At a Juncture: Exploring Patterns and Trends in FASD Prevention Research from 2015 – 2021 Using the Four-Part Model of Prevention

Abstract

Background and Objective: FASD prevention efforts have been expanded in the last 25 years to go beyond the moral panic that guided early public awareness campaigns and policy responses. In Canada, a Four-Part Model of FASD Prevention has been developed and used that describes a continuum of multi-sectoral efforts for women, girls, children, and their support networks, including broad awareness campaigns, safe and respectful conversations around pregnancy and alcohol use, and holistic and wraparound support services for pregnant and postpartum women with alcohol and other health and social concerns. The purpose of this article is to describe the state of the evidence on FASD prevention from 2015 – 2021, including the prevalence and influences on alcohol use during pregnancy, interventions at each of the four levels of the Four-Part Model, as well as systemic, destigmatizing, and ethical considerations.
 Materials and Methods: Using EBSCO Host, seven academic databases were annually searched for articles related to FASD prevention from 2015 – 2021. English language articles were screened for relevance to alcohol use in pregnancy and FASD prevention. Using outlined procedures for thematic analysis, the findings were categorized within the following key themes: prevalence and influences on women’s drinking; Level 1 prevention; Level 2 prevention; Level 3 prevention; Level 4 prevention; and systemic, destigmatizing, and ethical considerations.
 Results: From January 2015 – December 2020 n = 532 articles were identified that addressed the prevalence and influences on alcohol use during pregnancy, interventions at each of the four levels, and systemic, destigmatizing, and ethical considerations. The most recent research on FASD prevention published in English was generated in the United States (US; n = 216, 40.6%), Canada (n = 91, 17.1%), the United Kingdom (UK; n = 60, 11.3%), and Australia (n = 58, 10.9%). However, there was an increase in studies published from other countries over the last six years. The literature heavily focused on prevalence and influences on alcohol use during pregnancy (n = 182, 34.2%), with an increase of prevalence research from countries outside of Canada, the US, Australia, and the UK, and on Level 2 prevention efforts (n = 174, 32.7%), specifically around the efficacy and implementation of brief interventions. Across Level 1 and Level 2 prevention efforts, there was an increase in literature published on the role of technology in supporting health promotion, education, screening, and brief interventions. Attention to Levels 3 and 4 demonstrated nuanced multi-service, trauma-informed, relational, and holistic approaches to supporting women and their children. However, efforts are needed to address stigma, which acted as a systemic barrier to care across each level of prevention.
 Conclusion: Research and practice on FASD prevention has continued to expand. Through our generated deductive themes, this review synthesized the findings and demonstrated how the work on FASD prevention has been amplified in recent years and how efforts to support women and children’s health are complex and interconnected. The findings highlight opportunities for prevention through research and evidence-informed policy and practice.

Towards Healthy Outcomes for Individuals with FASD

“…The study conducted by Kennedy et al 23 on mathematics achievement scores over time for individuals with FASD reinforced the importance of examining both group-and individual-level data when conducting FASD research to identify and leverage individual strengths. Wolfson et al 24 and Harding et al 25 focused on FASD prevention, identifying how research and practice on FASD prevention has continued to expand. 24 Both groups of researchers established how unique approaches to FASD prevention, such as exploring television media, 25 may aid in increasing awareness about FASD and alcohol use during pregnancy.…”

“…Wolfson et al 24 and Harding et al 25 focused on FASD prevention, identifying how research and practice on FASD prevention has continued to expand. 24 Both groups of researchers established how unique approaches to FASD prevention, such as exploring television media, 25 may aid in increasing awareness about FASD and alcohol use during pregnancy. Lastly, individuals with lived experience (including those with in-body and in-home lived experience), in collaboration with researchers, brought forth their perspectives on the need to conduct research with individuals with lived experience.…”

“…22,23,32 While these systems of potential influence can be positive, they may also be touch points where individuals with FASD, their caregivers, and pregnant women and mothers who use(d) substances may face experiences of stigma and discrimination. 24 Given the complexity of FASD, as well as the language and framing often attributed to prenatal alcohol use and FASD, 19,25 individuals with FASD and women who use(d) substances during pregnancy may experience stigma at individual, interpersonal, institutional, and/or population or public levels. 24,38,39 As highlighted by Wolfson et al 24 in this special issue, there is a critical need to acknowledge and address the immense impact of stigma on access to services with approaches that are empowering, attend to diversity, and respond to the complexity of individuals' lives.…”

Message from the Editors

“…Broadly, the key themes addressed in this special issue include FASD challenges, 18,19 solutions, [20][21][22][23] and evolving understandings and approaches. [24][25][26][27] Our hope is that readers will take from this special issue that it is not about doing one type of work but rather all work with a sense of the desired and intentional impact. The articles in this special issue span a diverse range of topic areas in line with CanFASD's priority areas for FASD -prevention, intervention, diagnosis, justice, and child welfare -and how each can support a balanced story of FASD.…”

“…This special collection took shape over much of 2021 and 2022 and ultimately includes ten academic articles. Various topics related to FASD are explored including the importance of language when discussing FASD 24 ; essential considerations for collaborative FASD research 22 ; recent patterns and trends in the field of FASD prevention 25 ; effective screening approaches for FASD 23 ; psychotropic medication usage among individuals with FASD with co-morbid psychiatric conditions 20 ; a policy analysis of Canadian Child Advocate reports of infants, children, and youth prenatally exposed to alcohol and other substances 18 ; mathematics achievement among children and adolescents with FASD 21 ; portrayals of alcohol and substance use on mainstream television 19 ; meaningfully incorporating the voices of individuals with lived experience in FASD research 26 ; and advancing a strengths-based, person-centred lifespan approach to interventions for individuals with FASD. 27 We believe that by featuring the diverse voices within the FASD community, this collection of articles will advance knowledge in a strengths-based and human-centred way.…”