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JFAS Int 2006;4:e7; May 10, 2006
Midwest Family Physicians' Knowledge and Attitudes About FAS, FASD, and Alcohol Use During Pregnancy

Mark B. Menge,1 Margaret Ulione,1 Keely Cook,2 Danny Wedding,3 Kevin Rudeen,4 Stephen Braddock, 5 Melinda Ohlemiller 6

1Department of Community and Family Medicine-Saint Louis University, USA, 2Physician Assistant Education, Doisy College of Health Sciences-Saint Louis University, USA, 3Missouri Institute of Mental Health -University of Missouri- Columbia, USA, 4School of Health Professions -University of Missouri-Columbia, USA, 5Department of Child Health -University of Missouri-Columbia, USA, 6St. Louis -Arc, USA

Background
Conduct a comprehensive survey of FASD knowledge, skill, and attitudes regarding recognition, diagnosis, treatment, and prevention among family physicians in the Midwest.

Methods
A 35 question survey on FASD recognition, diagnosis, treatment, and prevention was sent to a random sample of 1,000 active members of the AAFP from Missouri and the 5 surrounding states.

Results
Twelve percent of participants returned surveys. The mean age was 44 years, 64% were male, 86.3% were Caucasian, and 43.6% were from rural areas. The survey revealed that the great majority of family physicians possess general knowledge about FAS and the effects of alcohol on children, including the importance of early diagnosis and reducing secondary disabilities. However, the survey revealed significant deficits when it came to recognition and diagnosis of FAS, with the great majority of family physicians uncertain about the facial dysmorphology features associated with FAS. In addition, the majority had not made or referred a child for the diagnosis of FAS during the past year, and if they had made the diagnosis, they had not used an evidence-based protocol to do so. Significant barriers to making the diagnosis of FAS were identified, including inadequate training and the belief that better qualified specialists were available to make the diagnosis. Regarding treatment, a significant majority of family physicians had not received any clinical training in the care of children with FAS, and those who had received training felt it was only of fair quality. Regarding prevention, only 12.8% of family physicians asked when seeing a new pediatric patient if the child was exposed to alcohol in utero. Finally, many family physicians reported that education materials on FASD were not available in their area, and many believed the presence of these educational resources would be extremely helpful if they were available.

Conclusions
While family physicians possess a general knowledge base about FAS, FASD, and alcohol use during pregnancy, significant knowledge deficits exist in the area of prevention, diagnosis, and treatment, and significant barriers make completion of these tasks difficult in practice. Inadequate clinical training in medical school, residency, and continuing education venues may be a prime reason why these deficits occurred.

Key Words: fetal alcohol syndrome, alcohol, pregnancy, teratogen, family practice

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