SBIR Phase II New Risk Assessment/Intervention For Pregnant Woman

药物使用在孕妇中很常见，但估计只有32%至42%的产前护理提供者经常询问患者使用药物的情况。产前检查为服务提供者提供了一个独特的机会，使其能够教育妇女了解预防，并发现怀孕期间的吸毒情况。为了方便有效地利用供应商的资源，我们开发了一个计算机化的互动调查访谈，怀孕信息程序（PIP），已在非西班牙裔白色，西班牙裔和美洲印第安人的人口进行了广泛的测试。早期的研究表明，PIP在多个种族/种族的怀孕人群中受到欢迎。更重要的是，PIP比纸笔问卷更诚实地回答了吸毒和其他社会污名化行为。在第一阶段，我们更新了程序，整合了当前的诊断标准，增加了定制的动机干预，并将音频和视频元素纳入程序。对于这个第二阶段的项目，我们建议进一步提高软件的能力，扩大使用领域的临床医生，并开发一个商业质量的CD ROM原型的整个仪器。我们将在6个社区妇女诊所测试完成的工具，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名孕妇进行一项随机对照临床试验，以确定PIP促进从怀孕初期到第三个三个月的行为改变的能力。本试验评估的主要结局包括自我报告的营养、药物使用、酒精使用、吸烟、HIV风险行为和伴侣虐待避免的变化。我们还将评估变革的准备阶段，在那里变革尚未显现。受试者在妊娠早期将随机完成PIP或计算机问卷，减去教育和定制的动机反馈。这两个小组还将收到印刷的教育信息。在妊娠晚期，受试者将完成第二次基于计算机的问卷调查，以确定当前的行为，并将参加关于他们对PIP反应的个人访谈。将使用广义线性混合模型分析配对数据，以估计组间和组内随时间的差异。这项研究将揭示PIP的潜力，以提高产前健康行为，并改善出生结果，同时节省供应商的时间。

DESCRIPTION (provided by applicant): Drug use is common among pregnant women, yet only an estimated 32 percent to 42 percent 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.