Cudore L. Snell

Maternal risk factors for fetal alcohol syndrome in the Western cape province of South Africa: a population-based study.

OBJECTIVES We defined risk factors for fetal alcohol syndrome (FAS) in a region with the highest documented prevalence of FAS in the world. METHODS We compared mothers of 53 first-grade students with FAS (cases) with 116 randomly selected mothers of first-grade students without FAS (controls). RESULTS Differences between case and control mothers in our study population existed regarding socioeconomic status, religiosity, education, gravidity, parity, and marital status. Mothers of children with FAS came from alcohol-abusing families in which heavy drinking was almost universal; control mothers drank little to no alcohol. Current and past alcohol use by case mothers was characterized by heavy binge drinking on weekends, with no reduction of use during pregnancy in 87% of the mothers. Twenty percent of control mothers drank during pregnancy, a rate that declined to 12.7% by the third trimester. The percentage who smoked during pregnancy was higher for case mothers than for control mothers (75.5% vs 30.3%), but the number of cigarettes smoked was low among case mothers. The incidence of FAS in offspring of relatively young women (28 years) was not explained by early drinking onset or years of drinking (mean, 7.6 years among case mothers). In addition to traditional FAS risk factors, case mothers were smaller in height, weight, head circumference, and body mass index, all anthropomorphic measures that indicate poor nutrition and second-generation fetal alcohol exposure. CONCLUSIONS Preventive interventions are needed to address maternal risk factors for FAS.

Maternal Risk Factors for Fetal Alcohol Syndrome and Partial Fetal Alcohol Syndrome in South Africa: A Third Study

OBJECTIVES This is a third exploration of risk factors for the two most severe forms of fetal alcohol spectrum disorders (FASD), fetal alcohol syndrome (FAS) and Partial FAS (PFAS), in a South African community with the highest reported prevalence of FAS in the world. METHODS In a case control design, interview and collateral data concerning mothers of 72 first grade children with FAS or PFAS are compared with 134 randomly selected maternal controls of children from the same schools. RESULTS Significant differences were found between the mothers of FASD children and controls in socio-economic status, educational attainment, and a higher prevalence of FASD among rural residents. The birth order of the index children, gravidity, and still birth were significantly higher among mothers of FASD children. Mothers of children with a FASD are less likely to be married and more likely to have a male partner who drank during the index pregnancy. Current and gestational alcohol use by mothers of FASD children is bingeing on weekends, with no reduction in drinking reported in any trimester in 75 to 90% of the pregnancies that resulted in an FAS child or during 50 to 87% of PFAS-producing pregnancies. There was significantly less drinking among the controls in the second and third trimesters (11 to 14%). Estimated peak blood alcohol concentrations (BAC)s of the mothers of PFAS children range from 0.155 in the first trimester to 0.102 in the third, and for mothers of FAS children the range is from 0.197 to 0.200 to 0.191 in the first, second, and third. Smoking percentage during pregnancy was significantly higher for mothers of FASD children (82 to 84%) than controls (35%); but average quantity smoked is low in the 3 groups at 30 to 41 cigarettes per week. A relatively young average age of the mother at the time of FAS and PFAS births (28.8 and 24.8 years respectively) is not explained by early onset of regular drinking (mean = 20.3 to 20.5 years of age). But the mean years of alcohol consumption is different between groups, 16.3, 10.7, and 12.1 years respectively for mothers of FAS, FASD, and drinking controls. Mothers of FAS and PFAS children were significantly smaller in height and weight than controls at time of interview. The childs total dysmorphology score correlates significantly with mothers weight (-0.46) and BMI (-0.39). Bivariate correlations are significant between the childs dysmorphology and known independent demographic and behavioral maternal risk factors for FASD: higher gravidity and parity; lower education and income; rural residence; drinks consumed daily, weekly, and bingeing during pregnancy; drinking in all trimesters; partners alcohol consumption during pregnancy; and use of tobacco during pregnancy. Similar significant correlations were also found for most of the above independent maternal risk variables and the childs verbal IQ, non-verbal IQ and behavioral problems. CONCLUSIONS Maternal data in this population are generally consistent with a spectrum of effects exhibited in the children. Variation within the spectrum links greater alcohol doses with a greater severity of effects among children of older and smaller mothers of lower socio economic status in their later pregnancies. Prevention is needed to address known maternal risk factors for FASD in this population.

