Monthly Archives: July 2016

Health insurance coverage is associated with lower odds of alcohol use by pregnant women



Health insurance coverage is associated with lower odds of alcohol use by pregnant women


Researchers at Columbia University’s Mailman School of Public Health studied the relationship between health insurance coverage and tobacco and alcohol use among reproductive age women in the United States, and whether there were differences according to pregnancy status. The findings showed that pregnant women with insurance coverage had lower odds of alcohol use in the past month; however the odds of tobacco use were not affected. For non-pregnant women, insurance coverage resulted in higher odds of alcohol use but lower odds of using tobacco. The study is published online in the journal Drug and Alcohol Dependence.

“Prenatal substance use is a major public health concern, and poses significant threats to maternal and child health,” said Dr. Qiana L. Brown, postdoctoral research fellow in the Department of Epidemiology, and the study’s first author. “The widespread availability of health insurance through the Affordable Care Act may serve as a universal prevention intervention to help reduce prenatal substance use.”

The researchers studied data from 97,788 women ages 12 to 44 years old who participated in the U.S. National Survey of Drug Use and Health from 2010 to 2014. Among these women, 3 percent were pregnant. Controlling for age, race, and ethnicity, education, marital status, and poverty, there were significant differences between pregnant and non-pregnant women in the relationship between health insurance and alcohol use and health insurance and tobacco use.

A larger proportion of pregnant women used alcohol and tobacco in their first trimester as compared to the second and third trimesters, regardless of insurance status: 19 percent drank alcohol in the past month during the first trimester, and 22 percent used tobacco in the past month during the first trimester. For all women of reproductive age, 22 percent with insurance reported tobacco use in the last 30 days versus 33 percent of the women without coverage. Additionally, among all reproductive age women, 50 percent of those with insurance reported alcohol use in the past month, compared to 47 percent of uninsured women.

“Prenatal visits may present a good opportunity for screening and brief intervention regarding tobacco and particularly alcohol use,” noted co-author Deborah Hasin, PhD, professor of Epidemiology at the Mailman School of Public Health and in the Department of Psychiatry at Columbia University Medical Center. “Particularly for alcohol, evidence indicates that screening and brief advice can be surprisingly effective for medical patients whose drinking is greater than advisable levels but who are not alcohol dependent.”

“In addition, there is the need for greater health provider attention to smoking among pregnant women,” said Silvia Martins, MD, PhD, associate professor of Epidemiology at the Mailman School of Public Health, and a co-author of the paper. “Our results suggest missed opportunities for tobacco prevention in prenatal visits.”


The study was supported by the National Institute on Drug Abuse (T32DA031099, 1R01DA037866), the National Institute on Alcohol Abuse and Alcoholism (K01AA021511), and the New York State Psychiatric Institute.

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NEW Adult Reproductive Life Plan

NEW Adult Reproductive Life Plan

The Best Start Resource Centre is pleased to release My Reproductive Life Plan

This booklet is for adults who want to have children someday, but not right now.  It helps individuals understand how to protect their ability to have children, think about when to have children and how to have the healthiest baby possible when they are ready.

Topics include writing a reproductive life plan, physical health, sexual health, mental health, family health history, and next steps.

Click to download!



Alcohol Is Even Deadlier Than You Think, Study Suggests

Alcohol Is Even Deadlier Than You Think, Study Suggests

If you’ve recently had a drink, we have some terrible news for you.

Lauren Aratani Intern, HuffPost Hawaii

A new study suggests that alcohol is a direct cause of cancer in several areas of the body.

The study, published Thursday in the scientific journal Addiction, consists of a major review of 10 years’ worth of studies from several organizations, including the World Cancer Research Fund, the American Institute for Cancer Research and the International Agency for Research on Cancer.

And its conclusions are dire.

Nearly 6 percent of cancer deaths worldwide can be linked to alcohol, including in people who drink light to moderate amounts of alcohol, the study concludes. “From a public health perspective, alcohol is estimated to have caused approximately half a million deaths from cancer in 2012,” wrote study author Jennie Connor, a professor of epidemiology at the University of Otago in New Zealand.

The study determined that there is a strong link between alcohol consumption and cancer in specific areas of the body, such as the liver, colon, esophagus and female breast. There are also causal contributions in other areas such as the prostate, pancreas and skin.

How alcohol causes cancer is not deeply understood, according to the study, but it is thought to depend on the “target organ.” For example, cancers of the throat, mouth and liver can be largely attributed to a carcinogenic compound called acetaldehyde. Salivary acetaldehyde levels have been found to reach high levels when drinking.

Breast tissue is another area that seems to be particularly susceptible to alcohol.



Connor noted the United Kingdom’s Million Women Cohort study, which found that women who drank 70 to 140 grams of alcohol per week experienced a 13 percent increase in breast cancer and a 5 percent increase in total cancer compared to those who drank less than 20 grams per week.

