Category Archives: Research

Alberta Family Wellness Initiative: Research Update

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Early Adversity, Toxic Stress, and Resilience: Pediatrics for Today.

Dowd, M. D.

Pediatric Annals46(7), e246–9.

Never before in the history of science have we had better insight into the factors that determine the health and well-being of a person from infancy to adulthood. An expanding body of knowledge is converging from numerous disciplines including neuroscience, education, behavioral science, public health, the social sciences, and medicine. Awareness of the impact of early childhood adversity and toxic stress is growing rapidly among both professionals and the lay public. This calls for a reevaluation of how and what we, as child health care providers, should deliver to maximize our impact on individual health and well-being across the lifespan. This article briefly summarizes the topic and gives examples of how child health care providers are innovatively incorporating the latest science in practice.

Implementation of an Evidence-Based Parenting Program in a Community Mental Health Setting.

Roosa Ordway, M. et al.

Infant Mental Health Journal39(1), 92–105.

The process of mental health intervention implementation with vulnerable populations is not well-described in the literature. The authors worked as a community-partnered team to adapt and pilot an empirically supported intervention program for mothers of infants and toddlers in an outpatient mental health clinic that primarily serves a low-income community. We used qualitative ethnographic methods to document the adaption of an evidence-based intervention, Mothering from the Inside Out, and the pilot implementation in a community mental health clinic.

Mobile Technology-Based Interventions for Adult Users of Alcohol: A Systematic Review of the Literature

Fowler, L. A. et al.

Addictive Behaviors62, 25–34.

Worldwide, 16% of people aged 15 and older engage in harmful use of alcohol. Harmful alcohol use leads to a host of preventable negative social and health consequences. Mobile technology-based interventions provide a particularly promising avenue for the widespread and cost-effective delivery of treatment that is accessible, affordable, individualized, and destigmatized to both alcohol-dependent and nondependent individuals.

Toward a Targeted Treatment for Addiction

Creed, M. C.

Science 357(6350), 464–5.

A major challenge in treating many neuropsychiatric disorders is that diagnoses are regularly based on behavior rather than on biomarkers, as well as the fact that such conditions are often not associated with gross structural brain changes. Addiction is one example of a disorder defined by pathological behavior (drug seeking despite harmful consequences) in which there is no significant loss of neurons and for which there is no cure.

CanFASD: Alcohol and Colonization in Māori Society

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MASTER’S THESIS PROVIDES NEW PERSPECTIVES ON MĀORI WOMEN’S UNDERSTANDINGS OF ALCOHOL USE DURING PREGNANCY

I recently encountered a wonderful Master’s thesis by Keriata Stuart on how Māori women negotiate drinking alcohol during pregnancy. In this grounded theory study, Stuart explores the factors that influence Māori women’s decisions about alcohol use during pregnancy. The study recognizes that women’s decisions are shaped by social and cultural expectations about gender roles as well as their knowledge about alcohol and pregnancy.

I found Stuart’s first chapter to be particularly fascinating as she provides the backstory to how she came to the research project and her framing of FASD as a Māori and gender issue. Her first introduction to FASD came at a gathering on substance use issues in indigenous communities in 1998 when she was a senior health policy analyst in the NZ Ministry of Women’s Affairs. She describes how many of the ideas about FASD prevention that were considered “groundbreaking” in 1998 had become commonplace by the time she completed her thesis in 2009. An interesting look at how things can change (and perhaps on how much more needs to change).

I appreciate that Stuart challenges the common assumption that alcohol & pregnancy are often thought to be a “special problem” for Māori women and the stereotypical association of alcoholism with indigenous women (Māori and non-Māori women are equally likely to stop drinking during pregnancy).

