Fetal+Alcohol+Syndrome+Among+American+Indians

** Symptoms of Fetal Alcohol Syndrome **
toc

Fetal Alcohol Syndrome, commonly known as FAS, occurs in babies whose mothers drank alcohol while they were pregnant. FAS can cause lifelong problems with learning, memory, attention span, communication, vision, and hearing (3). There are also certain facial abnormalities, growth deficits, cardiac and skeletal abnormalities, as well as central nervous system problems in an individual with Fetal Alcohol Syndrome. People with FAS often show the characteristics of having a small head, thin upper lip, decreased height and weight, slow brain growth, impaired hand-eye coordination, and behavioral problems among other things (7). There is a strong misunderstanding that American Indians have the highest rate of Fetal Alcohol Syndrome in the nation. While this may be true for some tribes, it is a very over-generalized statement that gives all American Indians a bad reputation.

**Prevalence Among American Indians**
There are many statistics that can be found that seem to prove the high prevalence of FAS in American Indians. Some studies have found rates to be as high as 1.5 to 2.5 children born with FAS for every 1000 live births (2), while others even claim that is 3 children out of every 1000 for American Indians compared to .6/1000 among blacks and .1/1000 among whites (6). Other people have recognized that the instance of Fetal Alcohol Syndrome varies from tribe to tribe. Studies of the Navajo and Pueblo tribes report FAS rates that are similar to the rates of the overall U.S. population, while Southwest Plains Indians reported a much higher prevalence (5). This was demonstrated when 10.7 out of every 1000 children were born with fetal alcohol syndrome on a study conducted on two southwestern reservations (13). Some of these rates may actually be higher than they are stated to be, depending on how the study is conducted. In most cases, certain symptoms are chosen to identify children with FAS and they must portray all symptoms to count. This means that not all children that were affected by alcohol have been taken into account. An instance where this has happened is in a study of American Indians in the Aberdeen area where 24% of the population were said to have FAS, but 88% had one or more of the clinical signs, just not all five clinical signs that were set as the standard for having FAS (10).

**Causes of Fetal Alcohol Syndrome**
A combination of many environmental conditions are thought to cause these high rates of Fetal Alcohol Syndrome among American Indians. Throughout history, American Indian life has been filled with violence, oppression, displacement, and loss of self-determination. It is thought that all of these factors have led them to turn to alcohol to cope with their situations. In addition, the fact that 32% of American Indians live below the poverty line, the lack of health care they receive, and the average young age of the population put them in a position to be at risk for binge drinking and risky behaviors (2). Some American Indians also lack the education to understand the effect of alcohol to the fetus. Only 71% of Indians obtain their high school diploma or GED compared to 80% of all other Americans. In addition, only 11.5% obtain their bachelor’s degree. American Indian women who live on or near a reservation have high drop out rates and are least likely to graduate high school (8). This lack of education among American Indians was demonstrated in a survey of sixth through eighth grade students about their attitudes and knowledge of Fetal Alcohol Syndrome. 52% of these students drank prior to the survey and were also sexually active, but it was concluded that even though they took part in these activities, they lacked knowledge about the relationship between alcohol and what it does to a fetus (15).

There was also a study conducted on Northern Plains Indians to see how the father affects the issue of FAS. In these Indians, FAS occurred in 8.5 out of every 1000 live births, which is a very high rate compared to the national averages of .6/1000 among blacks and .1/1000 among whites. It was found that 90% of these fathers who had a child with Fetal Alcohol Syndrome used alcohol themselves and it was concluded that women are more likely to drink if their partner does. In addition, the women whose partner’s drank also experienced more injuries due to that alcohol use and injuries among pregnant women have been found to be a risk factor for having children with FAS (12). Lastly, a genetic predisposition to problem drinking, such as a history of alcoholism in the family, could cause a mother to become an alcoholic and therefore give birth to children with FAS (9).

