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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