Question: RESEARCH PAPER EXAMPLE: Factors Related to Alcohol Use by Preconceptual and Pregnant Women

Expert answer

Factors Related to Alcohol Use by Preconceptual and Pregnant Women

Fetal alcohol spectrum disorders (FASDs) affect a substantial number of our Nation’s children.  FASDs encompass fetal alcohol syndrome (FAS).  To obtain a diagnosis of FAS, children must meet the following three criteria: growth retardation, central nervous system damage, and craniofacial malformations (Stratton, Howe, & Battaglia, 1996).  Children may not have full-blown FAS, but they may suffer from other related effects, such as alcohol-related birth defects and alcohol-related neurodevelopmental disorder. These other related effects occur approximately three to four times more often than FAS.  While there is no cure for FASDs, FASDs are 100% preventable if a woman abstains from alcohol use during preconception and pregnancy (Centers for Disease Control and Prevention, 2012). Various community-based studies indicate that the incidence of FASDs ranges from three to 22 cases per 10,000 births (Sampson et al., 2007). Despite public education and outreach efforts, the prevalence of FASDs has not declined during recent years (Centers for Disease Control and Prevention, 2012).

Although drinking large amounts of alcohol increases the risk for having a child with FASDs, drinking any amount of alcohol can increase risk. Alcohol use appears to be the most harmful during the first three months of pregnancy, but drinking alcohol any time during pregnancy can be harmful. No safe level of alcohol use during pregnancy has been established and evidence is accumulating that prenatal alcohol consumption at levels less than one drink per day can adversely affect fetal growth and development (Chang et al., 2005). Women who are trying to conceive are also at high risk because often times they drink alcohol before they are even aware that they are pregnant (Carlo, 2007).

Research has shown that many women associate FASDS with heavy alcohol use and are unaware that light and moderate drinking can harm their unborn baby.  Light drinking is consumption of one to two drinks per week. Moderate drinking is consumption of three to five drinks per week, and no more than two drinks per day (Abel, Kruger, & Friedl, 1998). Interventions that encourage preconceptual women, who are trying to become pregnant but have not yet confirmed their pregnancy status, and pregnant women, who are light and moderate drinkers to abstain from all alcohol use could positively impact incidence rates of FASDs.

This research brief explores women’s knowledge and beliefs about alcohol use and FASDs and the barriers they encounter when trying to abstain from alcohol use during preconception and pregnancy. The brief focuses on women in the U.S. who are preconceptual or pregnant, aged 18 to 39 years, and light to moderate drinkers. Communication practitioners can use the results of this research brief to develop more effective messages and interventions for this target audience.

Literature Review

This brief reviews literature in three primary areas: knowledge and beliefs about FASD among the target audience, perceived social barriers to alcohol abstention, and women’s self-efficacy to abstain from alcohol in social situations. Self-efficacy refers to a person’s confidence in their ability to take an action (Baranowski, Perry, & Parcel, 2002). 

Knowledge & Beliefs about FASD

            Research indicates that many women associate FASDs with heavy alcohol use and are unaware that light and moderate drinking can harm their unborn baby.  In a random sample survey of 1,005 women of childbearing age in the U.S., more than half (52%) identified “alcoholics” or “binge drinkers” as exclusively vulnerable to having a child with FASD (Kaskutas, Greenfield, Lee, & Cote, 2008).  In addition, focus groups with a purposive sample of 72 women, ages 18 to 30, living in low-income areas of Atlanta, GA, who planned to get pregnant in the next two years, revealed that little risk was associated with light drinking, a belief that was more prevalent among younger focus groups participants. For example, participants made comments such as “a couple of drinks for a special occasion is okay,” “you can’t go crazy with the cocktails is all,” or “having a drink or two on the weekend can’t hurt” (Brown & Jones, 2010, p. 461).  In a convenience survey conducted over a two-month period with 321 women who received educational counseling and a brochure about FASDs as part of an annual check-up with their gynecologist at three Fallon Clinic health care sites in New England, 41% of women reported being surprised to learn that a women should refrain from all alcohol use when trying to get pregnant (Green, 2008, p. 22).

