Determinants of pregnant women’s compliance with alcohol guidelines: A prospective cohort study

In 2009, Australian alcohol guidelines for pregnancy changed from low to no alcohol intake. Previous research found a high proportion of pregnant Australian women drank during pregnancy; however, there has been limited investigation of whether pregnant women comply with 2009 alcohol guidelines.

The purpose of this study was to provide an assessment of pregnant women’s compliance with 2009 Australian alcohol guidelines and identify predictors of such compliance. Data from 837 women from the 1973–1978 cohort of the Australian Longitudinal Study on Women’s Health was analysed, involving women aged 30–36 years who were pregnant at the 2009 survey.

  • 72% of pregnant women did not comply with the 2009 alcohol guidelines and 82% of these women drank less than seven drinks per week, with no more than one or two drinks per drinking day.
  • Women who previously complied with the 2001 alcohol guidelines were more than 3 times as likely to comply with the 2009 guidelines as those who did not.
  • Women whose household incomes were $36,400 or more were less likely to comply with the guidelines, as were women who consumed alcohol at least weekly prior to pregnancy
  • Those who abstained from alcohol prior to pregnancy were more likely to comply.

Most pregnant women did not comply with alcohol guidelines promoting abstinence. Prior alcohol behaviour was the strongest predictor of compliance during pregnancy, suggesting alcohol use should be addressed in women of child-bearing age.

Citation: Anderson AE, Hure AJ, Powers JR, Kay-Lambkin FJ, Loxton DJ (2012). Determinants of pregnant women’s compliance with alcohol guidelines: A prospective cohort study. BMC Public Health, 12:777. doi:10.1186/1471-2458-12-777

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Recruiting online: Lessons from a longitudinal survey of contraception and pregnancy intentions of young Australian women

Recruiting participants for health surveys has become increasingly difficult, particularly where young people are concerned. Traditional recruitment practices involve methods such as postal, telephone and face-to-face invitations, which may not be compatible with the high usage and reliance on more modern forms of technology amongst younger people.

In recent years researchers have made use of social media as a means of recruiting young participants into health surveys, but it is not yet clear whether this is a cost-effective approach, or whether it can provide samples that demographically reflect the general population, particularly for longitudinal research.

In the current study, the researchers assessed the effectiveness of online recruitment methods in recruiting women aged 18-23 for the Contraceptive Use, Pregnancy Intention, and Decisions (CUPID) Study. A variety of methods were used, including Facebook advertisements and posts, Twitter, and online forums, as well as face-to-face events, distribution of promotional material, and media releases.

Over the one-year recruitment period, a total of 3,795 women were recruited to take part in the online survey, almost double the original target of 2,000. Women were recruited at an average cost of $11 per participant, substantially lower than that for the pilot version of the study, which, using mailed invitations, attracted only 54 participants at a cost of around $100 each. The sample was found to be broadly representative of 18-23 year old women in Australia in terms of demographics, with the exception of a higher proportion of women who had completed year 12 education.

While the use of multiple approaches makes it difficult to determine the success of individual strategies, Facebook appears to be a particularly effective means of recruitment, with a large daily increase in respondents observed following changes to the placement of advertisements from the sidebar to the central newsfeed.

facebook-793049_1280The findings from the current study suggest that it is possible to recruit a demographically representative sample of young women using online methods, and that this can be done at a reasonable cost.

This paper generated significant interest, with an invited commentary commissioned by the American Journal of Epidemiology. In this commentary Dr Jenifer Allsworth from the University of Missouri – Kansa City praised the study design, suggesting that the study was well conducted and made an important contribution to the literature.

Contact person: Melissa.Harris@newcastle.edu.au

Citation: Harris ML, Loxton D, Wigginton B, Lucke J. Recruiting online: Lessons from a longitudinal survey of contraception and pregnancy intentions of young Australian women. American Journal of Epidemiology, 2015. doi: 10.1093/aje/kwv006

Acquisition and utilization of information about alcohol use during pregnancy among Australian pregnant women and service providers

pregnant-216160_1280Because of an unknown safe level of alcohol consumption during pregnancy and inconsistent alcohol guidelines for pregnant women, it is unclear what information is being circulated with regard to alcohol use and pregnancy. This study aimed to explore how pregnant women and service providers acquire and utilize information about alcohol use during pregnancy.

