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Table 2 General characteristics of included studies

From: A systematic review of prevention interventions to reduce prenatal alcohol exposure and fetal alcohol spectrum disorder in indigenous communities

Study Country Target Population Study Population Design Brief Description of the Intervention Outcome Types Results
Indicated Strategies
KB Masis & PA May, 1991 [29] US, Arizona American Indian women from Tuba City Women referred to an Indian Medical centre at ‘high risk’ for producing alcohol affected children Single cohort with surveys conducted post-intervention Primary prevention included: community media, posters, and pamphlets; training of school and health personnel
Secondary prevention included: screening of prenatal patients for alcohol use with education about FAS and alcohol; referral of women with high risk drinking or a child with FAS to tertiary prevention
Tertiary prevention evaluated in this study: case management; counselling; detoxification; individual and group alcohol treatment, follow-up and after care; voluntary birth control or sterilisation
Number of children born with FAS-FAE
Alcohol consumption: Screening tool assessment of risky drinking; self-reported frequency and quantity verified by family members at 18 months (n = 32)
Contraceptive Use (n = 32)
See brief summary in text
PA May et al., 2008 [30] US American Indian women from four communities in Northern Plains States Women at extremely high risk for PAE (substantial history of alcohol abuse, drinking during pregnancy or previous birth of a child with FASD) Pre-post cohort study with data collected at baseline then at six month periods through to 72 months Training of a prevention site manager and case manager at each of the four sites who provided three levels of FASD prevention activities.
Community: education and policy strategies
High risk groups: Screening, targeted messages, referral for alcohol abuse
Women identified through screening: Case management enhanced by brief intervention based on MI
Number of children born with FASD
Alcohol consumption: Frequency, Times “high” or drunk, binge drinking (Three drinks or more per occasion per day)
Birth control status
Overall, 69.5% of the time (n = 105) fetuses were protected from PAE either by using birth control while drinking (39%), not drinking and using birth control (18.1%), or not drinking and not using birth control (12.4%)
Further results are not reported due to high loss to follow-up from baseline (n = 115) to 6 months (n = 39) and 12 months (n = 37).
JD Hanson et al., 2017 [31] US American Indian women from two reservation sites and one urban site
≥18 years old, sexually active and fertile
Non-pregnant women
All participants were at risk of AEP (4 or more drinks per occasion or 8 or more drinks per week and not using any contraception or using a method incorrectly or inconsistently)
Single cohort study with surveys at baseline, and three and six months post-intervention Oglala Sioux Tribe (OST) CHOICES Program was delivered to all participants (2– 4 sessions)
The intervention included MI techniques delivered by trained interventionists to encourage participants to decrease binge drinking and increase birth control use to reduce the risk of AEP
The program supported participants to: Set goals related to alcohol use and contraception use; Complete daily diaries to track alcohol use, sexual activity and birth control use; and seek health practitioner support for birth control through referrals
Proportion of women at risk of AEP (defined as per the inclusion criteria, along with the proportion of participants pregnant at follow-up)
Alcohol consumption: Volume, frequency, binge episodes
Contraceptive use: Use of effective birth control and sexual activity
Significant reduction in AEP risk from baseline (100%) to three months (exact value not provided, p value not stated), and six months (exact value not provided, p value not stated)
Selective Strategies  
P Bridge, 2011 [27] Australia, Ord Valley in remote North- Western Australia Five target groups
1. All Aboriginal antenatal clients attending Ord Valley Aboriginal Health Service (OVAHS)
2. All Aboriginal women aged 13–45 years in the Ord Valley
3. All OVAHS staff
4. Local Aboriginal men
5. Broader community including national and international FASD networks
All women attending OVAHS antenatal clinics
Aboriginal women aged 13–45 years in the Ord Valley
Pre-post cohort study The following were provided to each antenatal client and extended to partners, families and the wider community: FASD education including contraception education and advice; alcohol and other drug assessment; one-to-one counselling; brief intervention; and MI
Intervention quantity and consistency were not reported
Community stalls and FASD workshops (33 female only, 6 male only and 23 mixed gender)
OVAHS staff received FASD education including contraception education and advice and training in brief interventions for alcohol and contraception use and MI
Antenatal clients completed routine assessments at three times during pregnancy
Alcohol consumption
Proportion of unplanned pregnancies
Proportion of people receiving FASD education, satisfaction with education received
See brief summary in text
JD Hanson et al., 2013 [28] US, Northern Plains American Indian women from three tribes Non-pregnant, sexually active women who had consumed alcohol in the past three months Descriptive longitudinal cohort study with surveys at baseline and every three months for one year Brief interventions based on MI delivered by phone with supporting intervention materials mailed to participants Risk of AEP (> 4 drinks in a day or > 7 drinks in a week or no protection at any one point or failure to not always use a contraceptive method or both)
Alcohol consumption in the past 90 days: Most drinks at any one time, average drinks per day, average drinks per week, and how many times consumed 3+ drinks
Birth control use (n = 162) in past 90 days: sexual activity, contraception method, frequency
All categories of alcohol consumption showed decreases over time
Birth control use increased at three months and remained consistent across the rest of the study
Due to loss to follow-up detailed results are not reported
AC Montag et al., 2015 [34] US, Southern California American Indian/Alaskan Native women Women of childbearing age recruited at three AIAN health clinics Randomised control trial of an intervention compared with treatment as usual with surveys at baseline and one, three and six months post-intervention ~ 20-min web-based brief assessment and intervention tool tailored to the population consisting of an anonymous survey followed by individualised risk feedback for AEP, including impact of alcohol exposure on a fetus, physical and financial costs of alcohol consumption and comparison of drinking levels with other Native women
Information on additional resources was provided at the end of the web session and could be printed
Treatment as usual control: Assessment of alcohol use and access to displayed health education brochures that did not include FASD specific information
Proportion of women at high risk of AEP
Alcohol Consumption: number of drinks per week and per occasion, number of binge episodes (> = 3 drinks) in past 2 weeks.
