Reducing Polysubstance Use in Pregnancy
Define and describe the public health issue.
The term “unhealthy alcohol use” is used by the USPSTF to describe a range of behaviors ranging from risky drinking to alcohol use disorder (AUD) Schuckit (2019). Drinking more than the recommended daily, weekly, or per-occasion amounts of alcohol, resulting in an increased risk of health consequences but not meeting criteria for AUD, is considered risky.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) defines “risky use” as more than four drinks per day (56 g/d based on the US standard of 14 g/drink) or 14 drinks per week (196 g/d) for healthy adult men aged 21 to 64 years, or three drinks per day or seven drinks per week (42 g/d or 98 g/week) for all adult women of any age and men 65 years or older Schuckit (2019).
A basic drink describes as 12.0 oz of beer (5% alcohol), 5.0 oz of wine (12%), or 1.5 oz of liquor (40 percent alcohol). “Hazardous use” is defined by the American Society of Addiction Medicine (ASAM) as alcohol use that increases the risk of future hurtful health consequences. Schuckit (2019). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) categorizes AUD severity (mild, moderate, or severe) according to the number of criteria met. Previous versions of the DSM-5 had separate diagnoses for alcohol abuse and alcohol dependence, but these diagnoses are no longer separated Schuckit (2019).
There is currently no universal agreement on what constitutes risky drinking. Furthermore, the definition of a standard drink differs by country. Pregnant women and adolescents advise avoiding all alcohol consumption Schuckit (2019). The meaning of moderate- or high-risk alcohol use in adolescents varies by age and based on days use per year. Excessive alcohol use is one of the leading causes of premature death in the United States Schuckit (2019).
Between 2006 and 2010, an estimated 88,000 alcohol-related deaths occurred in the United States each year, caused by acute (injuries from motor vehicle collisions) and chronic conditions (alcoholic liver disease) Schuckit (2019). Pregnancy alcohol use is also one of the leading preventable causes of obstacles to birth and developmental disabilities.
Describe the population that is affected by the health problem.
Although the use of alcohol and cigarettes while pregnant is one of the most preventable factors in poor perinatal clinical outcomes, there have been few cognitively delicate, population-based studies of such an occurrence (Oh et al., 2017). The current study looked at the preponderance and predictors of alcohol and other drug use in early mothers (ages 12-17) and adults (ages 18-44) in the United States. Between 2005 and 2014, data from the inhabitants National Survey of Drug Use and Health (80,498 teenagers and 152,043 grown women) gathered (Oh et al., 2017).
The results indicate alarming levels of previous use throughout expectant mothers, with 11.5 percent of teenagers and 8.7 percent of adult women using alcohol and 23.0 percent of adolescents, and 14.9 percent of adult females utilizing nicotine (Oh et al., 2017). Adolescents who were pregnant were less likely to report likely to notify past 30-day teenage substance use. However, they are more likely to report past 30-day tobacco use. Pregnant women who reported alcohol/tobacco use were more likely to have had a major depressive episode in the previous 12 months, be involved in the criminal justice system, and support comorbid alcohol/tobacco use than pregnant abstainers. Given the dangers of alcohol and tobacco during pregnancy, more emphasis on reducing use is essential (Oh et al., 2017).
Explain the reasons why the health problem exists.
What are the risk factors? Is it caused by environmental, hereditary, or dietary factors? How well you explain the reasons why the health problem exists by including the risk factors and the causes.
Age, race/ethnicity, marital status, education level, and income are all potential risk factors associated with alcohol use in all adults35–37. Nevertheless, the study uses 16 years of general U.S. population data to evaluate sociodemographic and clinical risk factors for drinking during pregnancy, both overall and by pregnancy stage.
Early pregnancy, other substance use, AUD, depression, and being unmarried were all associated with a higher risk of any use or binge drinking. A higher risk of drinking was associated with higher socioeconomic status and adolescence. For binge drinking, lower risk was associated with ages 35–44 in early pregnancy, while the higher risk was associated with lower socioeconomic status and Black race in middle/late pregnancy.