Her thesis also provides an interesting perspective on the relationship of colonization with alcohol. She describes how Māori society was one of the few that did not independently discover or use the process of fermentation or distillation. As a result, there were no cultural systems to regulate the use of alcohol at the time of colonization. By 1840, historical documents mention the use of alcohol in Māori society. By the 1850s, alcohol was a tool of colonization – Māori landowners were encouraged to run up bills at hotels and their land taken to settle their debts. That said, Stuart cautions that it is important not to view the Māori as passive victims of alcohol; alcohol was part of a complex dynamic in adaptation to new lifestyles, opportunities for trade, and new regulatory roles for tribal leaders. She describes how over time alcohol use in Māori women became perceived as a “social problem” and as a response to dispossession, economic hardship, and the loss of social and cultural supporting structures.

Stuart’s thesis can be downloaded from the Massey University web site.

Reference

Stuart, Keriata. (2009). Trading off : a grounded theory on how Māori women negotiate drinking alcohol during pregnancy. Master’s thesis, Massey University, Wellington, New Zealand.

 

Alcohol Increases The Risk Of Breast Cancer – Research Suggests

06-fruit-smoothies-mango-12By ANDREA WHITE

The recent rise of cancer in the world can be explained by looking at not one but several environmental, genetic, and hormonal factors. Similarly, such aspects can also be observed to see the rise in cases of breast cancer across the world.

Recent studies have suggested further reasons that can give details on breast cancer.  For example, a research from May 2016 has highlighted the impact of lifestyle factors on breast cancer in women including the amount of alcohol intake.

Know about the types of breast cancer here. 

In addition, a Danish study published in the British Journal of Medicine took into account the connection between alcohol intake and breast cancer providing the researchers with further information on the issue.

The Danish researchers concentrated on the changes in intake of alcohol in women over the past five years and concluded that the women who increased their alcohol consumption had a higher chance of developing breast cancer.

Women who added as little as two more drinks in their daily routine in five years had thirty percent higher risk of breast cancer than the women who had the same and unchanged amount of alcohol in their daily diets.

Furthermore, the study also saw a twenty percent decrease in chances of developing heart disease in the women who increased their alcohol consumption. However, the researchers unanimously agreed that there are other ways to lower heart disease chances which do not increase the risk of cancer.

How does alcohol increase the chances of breast cancer?

There is now a good number of studies available that corroborate the fact that an increased alcohol intake leads to an increased danger of hormone receptive positive breast cancer.

The higher amount of alcohol causes an overproduction of estrogen and other hormones which are linked to hormone receptive positive breast cancer along with damaging the DNA in the cells.

Hence, women who drink three alcoholic drinks a day have a fifteen percent higher risk of breast cancer than those who do not have alcohol in their diets at all. In accordance with breastcancer.org, the risk of breast cancer increase by ten percent with an addition of an alcoholic drink to a day.

A study conducted by University of Houston in 2016 provided further details on the effects of alcohol on the women’s bodies.

It showed that alcohol not only triggers an extra production of estrogen but makes the cancer-treating drug Tamoxifen which is used popularly to block excessive estrogen production ineffective.

Therefore, the US Center for Disease Control and Prevention advises women to have no more than one drink a day. If your consumption is even less than this, it is advised that you do not increase your diet anymore.

How do you really define a ‘drink’?

It is important to know what all of the studies on the link between breast cancer and alcohol refer to as a drink as there are differences in many types of alcohols and their amount.  Having a glass of wine is not the same as having a glass of martini.

Both of them look like a single drink to most of the people. In reality, a ‘dirty’ martini contains about six ounces of vodka. This is actually equivalent to a total of four drinks. The official guidelines provided by National Institute on Alcohol Abuse and Alcoholism are used popularly by researchers to define a drink.

According to the guidelines, the following can be considered a drink:

  • 5 ounces or what is a ‘shot’ of 80-proof liquor
  • 8 ounces of malt liquor
  • 6 ounces of pure alcohol
  • 12 ounces of hard cider or beer (which is 3-7 percent of alcohol)
  • 5 ounces of wine

Men who drink more than two drinks and women who have more than one drink of alcohol are said to have a moderate alcohol intake which is safe. Anything more than this will harm you in the long run. Make sure you have an idea of what you are drinking and not just the glasses as well.