Unfortunately, the amount you drink might not matter all that much. While heavy drinkers have a higher risk of liver, colon and laryngeal cancer than light drinkers, all drinkers have the same risk of mouth, esophagus, breast and pharynx cancer.

Connor also acknowledges that some of the studies she reviewed show that those who drink light to moderate of alcohol have a reduced risk of developing cardiovascular disease than abstainers.

But many epidemiologists agree that research confirms alcohol actually causes cancer, Connor wrote, while the relationship between drinking and heart disease is not as conclusive.

For example, other lifestyle factors beyond alcohol consumption ― such as a person’s healthy behavior and demographic conditions ― typically put abstainers at a higher risk than those who moderately drink. Connor cites a 2005 study that showed 27 out of 30 risk factors for cardiovascular disease were more prevalent in abstainers than moderate drinkers.

“Promotion of health benefits from drinking at moderate levels is seen increasingly as disingenuous or irrelevant in comparison to the increase in risk of a range of cancers,” she wrote in the study.




As a solution to alcohol-attributed cancer, Connor suggests everyone should reduce their alcohol consumption, not just heavy drinkers.

“Population-wide reduction in alcohol consumption will have an important effect on the incidence of [cancer], while targeting the heaviest drinkers alone has limited potential,” she wrote in the study.

However, most people today are hesitant to adapt to the facts. While the majority of the population readily accepts that smoking causes lung cancer, “alcohol’s causal role is perceived to be more complex than tobacco’s,” Connor wrote.

For this reason, simply getting people to stop drinking to prevent cancer ― as many have done in the case of smoking ― is broadly considered unacceptable.

Connor also warns of the backlash that research such as her own may receive from alcohol companies.

“There will be orchestrated attempts to discredit the science and the researchers, and to confuse the public,” she wrote. “The stakes are high for alcohol industries when there is no argument, on current evidence, for a safe level of drinking with respect to cancer.”

Ultimately, alcohol is just one of many factors that can cause cancer, but Connor’s study suggests reducing consumption or even partaking in a “dry period” as steps in the right direction to reduce your risk.

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How childhood trauma affects health across a lifetime

Nadine Burke Harris:

How childhood trauma affects health across a lifetime

Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris explains that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain. This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer. An impassioned plea for pediatric medicine to confront the prevention and treatment of trauma, head-on.

Moms-at-risk get needed support in inner city Edmonton

Moms-at-risk get needed support in inner city Edmonton

"Jenny," who's name has been changed to protect the identity of her two children in government care, was supported by the Healthy, Empowered, and Resilient Pregnancy Program during her third pregnancy. She is now successfully caring for 2-month old Britney. Edmonton, Monday, July 18, 2016. Ed Kaiser/Postmedia

The birth of her baby girl should have been the happiest day of the young mom’s life; instead, it became an agonizing experience.

The baby was just 10 hours old when Child and Family Services apprehended her, as they had her son a few months before.

“It was so painful to have that happen,” said ‘Jenny,’ whose name has been changed to protect the identity of her children who remain in care.

“I just get really pissed off that that happened, because I could have prevented it. I don’t know why I was so … stupid back then,” she said, turning away tearfully.

Three years later, the ache of that moment is dulled by the joy of caring for her newborn daughter Britney.

As she sat in the pregnancy support office at Edmonton’s Boyle Street Community Services, Britney cooing and gurgling nearby, Jenny shared the story of how she battled back from abuse, depression, and the apprehension of her first two children.

She was seven months pregnant with Britney, living on a couch, and falling into a frustrated depression when a friend suggested she visit the Healthy, Empowered, and Resilient (HER) pregnancy program at Boyle Street.

HER is an outreach program that supports vulnerable pregnant women and mothers up to six months after they’ve given birth. Four pregnancy support workers, a social worker, and two registered nurses serve their clients wherever they feel most comfortable, even if that means checking fetal heart rates or doing blood work and STI testing in a back alley or out of their cars.

The HER program is supported by Alberta Health, which committed $1.4 million to the program between 2014 and 2017. That funding is set to expire at the end of March.

Carolyn Ziegler, a spokeswoman for Alberta Health, said she hoped to have an update available soon on the likelihood of continued funding.

“This program shouldn’t be put into a world where it’s depending on donations, this is very valuable work,” said Marliss Taylor, the manager of Edmonton’s Streetworks.

While the team isn’t worried yet, they will be if there’s no word on funding by the fall, said Taylor. By Christmas, they’ll have to stop taking clients; it wouldn’t be fair if they could only stay with them for a few months, she said.

Since its first iteration in 2007, almost 550 women have accessed services through the HER program.

