FAS Prevention: A Trial of the IOM Model

FAS 预防：IOM 模型的试验

• 批准号: 7856044
• 负责人: Philip Alan May
• 金额: $ 25.2万
• 依托单位: UNIVERSITY OF NEW MEXICO
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-20 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7856044
• 关键词: Address; Adult; Advocacy; African; Age; Alcohol abuse; American Indians; Area; Attitude; Basic Science; Behavioral; Belief; Birth; Case Management; Categories; Characteristics; Child; Clinical; Communities; Community Health Education; Complex; Data Analyses; Data Sources; Diagnosis; Diagnostic; Diagnostic Procedure; Effectiveness; Epidemiologic Studies; Epidemiology; Etiology; Evaluation; Fetal Alcohol Spectrum Disorder; Fetal Alcohol Syndrome; Genetic; Health Knowledge, Attitudes, Practice; High Prevalence; Human Resources; Indigenous; Individual; Infant; Institute of Medicine (U.S.); Institutes; Intervention; Knowledge; Link; Measurement; Measures; Methods; Mining; Modeling; Newborn Infant; Nutritional; Outcome; Phase; Policies; Population; Predisposition; Prevalence; Prevention; Prevention Research; Prevention program; Process; Program Evaluation; Prophylactic treatment; Proxy; Psychological reinforcement; Public Health; Readiness; Research; Research Design; Research Personnel; Research Technics; Risk; Risk Factors; Rural; Sampling; Schools; Screening procedure; Site; South Africa; Specificity; Surveys; Techniques; Testing; Time; TimeLine; Universities; Work; base; birth control; brief intervention; cohort; comparative; design; drinking; drinking behavior; efficacy research; efficacy trial; empowerment; high risk; indicated prevention; motivational enhancement therapy; nutrition; post intervention; programs; public health research; skills; social; universal prevention

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.

世界上最高的胎儿酒精综合症（FAS）在南非（SA）中发现 这个城镇针对预防研究。 FAS的速率为46和75，波浪I和II 第三波的研究和初步率为79。 预防研究对SA，美国和发展中人口的计划具有广泛的影响。 这是一项全面的，公共卫生模型，社区范围内的多站点，有效的试验 医学研究所（IOM）定义的预防计划。它利用了比较社区和 通过严格诊断儿童和婴儿的FAS进行评估的预防效率/后预防设计，以及 随机样品饮酒实践调查的措施变化。严格的计划评估将 还评估指示，选择的和通用的预防技术。 工人。预防地点（城市和农村组件）与四个比较社区相匹配 将在总体和不同的实体中进行分析，以评估混杂影响。利用 LOM强调的研究和预防技术先前在美洲印第安人 社区，这项研究将确定SA中跨社区范围预防FAS的功效，以及 特定组件最可行。预防设计中的嵌套研究也解决了基本 研究流行病学和临床特征的进一步特异性：FAS，成人饮酒和 FAS的母亲危险因素。 具体目的是：1。）评估IOM，FAS预防计划的功效； 2.）直接测量 流行病学“仅研究”阶段的预防功效通过年龄特异性的FAS率变化； 3.） 衡量成人知识，态度，信念和饮酒行为（KABB）以及社区的变化 准备变革； 4.）通过 过程评估； 5.）进一步定义了FAS的产妇危险因素； 6.）探索风险的基本问题和 通过嵌套研究保护。为每个目标提供了广泛的多元数据分析计划。 预防由以下方式实施：七个现场预防人员，开普敦大学 员工以及美国和SA调查人员/培训师。在指定的预防中，通过以下方式降低了孕产妇风险：病例 管理高风险个人，获得节育和增强营养；简短的干预措施 使用动机访谈和社区强化方法的原则；和个人 授权/技能建设。选择性和普遍的预防用途：筛查酗酒；目标 更改规范和kabb的消息；政策倡导；以及社区教育和对话。