**Problems with the Statistics**
The reality of these statistics and reasons behind them is that they are not representative of American Indians as a whole. For example, studies of Canadian Indians have only focused on small communities in high-risk and heavy drinking areas. Limiting the study to this population is bound to give much higher rates of FAS when compared to studies done of European and Northern American prevalence that have mostly been clinic-based in urban areas (19). In fact, when studies have been based on the largest populations of American Indians who are living in stable reservation communities, they have found that the rate of FAS among these Indians was only slightly higher than that of the U.S. estimated rates (20). It is also important to take into consideration that high proportions of certain tribes don’t drink at all, just those who do drink drink more heavily and take part in riskier behavior (18). This leads to a scenario where a small number of women are producing all of the FAS children, making the statistics unrepresentative of the tribe as a whole (20). This occurred in an Alaska Natives study where one woman gave birth to four FAS children and to three other children who had a physician notation of FAS in their medical charts (16). It is also important to note that the higher FAS rates may be a result of higher reporting of FAS for American Indians compared to other populations (20). The reasons for higher reporting among American Indians could be for a number of reasons. It may be in part to extensive case finding by the IHS and under reporting of FAS among non-natives (16), or their minority status could cause them to have to report more (18). Nevertheless, while the statistics probably aren’t as dramatic as they are portrayed to be, the highest rate of FAS found in non-Indian, low socio-economic groups in the United States were 3.0-3.1 per 1000 live births, which is still lower than the rates found in low socio-economic groups of Indians (19). Researchers have tried using different methods to conduct their studies and still find American Indian rates of FAS are higher than those of whites, even if just slightly (4). So it can be concluded that American Indians as a whole don’t have the highest rates of FAS, but tribes located in high-risk environments do.

**Prevention of Future Fetal Alcohol Syndrome**
There are many things going on to reverse these high rates of Fetal Alcohol Syndrome. One attempt to do this is the movie called “Faces Yet to Come.” This is a 7th generation fetal alcohol syndrome prevention video aimed at American Indian students in sixth through eighth grade. This video contains nineteen lessons that educate the students about FAS and the students are able to actively participate (14). There are also many organizations who are committed to helping the fetal alcohol syndrome issue. One in particular, the National Organization of Fetal Alcohol Syndrome, or NOFAS, works to develop culturally appropriate and community-based public health awareness and education for the tribes (11). This is important because it has been found that the best way to intervene on American Indian tribes is to do so through the way their culture already is, not try to change their culture. For example, if pregnancy is a sacred time for that tribe, the goal should be to build on that aspect of their life and help them to consider the impact of their decisions on future generations (2). This has been put into action as NOFAS launched an FAS prevention campaign at the Cherokee Nation. Besides offering training to health professionals who serve the Cherokee Nation, they will be integrating artwork, music, festivals, and powwows that are already aspects of the tribe into the prevention campaign (17).

Whether or not the rates of FAS among American Indians is lower than what some experts say it is, the fact that children are being born with this disease is an issue because fetal alcohol syndrome is the leading cause of mental retardation that is completely preventable (8). People are becoming aware of this and there is a lot being done to educate people about FAS, but it is essential that this continues until no children have to grow up with and suffer from this preventable disease.

**References**
1. Hetland, Cara, and Tom Robertson. "Fetal Alcohol Syndrome: The Invisible Disorder ." MPR News. Minnesota Public Radio, 7 Sept. 2007. Web. 7 Apr. 2011. <__[]__>.

This online article is about a man who is a member of the White Earth Band of the Ojibwe, who is living with fetal alcohol syndrome as an adult. It discusses the things he had to deal with as a child because of this disease and what he is going through as an adult also. This site is pretty credible because it is sponsored by an organization and it is current.

2. "Fetal Alcohol Spectrum Disorders Among Native Americans." Samhsa.gov. U.S. Department of Health and Human Services, 2007. Web. 7 Apr. 2011. <__[]__ __ [|NI_WYNTK_FASD_Among_AIAN.pdf] __>.

This website gives strictly information about the prevalence of fetal alcohol spectrum disorder in Native Americans. It does not address any other populations. It is credible because it is sponsored by the U.S. Department of Health and Human Services.

3. "Minority Women's Health: Alcoholism and Drug Abuse." Womenshealth.gov. The National Women's Health Information Center, 18 May 2010. Web. 7 Apr. 2011. <__[]__>.

