FAS Prevention: A Trial of the IOM Model

描述：世界上胎儿酒精综合征（FAS）发病率最高的地方是南非（SA），在这个小镇进行预防研究。在第一和第二波研究中，FAS的发生率分别为每1000人中46人和75人，而在第三波研究中，FAS的初步发生率为每1000人中79人。FAS在南非其他地区也有较高的患病率。预防研究对南非、美国和发展中国家的项目有广泛的影响。这是一项由医学研究所（IOM）定义的综合性、公共卫生模式、社区范围内的FAS预防项目的多地点、疗效试验。它采用比较社区和前后预防设计，通过严格诊断儿童和婴儿的FAS进行评估，并通过随机抽样饮酒习惯调查的措施反映饮酒习惯的变化。严格的项目评估还将评估当地工人应用的具体指示、选择和普遍预防技术。多层次干预措施包括：指示性预防，通过以下方式降低孕产妇风险：对高危个体进行病例管理、获得节育服务和加强营养；运用动机性访谈法和社区强化法进行简短干预；以及个人赋权/技能培养。选择性和普遍预防使用：酒精滥用筛查；有针对性的信息，以改变规范和KABB；政策宣传;以及社区教育和对话。目前的试验已经进行了修改，以开始解决存在于相同高危妇女中的艾滋病毒/艾滋病的合并症，并且具有许多相同的预测不良妊娠结局的病因因素。由于这项预防试验的设计是全面的和社区范围的，因此有多种机会收集数据，进行风险评估，并评估孕产妇和胎儿干预对FASD和艾滋病毒/艾滋病高危母亲及其子女的疗效。

DESCRIPTION: 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 drinking practices reflected 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. Multilevel interventions include: indicated prevention where 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. The current trial has been modified to begin to address the comorbid condition of HIV/AIDS that is present in the same high-risk women and has many of the same etiological factors predicting adverse pregnancy outcomes. Because this prevention trial is designed as comprehensive and community-wide, there are multiple opportunities for data collection, risk assessment, and evaluation of efficacy of maternal and fetal interventions on both FASD and HIV/AIDS at-risk mothers and their children. 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; and 7) examine the prevalence and characteristics of, and risk factors for HIV/AIDS in the Western Cape Province of South Africa including disease progression, AIDS medication availability, and HIV-related fetal outcomes.