Dr Amy Anderson

Issue addressed: The aim of this study was to assess potential barriers to the implementation of clinical guideline recommendations regarding maternal alcohol consumption by antenatal clinicians and managers. Methods: Cross-sectional surveys of antenatal clinicians and managers employed in a New South Wales Local Health District were undertaken. Survey items were developed based on 11 domains of the Theoretical Domains Framework. Consistent with previous studies, a cut point of less than 4 was applied to mean values of survey items (range: 1-5) to identify domains representing barriers to the implementation. Results: Thirty-three antenatal clinicians and eight managers completed the surveys. For clinicians, the domains with the lowest mean values included ¿environmental context and resources¿ (ie, complexity of appointments and availability of supporting systems) (mean: 3.13, SD: 0.93); ¿social influences¿ (ie, expectations of others that alcohol will be addressed) (mean: 3.33, SD: 0.68); ¿beliefs about capabilities¿ (ie, confidence in providing guideline recommendations) (mean: 3.51, SD: 0.67); and ¿behavioural regulation¿ (ie, planning and responding to feedback) (mean: 3.53, SD: 0.64). For managers, ¿emotion regulation¿ (ie, stress in managing change) (mean: 2.13, SD: 0.64) and ¿environmental context and resources¿ (ie, complexities of managing change) (mean: 3.13, SD: 0.83) were the lowest scoring domains. Conclusions: The antenatal service environment and availability of resources appear to be primary barriers to both clinicians and managers implementing guidelines for maternal alcohol consumption. So what?: In the development of interventions to support the delivery of clinical guideline recommendations addressing alcohol consumption during pregnancy, a broad range of potential barriers at both the clinician and manager levels need to be considered and targeted by effective implementation strategies.

Objective: To cross-sectionally examine heavy episodic drinking (HED) and pre-loading with alcohol among young Australian women in relation to the alcohol-induced adverse outcomes of memory loss, vomiting and injury. Methods: A total of 7,800 participants, aged 20¿25 years, from the 1989¿95 cohort of the Australian Longitudinal Study on Women's Health answered all questions on alcohol use, reported drinking alcohol in the previous year and were not pregnant at the third survey in 2015. Log-binomial models were used to estimate prevalence ratios for adverse outcomes associated with increased frequency of HED and pre-loading. Results: The majority of participants reported HED (83.4%) and/or pre-loading (65.6%), which had a moderate correlation (r=0.646). Just over half (55.2%) of participants experienced at least one adverse event, with vomiting being most common. As the frequency of HED or pre-loading increased, so did the risk of an adverse outcome. Conclusions: Both HED and pre-loading pose a risk to young Australian women, and that risk rises with increased frequency. Implications for public health: Although HED has been a target of public health policy and interventions, pre-loading has received limited attention. In addition to addressing HED, there is a need to consider the risk posed by pre-loading, a related, yet unique risky drinking behaviour.

Introduction and Aims: To examine women's drinking behaviour relative to Australian guidelines and identify associated factors over the lifespan. Design and Methods: Data came from three prospective cohorts of the Australian Longitudinal Study on Women's Health aged 18-23 (n=14247), 45-50 (n=13715) and 70-75 years (n=12432) when first surveyed in 1996. The same women were re-surveyed at roughly 3-year intervals until 2012. At each survey, four drinking behaviours were based on two guidelines: long-term drinking (no more than two standard drinks per day) and episodic drinking (no more than four standard drinks on an occasion): (i) no risk (within both guidelines); (ii) low episodic risk (less than once a month); high episodic risk (at least once a month); long-term risk (more than two drinks per day regardless of episodic drinking). Results: No risk drinking increased with age, low episodic risk drinking remained almost constant between ages 18 and 39, and high episodic risk drinking declined rapidly. Few women drank at long-term risk. Factors associated with risky drinking varied with age; however, being a past or current smoker consistently increased the risk, and risks for smokers increased with age. Risky drinking was less likely to be practised by women providing care and needing help with daily tasks, or by pregnant women and those living with children. Discussion and Conclusions: Risky drinking behaviour should be addressed in younger women and in those who smoke. Interventions to reduce risky drinking, possibly in combination with reducing smoking, could be offered through general practice centres.

Objective: The study assessed the association of supportive clinical systems and procedures with smoking cessation care at community mental health centers. Methods: Managers (N584) of community mental health centers in New South Wales, Australia, were asked to complete a survey during 2009 about smoking cessation care. Results: Of the 79 managers who responded, 56% reported that the centers assessed smoking for over 60% of clients, and 34% reported that more than 60% of clients received minimum acceptable smoking cessation care. They reported the use of guidelines and protocols (34%), the use of forms to record smoking status (65%), and the practice of always enforcing smoking bans (52%). Minimum acceptable smoking cessation care was associated with encouraging nicotine replacement therapy for staff who smoke (odds ratio [OR]59.42), using forms for recording smoking status (OR55.80), and always enforcing smoking bans (OR53.82). Conclusions: Smoking cessation care was suboptimal, and additional supportive systems and procedures are required to increase its delivery.

Objective To identify predictors of antenatal alcohol consumption among women who usually consume alcohol. Design Prospective cohort study. Setting Australian Longitudinal Study on Women's Health (ALSWH). Population or Sample A total of 1969 women sampled from the ALSWH 1973-78 cohort. Methods Women were included if they were pregnant in 2000, 2003, 2006 or 2009. The relationship between antenatal alcohol consumption and sociodemographics, reproductive health, mental health, physical health, health behaviours, alcohol guidelines and healthcare factors was investigated using a multivariate logistic regression model. Main outcome measures Alcohol use during pregnancy. Results Most (82.0%) women continued to drink alcohol during pregnancy. Women were more likely to drink alcohol during pregnancy if they had consumed alcohol on a weekly basis before pregnancy (odds ratio [OR] 1.47; 95% confidence interval [95% CI] 1.13-1.90), binge drank before pregnancy (OR 2.28; 95% CI 1.76-2.94), or if they were pregnant while alcohol guidelines recommended low alcohol versus abstinence (OR 1.60; 95% CI 1.26-2.03). Drinking during pregnancy was less likely if women had a Health Care Card (OR 0.63; 95% CI 0.45-0.88) or if they had ever had fertility problems (OR 0.64; 95% CI 0.48-0.86). Conclusions Most Australian women who drank alcohol continued to do so during pregnancy. Prepregnancy alcohol consumption was one of the main predictors of antenatal alcohol use. Alcohol guidelines, fertility problems and Health Care Card status also impacted antenatal alcohol consumption. © 2013 RCOG.