Retrieved from https://reportshealthcare.com/alcohol-increases-risk-breast-cancer-research-suggestsv/

There is no safe amount of alcohol during pregnancy, new study shows

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Date: October 24, 2017

Source: Binghamton University

Summary: Any amount of alcohol exposure during pregnancy can cause extreme lasting effects on a child, according to new research.

Any amount of alcohol exposure during pregnancy can cause extreme lasting effects on a child, according to new research from Binghamton University, State University of New York.

A team of researchers led by Marvin Diaz, assistant professor of psychology at Binghamton University, determined that even a small to moderate amount of alcohol exposure produces significant amounts of anxiety in offspring, lasting through adolescence and into adulthood. This research differed in its use of only low levels of alcohol exposure, whereas prior studies used high levels of exposure to reach the same conclusion.

“There’s been a lot of media coverage on whether there’s a safe amount of alcohol to drink,” said Diaz. “This study shows that there isn’t.”

Pregnant rats were exposed to ethyl alcohol vapor for a six-hour period on their twelfth day of gestation; this was the only time the rats were exposed to alcohol. The offspring were then subjected to a series of anxiety tests. The researchers found that anxiety was most apparent in male rats during their adolescence. After entering adulthood, the effects were opposite, with ethanol-exposed male rats showing reduced anxiety, while the females still appear to be unaffected.

“The most important takeaway from this study is that the effects we studied on the rats only took one day of exposure to produce — just six hours,” said Diaz.

Diaz is interested in taking this research further, to determine exactly what changed in the brain to cause such increased levels of anxiety after alcohol exposure, and to see why the effects are apparent in male rats but not females.

Journal Reference:

  1. Siara K. Rouzer, Jesse M. Cole, Julia M. Johnson, Elena I. Varlinskaya, Marvin R. Diaz. Moderate Maternal Alcohol Exposure on Gestational Day 12 Impacts Anxiety-Like Behavior in Offspring. Frontiers in Behavioral Neuroscience, 2017; 11 DOI: 10.3389/fnbeh.2017.00183

Retrieved from:

Binghamton University. “There is no safe amount of alcohol during pregnancy, new study shows.” ScienceDaily. ScienceDaily, 24 October 2017. <www.sciencedaily.com/releases/2017/10/171024130614.htm>.

Global Prevalence of Fetal Alcohol Spectrum Disorder Among Children and Youth A Systematic Review and Meta-analysis

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JAMA Pediatr. 2017;171(10):948-956. doi:10.1001/jamapediatrics.2017.1919

Key Points

Question  What is the prevalence of fetal alcohol spectrum disorder among children and youth in the general population?

Findings  In this meta-analysis of 24 unique studies and 1416 unique children and youth with fetal alcohol spectrum disorder, approximately 8 of 1000 in the general population had fetal alcohol spectrum disorder, and 1 of every 13 pregnant women who consumed alcohol during pregnancy delivered a child with fetal alcohol spectrum disorder. The prevalence of fetal alcohol spectrum disorder was found to be notably higher among special populations.

Meaning  The prevalence of fetal alcohol spectrum disorder among children and youth in the general population exceeds 1% in 76 countries, which underscores the need for universal prevention initiatives targeting maternal alcohol consumption, screening protocols, and improved access to diagnostic services, especially in special populations.

Abstract

Importance  Prevalence estimates are essential to effectively prioritize, plan, and deliver health care to high-needs populations such as children and youth with fetal alcohol spectrum disorder (FASD). However, most countries do not have population-level prevalence data for FASD.

Objective  To obtain prevalence estimates of FASD among children and youth in the general population by country, by World Health Organization (WHO) region, and globally.