While Child and Family Services likely would have apprehended many of these women’s children, HER has flipped the statistics. Between October 2015 and March 2016, 73 per cent of the moms who planned to parent still had custody of their babies six months after they gave birth.

Over the same period, 11 of the 17 babies were born at a healthy weight, and just one had to be admitted to a neonatal intensive care unit. The program works with women who may have had numerous bad experiences with the child welfare system, who may be homeless, fleeing abuse, or have a history of using drugs and alcohol.

“We focus on reaching out to the women that have basically fallen through the cracks,” said Morgan Chalifoux, one of HER’s pregnancy support workers.

Morgan Chalifoux is the team lead for the HER Streetworks program, that provides support for at-risk women during pregnancy, taken on Wednesday, June 22, 2016 in Edmonton. Greg Southam / Postmedia (For a Edmonton Journal story by Ainslie Cruickshank)
Morgan Chalifoux is a pregnancy support worker with the HER Pregnancy Program, which supports vulnerable women throughout their pregnancies. Greg Southam / Postmedia  GREG SOUTHAM / EDMONTON JOURNAL

Many of the women they work with don’t have any kind of support, so when they walk through the door, HER gives them “wrap-around” services, Chalifoux said.

That can include helping them access government housing and income support, health education and prenatal care. For others, it’s touring the hospital to prepare for delivery, connecting them with cultural and spiritual supports, or simply being there to talk.

HER’s harm reduction approach is also critical to its success – they don’t insist their moms are clean and sober.

“We have an open door policy,” said Chalifoux.

If clients want to work on their addictions, help is available. If not, they are encouraged to make healthy decision in other ways: using clean needles, getting enough sleep, eating healthy foods, and taking pre-natal vitamins.

“Abstinence doesn’t work for everyone,” said Nadine Santin, one of HER’s registered nurses. But addressing factors like housing, income, and healthy diets can have a huge effect, she said.

Many of HER’s clients grew up in and out of care. The program aims to break that cycle – and Chalifoux is proof it’s possible. She was homeless and pregnant with her first son at 14.

“When you’re that young the stats and the odds are kind of against you,” she said. “Fourteen years later I have a teenager that stands almost the same height as me and we argue over him putting on deodorant.”

Jenny is on track for the same happy ending.

“I’m just glad that these women took me in as their own,” she said.

Growing up in Saddle Lake Cree Nation, Jenny was close with her family. Her parents were “very traditional” and taught her to embrace her indigenous culture, she said.

Later in life, Jenny isolated herself as a relationship turned abusive and both her children were taken. “I was ashamed,” she said. “I just kept everything a secret.”

She walked away from the abuse six months before she got pregnant with Britney and was soon homeless and using drugs.

But she made the choice to rebuild her life and the HER program has helped her succeed.

“It just slowly fell into place, it’s like boom, boom, boom, I had a home, I got my baby, I don’t have child welfare involvement, it just all panned out pretty much perfectly,” Jenny said.

Now she’s planning to go back to school to become a community support worker. “I want to be able to make a difference in someone’s life, the way they made a difference in my life,” she said.

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Who coined the term “mocktail” anyway?

Well, it just so happens that I bumped into an article from a 1983 issue of American Speech where the answer was to be found (please don’t ask how I seemed to be randomly browsing such an esoteric journal).

Philip Kolin says: The coinage mocktail appears for the first time, I believe, in an advertisement for Libbey Glass in Food Service Marketing (Feb. 1979, p. 76). According to that ad, mocktails “are a relatively new group of beverages prepared without any alcohol whatsoever.” Kolin comments that the ad was for a new line of mocktail glassware (I had no idea that glassware was so specialized – perhaps because most of mine was purchased at Ikea).

He further states, clearly with the air of someone who loves language: Mocktail is a clever invention. It humorously rhymes with cocktail, but has a semantically appropriate first syllable. Mocktails are literally mock cocktails, with the sense of mock in mock chicken or mock turtle soup. The -tail of the second syllable of mocktail, however, has acquired a new meaning-that of the unshortened (and unadulterated) cocktail.

If the term mocktail has only been around since the late 1970s, what about the term cocktail? Well according to a Wikipedia article, the term cocktail first appeared in print in 1806 where it was described as a ” stimulating liquor composed of spirits of any kind, sugar, water, and bitters — it is vulgarly called a bittered sling and is supposed to be an excellent electioneering potion, in a smuch as it renders the heart stout and bold, at the same time that it fuddles the head.”

Just a little etymology to end you week.

Reference: Kolin, P.C. (1983). Mocktails, Anyone? American Speech, 58(2): 190-191.

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Preconception Interventions – Trending or Mainstream?


It seems more attention is being brought to preconception health and its role in FASD prevention.  We have known about the value of preconception intervention for many years. The Project CHOICES Research Group described positive intervention results using Motivational Interviewing in 2003 [1]. Yet now attention to the preconception period seems to be “trending.”