The study involved 10-minute semi-structured interviews with 74 mothers of young children and focus groups with 14 service providers in urban and rural areas of New South Wales in 2008 and 2009.

  • Women and service providers expressed uncertainty about what the alcohol recommendations were for pregnant women.
  • Health care providers were inclined to discuss alcohol use with women they perceived to be high risk but not otherwise.
  • Women felt pressure to both drink and not drink during their pregnancies.
  • Those who drank discounted abstinence messages and reported a process of internal bargaining on issues such as the stage of their pregnancy and the type of beverages they consumed.
  • Those who abstained did so mainly because they were afraid of being held responsible for any problems with their pregnancies or infants that might have occurred from drinking.

Confusion surrounding the recommendations regarding alcohol use during pregnancy, inconsistency in addressing alcohol use with pregnant women, information overload, and a perceived culture of drinking appear to contribute to the high proportion of Australian women drinking during pregnancy.beer-199650_1280

Citation: Loxton D, Chojenta C, Anderson AE, Powers JR, Shakeshaft A, Burns L (2013). Acquisition and utilization of information about alcohol use during pregnancy among Australian pregnant women and service providers. Journal of Midwifery and Women’s Health, 58(5):523-530.

Contact person: Deborah Loxton Deborah.Loxton@newcastle.edu.au

Recruiting online: Lessons from a longitudinal survey of contraception and pregnancy intentions of young Australian women

Recruiting participants for health surveys has become increasingly difficult, particularly where young people are concerned. Traditional recruitment practices involve methods such as postal, telephone and face-to-face invitations, which may not be compatible with the high usage and reliance on more modern forms of technology amongst younger people.

In recent years researchers have made use of social media as a means of recruiting young participants into health surveys, but it is not yet clear whether this is a cost-effective approach, or whether it can provide samples that demographically reflect the general population, particularly for longitudinal research.

In the current study, the researchers assessed the effectiveness of online recruitment methods in recruiting women aged 18-23 for the Contraceptive Use, Pregnancy Intention, and Decisions (CUPID) Study. A variety of methods were used, including Facebook advertisements and posts, Twitter, and online forums, as well as face-to-face events, distribution of promotional material, and media releases.

Over the one-year recruitment period, a total of 3,795 women were recruited to take part in the online survey, almost double the original target of 2,000. Women were recruited at an average cost of $11 per participant, substantially lower than that for the pilot version of the study, which, using mailed invitations, attracted only 54 participants at a cost of around $100 each. The sample was found to be broadly representative of 18-23 year old women in Australia in terms of demographics, with the exception of a higher proportion of women who had completed year 12 education.

While the use of multiple approaches makes it difficult to determine the success of individual strategies, Facebook appears to be a particularly effective means of recruitment, with a large daily increase in respondents observed following changes to the placement of advertisements from the sidebar to the central newsfeed.

The findings from the current study suggest that it is possible to recruit a demographically representative sample of young women using online methods, and that this can be done at a reasonable cost.

This paper generated significant interest, with an invited commentary commissioned by the American Journal of Epidemiology. In this commentary Dr Jenifer Allsworth from the University of Missouri – Kansa City praised the study design, suggesting that the study was well conducted and made an important contribution to the literature.

Contact person: Melissa.Harris@newcastle.edu.au

Citation: Harris ML, Loxton D, Wigginton B, Lucke J. Recruiting online: Lessons from a longitudinal survey of contraception and pregnancy intentions of young Australian women. American Journal of Epidemiology, 2015. doi: 10.1093/aje/kwv006

Loss to follow-up was used to estimate bias in a longitudinal study: a new approach

When participants fail to respond to health surveys this may bias the results. Findings suggest that non-response is increasingly due to difficulties contacting participants, rather than other reasons such as death or participants refusing to take part, but little is known about how this type of non-response might influence results.

The study compared people who responded and those who could not be contacted on health factors (e.g. smoking) and the relationship between health factors (e.g. between smoking and self-rated health). It found that those who could not be contacted were more likely to bcomputer-313840_1280e less educated, stressed about money, separated, divorced or widowed, to have experienced violence, and to be a smoker. For relationships between health factors, the effect of monetary stress on self-rated health was higher for those who responded, but all other relationships were similar. These findings suggest that despite the loss of participants the relationships between health factors were found to be accurate.

