PREVENTING ALCOHOL USE IN PREGNANT WOMEN UTILIZING WIC

拟议的研究是一项受控的短期干预，旨在减少洛杉矶县WIC（妇女、婴儿和儿童）项目中低收入、不同种族的孕妇的酒精使用。将实现若干目标：增加对孕妇孕期酒精使用情况的检测；评价短期干预对减少孕妇孕期饮酒的影响；确定影响短期干预效果的产妇特征；确定有助于减少产妇饮酒量的短期干预措施的特点；并评估短期干预对婴儿出生结果的影响。12家WIC诊所将被匹配并随机分配到以下两种条件中的一种：(1)仅评估（AO）条件（n=252），在这种条件下，母亲将接受酒精使用的全面评估，然后是目前的WIC标准护理；(2)短期干预（BI）条件（n=252），在此条件下，母亲接受相同的综合评估，并接受旨在减少母亲饮酒的标准化短期干预。在每月与WIC营养师预约期间支持任何酒精使用的妇女将被招募用于研究。营养学家将在母亲产前检查期间进行评估和干预。酒精消费的多种自我报告措施将用于获得酒精使用的准确评估。对于那些在BI条件下的妇女，将采用人工简短干预程序。感兴趣的母亲变量包括：种族和文化适应、年龄、开始饮酒的年龄、饮酒史持续时间、抑郁症和社会饮酒环境。干预的特征将包括：干预的时间和数量，以及营养学家的态度和信念。婴儿结局指标将包括：出生体重和体长、妊娠和新生儿并发症。如果这些假设得到支持，并且改进的评估和简短的干预技术成功地减少了WIC母亲的酒精摄入量，那么干预是一种低成本的FAS预防模式，可以在全国WIC系统中推广。

The proposed study is a controlled brief intervention designed to decrease alcohol use by low-income, ethnically diverse pregnant women enrolled in the Los Angeles County WIC (Women, Infants and Children) program. A number of aims will be addressed: To increase the detection of alcohol use during pregnancy in the WIC population; to evaluate the impact of brief intervention on reduction of maternal drinking during pregnancy; to identify maternal characteristics that influence the effectiveness of brief intervention; to identify characteristics of the brief intervention that contribute to a reduction in maternal alcohol consumption; and to evaluate the impact of brief intervention on infant birth outcomes. Twelve WIC clinics will be matched and randomized to one of two conditions: (1) the Assessment Only (AO) Condition (n=252), in which mothers will receive a comprehensive assessment of alcohol use, followed by the current WIC standard of care; or (2) the Brief Intervention (BI) Condition (n=252), in which mothers receive the same comprehensive assessment plus a standardized brief intervention designed to reduce maternal alcohol consumption. Women who endorse any alcohol use during their monthly appointment with a WIC nutritionist will be recruited for study. Assessment and intervention will be carried out by nutritionists during the mother's prenatal visits. Multiple self-report measures of alcohol consumption will be used to obtain an accurate assessment of alcohol use. For those women in the BI Condition, a manualized brief intervention procedure will be employed. Maternal variables of interest will include: ethnicity and acculturation, age, age of onset of drinking, duration of drinking history, depression, and social drinking milieu. Characteristics of intervention will include: the timing and quantity of interventions, and nutritionist attitudes and beliefs. Infant outcome measures will include: birth weight and length, gestation, and neonatal complications. Provided the hypotheses are upheld, and improved assessment and brief intervention techniques are successful in reducing maternal alcohol consumption among WIC mothers, the intervention represents a low-cost model for FAS prevention that can be disseminated nation-wide in the WIC system.