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Prevention
Sylvia Roozen
Presenter Disclosure
Sylvia Roozen
I have no current or past relationship with commercial entities.
Negative effects
Positive effects
Why should we care?
Roozen S, Peters GY, Kok G, Townend D, Nijhuis JG, & Curfs LMG. Worldwide Prevalence of Fetal Alcohol Spectrum Disorders: A Systematic Literature Review Including Meta-Analysis. Alcoholism, Clinical and Experimental Research. 2016: 40(1), p 18-32. DOI 10.1111/acer.12939.Popova, S., Lange, S., Probst, C., Gmel, G., & Rehm, J. (2017). Estimation of national, regional, and global prevalence of alcohol use during pregnancy and fetal alcohol syndrome: a systematic review and meta-analysis. The Lancet Global Health, 5(3), e290-e299.
ARND5.19 per 1,000
ARBD3.52 per 1,000
pFAS11.22 per 1,000
FASD22.22 per 1,000
FAS2.89 per 1,000
FAS1.46 per 1,000Popova et al., 2017
Down Syndrome1 per 1,000
Lessons of history we’ve failed to learn
FASD Prevention
“The act of stopping something from happening”
Primary Secondary TertiaryEarly detection,
minimizing outcomes
Retain QoL, disease control
Occurrence
What has been done so far?
Ehrhart, F.*, Roozen, S.*, Verbeek, J., Koek G., Kok, G., Van Kranen, H., Evelo, C. T., Curfs, L.M.G (2018). Review and gap analysis: molecular pathways leading to Fetal Alcohol Spectrum Disorders. Molecular Psychiatry, 1
Management and care
Problem identification Problem Solving
Health Promoting
Goal
Health Promoting
Program
Roozen, S., Black, D., Peters, G.Y., Kok, G., Townend, D., Nijhuis, J.G., Koek, G.H. and Curfs, L.M.G. (2016). Fetal Alcohol Spectrum Disorders (FASD): an Approach to Effective Prevention. Current Developmental Disorders Reports, pp.1-6.
Who to Influence?
Society: Governmentalagencies, PoliciesCommunity: Community leadersOrganization: Hospital, Healthcare providersInterpersonal: Partner, Family, Friends
Individual: Pregnant women, Women in childbearing age, Womenwith alcohol abuse, Etc.
Example ApproachesLarge-scale campaigns, alcohol policy, network linkages, researchCommunity-based interventions, mobilizing advocacyHolistic services for e.g., high risk pregnant womenSupport Services for e.g., family
Screening, brief ìnterventions(motivational interviewing)
Desired behavior(s)
What to Change?Undesired behavior(s)
?
?
?
?
Beliefs “My family said that drinking alcohol would help me
during pregnancy”
“If I have already eaten well and I
drink a little glass of red wine, I do not
feel that I put my baby at risk”
“Some family members or friends also drank alcohol throughout
pregnancy and had very normal, even beautiful
kids”
“If I do not drink alcohol in
pregnancy I feel more stressed”
Roozen, S., Peters, G. Y., Kok, G., & Curfs, L (2018). Identifying psychosocial determinants related to alcohol consumption during pregnancy: a systematic literature review. Preprint.
DeterminantsInjunctive
norm
Risk perception
Descriptive norm
Attitude /Self Efficacy
Roozen, S., Peters, G. Y., Kok, G., & Curfs, L (2018). Identifying psychosocial determinants related to alcohol consumption during pregnancy: a systematic literature review. Preprint.
France, K. E., Donovan, R. J., Bower, C., Elliott, E. J., Payne, J. M., D’Antoine, H., & Bartu, A. E. (2014). Messages that increase women’s intentions to abstain from alcohol during pregnancy: results from quantitative testing of advertising concepts. BMC Public Health, 14(1), 30.
Attitude Response efficacy Instrumentalattitude
Perceived norm Descriptive norm Injunctive norm
Self-efficacy Capacity Autonomy
Habit Perceived social support Skills
Knowledge Craving Motivation to comply
Applying Methods
Methods - Parameters
Kok, G., Gottlieb, N. H., Peters, G. J. Y., Mullen, P. D., Parcel, G. S., Ruiter, R. A., ... & Bartholomew, L. K. (2016). A taxonomy of behaviour change methods: an Intervention Mapping approach. Health psychology review, 10(3), 297-312.
Effectiveness?
Health Problem
Intervention/ Program
Intervention/ Program
Intervention/ Program
?
?
The Need for a Framework
Step 1Problem analysis
Needs assessment
Step 2Program Objectives
Determinant analysis
Step 3Program Design
Methods & Applications
Step 4Program
ProductionIntervention
Step 5Implementation
Plan
Step 6Evaluation Plan
Now what? FASD is an important health problem in need of prevention
FASD warrants simultaneous prevention on multiple levels
and requires a multidisciplinary approach
For FASD prevention there is room for improvement
Decisions about prioritizing short-term and log-term actions
are important
“Each one of us can make a difference. Together we make change”
2040?
Given the complexity of FASD prevention, what two areas would you consider to be prevention
research priorities over the next 20 years?Why?