Social Barriers to Abstention

Research exploring barriers to alcohol abstention among pregnant women has revealed that the social nature of alcohol use may pose significant challenges for women trying to abstain from alcohol to protect their unborn children.  The Roper Organization (1999), which surveyed a random digit dial sample of 1,011 males and females ages 18 or older across the U.S. in 1999, found that respondents who drank alcohol usually did so in social settings, including at parties (75%), friends’ houses (72%), and at home with their families (62%).  Far fewer drank at home alone (40%).  Similarly, motives for drinking often related to socializing, such as celebrating (42%) and doing something with friends (27%).  Branco and Kaskutas (2001), who conducted focus groups with a convenience sample of 39 Native American and African American pregnant and postpartum women in Los Angeles, CA, in 1997, found that women felt socially isolated when refraining from alcohol in social situations.  Participants recalled times when they found themselves in social situations where they were the only ones not drinking.  They reported feeling like an “outcast,” becoming the “adult babysitter,” and acting as the “designated driver” (p. 342).

Pregnancy is a time when many women may need extra social support to refrain from alcohol use. Astley, Bailey, Talbot, and Clarren (2000) conducted in-depth interviews with a snowball sample of 24 women who gave birth to children with FASDs and were patients at two hospitals in Seattle, WA in 1998.  Participants recalled that they had received little social support during pregnancy, feeling uncertain and lonely and needing affirmation that they were doing the right things for their unborn children. Testa and Leonard (1995), who surveyed a convenience sample of 159 pregnant women ages 18 to 39 in Buffalo, NY, in 1994, found that positive social support may be associated with decreased alcohol consumption.  Women who reported receiving social approval for changing their drinking habits during pregnancy were more likely to reduce their alcohol consumption or abstain from alcohol entirely during pregnancy than women who reported no social approval (69% versus 52%).   

Self-efficacy to Abstain

Some studies have explored the role perceived self-efficacy plays in refraining from alcohol use in social situations.  Kost, Landry, and Darrock (1998) surveyed a simple random sample of 168 pregnant women in their second and third trimesters attending birthing trainings at a hospital in Pineville, LA, from 1996 to 1997.  They found that, on average, women rated their confidence in their ability to refuse a drink of alcohol in a social setting as 2.98 on a 1.00 to 5.00 scale (SD = 0.98). While not all studies focus specifically on pregnant women, drinking refusal self-efficacy has long been established in the addiction and treatment literature as a predictor of successful abstention from alcohol. For example, a convenience survey of women and men, ages 21 to 65, conducted at 10 major hospitals in the U.S. offering clinical addiction services, found that the inability to refuse a drink in social situations was associated with 34% of all relapse behaviors (Brock, Taylor, & Smith, 2002).

Chang et al. (2005) conducted a randomized-controlled trial with 304 newly pregnant women identified at risk for alcohol use during pregnancy via a screening questionnaire at Brigham and Women’s Hospital in Boston, Massachusetts. Participants were predominantly white (78.6%) and married (80.5%), with a median age of 31.4 years.  Half the women were randomly assigned to receive a brief counseling intervention by a nurse practitioner, and the other half were assigned to a control group that received no intervention. Postpartum follow-up surveys revealed that fewer than 20% of participants who received the intervention abstained from alcohol use during their pregnancy. Temptation to drink in social situations was found to positively predict alcohol use and was associated with consuming more drinks per drinking episode. In addition, women who expressed greater confidence in their ability to refuse a drink in social situations were less likely to report alcohol use.

The role partners, family members, and friends play in women’s self-efficacy to refuse alcohol was explored in 32 in-depth, qualitative interviews with a convenience sample of pregnant women of all ages who participated in a weekend prenatal health education seminar offered by the Kaiser Permanente Health Plan in Oakland, CA (Compano & Moss, 2003). Some participants reported feeling pressured by loved ones and friends who did not understand or believe the dangers associated with limited alcohol use. Participants told stories of partners, family members and friends who encouraged them “not to listen to every little piece of advice” about pregnancy.  A few participants who reported refusing a drink said their refusal was ignored with comments like “you need to relax” or “just have a small one.” These situations left participants feeling uncertain about how to respond without seeming combative.

