 探讨风险和风险的基本问题 通过嵌套研究进行保护。为每个目标提供了广泛的多变量数据分析计划。 预防工作由以下人员实施：开普敦大学的七名现场预防人员 工作人员以及美国和南澳调查员/培训师。在指示性预防中，孕产妇风险可通过以下方式降低： 高危人群的管理、节育和加强营养；简短的发言 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。选择性和普遍的预防用途：筛查酒精滥用；有针对性的 改变规范和 KABB 的消息；政策宣传；以及社区教育和对话。

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.