Citation: Powers J, Tavener M, Graves A, Loxton D, ‘Loss to follow-up was used to estimate bias in a longitudinal study: A new approach’, Journal of Clinical Epidemiology, (2015)

Contact: Jennifer Powers jenny.powers@newcastle.edu.au

Coming to terms with a deteriorating body for older women with osteoarthritis

hands-195648_1280Osteoarthritis is a chronic, painful condition marked by significant limitations in movement and daily functioning, which in turn has negative effects on psychological functioning. However, little is known about how individuals with this condition psychologically adjust to the disease over time. Dr Melissa Harris, Professor Julie Byles and Associate Professor Deborah Loxton from the University of Newcastle, and David Sibbritt from UTS investigated this issue.

The study interviewed women from the 1946-1951 cohort of the Australian Longitudinal Study on Women’s Health about their experiences with osteoarthritis and the ways in which they adjust to the disease. The researchers found that the condition had a heavy physical and psychological impact on sufferers, with pain and loss of function being significant burdens. Most women accepted the disease to some extent, and had learnt to live with it. Women identified a range of factors that helped them to adjust to the disease. These included accepting pain and limitations, minimising symptoms (e.g. viewing them as “wear and tear”), comparing their circumstances to people who are worse off, and using the disease as an opportunity for personal growth. For example, having arthritis assisted some women in developing a greater awareness and appreciation for the struggle others face, as well as gaining an awareness of their bodies and having greater attunement to their physical limitations.

Some coping strategies, while perceived by the participants as beneficial for psychological adjustment, may present as barriers to help seeking and lead to poorer long-term physical outcomes, for example ignoring key arthritis-related symptoms and having ingrained beliefs about arthritis as a wear and tear disease, or behaving physically as they had done prior to having osteoarthritis.

Health service providers should be aware that women with osteoarthritis use cognitive strategies that can act as a catalyst for personal growth, but may be detrimental to their long-term physical health.

Citation: Harris ML, Byles JE, Sibbritt D, Loxton D, ‘”Just get on with it”: qualitative insights of coming to terms with a deteriorating body for older women with osteoarthritis.’, PLoS One, 10 e0120507 (2015)

Contact person: Melissa Harris Melissa.Harris@newcastle.edu.au

Dietary intervention increases the size of the baby at birth

What you need to know:

There is evidence that dietary intervention during pregnancy can increase the size of the baby at birth. Interventions providing food and fortified food products or targeting pregnant women who are underweight, nutritionally at-risk or from a low income country are the most promising strategies to increase the size of the baby at birth. However, size is just a surrogate marker for other health and economic outcomes. Further large high-quality randomised controlled trials investigating combination dietary intervention and micronutrient provision from food are needed. Future trials spanning preconception, the duration of pregnancy and even between pregnancies are needed to advance our understanding of optimal maternal nutrition for maternal-child health.

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What this research is about:

Nutrition before conception and during pregnancy is important to ensure a healthy pregnancy outcome. Research has demonstrated the importance of diet as a prevention strategy for some adverse neonatal outcomes, particularly the role of folic acid for the prevention of neural tube defects. However, there is a clear need to identify the best dietary interventions for pregnant women aimed at preventing adverse neonatal and infant outcomes. The aim of this study was to synthesise the best of the available evidence by conducting a systematic review and meta-analysis to determine whether dietary interventions before or during pregnancy have any effect on neonatal or infant outcomes.

What did the researchers do:

A systematic review was conducted without date restrictions. Randomised controlled trials evaluating whole diet or dietary components and pregnancy outcomes were included. Two authors independently identified articles for inclusion and assessed methodological quality. Meta-analysis was conducted separately for each outcome using random effects models. Results were reported by type of dietary intervention: (i) counselling, (ii) food and fortified food products, or (iii) combination (counselling + food); and collectively for all dietary interventions. Results were further grouped by trimester when the intervention commenced, nutrient of interest, country income and body mass index.