Data Sources  MEDLINE, MEDLINE in process, EMBASE, Education Resource Information Center, Cumulative Index to Nursing and Allied Health Literature, Web of Science, PsychINFO, and Scopus were systematically searched for studies published from November 1, 1973, through June 30, 2015, without geographic or language restrictions.

Study Selection  Original quantitative studies that reported the prevalence of FASD among children and youth in the general population, used active case ascertainment or clinic-based methods, and specified the diagnostic guideline or case definition used were included.

Data Extraction and Synthesis  Individual study characteristics and prevalence of FASD were extracted. Country-specific random-effects meta-analyses were conducted. For countries with 1 or no empirical study on the prevalence of FASD, this indicator was estimated based on the proportion of women who consumed alcohol during pregnancy per 1 case of FASD. Finally, WHO regional and global mean prevalence of FASD weighted by the number of live births in each country was estimated.

Main Outcomes and Measures  Prevalence of FASD.

Results  A total of 24 unique studies including 1416 unique children and youth diagnosed with FASD (age range, 0-16.4 years) were retained for data extraction. The global prevalence of FASD among children and youth in the general population was estimated to be 7.7 per 1000 population (95% CI, 4.9-11.7 per 1000 population). The WHO European Region had the highest prevalence (19.8 per 1000 population; 95% CI, 14.1-28.0 per 1000 population), and the WHO Eastern Mediterranean Region had the lowest (0.1 per 1000 population; 95% CI, 0.1-0.5 per 1000 population). Of 187 countries, South Africa was estimated to have the highest prevalence of FASD at 111.1 per 1000 population (95% CI, 71.1-158.4 per 1000 population), followed by Croatia at 53.3 per 1000 population (95% CI, 30.9-81.2 per 1000 population) and Ireland at 47.5 per 1000 population (95% CI, 28.0-73.6 per 1000 population).

Conclusions and Relevance  Globally, FASD is a prevalent alcohol-related developmental disability that is largely preventable. The findings highlight the need to establish a universal public health message about the potential harm of prenatal alcohol exposure and a routine screening protocol. Brief interventions should be provided, where appropriate.

Retrieved from: https://jamanetwork.com/journals/jamapediatrics/article-abstract/2649225?utm_source=twitter&utm_campaign=content-shareicons&utm_content=article_engagement&utm_medium=social&utm_term=101717#.Web6R23_fvc.twitter

With Heavy Drinking On The Rise, How Much Is Too Much?

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Binge-drinking sounds like an all-night bender, but here’s a reality check: Many social drinkers may “binge” without knowing it. Women who drink four or more drinks on an occasion are binge-drinking.

If one glass of wine takes the edge off, why not drink a few more?

This thinking may help explain the findings of a new study that points to an increase in drinking among adults in the U.S., especially women.

“We found that both alcohol use and high-risk drinking, which is sometimes called binge-drinking, increased over time,” says Deborah Hasin, a professor of epidemiology at the Columbia University Medical Center and an author of the study.

To assess drinking trends, researchers conducted face-to-face interviews with thousands of adults. Researchers asked a series of questions, such as: Did you ever drink four or more drinks on an occasion, and if so, how often? The study compares the findings from two surveys. One was carried out in 2001-2002; the other was from 2012-2013.

So what’s behind the increase? The study wasn’t designed to answer this question, but Hasin says there could be a combination of factors.

“Increasing numbers of people feel pessimistic about their economic chances,” she says. So this might help explain the increase in drinking among low-income Americans. As we’ve reported, economists have linked the economy to so-called deaths of despair from causes including opioid overdoses and alcohol abuse.

When it comes to explaining the increase found among women, the way alcohol is marketed may play a role, too. Hasin says she is speculating here, “but just looking at display windows in liquor stores,” they seem designed to appeal to women. “Everything is pink, it’s all rose,” she says.

