HomeMy WebLinkAboutCOM 0900.001 2008-2010 BRENDA J. FORD -• Phone: (808) 326 -5684
Council Member `F. 1 - ' N~' +.,'. Fax: (808) 329 -4786
��z.e ` Email: bford @co.hawaii.hi.us
Council District 7 — Central Kona ,\ , tt . ' %\ :
Hawai `i County Council
County of Hawai i f Mr'
Kailua Trade Center ►—•
75 -5706 Hanama Place, Suite 109
Kailua -Kona, Hawaii 96740
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August 10, 2010 Re: Comm. 900
To: J Yoshimoto, Chair
And Hawai`i County Council Committee Members
From: Brenda J. Ford
Council Member, District 7
Subject: Fetal Alcohol Syndrome (FAS) Presentation Materials
The attached "FAS Big Island Handout" is a copy of the presentation by Dr. Ira Chasnoff, to be
held during the Human Service and Economic Development Committee on August 17, 2010, in
Kona. Please provide a copy to each Council Member and the appropriate staff.
If you have any questions feel free to email or call my office.
Mahalo,
BJF /lw
Comte. vi 00. 1
Ref. To:
Ref. D ate G 17 2
Serving the Interests of the People of Our Island
Hawai `i County is an Equal Opportunity Provider and Employer
The First 1,000 Women
Perinatal Substance Use on Hawai'i Island
Ira J. Chasnoff, MD
Sharon Williams, RN
Daiki Sasaki
Drug Use in Pregnancy:
Infant Impact
• Prematurity
• Small for gestation age
• Increased rates of infant
morbidity and mortality
• Limb reduction deformities
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Fetal Alcohol Syndrome
• Poor growth, weight gain
• Central nervous system effects
• Facial dysmorphology
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Microcephaly Epicanthal foldsfolds
- Short palpebral Flat nasal bridge
fissures
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Flattened midface , Low set ears
Short, upturned nose"-
Flat philtrum
Thin upper lip Receding jaw
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Brain Damage from Prenatal
Alcohol Exposure
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(C) NTI Upstream, 2010 photo: Clarren, 1986
Benefits of Intervention in
Pregnancy
• Cessation of cocaine, methamphetamine, tobacco
use by third trimester decreases the rate of
• Preterm labor
• Intrauterine growth retardation
• Abruptio placentae
• Infant morbidity
• Newborn seizures
• Cessation of alcohol use by third trimester
• Improves cognitive functioning in child
• Decreases rate of FAS
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The 4P's Plus Screen for Substance
Use in Pregnancy
• Parents Did either of your parents ever have a
problem with alcohol or drugs?
• Partner Does your partner have a problem with
alcohol or drugs?
• Past Have you ever drunk alcohol?
• Pregnancy
• In the month before you knew you were pregnant, how
many cigarettes did you smoke?
• In the month before you knew you were pregnant, how
many beers did you drink?
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Validity Data for the 4P's Plus
Correct classification (1,514/1,884) 80%
Sensitivity (310/375) 83%
Specificity (1,204/1,509) 80%
Positive predictive validity (310/615) 50%
Negative predictive validity (1204/1269) 95%
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Goal
Develop an integrated system for the
identification of pregnant women at
risk for alcohol, tobacco, and illicit
drug abuse that will ensure that all
women have access to appropriate
interventions.
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Leadership Team
• Hawai'i Community • Child and Family Services
Foundation • Kamehameha Schools
• Hamakua Health Center • Hawai'i National Defense
• Office of the Lt. Gov. • BISAC
• Child welfare • Good Beginnings Alliance
• Drug Court • Department of Human
• Hawai'i Island Office of the Services
Mayor • Department of Health
• Hawai'i State Judiciary • Matemal /Child Health
• Private practitioners • Alcohol and Drug Abuse
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The SART System
• Screening
■ Assessment / Brief Intervention
• Referral
• Treatment
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-P+N.RW PreSider* ePs Plue Screening A Field Assessment Tool for Substance Use In Pregnancy
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Participating Providers
• Community Health Centers
• Hamakua Health Center
• Hilo Bay Clinic
• Keaau Family Health
• Pahoa Family Health Center
• West Hawai'i Community Health Center
• Private practitioners
• Ian Ebesegawa, MD
• Sintad Sira, MD
• Pam McKenna, MD
• Hospitals
• Kona Community Hospital
• North Hawai'i Community Hospital
• Malama Perinatal Services
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Process
• Training in screening, brief intervention,
and referral
• Linkage to treatment programs
• Implementation / Technical Assistance
• Data collection
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Population
• 1,000 pregnant women on Hawai'i
Island
• Screens at first prenatal visit
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Screening Results (N = 1,000)
50%
45%
III
40% -
35% ■
30% ■ ;'' -
25% ■ -
20% MI,,
, In 15% ■ E MI
10 /0 $ -
5
Al _ / ■
Tobacco Alcohol Mj Pos Screen
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Rates of Polydrug Use Among
Women with a Positive Screen
30% immiiiiiiim
25% b
20% I'
15% III
10%
I
5%
l I u
0%
A +T A +M T +M A +T +M
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Assessment Results
35%
30%
Prior to
25% ■ knowledge of
20% s pregnancy
15% ,,, ❑ After knowledge
15/0 ,`
! I !
of pregnancy
10°
Tbc AlcI llicit
drugs
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Alcohol Use Patterns
After Knowledge of Pregnancy
(N =146)
70%
50% ■
40%
30% ■
20% -. ■
10% ■
Daily 3 -6 d /wk 1 -2 d /wk <1 d /wk
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Special Populations: Age
(N = 957)
N
< 20 years 232
i 20 — 24 years 319
25 — 29 years 207
30 — 34 years 116
> 35 years 83
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Screening Results by Age
60%
50%
40% v., ___.
30% ■ 3 � �e
;t1
3 1 w
20 I � e1 I
1 °% I ", I Pi' I 11 :;44
1
�3t
0 %'
Tobacco* Alcohol Mj Pos Screen
*p<
.03 (C) NTI Upstream, 2010
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Special Populations:
Race and Ethnicity (N = 951)
Caucasian 136
Hawai'ian 409
Asian 56
Filipino 108
- Pacific Islander 110
Mixed /Other 132
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Screening Results
by Race and Ethnicity
70%
60% =111111111 0 M11
50% - 17
40 1 4 11
3to -
0%
I ' r 1
0% .. _
I ; ili3 I
Tobacco* Alcohol* Mj* Pos
Screen*
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Special Populations:
Payor Source (N = 792)
Private 222
trlegliff Medicaid 487
None /other 83
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Screening Results
by Payor Source
60%
50%
40%
30 /o
I 1
20%
o 31.. '
�3
X7 3Y
10°A)
X53 � � „,!„
Tobacco Alcohol Mj Pos Screen
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State Data
35%
30%
25% in
20% pr. i LA
15% I,. ❑NV
%
1 5% I:;.:. ;-,.. 1 1 P I • HI
le
Alcohol Tobacco Illicit
Drugs
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