The association of maternal alcohol use and paraprofessional home visiting with children’s health: A randomized controlled trial.

May combine two claims.

For height, prosocial behavior, MPI, both Bayley scales, Operation Span, and Something's the Same, the no-alcohol model was selected over the alcohol model, with no AIC improvement above +0.5.

“In the case of height, prosocial behavior, MPI, the two Bayley scales, Operation Span, and Something’s the Same, the model that did not account for alcohol outperforms the model that did (none of the AIC improvements exceeded +0.5).”

• AssumptionRests on an assumption: Complete-case analysis does not bias the estimated associations between maternal drinking, intervention, and child outcomes.

May combine two claims.

The intervention showed little impact on height, the Bayley scales, MPI, prosocial behavior, Operation Span, or Something's the Same.

“However, the intervention had little effect on height, the Bayley scales, MPI, prosocial behavior, the Operation Span task, or the Something’s the Same task.”

• AssumptionRests on an assumption: Complete-case analysis does not bias the estimated associations between maternal drinking, intervention, and child outcomes.

Probably not a substantial claim: may not pass S3 (load-bearing).

Children in the sample were overall shorter than average.

“Children were overall shorter than average”

• AssumptionRests on an assumption: Complete-case analysis does not bias the estimated associations between maternal drinking, intervention, and child outcomes.

May combine two claims.

Children's average weight was above normal at 6 months and had normalized by age 3.

“At 6 months, children were heavy on average, but reached normal weight by 3 years.”

• AssumptionRests on an assumption: Complete-case analysis does not bias the estimated associations between maternal drinking, intervention, and child outcomes.

Probably not a substantial claim: may not pass S3 (load-bearing).

The fastest increase in alcohol use occurred in the first six months after birth.

“the most rapid rise in alcohol use occurs in the first 6 months after birth”

May combine two claims.

The intervention reduced but did not eliminate the increase in aggression among children of problem drinkers.

“The intervention reduces, but does not eliminate, this increase in aggression among the children of problem drinkers.”

May combine two claims.

At five years, one in five mothers was drinking again, at a rate similar to before pregnancy.

“by five years, one in five mothers is again drinking, similar to the rate of alcohol use before pregnancy”

Probably not a substantial claim: may not pass S3 (load-bearing).

Early-life exposure to a single risk factor forecasts later maladaptive behaviors that can further harm healthy development.

“Recent research on children’s developmental cascades shows that exposure to one risk factor early in life predicts subsequent maladaptive behaviors, which then can further impair healthy development (Tomlinson et al., 2016; Masten & Cicchetti, 2010).”

• cites Tomlinson et al., 2016Not checked yet

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• cites Masten & Cicchetti, 2010Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Parental problem drinking is common in communities with poverty, food insecurity, and community or intimate partner violence.

“In communities marked by poverty, food insecurity, and community or intimate partner violence (IPV), parental problematic drinking is common (Davis et al., 2017; O’Connor et al., 2011).”

• cites Davis et al., 2017Not checked yet

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• cites O’Connor et al., 2011Not checked yet

  Not checked in the free run.

May combine two claims.

In utero alcohol exposure raises children's later risk of substance misuse, behavioral problems, poorer physical and mental health, and reduced cognitive capacity.

“In later life, children exposed to alcohol in utero experience increased risk for substance misuse, behavioral problems, poor physical and mental health, and diminished cognitive capacity (Johnson & Leff, 1999; Manning, Best, Faulkner, & Titherington, 2009).”

• cites Johnson & Leff, 1999Not checked yet

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• cites Manning et al., 2009Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Roughly a quarter of Cape Town South African women report drinking early in pregnancy before they know they are pregnant, nearly twice the national pregnant-women rate of 13.2%.

“Yet, about 25% of South African women in Cape Town report drinking early on in their pregnancies prior to realizing that they are pregnant (O’Connor et al., 2011); this is almost double the national rate of alcohol use among pregnant women (13.2%; Popova, Lange, Probst, Gmel, & Rehm, 2017).”

• cites O’Connor et al., 2011Not checked yet

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• cites Popova et al., 2017Not checked yet

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Classified as probably not a substantial claim. May combine two claims.

UCLA randomly assigned neighborhoods in six blocks of four, yielding 12 intervention and 12 control neighborhoods.