What did the research find:

Of the 2326 abstracts screened, a total of 29 randomised controlled trials (31 publications) were included in this review, which included 10,026 participants. Results indicate that food or fortified food products increase birth weight (by approximately 125g) and reduce the incidence of low birth weight (by approximately 27% decrease in odds). Combining all dietary interventions, both increase birth weight and reduce the incidence of low birth weight (62g and 24% decreased odds respectively), and increase length (0.07cm). In sub-group analyses the largest gains in birth size are made in underweight and nutritionally at-risk populations, in both high and low income countries, and dietary interventions that focus on macronutrients.

How can you use this research:

This review advances our understanding of the role of nutrition for a healthy birth outcome. Providing nutrition education as well as food or fortified food products to pregnant women, particularly those who are underweight, at nutritional risk, or come from a low income country, is likely to increase the size of the baby at birth with important health and financial ramifications.

Contact person: Ellie Gresham ellie.gresham@uon.edu.au

Citation: Gresham, E., Byles, J.E., Bisquera, A., & Hure, A.J. The effects of dietary interventions on neonatal and infant outcomes: a systematic review and meta-analysis. American Journal of Clinical Nutrition. 2014.

What Women Think about Information on Alcohol Use in Pregnancy

wineglass-553467_1280What you need to know:

Australian alcohol guidelines changed in 2009 to state that not drinking is the safest option for women who are pregnant or those who may become pregnant. Women who reported being pregnant after the introduction of this recommendation explained a number of problems with the information they received about alcohol use during pregnancy. There were differences in the amount of information they received, the message that was conveyed to them, and also in how they interpreted the recommendation. To improve how this information is communicated so women can make an informed decision about whether to drink or abstain during pregnancy, women suggested that a clear, strong and consistent recommendation be provided to women by healthcare professionals as early as possible.

What this research is about:

Heavy alcohol use during pregnancy can have negative impacts on the mother and child, but the potential effects of light to moderate drinking are unclear. In Australia, this has meant that the recommendations about a safe level of alcohol use during pregnancy have changed over the years. The latest recommendations are that not drinking is the safest option. It is important that women are made aware of the potential harms and the lack of a known safe level of consumption. Women should be given enough information to feel confident in making their own personal decision on whether or not to drink alcohol during pregnancy. This study explored what women thought about the information they received about alcohol use during pregnancy.

What did the researchers do:

Telephone interviews were conducted with 19 women from the 1973-78 cohort of the Australian Longitudinal Study on Women’s Health (ALSWH) who had been pregnant after the 2009 alcohol recommendations were introduced.

What did the research find:

There were a lot of inconsistencies in the information that pregnant women received about alcohol use. Some women found that too much information was given, whereas others received none. The actual recommendations that the women were given varied from no alcohol to a little bit being okay. Conflicting messages were common. Women interpreted the information differently. Some believed that not knowing a safe level of alcohol use during pregnancy meant that small amounts were okay, but others concluded that that meant that no alcohol was safe. Overall, the women believed that there was a need to provide better information to pregnant women about alcohol use. They suggested thwoman-358779_1280at a clear, consistent recommendation be provided as early as possible, preferably by healthcare professionals.

How can you use this research:

Information about alcohol use during pregnancy should be provided systematically by healthcare professionals to all women of childbearing age. This will facilitate informed decision making by women who are pregnant or who may become pregnant.

Contact person: Amy Anderson Amy.Anderson@newcastle.edu.au

Citation: Anderson AE, Hure AJ, Kay-Lambkin FJ, Loxton DJ. Women’s perceptions of information about alcohol use during pregnancy: a qualitative study BMC Public Health 2014;14:1048

Breastfeeding is worth the effort

What you need to know:

Breastfeeding improves the health of mothers and babies and saves money. Most babies are breastfed for a month, but only six in ten babies are still being breastfed at six months. If mothers breastfeed their first baby for six months, most will breastfeed their next baby for six months. So it is particularly important to help women with breastfeeding their first baby. For the first six months after the birth, ongoing help should be provided for all first time mothers.

What this research is about:

Breastfeeding results in the best outcomes for mothers and their babies. For more than ten years, the World Health Organization has recommended that all babies should be breastfed for the first six month1s of their lives. Current Australian recommendations are to breastfeed for at least a year. They also say that it is good to breastfeed for another year, making two years in total. Although there are some figures on the proportions of babies who are breastfed, less is known about the mothers and whether they behave in the same way for all of their babies.

