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Medical students, pregnant women, alcohol screening and counseling, FASD
Fetal Alcohol Spectrum Disorders (FASDs) are one of the leading preventable causes of mental retardation and birth defects in the United States. FASDs are 100% preventable if a mother does not consume alcohol during pregnancy. Research suggests that physician advice is one of the most important factors in determining whether or not a pregnant woman decreases her alcohol intake. However, most physicians receive very little training on counseling and screening pregnant women for alcohol use.
To assess the knowledge and perceived self-efficacy to counsel and screen for alcohol use among pregnant women in third year medical students at two Midwestern medical schools.
Third year medical students (n = 259) from two Midwestern medical schools were administered a questionnaire via Survey Monkey assessing their knowledge and perceived self-efficacy to counsel for alcohol use among pregnant women as well as their perceived self-efficacy to screen for alcohol use among pregnant women using the T-ACE, CAGE, TWEAK, MAST and AUDIT.
Findings revealed that most participants were knowledgeable about the health risks associated with consuming alcohol while pregnant and the screening tools, but less knowledgeable about the selfhelp/ group support and treatment programs available to patients. In contrast, when asked about their confidence in using the different screening tools, although reporting being knowledgeable, they were most confident in using the CAGE and least confident in using the TACE, TWEAK, MAST and AUDIT respectively.
Recommendations are offered to medical schools for incorporating additional training in screening instruments and self-help/group support and treatment programs available to patients.
2. Centers for Disease Control and Prevention [CDC]. Alcohol consumption among women who are pregnant or who might become pregnant – U.S. 2002. MMWR, 2004;53:1178- 81.
3. National Institute on Alcohol Abuse and Alcoholism. Alcohol – an important women‘s health issue. Alcohol Alert No. 62; Rockville, MD, 2004.
4. Substance Abuse and Mental Health Services Administration. Substance abuse among pregnant women during 1999 & 2000. The NHSDA Report. (May 17, 2002) http://www.samhsa.gov/oas/2k2/preg/preg.htm (April 4, 2011).
5. United States Preventive Services Task Force. Screening and behavioral counseling interventions in primary care to reduce alcohol misuse. Washington, DC;2004.
6. American Medical Association [AMA], Women Physicians Congress Policy Compendium. (2007) http://www.amaassn. org/resources/doc/wpc/wpccompendfinal.p df (April 8, 2009).
7. American College of Obstetricians and Gynecologist. Substance use and abuse: Tobacco, alcohol and illegal drugs. Guidelines for Women’s Health Care (2nd ed., pp. 375- 381). Washington, DC, 2002.
8. Hennepin County Community Health Department. Healthy Babies: The provider’s role in fetal alcohol syndrome prevention. Minneapolis, MN, 2002.
9. Diekman ST, Floyd RL, Decoufle P, Schulkin J, Ebrahim SH, Sokol RJ. A survey of obstetrician-gynecologists on their patients’ alcohol use during pregnancy. Obstetrics and Gynecology 2000;95: 756-63.
10. Frost-Pineda K, VanSusteren T, Gold MS. Are physicians and medical students prepared to educate patients about alcohol consumption? Journal of Addictive Diseases 2004;23:1-13.
11. Jones-Webb R, McKiver M, Pirie P, Miner K. Relationships between physician advice and tobacco and alcohol use during pregnancy. American Journal of Preventive Medicine 1999;16:244-47.
12. Saunders JB, Aasland OG, Babor TF, de la Fuente JR, Grant M. Development of the Alcohol Use Disorders Indetification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption - II. Addiction 1993;88:791-804.
13. Office of National Drug Control Policy. National Leadership Conference on Medical Education in Substance Abuse (May 5, 2007). http://www.ncjrs.gov/ondcppubs/publicatio ns/pdf/medical_educ_2006.pdf (April 1, 2011).
14. Hart CL, Ksir C, Ray O. Drugs, Society and Human Behavior (13th ed). New York, NY; McGraw-Hill, 2009.
15. American Psychological Association. DSM-5 Development: Timeline (n.d.). http://www.dsm5.org/about/Pages/Timelin e.aspx (August 12, 2011).
