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USAID Applying Science to Strengthen and Improve Systems (ASSIST) Project | Ukraine
Alcohol and tobacco use in Ukraine are among the highest in the world and pose a dual risk to the health of a woman and to her baby. Tobacco use during pregnancy increases the risk of miscarriage, preterm birth, low birth weight, and prenatal mortality, as well as asthma and sudden infant death syndrome. Approximately 2.5 million Ukrainian women smoke tobacco and their smoking increases with age, from 14.7% for women aged 15-24 to 19.8% for those aged 25-44. In comparison, 19.2% of US women age 18-44 reported smoking in 2011.
Alcohol use during pregnancy creates a risk of fetal alcohol syndrome (FAS) and related disorders, including mental and growth retardation and problems with vision, hearing, and behavior. Screening for FAS is not widely performed in Ukraine, but it appears to be highly prevalent. The 2007 Ukraine Demographic and Health Survey found that 62% of reproductive age women had at least one drink in the month before the survey, and 9% of women reported drinking once or twice a week.
To assist Ukrainian partners in reducing alcohol and tobacco use during pregnancy, the USAID ASSIST Project supports the implementation of evidence-based “Brief Physician Interventions” (BPIs.) These interventions are highly standardized, short counseling protocols that take place during an outpatient visit, usually accompanied by patient educational materials. They have been shown to be effective in US studies in promoting cessation of alcohol and tobacco use during pregnancy.
The approach is based on the “5 A’s”:
- Ask about substance use;
- Advise the patient to quit;
- Assess willingness to quit;
- Assist in quitting; and
- Arrange follow-up.
- Train trainers on evidence-based BPIs for tobacco and alcohol cessation and family planning counseling.
- Support training of health care providers on BPIs for tobacco and alcohol cessation and family planning counseling.
- Develop a clinical-organizational protocol (guideline) for BPI implementation nationwide.
- Develop a training curriculum for BPI and the facilitation of incorporating it into post-graduate medical education in one or two medical education institutions in Ukraine.