Trimester 1 had the highest risk, as alcohol consumption, particularly binge drinking, can be extremely harmful. Because most women aren’t aware of their pregnancy until 4–6 weeks, females may drink before they recognize they’re pregnant Shmulewitz& Hasin. (2019). Some women may need time to reduce or stop drinking after becoming pregnant. While others may not receive early prenatal care or be fully aware of the risks of prenatal alcohol exposure. Lowering alcohol consumption among all women of reproductive age could reduce early pregnancy alcohol exposure, but these women’s drinking has increased Shmulewitz& Hasin. (2019).
Although abstinence can suggest for pregnant women, it views as patronizing and patriarchal, and expecting young adult women not to consume alcohol is unrealistic. Furthermore, pre-pregnancy health counseling might include the standard of care for women of reproductive age to discuss the risks of heavy drinking and avoid or reduce exposure as much as possible Shmulewitz& Hasin. (2019). Furthermore, having reliable, accessible, and reasonably priced contraception may aid in preventing early alcohol exposure in unwanted pregnancies for females who want to avoid getting pregnant.
Clinical factors were consistently linked to any use and binge drinking during pregnancy, implying that health care providers should address the issue of drinking during pregnancy with these at-risk women and motivate change as needed Shmulewitz& Hasin. (2019). Women with alcohol use disorders find to be at a higher risk; these women may expose their fetuses to higher doses of alcohol and may struggle to cut back or quit drinking, necessitating specialized treatment. Women who used other substances (e.g., tobacco, marijuana, cocaine) were at a higher risk, which is consistent with the evidence of polysubstance use among pregnant women in alcohol treatment Shmulewitz& Hasin. (2019).
An examination of sociodemographic risk factors revealed effects that are common by all pregnant women for any use and binge drinking, as well as the impact that differed by pregnancy stage for binge drinking. Shmulewitz& Hasin. (2019). As in previous studies, marital status had a strong influence, with unmarried pregnant women having a higher risk of any use and binge drinking. It could be due to the lack of social support brought about by marriage, implying that health care providers who see unmarried pregnant women should discuss the difficulties of coping with pregnancy and assist them in developing support networks Shmulewitz& Hasin. (2019). Women ages 35–44 showed a lower risk of binge drinking in early pregnancy, comparable to effects in non-pregnant and all women, implying that risk in early pregnancy is somewhat like non-pregnancy.
In the middle-to-late stages of pregnancy, black women and women with lower socioeconomic status had a higher risk of miscarriage Shmulewitz& Hasin. (2019). These women may be less likely to receive adequate prenatal care, possibly because of perceived discrimination, a lack of providers who accept public insurance, and transportation issues. Home-visiting programs may assist in alleviating some of these issues and improving prenatal care for vulnerable populations Shmulewitz& Hasin. (2019).
Furthermore, low-income women may be less aware of the risks of drinking while pregnant64 and may lack the resources needed to cope with pregnancy Shmulewitz& Hasin. (2019). Pregnant women should inform about assistance programs such as the Women, Infants, and Children (WIC) nutrition program, which provides low-income pregnant women with supplemental food and counseling, potentially lowering stress and drinking to cope Shmulewitz& Hasin. (2019). In contrast, as in previous studies, all pregnant women with higher socioeconomic status had a higher risk of drinking, which is consistent with the effects observed in all women.
It could attribute to changing social norms, which have resulted in more permissive attitudes toward drinking among such women65. More research is needed to identify the mechanisms underlying the associations and the differences in effects for any drinking and binge drinking and to replicate differences in impacts by pregnancy stage Shmulewitz& Hasin. (2019).
List the Topic Area(s) and CORE Objective(s) in Healthy People 2030that are related to the health problem you have selected.
Make sure to include the baseline and the target for the CORE objective you selected. (Note: the health problem might be related to several focus areas and objectives.) Correctly List the Focus Area(s) and Objective(s) in Healthy People 2030 that are related to the public health issues you have selected and include the baseline and the target for the objective you selected
Pregnancy and childbirth, drug and alcohol use, and women are the topic(s) of the area.
The core objective is to Increase pregnant women’s abstinence from alcohol.
SAMHSA’s National Survey on Drug Use and Health (NSDUH) is the source of the data.