And beer-makers have sharpened their pitch to female drinkers too, as this Advertising Age article points out. A recent campaign for Coors Light features women competing in races and climbing mountains. “Every climb deserves a refreshing finish,” the ad’s narrator intones.

So if the makers of wine, beer and spirits are enticing us to drink, are some of us ignoring the risks of excessive drinking? Or maybe many women don’t realize when they’re drinking too much?

Not all national surveys have pointed to an increase in drinking. In fact, the National Survey on Drug Use and Health found a slight decline in alcohol use disorders between 2002 and 2013. But even if there’s been no increase, public health experts say excessive alcohol consumption has long been a problem in the U.S.

“Excessive alcohol use is a huge public health problem in the United States,” says physician Bob Brewer, who leads the alcohol program at the National Center for Chronic Disease Prevention and Health Promotion at the Centers for Disease Control and Prevention. The CDC estimates that there are about 88,000 deaths due to excessive alcohol use in the U.S. each year.

“Ninety percent of people in the U.S. who drink to excess are binge-drinking,” Brewer says.

Binge-drinking, to me, always sounds like a term for an all-night bender. But here’s the reality check: It’s easier to “binge” than you might think.

The definition of binge-drinking is “four or more drinks for a woman on an occasion, five or more for a man,” Brewer explains.

So think of an evening out: Perhaps you start with a cocktail, then add beer or wine with dinner. The drinks can add up faster than you think.

“It can be tricky sometimes for people to really keep track of the number of drinks they’re consuming,” Brewer says.

A 5-ounce serving of wine counts as one drink. And a 1.5-ounce shot of spirits (such as vodka, gin, or bourbon) counts as a drink, too. But often, cocktails contain more than one shot. (Exactly what counts as “a drink” is detailed here.)

“A lot of beers now, particularly craft beers, may have higher alcohol content,” Brewer says. “So, if you have a 12-ounce beer that [contains] 9 percent alcohol, you’re really drinking the equivalent of close to two drinks,” Brewer says.

There are tips to help you guard against drinking too much, especially at a festive event or social gathering, such as an office party. One tip: Make a pact with yourself or with somebody else to take a break before each drink. And another: Alternate between glasses of water and alcohol.

Brewer says it’s worth reminding everyone that the U.S. Dietary Guidelines recommend that women limit alcohol to one drink per day, two for men.

Retrieved from: http://www.npr.org/sections/thesalt/2017/08/16/543965637/women-who-love-wine-are-you-binge-drinking-without-realizing-it?utm_campaign=storyshare&utm_source=twitter.com&utm_medium=social

FASD Justice and Reconciliation: Tough Questions, New Collaborations

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Final Report- FASD Justice &amp; Reconciliation (final 07-17)

Fetal Alcohol Spectrum Disorder (FASD) is an umbrella term used to describe a spectrum of physical, neurological, cognitive, socio-emotional, and behavioural impairments that may result from prenatal exposure to alcohol. In addition to these impairments, secondary challenges (such as involvement with the criminal justice system) may be experienced in the absence of appropriate supports and services. FASD is often discussed in the context of the criminal justice system, as individuals with FASD are understood to be overrepresented in the justice system.

In 2015, the Truth and Reconciliation Commission of Canada released 94 Calls to Action, directed at various levels of government and to all Canadians. TRC Calls to Action 33 and 34 specifically address FASD. The Calls to Action provided an opportunity to bring together policy makers, front-line workers, parents/caregivers, and students to discuss how the TRC can be considered in justice practices. The Symposium took a holistic look at how justice programs at the local and national level may incorporate culturally-appropriate programming. This included discussions on how individuals and families can be best supported in the community and, when necessary, in the justice system.