“Neighborhoods were randomly assigned by the UCLA, organized in 6 blocked sets of 4 neighborhoods apiece, into 12 intervention neighborhoods and 12 control neighborhoods.”

May combine two claims.

The shared cultural/ethnic background of interviewers and the high consent rate suggest that women were open to discussing their pre- and postnatal practices.

“interviewers in this study are of the same cultural/ethnic background as participants and the rate of consent to participate is high (98%), suggesting that women are open to discussing their pre-and postnatal practices.”

Classified as probably not a substantial claim.

Mothers' drinking was measured at each assessment with the AUDIT-C.

“Mothers were asked about their drinking at every assessment using the AUDIT-C (Dawson, Grant, & Stinson, 2005).”

• cites Dawson et al., 2005Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Recruiters each covered one intervention and one control neighborhood so that recruiter skill would be comparable between arms.

“Each recruiter worked in one intervention and one control neighborhood to ensure that recruiter competence was similar across conditions.”

Classified as probably not a substantial claim.

To lower bias risk, data collection, intervention delivery, and analyses were handled by three distinct teams.

“To reduce potential bias, three separate teams led different study components: data collection (Stellenbosch University), intervention implementation (the Philani Program), and analyses (UCLA).”

Classified as probably not a substantial claim.

Community health worker home visits might effectively reduce or stop problem drinking.

“Home visiting by community health workers may be an effective strategy to stop or reduce problematic drinking. By bringing services to women’s residences, home visiting circumvents access barriers to health care (Lewin et al., 2010).”

• cites Lewin et al., 2010Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

At five years, 8.9% of mother-child pairs had experienced a death and were no longer eligible.

“By five years, a death occurred in 8.9% of mother-child pairs and were then ineligible for the study.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

All measures underwent translation and back-translation into Xhosa and were reviewed by township women focus groups.

“Trained and certified interviewers monitored the following measures, which were all translated and back translated into the mothers’ native language, Xhosa. All questions were reviewed in focus groups composed of township women prior to mounting the study.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Mentor Mothers used mobile phones to record each visit's length, content, and location for monitoring.

“MM carried mobile phones to allow monitoring of the duration, content, and place of each visit, pre-programmed by Mobenzi (http://www.mobenzi.com/researcher/).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Alcohol use is very common among adolescents in South Africa.

“is highly prevalent among adolescents”

• cites Parry et al 2004Not checked yet

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• cites Madu & Matla, 2003Not checked yet

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Classified as probably not a substantial claim.

Neighborhoods were paired on housing, utilities, sanitation, size, density, child-care resources, bar count, clinic distance, and residence duration.

“Neighborhoods (N=24) of 450 to 600 households each were identified and matched on housing type, availability of electricity, water, sanitation, size, density, presence of child-care resources, the number of bars (shebeens), distance to health clinics within 5km, and duration of residence.”

Probably not a substantial claim: may not pass S3 (load-bearing).

As many as 42% of women in Cape Town townships engage in problematic drinking according to self-administered questionnaires.

“Past data show that as many as 42% of women in Cape Town townships engage in problematic drinking, according to self-administered (as opposed to interviewer-administered) questionnaires (Wong, Huang, DiGangi, Thompson, & Smith, 2008).”

• cites Wong, Huang, DiGangi, Thompson, & Smith, 2008Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Mothers in the sample may have underreported their drinking to interviewers because of stigma around alcohol.

“it is possible that mothers in our sample underreported their drinking levels to interviewers, due to the stigma around alcohol (Viljoen, Croxford, Gossage, Kodituwakku, & May, 2002).”

• cites Viljoen, Croxford, Gossage, Kodituwakku, & May, 2002Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The Strengths and Difficulties Questionnaire has validation in South Africa.

“Mothers also rated their children on the Prosocial Behavior subscale of the Strengths and Difficulties Questionnaire, a screening questionnaire validated in South Africa (Vostanis, 2006).”

• cites Vostanis, 2006Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The Executive Function Battery has validation in other low- and middle-income countries.

“At 3 and 5 years, the number of correct items on three tasks were reported from the Executive Function Battery, a measure validated in other LMIC (Willoughby, Piper, Kwayumba, & McCune, 2018).”

• cites Willoughby et al., 2018Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Prior Philani Program reports show mother and child benefits: more breastfeeding, improved infant growth, recovery from malnutrition, better adherence to one feeding method, and prevention of vertical HIV transmission.

