Tablet-based intervention to prevent substance-exposed pregnancy in primary care

说明(申请人提供)：酒精、烟草和大麻是育龄妇女最常用的物质，怀孕期间使用这些物质会导致妇女和婴儿严重患病。酒精和烟草对胎儿的有害后果是众所周知的，最新的研究证明了产前使用大麻的有害影响(例如，增加婴儿死亡率)。这尤其令人担忧，因为大麻的使用量正在上升。由于许多妇女在不知道自己怀孕的情况下使用这些物质，在未孕期进行干预对于预防物质暴露怀孕(SEP)至关重要。SEP主要集中在经济资源较低的妇女身上，缺乏针对育龄妇女解决这些问题的服务。初级保健环境提供了一个机会，让这些难以接触的人群参与进来，并解决相互关联的问题，包括药物滥用、无效避孕和艾滋病毒危险行为。涉及敏感信息(例如，药物使用和性行为)的面对面干预可能会限制披露，并从繁忙的做法中汲取资源。更重要的是，最近的研究表明，披露药物使用，特别是大麻的使用， 通过基于计算机的干预与面对面的干预进行改进。因此，需要创新和成本效益高的方法，这些方法可以很容易地整合到真实的医疗环境中。自我引导的、基于计算机的干预可以改善信息披露，并更有效力和效率。我们之前在预防酒精和烟草暴露的怀孕的简短激励干预方面的工作取得了良好的结果，但后续使用大麻始终与显著较差的干预结果相关。因此，需要解决先入为主的大麻使用问题，以最大限度地降低SEP。这项及时而实用的随机对照研究在初级保健环境中对360名育龄妇女进行研究，将比较由电脑平板电脑提供的Choices4健康干预、由咨询师提供的Choices4健康干预和简短建议的效果；所有这些都旨在降低SEP(饮酒低于风险水平、戒烟、停止大麻和/或有效使用避孕措施)。次要成果包括减少艾滋病毒风险和成本效益。我们认为，这项工作符合在一线医疗环境中提供有效和高效的物质使用筛查和治疗的需要，并将对目前的怀孕前护理标准产生重大影响。

DESCRIPTION (provided by applicant): Alcohol, tobacco, and marijuana are the most commonly used substances among women of childbearing age, and use of these substances during pregnancy results in significant morbidities for both women and infants. The damaging fetal consequences of alcohol and tobacco are well-known, and newer research documents the harmful effects (e.g., increased infant mortality) of prenatal marijuana use. This is particularly alarming as marijuana use is on the rise. As many women use these substances unaware of their pregnancy, intervention during the preconception period is critical for preventing substance-exposed pregnancies (SEP). SEPs are heavily concentrated in women with lower financial resources, and services to address these issues with women of childbearing age are lacking. Primary care settings afford an opportunity to engage this hard-to-reach population and address interrelated problems, including substance abuse, ineffective contraception and HIV-risk behaviors. Face-to-face interventions involving sensitive information (e.g., substance use and sexual behaviors) may limit disclosure and draw resources from busy practices. Even more importantly, recent research indicates that disclosure of substance use, particularly marijuana, is improved with computer-based vs. face-to-face interventions. Thus, innovative and cost-effective methods that can be easily integrated to real-world medical settings are needed. Self-guided, computer-based interventions could improve disclosure and be more effective and efficient. Our previous work on brief motivational interventions to prevent alcohol- and tobacco-exposed pregnancies has yielded favorable results, yet marijuana use at follow-up was consistently associated with significantly poorer intervention outcomes. Therefore, preconception marijuana use needs to be addressed for maximal SEP reduction. This timely and practical randomized controlled study of 360 women of childbearing age within a primary care setting will compare the efficacy of the Choices4Health intervention delivered by a computerized tablet, the Choices4Health intervention delivered by a counselor and Brief Advice; all with the goal of reducing SEP (drinking below risk levels, tobacco cessation, marijuana cessation, and/or effective contraception use). Secondary outcomes include HIV-risk reduction and cost effectiveness. We believe this work is aligned with the need to offer effective and efficient substance use screening and treatment in front- line medical settings and will have significant impact on current standards of preconception care.