Cigarette, alcohol and other drug use among small city pregnant adolescents.

PURPOSE: To determine the prevalence of cigarette, alcohol and other drug use and associated factors of use among predominantly Caucasian small-city pregnant adolescents, a little-studied population. METHODS: At the initial prenatal visit 117 enrollees completed a self-administered questionnaire. Patients provided urine samples for drug metabolites. Chart review determined medical provider documentation of substance use. RESULTS: Thirty-five percent of patients were positive for alcohol or other drug use by questionnaire self-report, provider report or initial urine drug screening test. Thirteen percent of patients were positive for at least one drug metabolite in the urine. Multiple logistic regression analysis indicated a model with four significant risk factors associated with pregnant adolescent alcohol and other drug use: lack of closeness with the father of the baby, neither parent in the home, patient experiencing consequences of alcohol and other drug use, and father of the baby experiencing consequences of alcohol and other drug use. CONCLUSIONS: The high prevalence of cigarette, alcohol and other drug use in this predominantly Caucasian sample was comparable to previous inner city data. Awareness of risk factors may improve identification and management of substance use among pregnant adolescents.

PIP: During May 1990-July 1991, health workers recruited 117 pregnant adolescents at two hospital-based perinatal clinics and two family practice residency clinics in Madison, Wisconsin, into a study designed to determine the prevalence of cigarette, alcohol, and other drug use among pregnant teenagers in a small US city. 68.4% of the teenagers were Caucasian. They underwent a urine drug screening for amphetamines, benzodiazepines, cannabinoids, cocaine, opiates, LSD, and phencyclidine at the initial and third-trimester visits. The provider reviewed the medical record from the initial prenatal visit detailing the history of substance abuse. Based on the self-reports, 48.3% smoked cigarettes, 8.6% drank alcohol, and 7.7% used other drugs. 12.8% of the patients tested positive for at least one drug metabolite. These prevalences were similar to those of other inner city data. The medical provider report showed that 56.3% had used tobacco, 22.7% had used alcohol, and 11.4% had used other drugs. Medical providers detected 98.2% of the cigarette smokers, 60% of the alcohol users, and only 25% of the users of other drugs. During the third-trimester visit, 8 of 81 patients (9.9%) tested positive for marijuana (6) and cocaine (2). Of these 81 teenagers, 16 were positive for other drug use either at the first- or third-trimester visits. Three tested positive for other drug use during both visits. No significant difference in the percentage of cigarette smokers between positive and negative substance users existed. Risk factors for alcohol and other drug use included: neither parent at home (odds ratio [OR] = 3.47); father of the baby not close to the pregnant teenager (OR = 10.26); father of the baby had at least one consequence related to alcohol and other drug use (OR = 3.45); and pregnant teenager had at least one consequence related to alcohol and other drug use (OR = 8.19). These findings suggest that if clinicians are aware of these risk factors, identification and management of substance use among pregnant teenagers will improve.

Maternal birthing positions and perineal injury.

A study to evaluate the relationship between maternal birthing position and perineal outcome was undertaken on 335 patients in a rural family physician's practice whose babies were delivered vaginally between December 1980 and December 1988. The most common birthing position used by the women was the semi-sitting position in the birthing bed (44%, n = 146). Ninety-four women (28%) gave birth from the conventional lithotomy position, 80 (24%) used the birthing chair, and less than 5% used a side-lying position. Almost 30% of the women gave birth with intact perineum; the incidence of episiotomy was 44%. The use of a particular position for delivery varied with parity, and multiparous women used the semi-sitting position in the birthing bed more frequently than did primiparous women. There was no statistically significant relationship between birthing position and perineal outcome for primiparous women. A statistically significant relationship between delivery position and perineal outcome was found for multiparous women. Multiparous women using the birthing bed were more likely to have less perineal trauma than women giving birth on the delivery table.

Epidemiology of problem drinking among elderly people.

The prevalence of alcohol use and misuse declines with age, but misuse remains an important public health problem among older people. Between 2 and 4% of the United States elderly population meet DSM-III criteria for "alcohol abuse" or dependence. Up to 10% are "heavy" or problem drinkers. Alcohol use and misuse are both more common among men than women. Since the elderly population is expanding, we will see an increase in the absolute number of older problem drinkers over the next few decades even if the prevalence of problem drinking remains constant. It is incumbent on health care providers and administrators to plan for the prevention and treatment of alcohol problems among these people.

Development and operation of the Wisconsin Research Network.

In 1987, the Wisconsin Academy of Family Physicians developed the Wisconsin Research Network (WReN) to support practice-based primary care research throughout Wisconsin. WReN has three objectives: to support the research efforts of individual physicians in community practices, to facilitate collaborative research among practicing physicians, and to provide academically based investigators with access to community practice sites. Due to a policy of actively encouraging membership, WReN has grown to 460 members during its 4-year history. Five WReN-supported papers have been published, and 22 state and national level presentations of WReN-supported research results have been made. Competitive grants totaling more than $2 million have been awarded to university-based investigators for studies using the resources of WReN. This paper describes the development, organization, and success of WReN as well as the challenges which must be addressed.