Alcohol Use, Working Conditions, Job Benefits, and the Legacy of the ―Dop‖ System among Farm Workers in the Western Cape Province, South Africa: Hope Despite High Levels of Risky Drinking

This study describes alcohol consumption in five Western Cape Province communities. Cross-sectional data from a community household sample (n = 591) describe the alcohol use patterns of adult males and females, and farm workers vs. others. Data reveal that men were more likely to be current drinkers than women, 75.1% vs. 65.8% (p = 0.033); farm laborers were more likely to be current drinkers than individuals in other occupations 83.1% vs. 66.8% (p = 0.004). Group, binge drinking on weekends was the norm; men were more likely to be binge drinkers in the past week than women 59.8% vs. 48.8% (p = 0.086); farm workers were more likely to binge than others 75.0% vs. 47.5% (p < 0.001). The legacy of “Dop” contributes to current risky drinking behaviors. Farm owners or managers were interviewed on 11 farms, they described working conditions on their farms and how the legacy of “Dop” is reflected in the current use of alcohol by their workers. “Dop” was given to farm workers in the past on six of the 11 farms, but was discontinued for different reasons. There is zero tolerance for coming to work intoxicated; farm owners encourage responsible use of alcohol and assist farm workers in getting help for alcohol problems when necessary. The farm owners report some positive initiatives, were ahead of the movement to provide meaningful wages, and provide other important amenities. Further research is needed to assess whether progressive practices on some farms will reduce harmful alcohol use.

Indicated Prevention of Fetal Alcohol Spectrum Disorders in South Africa: Effectiveness of Case Management

In the Western Cape Province of South Africa (ZA) a subculture of binge drinking produces the highest global documented prevalence of fetal alcohol spectrum disorders (FASD). FASD prevention research activities in ZA use the Comprehensive Prevention approach from the United States Institute of Medicine. Case management (CM) was delivered as a method of indicated prevention to empower heavy drinking pregnant women to achieve cessation or a reduction in drinking. CM activities incorporated life management, Motivational Interviewing (MI) techniques and the Community Reinforcement Approach (CRA). Data were collected at baseline, 6, 12 and 18 months. Mean drinking decreases 6 months into CM; but overall alcohol consumption rose significantly over time to levels higher than baseline at 12 and 18 months. Alcohol consumption drops significantly from before pregnancy to the second and third trimesters. AUDIT scores indicate that problematic drinking decreases significantly even after the vulnerable fetus/baby was born. CM significantly increases client happiness, which correlates with reduced weekend drinking. CM was successful for women with high-risk drinking behaviour, and was effective in helping women stop drinking, or drink less, while pregnant, reducing the risk of FASD.

Parenting while powerless: Consequences of “the talk”

ABSTRACT Historically, African American parents have struggled to negotiate the tensions related to raising their children in a hostile society. The recent and tragic events involving the murders of unarmed African American boys and men by police officers, enraged motorists, and vigilante neighbors have sparked a resurgence in discussion and activism related to these historic tensions. In addition to protests and a heightened level of public discourse, there is also new emphasis on African American parents having “the Talk” with their children, particularly their sons. “The Talk” represents the “surviving interactions with police or other members of authority” discussion and is largely considered an essential rite of passage in African American homes. And, although the pretext for “the Talk” is providing children with the rule book for survival from an authoritative source, the subtext for this conversation is the inherent powerlessness of African American parents and their inability to protect their children. Despite its necessity, “the Talk” has an ugly underside that also manifests in disruptions to child development, families, and the larger community. These disruptions are particularly critical in an allegedly postracial environment.

Help-Seeking and Risk-Taking Behavior Among Black Street Youth: Implications for HIV/AIDS Prevention and Social Policy

Abstract This article explores and analyzes the help-seeking and risk-taking behavior of Black urban street youth in Washington, DC, USA and Cape Town, South Africa. The target population of 100 youths came from the streets of Washington, DC and Cape Town, South Africa. Structured face-to-face interviews and direct observation of informal and formal settings where youths congregated were used to gather data. Major findings indicate that the majority received high levels of support from families and friends. In terms of formal systems, social and mental health services are viewed as much less accessible or useful. Youths were knowledgeable about HIV/AIDS but did not translate this into safer sexual practices. Implications for health and social policy are outlined.

Black perspectives and social work practice

ABSTRACT Social work and social welfare have historically operated from a Black perspective in understanding problems, identifying structural inequities, and designing social services for the Black community. Obviously there is no singular Black perspective, but a diversity of models promulgated by diverse players for meeting the community’s needs. Often marginalized, the practice models discussed herein provide divergent approaches and illustrate the critical roles that the Black perspective played in shaping the evolution of the social work profession.

The Role of Fathers in Adolescent Substance Abuse Prevention

Adolescent substance abuse has been a major problem in society for many decades. Prevention has been deemed the most successful approach for dealing with this problem. Most research on this area focuses on family and emphasizes the role of mothers as either protective factors or as risk factors. The role of the father is more ambiguously discussed. The father figure can either be a member of the biological family or of the selective family. This article looks through the lens of theory to explore the role of fathers in a family and elucidates several risk and protective factors that may influence the prevention of substance abuse in adolescents.