SBIR Phase II New Risk Assessment/Intervention For Pregnant Woman

吸毒在孕妇中很常见，但估计只有32%至42%的产前护理提供者 经常询问病人使用药物的情况。产前检查为提供者提供了一个独特的机会， 对妇女进行预防教育，并查明怀孕期间的吸毒情况。为了促进有效利用 提供者资源，我们开发了一个计算机化的互动调查访谈，怀孕信息 在非西班牙裔白色、西班牙裔和美洲印第安人中进行了广泛测试的PIP计划 人口。早期的研究表明，PIP在多民族/种族孕妇中受到欢迎， 人口。更重要的是，PIP唤起了对毒品使用和其他社会问题的更诚实的反应。 而不是纸笔问卷调查。在第一阶段，我们更新了程序， 目前的诊断标准，增加了定制的动机干预，并纳入音频和视频 元素到节目中。在第二期工程中，我们建议进一步提升软件功能， 扩大临床医生的使用领域，并开发一个商业质量的CD ROM原型的整个 仪器我们将在6个社区妇女诊所对完成的仪器进行beta测试，以确定其 可接受性和易用性，通过匿名临床医生调查和完成率。我们还将 对346名孕妇进行随机对照临床试验，以确定PIP促进 从怀孕初期到第三个三个月的行为变化。本试验评价的主要结局 包括自我报告的营养变化、药物使用、酒精使用、吸烟、艾滋病毒风险行为， 避免伴侣虐待我们还将评估变革准备就绪的阶段， manifest.受试者在孕早期将被随机分配完成PIP或计算机问卷 减去教育和定制的激励反馈。两组还将收到印刷的 教育信息。在他们的第三个三个月，受试者将完成第二个基于计算机的 问卷调查，以确定目前的行为，并将参加一个关于他们的个人采访， 对PIP的反应将使用广义线性混合模型分析配对数据，以估计差异 在群体之间和群体内。这项研究将揭示PIP的潜力，以提高产前 健康的行为，并改善生育结果，同时节省供应商的时间。

Drug use is common among pregnant women, yet only an estimated 32% to 42% of prenatal care providers routinely ask patients about their use of drugs. Prenatal visits afford a unique opportunity for providers to educate women about prevention, and to detect drug use during pregnancy. To facilitate efficient use of provider resources, we developed a computerized interactive survey interview, the Pregnancy Information Program (PIP) that has been extensively tested in non-Hispanic white, Hispanic, and American Indian populations. Earlier studies demonstrated that the PIP was well received in multiple ethnic/racial pregnant populations. More importantly, the PIP evoked more honest responses regarding drug use and other socially stigmatized behaviors than paper-and-pencil questionnaires. In Phase I we updated the program, integrated current diagnostic standards, added a tailored motivational intervention, and incorporated audio and video elements to the program. For this Phase II project, we propose to further enhance the software capabilities, expand the domains of use to clinicians, and develop a commercial quality CD ROM prototype of the entire instrument. We will beta test the completed instrument in 6 community women's clinics, to determine its acceptability and ease of use, through anonymous clinician surveys and rates of completion. We will also conduct a randomized, controlled clinical trial of 346 pregnant women to determine PIP's ability to promote behavior change from the initial to the third trimesters of pregnancy. Primary outcomes evaluated in this trial include self-reported changes in nutrition, drug use, alcohol use, cigarette smoking, HIV risk behavior, and partner abuse avoidance. We will also assess stages of readiness to change, where change is not yet manifest. Subjects in their first trimester will be randomized to complete the PIP or a computer questionnaire minus the educational and customized motivational feedback. Both groups also will receive printed educational information. In their third trimesters, subjects will complete a second computer-based questionnaire to determine current behaviors, and will participate in a personal interview regarding their reaction to PIP. Paired data will be analyzed using generalized linear mixed models to estimate differences between and within groups over time. This study will reveal the potential of the PIP to enhance prenatal healthy behaviors, and improve birth outcomes, while saving providers time.