Baseline: In 2017-18, 89.3 percent of pregnant females aged 15 to 44 years reported abstaining from alcohol in the previous 30 days.
92.2 percent is the target.
Numerator: The number of pregnant females aged 15 to 44 years who have not consumed alcohol in the previous 30 days.
The number of pregnant females aged 15 to 44 years old is the denominator.
Method of setting goals
There is little statistical significance.
Details on the Target-Setting Method
Minimal statistical significance, assuming the target and baseline have the same standard error.
Justification for the Target-Setting Method.
For this objective, trend data were analyzed, but it was not possible to project a target because the trend line was moving away from the desired direction. The standard error was used to calculate a target based on minimal statistical significance, with the target having the same standard error as the baseline. Because of the high baseline prevalence, this method was used. Healthy People 2030
Describe the community effort OR health intervention strategies which contributed to the success.
You might want to re-watch the webcast you have selected.
You are required to discuss at least one article from a peer-review journal that shows how the community effort was achieved. I strongly recommend you visit the evidence-based resources for the selected objective on Healthy People 2030 website.
You are expected to answer questions by including a description of the (a) study participants, (b) the materials, (c) the study design, (d) the study procedures, (e) the measurement and analysis, (f) the results, and (g) the conclusions.
How well you describe the community effort OR health intervention strategies which contributed to the success by including the study participants, the materials, the study design, the study procedures, the measurement, and analysis, as well as the results and the conclusions.
The United States Preventive Services Task Force (USPSTF) recommends screening for unhealthy alcohol use in adults 18 years of age and older, including pregnant women, in primary care settings. People who engage in risky drinking behaviors should also receive brief behavioral counseling, according to the USPSTF. Furthermore, the USPSTF determined that was insufficient evidence to determine whether the benefits of this type of screening and behavioral counseling outweighed the risks in adolescents aged 12 to 17 years.
Adults aged 18 and up are eligible to participate in the study, as are pregnant women and adolescents aged 12 to 17. and do not apply to people who have a current diagnosis of alcohol abuse or dependence or who are seeking evaluation or treatment for it.
The components of the USPSTF determined that 1- to 3-item screening instruments have the best accuracy for assessing unhealthy alcohol use in adults 18 years or older of the available screening tools. The abbreviated Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) and the NIAAA-recommended Single Alcohol Screening Question are among these tools (SASQ).
The shortened AUDIT-C has high sensitivity and specificity for detecting the full range of harmful alcohol use across multiple populations. The AUDIT-C consists of three questions about frequency of alcohol use, the typical amount of alcohol use, and instances of heavy use, and it takes 1 to 2 minutes to administer. The AUDIT and USAUDIT-C are designed in accordance with US standards. According to preliminary evidence (1 study), the AUDIT (specifically the USAUDIT-C) may be more useful in identifying at-risk college drinkers.
The SASQ also has adequate sensitivity and specificity across the unhealthy alcohol use spectrum and takes less than a minute to administer, asking “How many times in the last year have you had 5 [for men] or 4 [for women and all adults older than 65 years] or more drinks in a day?” The Cutdown, Annoyed, Guilty, Eye-opener (CAGE) tool is well-known, but it only detects alcohol dependence rather than the full spectrum of unhealthy alcohol use.
When patients test positive on a brief screening instrument (such as the SASQ or AUDIT-C), clinicians should ensure that they are followed up with a more in-depth risk assessment to confirm unhealthy alcohol use and determine the next steps of care. Evidence suggests that brief instruments with higher sensitivity but lower specificity should be used as an initial screening, followed by a long instrument with higher specificity ( AUDIT). The AUDIT consists of ten questions: three on the frequency of alcohol use, the typical amount of alcohol used, and instances of heavy use, and seven on the signs of alcohol dependence and common problems associated with alcohol use (being unable to stop once you start drinking). It takes between 2 and 5 minutes to administer. When using the AUDIT as an initial screening test, clinicians may use a lower cutoff (such as 3, 4, or 5) to balance sensitivity and specificity in screening for the full range of harmful alcohol use.
