Research using the DISC

Date: Thu, 19 Nov 1998
To: Marian 'Mainland Email mmainland@rogers.com
From: Michelle Cholowsky Email cholowsky@skyway.usask.ca
Subject: Summary of our Research

SUMMARY OF RESEARCH

Introduction.

Prenatal exposure to alcohol, tobacco, psychoactive drags, possibly caffeine, and inadequate diet, have been linked to such adverse outcomes as miscarriage, prematurity, low birth weight, neonatal mortality, congenital malformations, and developmental problems. Promoting maternal and child health requires information on the prevalence of health risk behaviours during pregnancy, the identification of groups at highest risks, and more specific and detailed information of the negative effects of such health risk behaviours on birth outcomes and child development. The Saskatoon Pregnancy and Health Study (SPHS) is a longitudinal study that examines the determinants and consequences of risk behaviour during pregnancy.

Study Population.

Respondents were recruited in two phases frown the population of women receiving either of two prenatal services - prenatal classes, or an outreach program for high-risk pregnant women from Saskatoon Public Health Services. Together, these services reach a diverse group of pregnant women in which primiparous women are disproportionately represented.

Research Instruments. Mothers were interviewed by trained interviewers three times concerning their health behaviours, initially at the 4/5 month of pregnancy; second, during the third trimester (8th month); and post-partum (18-30 months). For Phase 11 a Paternal/Partner Interview was included. Information on labour, delivery, and birth was abstracted by a trained nurse from hospital records. Finally, participants offspring were assessed for development delays using the Diagnostic Interview for Screening Children (DISC).

Findings. Some 1200+ women participated in the study. Response rates for the study were excellent and the retention of study subjects over the time was very good. The study was very well received by subjects. The study has resulted in the generation of a large complex set that will allow us to examine a large number of important hypotheses. To date the Phase I data has been analysed to look at the prevalence and predictors of health risk behaviours and physical abuse during pregnancy. We found that the most continuously used substance during pregnancy was caffeine (87%), followed by alcohol (46%), tobacco (30%), and psychoactive drugs (7%). Though these rates are high they are consistent with other Canadian studies. Overall, 36% of women reported using two substances, 16% three, and 4% all four substances. Risk behaviours were more prevalent among women with lower education and income levels, Aboriginal or Metis background, those not living with a partner, those with previous births, and in some cases, younger women. Prevalence of physical abuse was 5.7% during pregnancy, and 8.5% within the year preceding the third trimester interview. Women who had experienced abuse were significantly more likely to be Aboriginal (includes Metis), to have higher perceived stress scores and more negative life events in the last 12 months, and to have a male partner with a drinking problem. While they were less likely to report a wide network of people with whom they could talk openly, or socialise, at the same time they tended to report having actually socialised with a larger number of people in the previous month. It is suggested that to facilitate early intervention, prenatal services should include a routine assessment of domestic violence. In general, the findings of our study illuminate the needs of particular groups of pregnant women and the importance of understanding maternal risk behaviour within the structural and cultural realities of women's lives.

Dissemination.

Two published articles, 3 papers/abstracts at conferences, 2 presentations to health workers, and 1 PhD Thesis have been produced using SPHS data. In addition there have been media interviews based on the published articles.

Future Plans. We have received funding for a spin-off study to examine whether or not adverse birth outcomes (eg. low birth weight) results in a greater use of medical and hospital services during the first 3 years of life. We are also actively pursuing additional funding to follow the SPHS offspring cohort longitudinally over a 5 to 10 year period to examine the longer term impact of risk behaviours during pregnancy on child development, theft mental health and problem behaviour development. In addition many further analyses of the study dataset are planned.

Contact. Project Co-ordinator - Michelle Cholowsky, Applied Research/Psychiatry, University of Saskatchewan, Box 92, Royal University Hospital, 103 Hospital Drive, Saskatoon, SK, STN 0W8. Phone: (306) 966-8767; Fax: (306) 966-8774. Email: cholowsky@skyway.usask.ca

Date: July 8, 1997
From: Dr. Kevin Parker, Ph.D., C. Psych Email: parkerk@HDHKari.Net
To: Marian Mainland Email: mmainland@rogers.com
Subject: Update: Better Beginnings/Better Futures Research Update

The Better Beginnings/Better Futures project is a 25-year longitudinal prevention policy research demonstration project funded by three Ontario Ministries: (Community and Social Services, Education and Health) and the Federal Secretary of State.

The goals of the project are to prevent emotional, behavioural, social, physical and cognitive problems in children 0 - 8 years of age living in disadvantaged neighbourhoods in eight Ontario c0mmunities to promote healthy development in theses children; and to enhance the families and neighbourhoods in which these children live.

Better Beginnings is the first long-term prevention policy research demonstration project of its kind in Canada. The progress of children, their families and their neighbourhoods will be followed until the children reach theft jid-20s.

The prime measure of development of the children under five is a version of the Diagnostic inventory for Children (DISC) adapted to the research environment by, omitting the use of a basal and ceiling thus giving a standard set of items to all children in a specific age group and then altering the scoring.

Findings from this research will be posted as they are reported.

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