What did the researchers do:

In 1996, 18-23 years old women from all over Australia first took part in the Australian Longitudinal Study on Women’s Health. Since then, they have been answering surveys every three years and completed their fifth survey in 2009. In these surveys, the women reported how many children they have and how long they breastfed each child. We look at the proportions of babies who were breastfed for six months, a year and two years, and which babies are most likely to be breastfed. Having looked at the babies, we look at the mothers and who is most likely to breastfeed. If women breastfeed their first child for at least six months, do they do the same thing with their next child.

What did the research find:

More than nine in ten babies were breastfed for at least a month. Six of every ten babies were breastfed to six months. One in four babies was breastfed for a year. Very few babies were breastfed for two years. Babies were more likely to be breastfed for at least six months if they were not born premature or low birth weight. When we looked at mothers, we found more than two in three mothers breastfed at least one baby to six months. More than one in three mothers breastfed at least one baby for a year. Women who were older when they had their first child were more likely to breastfeed their babies. Babies were more likely to be breastfed if women who were more educated, were less stressed about money and had a partner. Women who breastfed their first baby to six months were much more likely to breastfeed their second baby.

How can you use this research:

Despite recommendations, many Australian babies are not being breastfed for at least six months. Although most babies are breastfed for the first month, breastfeeding does not continue. If women breastfeed their first baby for at least six months they are more likely to continue this practice with later babies. So it is particularly important to help women with breastfeeding their first baby. For the first six months after the birth, ongoing help should be provided for all first time mothers. Extra help should be provided to younger and less educated mothers.

Contact person: Alexis Hure Alexis.Hure@newcastle.edu.au

Citation: Hure, A. J., Powers, J. R., Chojenta, C. L., Byles, J. E., & Loxton, D. (2013). Poor adherence to national and international breastfeeding duration targets in an Australian longitudinal cohort. PLoS ONE, 8(1). doi:10.1371/journal.pone.0054409

Postal recruitment for young women is not cost effective

What you need to know:

Researchers have often used mailed invitations to ask people to participate in surveys. It is important to have enough people participate, and that they represent the population of interest. This study showed that postal recruitment methods are not cost effective in achieving representative samples of young people. When we chose young women from the Medicare Australia database and mailed them an invitation to participate in a survey only 5.4% of eligible participants completed the entire survey. At a cost of around AU$100 per participant this was not cost-effective. Innovative and flexible approaches with a focus on social media may hold the key.

What this research is about:

Population-based studies usually rely on randomly sampling methods to achieve samples that are representative of the larger population. In Australia, this has previously been achieved by using Medicare Australia’s health insurance database. This database has the most up-to-date age, sex and contact details of Australian citizens and permanent residence. The Australian Longitudinal Study on Women’s Health was able to successfully recruit a sample of 18-23 year old women in 1996 at a cost of AU$30 per participant using this approach. Since this time, response rates to population studies have declined. In this study we report on the cost-effectiveness of recruiting a representative sample of women aged 18-23 years living in NSW using the Medicare database for an online survey about contraception and unintended pregnancy.

What did the researchers do: 2

Using a stratified sampling frame (based on age and area of residence), a total of 900 young women were invited to participate in the pilot study. Assuming an 18% response rate, it was estimated that 150 participants would be achieved. Invitations were distributed by Medicare Australia on behalf of the research team in two batches using a modified Dillman protocol.

What did the research find:

Only 6.2% of eligible participants consented and initiated the survey. Of these, 5.8% completed at least one survey item and 5.4% completed the entire survey. The cost per participant was around AU$88 for survey initiation and AU$100 for survey completion.

How can you use this research:

Postal recruitment methods are not cost effective for achieving representative samples for young people. In a changing technological landscape, innovation and flexibility in recruitment strategies are required. Internet-based technologies (including social media) may hold the key but further research is required regarding the ability to achieve representative samples using this approach.

Contact person: Dr Melissa Harris: Melissa.Harris@newcastle.edu.au

Citation: Harris, ML, Herbert D, Loxton D, Dobson AJ, Wigginton B, Lucke J. Recruiting young women for health surveys: traditional random sampling methods are not cost-effective. Aust N Z J Public Health. 2014, 38 (5); p 495.