CHOICES+: Preconception approach to reducing alcohol & tobacco-exposed pregnancy

描述(申请人提供)：育龄妇女饮酒问题日益受到关注。研究估计，年龄在18-44岁之间的女性中，有50%的人在上个月饮酒，12.5%的人报告说在过去的一个月里酗酒。由于大约50%的怀孕是计划外的，而且许多女性直到怀孕几周甚至几个月后才意识到自己怀孕了，因此胎儿酒精暴露可能发生在怀孕早期，这是对酒精影响增加易感性的关键时期。此外，项目选择，一项关于预防酒精暴露怀孕(AEP)的先入为主的方法的研究发现，超过70%的有AEP风险的女性是吸烟者。鉴于有大量证据证明怀孕期间吸烟的有害影响，减少AEP和促进其他健康产前行为的干预措施也应该以戒烟为目标。 这项名为项目选择+的随机对照研究将确定项目选择干预加上一项基于证据的戒烟计划在降低接触酒精和烟草的怀孕风险方面的有效性。具体地说，我们将检验项目选择+干预与常规治疗(TAU)在以下方面的效果：将酒精使用量减少到既定风险水平以下；增加有效避孕措施的持续使用；增加戒烟治疗的参与度和戒烟率。此外，我们对选择+干预的增量成本(例如，员工时间、材料、行政服务、干预前和干预后的总医疗费用)的检查将为未来的成本/收益分析提供基础，这些分析将向决策者和医疗保健组织告知实施项目选择+的潜在好处。 项目选择+将在哈里斯县医院区(HCHD)的两家医院和11家社区卫生诊所实施，该公共卫生系统为德克萨斯州哈里斯县约386万居民服务，哈里斯县是美国人口第三多的县。卫生署将利用其全面的电子病历系统进行筛查、干预和跟进工作。我们经验丰富的多学科团队由最初项目选择研究的德克萨斯州现场的主要调查人员领导。它还包括HCHD医生和管理人员，他们将确保项目的实施和纳入标准医疗服务。我们在HCHD和其他医疗保健系统中实施项目的丰富历史将使我们能够与家庭医学、妇科、精神病学、护理、行为健康和其他关键单位密切合作，确保研究的成功实施。这项研究的结果将为促进健康的产前行为和减少接触酒精和烟草的怀孕的流行率提供信息并推动未来的努力。

DESCRIPTION (provided by applicant): There is growing concern about alcohol consumption among women of childbearing age. Studies have estimated that 50% of women, ages 18-44, used alcohol and 12.5 % reported binge drinking in the last month. Because approximately 50% of pregnancies are unplanned and many women do not realize they are pregnant until several weeks or even months after conception, fetal alcohol exposure may occur early in pregnancy, a critical time of increased susceptibility to the effects of alcohol. In addition, Project CHOICES, a study of a preconceptional approach to preventing alcohol-exposed pregnancies (AEP), found that over 70% of the women at risk of AEP were smokers. Given that a substantive body of evidence documents the deleterious effects of smoking while pregnant, interventions to reduce AEP and promote other healthy prenatal behaviors should also target smoking cessation. This randomized controlled study, Project CHOICES+, will determine the efficacy of the Project CHOICES intervention plus a referral to an evidence-based smoking cessation program in reducing the risk of alcohol and tobacco exposed pregnancies. Specifically, we will examine the effect of the Project CHOICES+ intervention compared to Treatment as Usual (TAU) in: reducing alcohol use below established risk levels; increasing consistent use of effective contraception; increasing engagement in smoking cessation treatment and increasing smoking cessation. In addition, our examination of the incremental costs of the CHOICES + intervention (e.g., staff time, materials, administrative services, total medical charges pre- and postintervention) will provide a basis for future cost/benefit analyses that will inform policymakers and healthcare organizations of the potential benefits of implementing Project CHOICES+. Project CHOICES+ will be implemented in the two hospitals and 11 community health clinics of Harris County Hospital District (HCHD), the public healthcare system that serves the approximately 3.86 million residents of Harris County, Texas, the third most populous county in the United States. HCHD's comprehensive electronic medical record (EMR) system will be utilized to facilitate screening, intervention and follow up efforts. Our experienced, multidisciplinary team headed is by the primary investigators from the Texas site of the original Project CHOICES study. It also includes HCHD physicians and administrators who will assure project implementation and integration into standard medical care. Our strong history of implementing programs within HCHD and other healthcare systems will enable us to work closely with family medicine, gynecology, psychiatry, nursing, behavioral health, and other key units to assure successful study implementation. Results from this study will inform and advance future efforts in the service of promoting healthy prenatal behavior and reducing the prevalence of alcohol and tobacco-exposed pregnancies.