Preconception intervention has been discussed all along (we were asking about it in a landmark study in the ‘90s[2]), but the recent actions like U.S. CDC recommendations and Yukon’s placement of pregnancy tests in bars are certainly highlighting preconception alcohol use and health behaviours. The current Annotated Bibliography of articles published on FASD prevention seems to bear this recent focus out:., there were a total of five articles on preconception efforts in the 2013 list; and in articles published in 2015, that number has doubled.

In the latest annotated list, Landeen et al. says that the “fetal origin of disease theory” provides the rationale for providing preconception interventions[3]. Johnson et al. describe the development and dissemination of the CHOICES model[4] and its successful adaptation in a variety of settings. Hanson et al. have written three articles that expand on the work they did adapting and implementing a CHOICES program with the Oglala Sioux Tribe in the U.S.[5-7]. Analyses by Hussein et al.[8], Mitra et al.[9] and Oza-Frank et al.[12015 Bibliography0] suggest that preconception interventions must be tailored if they are to be successful. McBride stresses the need for preconception counseling for men, as substance use during pregnancy is not solely a decision made by women or under their control [11].

Members of the pNAT are currently undertaking a review of the literature on preconception interventions and formulating recommendations for a national research agenda. They will present some of these recommendations at the research meeting in August at the University of Regina (See for more info on this meeting).  In keeping with our understanding of multiple forms of evidence, we are interested in knowing what you are seeing and hearing about preconception interventions on alcohol. Has preconception intervention been a part of your practice for a while? Who is funded to provide it in your location? What has worked, and how has it worked, in your experience?

For further reading on preconception interventions, see earlier postings:

Alcohol and FASD: It’s not just about women, June 6, 2016
FASD Prevention needs to begin before pregnancy: Findings from the US National Survey on Family Growth, May 20, 2015
Global Trends in Unintended Pregnancy: Implications for FASD Prevention,October 13, 2014
Impact Evaluation of the Healthy, Empowered and Resilient (H.E.R.) Pregnancy Program in Edmonton, Alberta, February 7, 2014
FASD Prevention in Nova Scotia, April 25, 2013
The Sacred Journey – new resource for service providers who work with First Nations families, August 1, 2012
FASD Prevention in Russia, February 15, 2012
New book: Fetal Alcohol Spectrum Disorder: Management and Policy Perspectives of FASD, Jan 6, 2011


  1. Reducing the risk of alcohol-exposed pregnancies: A study of a motivational intervention in community settings. Pediatrics, 2003.111(Supplement 1): p. 1131-1135.
  2. Astley, S.J., et al., Fetal Alcohol Syndrome primary prevention through FAS Diagnosis II, A comprehensive profile of 80 birth mothers of children with FAS Alcohol and Alcoholism, 2000. 35(5): p. 509-519.
  3. Landeen, L.B., R. Bogue, and M. Schuneman, Preconception and prenatal care–useful tools for providers of women’s health. South Dakota Medicine: The Journal Of The South Dakota State Medical Association, 2015. Spec No: p. 36-43.
  4. Johnson, S.K., M.M. Velasquez, and K. von Sternberg, CHOICES: An empirically supported intervention for preventing alcohol-exposed pregnancy in community settings. Research on Social Work Practice, 2015.25(4): p. 488-492.
  5. Hanson, J.D., K. Ingersoll, and S. Pourier, Development and implementation of choices group to reduce drinking, improve contraception, and prevent alcohol-exposed pregnancies in American Indian women. Journal of Substance Abuse Treatment, 2015.
  6. Hanson, J. and J. Jensen, Importance of Social Support in Preventing Alcohol-Exposed Pregnancies with American Indian Communities. Journal of Community Health, 2015. 40(1): p. 138-146 9p.
  7. Hanson, J.D. and S. Pourier, The Oglala Sioux Tribe CHOICES Program: Modifying an Existing Alcohol-Exposed Pregnancy Intervention for Use in an American Indian Community. International Journal Of Environmental Research And Public Health, 2015. 13(1).
  8. Hussein, N., J. Kai, and N. Qureshi, The effects of preconception interventions on improving reproductive health and pregnancy outcomes in primary care: A systematic review. The European Journal Of General Practice, 2015: p. 1-11.
  9. Mitra, M., et al., Disparities in adverse preconception risk factors between women with and without disabilities. Maternal and Child Health Journal, 2015.
  10. Oza-Frank, R., et al., Provision of specific preconception care messages and associated maternal health behaviors before and during pregnancy.American Journal of Obstetrics & Gynecology, 2015. 212(3): p. 372.e1-372.e8.
  11. McBride, N., Paternal involvement in alcohol exposure during pre-conception and pregnancy. Australian Nursing & Midwifery Journal, 2015.22(10): p. 51-51

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