Moreover, the Symposium drew attention to the need for programs that are attentive to the broader contexts that impact Indigenous peoples with FASD, particularly when in contact with the justice system. Indigenous voices and programs were at the centre of the discussion. Justice programs that have solidly incorporated Indigenous perspectives were also explored—from smaller community-based projects to larger programs embedded in province-wide judicial initiatives. The goal was for participants to be exposed to programs from across Canada, to gain a broader understanding of the complexity of issues when discussing FASD in the justice system and to be introduced to new tools and networks to respond to the TRC Calls to Action.

The Symposium featured six presenters who led an exploration of how justice system programming supports people with FASD, focusing on the experiences of Indigenous individuals. This included the perspectives of parents, front-line community workers, and diagnosticians. Participants engaged in discussions focused on current practices, future directions, and the path forward. From the feedback collected throughout the event, Dr. Stewart’s research team has produced 6 key findings and 18 recommendations for moving forward.

Key Findings and Recommendations

1 Culturally and Historically-Informed Practices

Participants noted that there is often a lack of culturally and historically-informed programming for individuals with FASD across systems.

Recommendation 1: Develop relationships between agencies and Indigenous communities.

Recommendation 2: Develop training focused on the TRC and the history of residential schools and colonialism in Canada for agencies.

Recommendation 3: Explore the potential for culturally and historically-informed practices within the health system.

2 Trauma

Participants recognized the role of trauma in the lived-experience of individuals with FASD, particularly in relation to the potential for re-traumatization within the justice system.

Recommendation 4: Develop and distribute training on trauma-informed practices.

Recommendation 5: Establish the capacity for trauma to be incorporated as a mitigating factor in sentencing.

Recommendation 6: Develop outreach and training material for frontline health professionals about practices surrounding diagnosis and care.

3 Advocacy

Participants discussed the ways in which individuals with FASD, families, and support agencies can advocate for greater awareness of FASD and confront the stigma surrounding FASD.

Recommendation 7: Facilitate collaborative spaces that are inclusive and welcoming of candid discussions.

Recommendation 8: Create spaces for individuals with FASD and caregivers to engage directly with policy-makers and program managers.

Recommendation 9: Facilitate spaces for individuals with FASD and families to access training.

Recommendation 10: Implement and integrate changes to programs and practices that honour Indigenous perspectives.

Recommendation 11: Establish keeping families together as a top priority informed by Indigenous perspectives.

4 Resources

Participants expressed that, while some jurisdictions have demonstrated success in establishing supports for individuals with FASD and their families, there are substantial gaps in services particularly in rural or remote communities.

Recommendation 12: Identify wise practices that best support individuals with FASD across the lifespan informed by Indigenous perspectives.

Recommendation 13: Prioritize community driven requests for supports and services with an emphasis on sustained funding.

Recommendation 14: Fund culturally appropriate diagnoses, mentorship, and respite for families, lifeskills and mentoring for individuals, and ongoing support that changes across the lifespan.

5 Interagency Collaboration

Participants noted that a primary challenge to the provision of appropriate supports and services to individuals with FASD is the “silo effect” (agencies working in isolation) which prohibits effective collaboration.

Recommendation 15: Facilitate regular opportunities for interdisciplinary teams to come together to share resources.

Recommendation 16: Strike working groups comprised of federal, provincial/territorial stakeholders, and policy-makers in collaboration with Indigenous communities to implement TRC Calls 33 and 34.

6 Challenging Systems and Policy

Participants noted many barriers to individuals with FASD accessing services, including the need for maternal confirmation and justice-specific concerns (such as conditions of release and use of legal jargon).

Recommendation 17: Complete a program and policy review through a TRC lens to make appropriate modifications to programs, practices, and protocols.

Recommendation 18: Undertake a review of culturally modified/culturally appropriate diagnostic practices to modify or enhance current diagnostic practices.

FASD, JUSTICE & RECONCILIATION: TOUGH QUESTIONS, NEW COLLABORATIONS n FEBRUARY 22 & 23, 2017 n EXECUTIVE SUMMARY

 

 

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