Conclusion

            This research brief found little awareness among preconceptual and pregnant women about the dangers of FASDs associated low and moderate drinking. The belief that FASDs are only a concern for alcoholics or women who drink excessively is a common misperception. Women may be even more unaware of the need to abstain from alcohol during the preconception period. The social nature of alcohol use also poses unique challenges for women trying to protect their unborn babies. Feelings of isolation in social situations where alcohol is being used and low self-efficacy to refuse a drink are associated with failure to abstain from alcohol use. Positive social approval and support may help combat these barriers.

References

Abel, E. L., Kruger, M. L., & Friedl, J. (1998). How do physicians define ‘light,’ ‘moderate,’ and‘heavy’drinking? Alcohol: Clinical and Experimental Research, 22, 979-84.

Astley, S. J., Bailey, D., Talbot, C., & Clarren, S. K. (2000). Fetal alcohol syndrome (FAS) primary prevention through FAS diagnosis: II: A comprehensive profile of 80 birth mothers of children with FAS. Alcohol and Alcoholism, 35(5), 509-19.

Baranowski, T., Perry, C. L., & Parcel, G. S. (2002). How individuals, environments, and health behavior interact. In K. Glanz, B. K. Rimer, & F. M. Lewis (Eds.), Health behavior and health education: Theory, research, and practice (3rd ed., pp. 165-184). San Francisco, CA: John Wiley & Sons.

Branco, E. I., & Kaskutas, L. A. (2001). “If it burns going down…”:  How focus groups can shape Fetal Alcohol Syndrome (FAS) prevention. Substance Abuse & Misuse, 36(3), 333-345.

Brock, L., Taylor, S., & Smith, J. (2002). Predictors of relapse in patients treated at alcohol addiction facilities. Journal of Addiction, 10(4), 52-64.

Brown, B., & Jones, J. (2010). Exploring awareness of the risks of drinking during pregnancy. Health Communication, 22(3), 455-467.

Carlo, W. A. (2007). Fetal alcohol syndrome. In Kliegman, R.M., Behrman, R.E., Jenson H.B., and Stanton B.F. (Eds.), Nelson textbook of pediatrics (18^th ed.). Philadelphia, Pa: Saunders Elsevier.

Centers for Disease Control and Prevention. (2012). Fetal Alcohol Spectrum Disorders (FASDS). Retrieved from http://www.cdc.gov/ncbddd/fasd/

Chang, G., McNamara, T. K., Orav, E. J., Koby, D., Lavigne, A., Ludman, B., Vincitorio, N. A., & Wilkins-Haug, L. (2005). Brief intervention for prenatal alcohol use: A randomized trial. Obstetrics & Gynecology, 105(5), 991-998.

Compano, B., & Moss, S. (2003). Exploring responses to a prenatal health intervention. Journal of Health Communication, 11(3), 91-111.

Green, L. (2008). Assessing a fetal alcohol intervention at clinical sites. Journal of Communication in Healthcare, 53(1), 21-31.

Kaskutas, L. A., Greenfield, T., Lee, M. E., & Cote, J. (2008). Reach and effects of health messages on drinking during pregnancy. Journal of Health Education, 29(1), 11-17.

Kost, K., Landry, D. J., & Darrock, J. E. (1998). Predicting maternal behaviors during pregnancy: Does intention matter? Family Planning Perspectives, 30(2), 79-88.

Roper Organization. (1999). [Roper’s public pulse]. Unpublished raw data. Retrieved from http://poll.orspub.com

Sampson, P. D., Streissguth, A. P., Bookstein, F. L., Little, R. E., Clarren, S. K., Dehaene, P., Hanson, J. W., & Graham, J. M. (2007). Incidence of fetal alcohol syndrome and prevalence of alcohol-related neurodevelopmental disorders. Teratology, 56, 317-326.

Stratton, K., Howe, C., & Battaglia, F. (1996). Fetal alcohol syndrome: Diagnosis, epidemiology, prevention and treatment. Washington, DC: National Academy Press.

Testa, M. & Leonard, K. E. (1995). Social influences on drinking during pregnancy. Psychology of Addictive Behaviors, 9(4), 258-268.