“Previous reports of the Philani Program’s impact include benefits for both the mothers and children receiving home visits, including increased breastfeeding, better infant growth trajectories and recoveries from malnutrition, as well as increased adherence to a single feeding method and tasks to prevent vertical HIV transmission for mothers living with HIV (le Roux et al., 2010; le Roux et al., 2”

• cites le Roux et al., 2010Not checked yet

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• cites le Roux et al., 2013Not checked yet

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• cites Rotheram et al., 2014Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Across five follow-up points, retention ranged from 83% to 96%, and 70% completed every assessment.

“There were five follow-up time points over five years (2 weeks, and 6, 18, 36, and 60 months), each with 83%−96% follow-up; 70% completed all assessments.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The KABC-II MPI has validation for low- and middle-income country use.

“The Mental Processing Index (MPI) of the KABC-II measured executive function and has been validated for use in LMIC (Bangirana et al., 2009).”

• cites Bangirana et al., 2009Not checked yet

  Not checked in the free run.

May combine two claims.

In high-income settings, parental problem drinking is linked to higher risk of childhood depression, anxiety, behavioral disinhibition, conduct disorders, and worse academic performance.

“In high-income countries, parental problematic drinking is also associated with an increased risk of childhood depression, anxiety, behavioral disinhibition, conduct disorders, and poor academic performance (King et al., 2009; Hill, Tessner, & McDermott, 2011).”

• cites King et al., 2009Not checked yet

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• cites Hill et al., 2011Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The lower inhibitory control scores among children of problem-drinking mothers align with earlier research that found poor cognitive inhibition in children of alcoholic mothers.

“These findings are consistent with prior research suggesting that children of alcoholic mothers perform poorly on tests of cognitive inhibition (Nigg et al., 2004; Noland et al., 2003).”

• cites Nigg et al., 2004Not checked yet

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• cites Noland et al., 2003Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

In South African women, alcohol use is linked to younger maternal age.

“alcohol use among South African women is associated with younger maternal age”

• cites O’Connor et al., 2011Not checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Buffer zones separated all neighborhoods to avoid cross-contamination.

“The neighborhoods were chosen so that all were separated by buffer zones, to prevent cross-contamination.”

May combine two claims.

Breastfeeding while drinking is linked to lower weight, lower verbal IQ, and more developmental anomalies, even after accounting for prenatal alcohol exposure.

“Drinking during breastfeeding is associated with lower weight, lower verbal IQ scores, and more developmental anomalies among children, even when controlling for prenatal alcohol exposure (May et al., 2016).”

• cites May et al., 2016Not checked yet

  Not checked in the free run.

May combine two claims.

Mothers' alcohol use goes down during pregnancy and then goes up after pregnancy.

“maternal alcohol use decreases during pregnancy but then increases after pregnancy”

May combine two claims.

Drinking after birth can still cause serious health risks for mothers and their children.

“postnatal drinking is far more prevalent and can still pose serious health risks for mothers and their children (Laborde & Mair, 2012).”

• cites Laborde & Mair, 2012Not checked yet

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May combine two claims.

Some effects of maternal drinking before and after birth may show up in early childhood but may not be detectable in the first years of life.

“some consequences of pre-and postnatal maternal drinking may manifest in early childhood years, but may not necessarily be detectable during the first years of life.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Studies of mothers' drinking after birth, which often focus on breastfeeding, have mixed findings on children's cognitive function depending on the child's age.

“research on maternal postpartum alcohol use – which commonly focuses on drinking during breastfeeding – shows mixed results regarding the effects on child cognitive function depending on the child’s age.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

One study reported that drinking while breastfeeding predicted lower motor development scores in infants but not lower mental development scores.

“One study found that alcohol use during breastfeeding is predictive of lower scores among infants on motor development tasks, but not mental development tasks (Little, Anderson, Ervin, Worthington-Roberts, & Clarren, 1989).”

• cites Little, Anderson, Ervin, Worthington-Roberts, & Clarren, 1989Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

More recent research found that drinking during breastfeeding is linked to significantly lower verbal IQ scores in first graders, even after accounting for prenatal alcohol exposure.

“More recent findings demonstrate that drinking while breastfeeding is associated with significantly lower verbal IQ scores in first graders, even after controlling for prenatal alcohol exposure (May et al., 2016).”

• cites May et al., 2016Not checked yet

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