16. Dillman DA. Mail and Internet surveys: The Tailored Design Method (2nd ed.). Hoboken, NJ: John Wiley and Sons, 2007.
17. Tresolini CP, Stritter FT. Medical students’ development of self-efficacy in conducting patient education for health promotion: An analysis of learning experiences. Presented at the Annual Conference of the American Educational Research Association. San Francisco, CA, April 21-24, 1992.
18. Tresolini CP, Stritter FT. An analysis of learning experiences contributing to medical students’ self-efficacy in conducting patient education for health promotion. Teaching & Learning in Medicine 1994;6:247-54.
19. Robinson JP, Shaver PR, Wrightsman LS. Criteria for scale selection and evaluation in Measures of Personality and Social Psychological Attitudes. San Diego, CA: Academic Press, 1973.
20. O’Connor PG, Nyquist JG, McLellan AT. Integrating addiction medicine into graduate medical education in primary care: The time has come. Annals of Internal Medicine 2011;154:56-59
21. Yoast RA, Filstead WJ, Wilford BB, Hayashi S, Reenan J, Epstein J. Medical Education: Teaching about substance abuse. Virtual Mentor 2008;10:21-29.
22. Arndt S, Schultz SK, Turvey C, Petersen A. Screening for alcoholism in the primary care setting: Are we talking to the right people? The Journal of Family Practice 2002;51:41-46.
23. Flocke SA, Stange KC. Direct observation and patient recall of health behavior advice. Preventive Medicine 2004;38:343-349.
24. Friedmann PD, McCullough D, Chin MH, Saitz R. Screening and intervention for alcohol problems. A national survey of primary care physicians and psychiatrists. Journal of General Internal Medicine, 2000;15:84-91.
25. Little RE, Streissguth AP, Guzinski GM, Grathwohl HL, Blumhagen JM, McIntyre CE. Change in obstetrician advice following a two-year community educational program on alcohol use and pregnancy. American Journal of Obstetrics and Gynecology 1983;146:23- 28.
26. Maheux B, Haley N, Rivard M, Gervais A. Do physicians assess lifestyle health risks during general medical examinations? A survey of general practitioners and obstetrician-gynecologists in Quebec. CMAJ 1999;160:1830-1834.
27. Petersen R, Connelly A, Martin SL, Kupper LL. Preventive counseling during prenatal care: Pregnancy Risk Assessment Monitoring System (PRAMS). American Journal of Preventive Medicine 2001;20:245-250.
28. Sarnoff R, Adams E, Shauffler H, Abrams, B. Disparities in reported prenatal care advice from health care providers among women of Mexican origin in California. Journal of Immigrant Health 2001;3:77-84.
29. Mengel MB, Searight HR, Cook K. Preventing alcohol-exposed pregnancies. Journal of the American Board of Family Medicine 2006;19(5):494-505.
30. Chang G. Alcohol-screening instruments for pregnant women. Alcohol Research & Health 2001;25:204-209.
31. Neal T. Screen all Women for Alcohol use, ACOG says. Medpage Today. (July 21, 2011). http://www.medpagetoday.com/OBGYN/Gen eralOBGYN/27662 (July 30, 2011).
32. Paley B, O’Connor MJ, Baillie SJ, Guiton G, Stuber ML. Integrating case topics in medical school curriculum to enhance multiple skill learning: using fetal alcohol spectrum disorders as an exemplary case. Academic Psychiatry 2009;33:143-148.
33. Rogelberg SG, Sederburg ME, Aziz S, Conway JM, Spitzmuller C, Knight WE. Profiling active and passive nonrespondents to an organizational survey. Journal of Applied Psychology 2003;88(6): 1104-1114.
34. Barr CD, Spitzmuller C, Stuebing KK. Too stressed out to participate? Examining the relation between stressors and survey response behavior. Journal of Occupational Health Psychology 2008;13 (3):232-243.