Birth control use (only reported at baseline).
Awareness of FASD and knowledge regarding the risks of alcohol consumption for women and their pregnancy (baseline only)
All outcomes showed a significant time effect but no intervention effect.
The proportion of women at high risk of AEP (%) for the intervention and control groups respectively was 36.4/33.6% at baseline, 18.8/21.9% at one month, 16.7/21.7% at three months and 18.9/22.1% at six months.
Drinks per week were 4.40 ± 0.94, 0.89 ± 0.21, 0.98 ± 0.26, and 1.64 ± 0.55 for the intervention group and 3.38 ± 0.50, 1.34 ± 0.24, 1.94 ± 0.38, and 1.99 ± 0.46 for the control group at baseline, one month, three months and six months respectively
Binge episodes (over two weeks) were 1.47 ± 0.40, 0.36 ± 0.08, 0.49 ± 0.17, 0.50 ± 0.12 for the intervention group and 1.06 ± 0.16, 0.49 ± 0.09, 0.62 ± 0.13, 0.72 ± 0.14 for the control group at
baseline, one month, three months and six months respectively
Universal Strategies
PA May & KJ Hymbaugh, 1989[26] US-wide Native American and Alaskan Native communities serviced by 92 Indian Health Services across 48 USA states Prenatal groups, school children, Indian Health Service (IHS) workers and community groups Pre-post intervention surveys with multiple disparate cohorts and limited follow-up The National Indian FAS Prevention Program was developed to provide knowledge, skills and educational resources for communities to carry out primary through tertiary prevention
Resources and materials developed for FAS prevention were keyed to one of the four target groups. Resources included ten pamphlets, six posters, 16 fact sheets and a set of 20 slides with accompanying narrative from a trained educator
Provision of training to Indian Health Service FAS trainers and personnel included a two-day workshop on clinical and educational interventions. Further phone and correspondence monitoring and coaching of trainees was also provided.
Five questionnaires were used to assess prevention education. Four consisted of fact identification and fixed response items and one had eleven open ended questions for adults.
FAS Knowledge
Four of eight school classes (from Grade 5 through to high school) had significant improvements (p < .05) in knowledge pre- to post-test
Eleven of 14 adult groups had significant improvements in knowledge (p < .01) pre- to post-test
Two out of three groups (two high school and one community health group) had significant knowledge gain (p < .01) from pre- to post-test after receiving the education materials alone
Of the six groups assessed at follow-up at least two months later (four school classes and two community groups), four had significant (p < .01) knowledge gain post-education and three were still significantly (p < .01) higher at follow-up compared with pre-test
KJ Plaisier, 1989 [33] US, Michigan’s Upper Peninsula American Indian Communities Women of childbearing age who were pregnant or had delivered an infant in last 12 months were recruited at clinics or by Indian health workers Cohort intervention with post intervention survey Indian health workers were educated using previously developed culturally sensitive materials, and helped to plan and deliver FAS education programs. Programs aimed to encourage women to participate in sponsored community-wide workshops, including school and senior citizen programs. Individual counselling was provided at clinics FAS Knowledge See brief summary in text
RJ Bowerman, 1997 [25] US, Alaska American Indian and Alaskan Native populations Pregnant women from six remote villages in Barrow in Arctic Alaska Cross-sectional pre- and post-intervention surveys with different groups 1994 ban on alcohol possession in the town of Barrow Alcohol consumption: reported by trimester as percentage engaged in “alcohol abuse” (not defined) The proportion of women engaged in alcohol abuse was reported as 42% for the pre-intervention sample and 9% for the post-intervention sample (RR = 0.21, 95% CI = 0.08, 0.55)
Alcohol abuse in the 1st Trimester was reported as 43% pre-intervention and 11% post-intervention (RR = 0.25, 95% CI = 0.07, 0.94)
Differences in pre- and post-intervention groups for Trimester 2 (17% and 7%) and Trimester 3 (14% and 5%) were not significant (RR, p value, and CI not reported)
JD Hanson et al., 2012 [32] US Three tribal American Indian communities located 400–600 miles apart in the Northern Plains American Indian Women of child bearing age (18–44 years) self-enrolled by calling a 1–800 phone line Post-intervention evaluation A culturally and linguistically tailored media campaign included:
posters displayed in community settings and local newspapers; radio advertisements; pens; brochures; and t-shirts.
The campaign was delivered through: information booths set up at local fairs or community events, community centres, health clinics and local tribal colleges; community presentations at local schools and treatment facilities; and Public Service Announcements and live interviews broadcast on local radio stations
Post-campaign telephone surveys assessed participants attitudes regarding the effects of the campaign including:
Alcohol consumption
FASD knowledge
Cultural appropriateness of the campaign
See brief summary in text