FAS Prevention: A Trial of the IOM Model

年，世界上胎儿酒精综合征(FAS)的发病率最高的是南非。 这个小镇被定为预防研究的目标。Fas在第I和第II波分别为46/1000和75/1000 第三波的研究和初步比率为79。在SA的其他部分，Fas的患病率很高。 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。 这是一项在社区范围内对综合公共卫生模式进行的多点疗效试验 医学研究所(IOM)定义的预防计划。它利用了比较社区和 通过对儿童和婴儿的Fas的严格诊断进行评估的预防前/后设计 从随机抽样的饮酒行为调查中测量的变化。严格的计划评估将 还评估土著人民采用的特定的、选定的和普遍的预防技术 工人们。预防地点(城市和农村部分)与四个对照社区匹配 它们将作为不同的实体进行综合分析，以评估令人困惑的影响。利用 LOM-以前在美洲印第安人应用的推荐的研究和预防技术 社区，这项研究将确定社区范围内预防SA中Fas的有效性，并且 特定的组件是最可行的。预防设计中的嵌套研究也解决了基本问题 进一步研究Fas、成人饮酒和饮酒的流行病学和临床特征 Fas的母体危险因素。 具体目标是：1.)评估国际移民组织、Fas预防计划的效果；直接测量 流行病学“仅供研究”阶段通过改变特定年龄段Fas比率的预防效果； 测量成人知识、态度、信念和饮酒行为(KABB)以及社区的变化 准备好迎接变化；4.)通过以下方式将参与预防活动的程度与具体成果联系起来 过程评估；5.)进一步确定产妇患Fas的风险因素；和6.)探讨风险的基本问题和 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。 预防由开普敦大学7名现场预防人员实施 工作人员，以及美国和SA调查人员/培训人员。在有指示的预防中，产妇风险通过以下方式降低：病例 管理高危人群、获得节育和加强营养；简短干预 使用激励性访谈和社区强化方法的原则；以及个人 赋权/技能建设。选择性和普遍的预防用途：酒精滥用筛查；有针对性 关于改变规范和KABB的信息；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.