This website gives information on alcoholism and drug use in women. It also discusses a lot of facts about binge drinking, alcoholism, and fetal alcohol syndrome prevalence in American Indians and Alaska Natives. This is a government sponsored website so the information in it should be accurate.

4. Burd, Larry, and Michael E. K. Moffatt. "Epidemiology of Fetal Alcohol Syndrome in American Indians, Alaskan Natives, and Canadian Aboriginal Peoples: a Review of the Literature." PubMed.gov. U.S. National Library of Medicine, Sept.-Oct. 1994. Web. 7 Apr. 2011. <[]>.

This article reviews studies of fetal alcohol syndrome in American Indians, Alaskan Natives, and Aboriginal peoples of Canada conducted by Medline, the National Institute on Alcohol Abuse and Alcoholism Database, and other relevant databases. This is a credible source due to the credentials of the authors, the only downfall is it is a little outdated.

5. "Fetal Alcohol Syndrome." About.com. New York Times Company, 2011. Web. 7 Apr. 2011. <__[]__>.

This is an informational article about fetal alcohol syndrome in general. It addresses the criteria for diagnosing FAS, the struggles of people with FAS, reported cases of FAS, whether or not there is a genetic susceptibility, and recommendations for avoiding FAS. The information in this article seems accurate but it is always good use caution when using websites that end in ".com" since they are usually for profit.

6. "Fact Sheet: Fetal Alcohol Syndrome." Alcohol Policies Project. Center for Science in the Public Interest, n.d. Web. 7 Apr. 2011. <__[]__>.

This article gives facts and statistics about fetal alcohol syndrome. It also addresses public awareness of FAS, and the possible solutions of treatment, education, and higher taxes. This website seems to give accurate statistics, but it does not have a copyright date so the information may or may not be outdated.

7. "Fetal Alcohol Syndrome." Wvu.edu. West Virginia University, 2011. Web. 7 Apr. 2011 <__[]__>.

This website gives information about the signs and symptoms of fetal alcohol syndrome. It tells about the facial abnormalities, growth deficits, central nervous system problems, cardiac abnormalities, and skeletal abnormalities as well as the social problems faced by both children and adults with this disease. This website is part of West Virginia University's website so that makes it credible, but the page itself didn't have a copyright date.

8. ADMIN. "Alcohol Use, Fetal Alcohol Syndrome Among Pregnant American Indian Women." Alaskapublicrecordsearch.org. N.p., 2010. Web. 7 Apr. 2011. <[]>.

This article discusses the prevalence of alcoholism and fetal alcohol syndrome among American Indian women. It also talks about the social factors, economic factors, ethical factors, political, and proper factors that these women face that may make them more susceptible to alcoholism or fetal alcohol disease. This is a credible source and the information is updated.

9. Wattendorf, Daniel J., and Maximilian Muenke. "Fetal Alcohol Spectrum Disorders." AAFP.org. American Family Physician, 15 July 2005. Web. 7 Apr. 2011. <__[]__>.

This article discusses the epidemiology of fetal alcohol spectrum disorder as well as the physical abnormalities that this disease causes and the diagnosis of it. In addition it gives information about the causes of fetal alcohol spectrum disorders and referral and management for patients. This is a credible source because it is recent and the authors have high credentials.

10. "Use of International Classification of Diseases Coding to Identify Fetal Alcohol Syndrome -- Indian Health Service Facilities, 1981-1992." CDC.gov. Department of Health and Human Services, 2 May 2001. Web. 7 Apr. 2011. <__[]__>.

This article tells the information collected by the Indian Health Services medical records between 1981-1991 about fetal alcohol syndrome among Native Americans. It gives the statistics collected from their medical records. This site is credible but the statistics are a little bit old.

11. "Testimony." NOFAS.org. National Organization on Fetal Alcohol Syndrome, 2001-2004. Web. 7 Apr. 2001. <__[]__>.

This is the testimony of the National Organization on Fetal Alcohol Syndrome. It discusses their commitment to helping to educate people about FAS with a particular interest in helping American Indians. The information given by this organization seems to be accurate.

