1. FAS Primary Prevention In a FAS Diagnostic Clinic Susan J. Astley, Ph.D. Sterling K. Clarren, M.D. Diane Bailey, M.N. Christina Talbot, M.S.W. Washington State FAS Diagnostic and Prevention Network (FAS DPN)

2. Primary Questions 1.What is the profile of this high-risk population? 2.What factors enhanced / hindered their ability to achieve sobriety and practice effective birth control? Maternal Interview 3-4 hour personal interview (87% enrollment success) Key topics Sociodemographics (age, race, education) Social support network Lifetime adverse events Mental health profile Alcohol use and treatment history Family planning history and preferences Primary Questions

3. Age MeanMin-Max At first drink 157 - 30 At maximum drinking 2310 - 41 At first attempt to stop2614 - 47 At birth of child with FAS2718 - 41 At most successful sobriety3120 - 52 At diagnosis of child with FAS3521 - 52 At interview 3823 - 55 Maternal Age at Key Events (n = 80)

4. Maternal Age

5. Maternal Race, Education

6. Maternal IQ

7. Lifetime Abuse of Mother

8. Maternal Mental Health

10. N% Childhood (0 - 8 years)33(45 %) Adolescent (9 - 17 years)31(42 %) Adult (18+ years)10(14 %) Earliest Age of Onset of Mental Health Disorder

11. Maternal Drug Use

12. Why she did not want to reduce alcohol use

13. Why she did not seek Alcohol Treatment

14. meanmaximum Proportion of Pregnancies/woman Unplanned77 %100 % No birth control81 %100 % Exposed to alcohol73 %100 % Reproductive History

15. Maternal Contraceptive Preference

16. Children At Risk

17. Parity of Child with FAS

18. Abstinent at Time of Interview Yes (n=50)No (n=25) Mean IQ9682 Married52 % 44 % Low Income: yearly income less than $10,00050 % 76 % Reported a religious affiliation72 % 44 % Parents had a problem with alcohol use88 % 64 % Most # of drinks/occasion prior to pregnancy3417 Mean # of individuals in social support network1711 Mean # of mental health disorders per woman55 Received mental health treatment*52 % 26 % Significant Contrasts Between Women Who Had And Had Not Achieved Abstinence

19. This study suggested women were more successful at stopping drinking ( 75 %) than avoiding unintended pregnancy ( 22 %). 30 years after US Supreme Court legalized contraception 57 % of U.S. pregnancies unintended (Forrest ‘94) 78 % pregnancies unintended in women with FAS kids May be due in part to lack of access to contraception. 1998 WA State Survey of Health Insurance Plans Only 30 % paid for contraception. 77 % paid for abortions 4 out of 5 women did not have contraceptive coverage Unintended Pregnancies

20. 1992 Survey of 79 King County Alcohol/Drug Treatment Agencies 33 % of clientele were women 54 % had no medical or MH services 84 % had no on-site child care 44 % had no on-site recovery support groups Among 80 birth mothers of children with FAS 96 % had mental health disorders. Those who received MH treatment more likely to achieve abstinence. 70 % had children. Those who entered support groups more likely to achieve abstinence. Treatment for Alcoholism