Screening instruments have also been developed specifically for various populations. Tolerance, Worried, Eye-opener, Amnesia, Kut down (TWEAK) Tolerance, Annoyed, Cut down, Eye-opener (T-ACE) Parents, Partner, Past, Present Pregnancy (4P’s Plus) and Normal drinker, Eye-opener, Tolerance are all screening tools for pregnant women (NET). The Car, Relax, Alone, Forget, Family, Friends, Trouble (CRAFFT) screening instrument is recommended by the NIAAA and the American Academy of Pediatrics for identifying risky substance use in adolescents.
The NIAAA also suggests asking patients about their alcohol use as well as the alcohol use of their friends. In older adults, the Comorbidity Alcohol Risk Evaluation Tool (CARET) is used. The World Health Organization (WHO) developed the Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) to screen adults for substance and alcohol use.
The specific components, administration, length, and interactions of behavioral counseling interventions for unhealthy alcohol use vary. Thirty percent of the USPSTF-reviewed interventions were web-based. Almost all interventions had four or fewer sessions; the median number of sessions was one (range, 0-21). The average length of contact was 30 minutes (range, 1-600 minutes). Most interventions had a total contact time of two hours or less. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) approach is used in primary care settings. Interventions aimed at adults other than college students (including pregnant and postpartum women) were more likely to take place in primary care settings, involve a primary care team, and have multiple sessions. Many interventions involved providing participants with general feedback (how their drinking fits with recommended limits, or how to reduce alcohol use). The most frequently reported intervention component was the use of personalized normative feedback sessions, in which participants were shown how their alcohol use compares to that of others; this technique was used in more than half of the included trials and almost all trials in young adults. In most trials involving young adults, 1 or 2 in-person or web-based personalized normative feedback sessions were held in university settings. Personalized normative feedback was frequently combined with motivational interviewing or more extensive cognitive-behavioral counseling. Drinking diaries, action plans, alcohol use “prescriptions,” stress management, and problem-solving were also frequently used cognitive-behavioral strategies. A primary care team has been involved in roughly one-third of the intervention trials in general and older adult populations. The USPSTF was unable to identify specific intervention characteristics or components that link to better outcomes.
The USPSTF discovered no evidence that patients of different races/ethnicity or lower socioeconomic status are less likely to benefit from interventions. The effects of interventions were also comparable in men and women.
Describe the three most important learning you will take with you in the future.
You are expected to incorporate what you have learned from this course in your discussions.
Include one article from a peer-review journal you cited in your final paper that best describes the innovative approach conducted in that State or the community.
References:
Oh, S., Reingle Gonzalez, J. M., Salas-Wright, C. P., Vaughn, M. G., & DiNitto, D. M. (2017). Prevalence and correlates of alcohol and tobacco use among pregnant women in the United States: Evidence from the NSDUH 2005-2014. Preventive medicine, 97, 93–99. https://doi.org/10.1016/j.ypmed.2017.01.006
Shmulewitz, D., & Hasin, D. S. (2019). Risk factors for alcohol use among pregnant women, ages 15-44, in the United States, 2002 to 2017. Preventive medicine, 124, 75–83. https://doi.org/10.1016/j.ypmed.2019.04.027
Centers for Disease Control and Prevention (2020, November 25). Polysubstance Use in Pregnancy. https://www.cdc.gov/pregnancy/polysubstance-use-in-pregnancy.html
Centers for Disease Control and Prevention (CDC). (2021, July 19). Reducing Polysubstance Use in Pregnancy. YouTube. https://www.youtube.com/watch?v=FNpxFCMXAnc&feature=youtu.be
Healthy People 2030. Office of Disease Prevention and Health Promotion (2020). Increase abstinence from alcohol among pregnant women — Data Methodology and Measurement. https://health.gov/healthypeople/objectives-and-data/browse-objectives/pregnancy-and-childbirth/increase-abstinence-alcohol-among-pregnant-women-mich-09/data-methodology
Schuckit, M. A. (2019). Screening and Brief Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adults 18 Years and Older, Including Pregnant Women. JAMA Psychiatry, 76(1), 5. https://doi.org/10.1001/jamapsychiatry.2018.3278