12. Kvigne, Valborg L., Gary R. Leondardson, and Thomas K. Welty. "Characteristics of Fathers Who Have Children with Fetal Alcohol Syndrome or Incomplete Fetal Alcohol Syndrome." South Dakota Medicine (Aug. 2006): 337-40. SDSMA.org. Web. 7 Apr. 2011. <__[]__>.

This article talks about the influence of fathers who abuse alcohol that have children with fetal alcohol syndrome, and whether there is a correlation between the two. The authors have good credentials and this is a recent article, so it is credible.

13. Ringwalt, Stuart. "Possible Links to Genetic Alcoholism in American Indians." Guilford.edu. Guilford College, 23 Apr. 2000. Web. 7 Apr. 2011. <__[|http://www.guilford.edu/original/academic/chemistry/current_courses/chem110/ ringwalt.html]__>.

This article is about the differences in how people metabolize alcohol, fetal alcohol syndrome, and antisocial alcoholism. All of these topics are discussed in how they pertain to American Indians. This is a school sponsored website so that would make it a credible source, but the author isn't listed as having any credentials.

14. "Faces Yet to Come." The American Indian Institute. The University of Oklahoma, 2009. Web. 7 Apr. 2001. <__[]__>.

This website explains the video "Faces Yet to Come" which is an educational video for American Indian students in sixth through eighth grade. The goal of this video is to decrease the rates of fetal alcohol syndrome in generations to come. This site is credible as it is sponsored by the University of Oklahoma.

15. Ma, Grace X., et al. "Native American Adolescents' Views of Fetal Alcohol Syndrome Prevention in Schools." Journal of School Health 68.4 (1998): 131-36. Abstract. Wiley Online Library. Web. 7 Apr. 2011. <__[]__>.

The abstract of this article talks about how the lack of education about the affects of alcohol on the fetus has been a big factor of the rates of fetal alcohol syndrome among American Indians. This is a credible journal and the authors have good credentials. The data is about twelve years old.

16. Cohlberg, Kevin. "Fetal Alcohol Syndrome." State of Alaska Epidemiology. N.p., 15 Sept. 1997. Web. 7 Apr. 2011. <__[]__>.

This article is about the characterization and prevention of fetal alcohol syndrome in Alaska. The information from this article comes from six and a half years worth of studies. This is a credible source because it is in depth and includes a variety of information.

17. "American Indian/Alaska Native Programs." NOFAS.org. National Organization on Fetal Alcohol Syndrome, 2004. Web. 7 Apr. 2011. <__[]__>.

This page is about how the NOFAS is launching a fetal alcohol syndrome prevention campaign on the Cherokee Nation. Their goal is to educate the people there while still incorporating parts of their lifestyle. This is a credible source since it states in the article that it is supported by the Centers for Disease Control.

18. Institute of Medicine. Fetal Alcohol Syndrome: Diagnosis, Epidemiology, Prevention, and Treatment. The National Academic Press. National Academy of Sciences, 1996. Web. 7 Apr. 2011. <__[|http://www.nap.edu/openbook.php]__ __ [|record_id=4991&page=82] __>.

This online book discusses lots of aspects of fetal alcohol syndrome. It was originally published in 1996, so it is a little bit outdated, but most of the information has not changed much since then so it is still a good source to use.

19. May, Philip A, "Fetal Alcohol Effects Among North American Indians." BNet. CBS Interactive, 2010. Web. 7 Apr. 2011. <__[|http://findarticles.com/p/articles/mi_m0847/ is_n3_v15/ai_12667793/?tag=content;col1]__>. This article talks about a lot of aspects of fetal alcohol syndrome, but I particularly used the information it gave about how the populations of American Indians that are used skew the statistics to make fetal alcohol syndrome more prevalent than it actually might be. This was a very informational article and seemed credible as well.

20. Champagne, Duane, ed. Contemporary Native American Cultural Issues. Vol. 3. Walnut Creek, CA: AltaMira Press, 1999. Print. 3 vols.

This book addresses many contemporary issues Native Americans face such as identity, gender, contemporary powwows, media, health, and environmental issues. This book is a credible source though it was published in 1999, which makes it a little bit outdated.