Substance-Exposed Pregnancy Prevention:

An Environmental Scan of Local Health Department Practices

Molly Schlife, MPH

Floyd RL, Jack BW, Cefalo R, Atrash H, Mahoney J, Herron A, Husten C, Sokol RJ. The clinical content of preconception care: Alcohol, tobacco, and illicit drug exposures.

American Journal of Obstetrics and Gynecology 2008; 199(6):S333-S339.

• 16.5% of pregnant women (and 29.5% of non-pregnant women of reproductive age) reported tobacco use

• 11.8% of pregnant women (and 53% non-pregnant women of reproductive age) reported alcohol use

• 4% of pregnant women (and 10% of non-pregnant women of reproductive age) reported using illicit drugs

Key Questions

• What are local health departments and their community partners doing to address the problem of substance-exposed pregnancies?

• What opportunities exist to expand the use of existing effective interventions and develop new interventions?

Definitions

"Substance-exposed pregnancies” (SEPs) are defined as those that include prenatal exposure to:

• alcohol • tobacco • illicit drugs and/or • prescription drugs (misused/abused)

• increasing community knowledge and awareness of the risks of substance use before and during pregnancy;

• decreasing unintended pregnancies among women who use substances;

• increasing health care and social service provider knowledge and improving practices around substance use screening and brief intervention;

• increasing public health department involvement in prevention activities.

SEP Prevention activities include those aimed at:

Methods

• An environmental scan/survey was developed• 136 MCH leaders in urban local health

departments contacted (April-May 2011)• 59 responses received• Response rate = 43%

Who responded?

Is SEP a problem in your community?

70%

19%

11%

Yes, a big problem

Yes, a small problem

No, not a problem

Don't know

Considers SEP Prevention a priority

55%31%

9%5%

Top 5

Top 10

Top 20

Not on radar

Perceived Readiness to Prevent SEPs

5%

15%

39%

41% Not ready at all

Not very ready

Somewhat ready

Very ready

What substances are you addressing?

9689

7873

64 6460

0

20

40

60

80

100

120

Tobacco Alcohol Marijuana Cocaine/crack cocaine

Heroin/other narcotics

Meth Perscription drugs (misused)

%

Funding Sources Used for SEP Prevention Activities?

64

4540

2519

11 9 7 6 6 50

10

20

30

40

50

60

70

%

*Respondent can check all that apply

Consumer groups targeted

93

61 59

45

36 34

70

10

20

30

40

50

60

70

80

90

100

Pregnant women

Women of reproductive

age at high risk

All women of Reproductive

age

Adolescents General Public Men/fathers Other

%

*Respondent can check all that apply

SEP Prevention Activities

• Individual Interventions with Women at Risk for SEPs – Project CHOICES, Intensive Case Management, counseling services provided by

LCSWs, Community Health Workers and Substance Abuse Counselors

• Pre/inter-conceptual Programs– Education for high risk newly delivered (interconceptual) women, preconception

peer education, birth control for at risk youth; tobacco and substance abuse screening in school-based health centers

• Collaboration/Coordination– Working with providers/hospitals who serve higher risk groups, Human Services,

family planning, Children Services, community SA treatment providers– Coordination of referrals (especially with high risk women seen by WIC or in STD

clinics) coordinating/participating on multiple Task Forces/Coalitions

Are you well-equipped in terms of…

2

8

10

20

42

46

60

50

56

46

30

30

0 10 20 30 40 50 60 70

Training

Time

Funding

Data

Yes No Don't know

%

Which programs include SEP prevention activities?

84

6055

42

15

90

10

20

30

40

50

60

70

80

90

Prenatal/maternal health services

Family planning/Reproductive

health

Teen pregnancy prevention/adolescent

sexual health

STD clinic services Other (SA recovery programs, WIC, NFP)

Don't know

%

*Respondent can check all that apply

Who is the lead organization coordinating SEP prevention activities?

13%

62%

23%

2%

Your agency

There is no lead

Another organization

Don't know

Implications (overall)

•Better understanding of current public health practice in the area of substance exposed pregnancies;

•Understanding priorities in this area at the local level

•Identification of needs in this area

•Help inform planning of future collaborative efforts

Implications for Preconception Health

• Opportunity for LHD leadership coordination role (e.g., data needs, programs, policy levers)

• Potential for bundling of substance use screening and intervention activities

• How to incorporate these issues into a broad women’s health umbrella?

Limitations

• Low response rate

• Self-reporting

• Geographic limitations

•Development of capacity-building opportunities for local health departments

•Promotion of increased community and clinical collaboration to reduce substance-exposed pregnancies

•Additional data analysis performed and a summary report disseminated (Fall 2011)

Acknowledgements

R. Louise Floyd, DSN, RNTeam Leader, FAS Prevention Team  

Joe Sniezek, MD, MPHChief, Prevention Research Branch

Mary Kate Weber, MPHPublic Health AnalystPrevention Research Branch

Molly Schlife, MPHProject Coordinator

Katie Brandert, MPH, CHESActing Associate Director of Programs

Laurin Kasehagen Robinson, MA, PhDSenior CDC MCH EpidemiologistAssignee to CityMatCHAdjunct Assistant Professor in Pediatrics

Contact for more information

Molly Schlife, MPHProject Coordinator, CityMatCH

(402)561-7528mschlife@unmc.edu