Computer-based brief intervention for perinatal drug, alcohol, and tobacco abuse

描述（由申请人提供）：药物滥用的健康、社会和经济成本是众所周知的；只有当围产期药物使用和相关风险（如艾滋病毒）也使婴儿在产前和产后处于危险中时，这些费用才会成倍增加。目前有一系列相关的治疗方案，但这些方案既不能覆盖所有需要治疗的妇女，也不能让许多已经确定并打算治疗的妇女参与进来。在初级保健中，即使是简短的动机干预——尽管前景巨大——也受到初级保健提供者所需要的时间、培训、专业知识和兴趣的限制。相比之下，基于计算机的简短干预可以使很大比例的妇女在围产期使用药物。计算机也可以以非常低的成本做到这一点，并且在社区中可以完美地复制。在I期R21下开发的基于计算机的简短动机干预显示出早期的希望：在3个月的初步临床试验随访中，产后妇女随机分配到20分钟的基于计算机的简短干预，使用可卡因，其他兴奋剂或阿片类药物的可能性降低了3倍。在第二阶段的应用中，本研究将从两个方面展开。首先，干预措施将根据初步临床试验的数据进行修改，并在更大的产后用药妇女样本中进行测试。第二，干预措施将扩大到解决酗酒和产前吸烟问题。具体而言，本研究将：(a)根据最初临床试验的数据修改和升级软件；(b)从城市产科医院招募500名产后妇女（200名非法药物使用筛查呈阳性，150名酗酒问题筛查呈阳性，150名吸烟筛查呈阳性）；(c)随机将女性分为干预组和对照组，在3个月和6个月时进行盲法随访评估。除了测试干预对药物使用结果（通过自我报告和毒理学分析测量）和相关结果（如艾滋病毒风险）的影响外，数据分析还将检查理论驱动的中介和调节因子，这些中介和调节因子是任何观察到的短暂干预和结果之间的关联。这项研究可以通过对所有形式的围产期药物滥用提供有效、实用、低成本和高可及性的干预措施来加强公众健康。

DESCRIPTION (provided by applicant): The health-related, social, and financial costs of drug abuse are well-known; these costs are only multiplied when perinatal drug use and associated risks (such as HIV) also place an infant at risk, both prenatally and postnatally. A range of relevant treatment programs exist, but such programs are not able to either reach all women who are in need of treatment, or to engage many of those they do identify and intend to treat. Even brief motivational interventions in primary care - despite tremendous promise - are limited by the amount of time, training, expertise, and interest they require from primary care providers. In contrast, computer-based brief interventions could allow access to high proportions of women using drugs during the perinatal period. Computers could also do so at very low cost, and with perfect replication in the community. A computer-based brief motivational intervention developed under a Stage I R21 has shown early promise: at 3-month follow-up in a preliminary clinical trial, postpartum women randomly assigned to a 20-minute computer-based brief intervention were 3 times less likely to be using either cocaine, other stimulants, or opiates. In this Stage II application, this research will be expanded in two ways. First, the intervention will be modified based on data from the preliminary clinical trial, and tested in a larger sample of drug-using postpartum women. Second, the intervention will be extended to also address problem alcohol use and prenatal smoking. Specifically, this research will: (a) revise and upgrade software based on data from the initial clinical trial; (b) recruit 500 post-partum women (200 screening positive for illicit drug use, 150 screening positive for problem alcohol abuse, and 150 screening positive for smoking) from an urban obstetric hospital; and (c) randomly assign women into intervention and control conditions, with blinded follow-up assessments at 3- and 6-months. In addition to testing the effect of the intervention on substance use outcomes (as measured by self-report and toxicological analysis) and related outcomes (such as HIV risk), data analyses will also examine theory-driven mediators and moderators of any observed association between the brief intervention and outcomes. This research could enhance public health by making available an effective, practical, low-cost, and high-reach intervention for all forms of perinatal substance abuse.