Maternal and Child Health Library

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January 26, 2007

1. INTERVENTION KIT DEVELOPED TO HELP HEALTH PROFESSIONALS PREVENT FETAL ALCOHOL SPECTRUM DISORDERS

Drinking and Reproductive Health: A Fetal Alcohol Spectrum Disorders Prevention Tool Kit presents strategies to help health professionals identify women who drink at risky levels and engage them in changing behavior to reduce their risk for an alcohol-exposed pregnancy. The continuing education activity, sponsored by the American College of Obstetricians and Gynecologists with support from the Centers for Disease Control and Prevention, is designed to help health professionals who care for women prevent fetal alcohol spectrum disorders (FASD) when they encounter risky drinking, regardless of the woman's pregnancy status. A brief guide provides information on FASD, screening and intervention guidelines, frequently asked questions, a blueprint for putting screening and intervention into practice, the Surgeon General's Advisory on Alcohol Use in Pregnancy, resources, and references. Other materials include handouts for patients about drinking and reproductive health, additional screening tools and counseling tips for health professionals, and a pocket card illustrating standard-sized drinks. More information is available at http://www.acog.org/from_home/misc/dept_pubs.cfm.

• Three states enacted enrollment caps in 2001 at the outset of the recession; four states capped enrollment between July and November 2003 at the height of the recession.
• With the exception of Montana, all states lifted their enrollment caps within 1 year of enactment.
• While caps were in place, total enrollment dropped by an aggregate 15% in the six states that capped and then reopened enrollment. Rates of attrition ranged from 6% in Florida and Maryland to 29% in North Carolina.
• Only simplified renewal was observed to reduce rates of enrollment attrition; neither maintaining a waiting list nor modifying cost-sharing policies had an effect on enrollment attrition or recovery.
• Informants described their reluctance to conduct outreach while programs were capped. However, agencies adjusted messages and strategies to emphasize renewal or applications for Medicaid. States and CKF grantees were eager to promote coverage once caps were lifted.
• Enrollment caps caused confusion for parents (e.g., fear that SCHIP had been entirely closed was widespread). However, rapid enrollment recovery in most states after caps were lifted and during open periods suggests that SCHIP still represents a needed and desirable product to parents.
• Rates of retention among SCHIP enrollees improved during and after caps.

• Rates of sexual activity did not decline significantly among adolescents ages 15-19 or among those ages 18-19; the decline in sexual activity among adolescents ages 15-17 was of borderline significance.
• The contraceptive risk index declined by 34% among adolescents ages 15-19, by 46% among those ages 15-17, and by 27% among those ages 18-19.
• Pregnancy risk declined by 38% among adolescents ages 15-19, by 55% among those ages 15-17, and by 27% among those ages 18-19.
• Fourteen percent of the change in pregnancy risk among adolescents ages 15-19 was attributable to a decrease in the percentage of sexually active young women, while 86% was attributable to changes in contraceptive method use; among adolescents ages 15-17, the corresponding percentages were 23% and 77%, respectively. All of the change in pregnancy risk among adolescents ages 18-19 was the result of increased contraceptive use.