Tablet-based intervention to prevent substance-exposed pregnancy in primary care

描述（由申请人提供）：酒精、烟草和大麻是育龄妇女最常用的物质，在怀孕期间使用这些物质会导致妇女和婴儿的显著发病率。酒精和烟草对胎儿的危害是众所周知的，较新的研究记录了产前使用大麻的有害影响（例如，婴儿死亡率增加）。这尤其令人担忧，因为大麻的使用量正在上升。由于许多妇女在使用这些物质时并不知道自己怀孕了，因此在孕前阶段进行干预对于预防物质暴露妊娠（SEP）至关重要。sep主要集中在经济资源较低的妇女中，并且缺乏为育龄妇女解决这些问题的服务。初级保健机构提供了一个机会，让这些难以接触到的人口参与进来，并解决相互关联的问题，包括药物滥用、无效避孕和艾滋病毒风险行为。涉及敏感信息（如物质使用和性行为）的面对面干预可能会限制信息披露，并从繁忙的实践中汲取资源。更重要的是，最近的研究表明，披露物质使用，尤其是大麻，是

DESCRIPTION (provided by applicant): Alcohol, tobacco, and marijuana are the most commonly used substances among women of childbearing age, and use of these substances during pregnancy results in significant morbidities for both women and infants. The damaging fetal consequences of alcohol and tobacco are well-known, and newer research documents the harmful effects (e.g., increased infant mortality) of prenatal marijuana use. This is particularly alarming as marijuana use is on the rise. As many women use these substances unaware of their pregnancy, intervention during the preconception period is critical for preventing substance-exposed pregnancies (SEP). SEPs are heavily concentrated in women with lower financial resources, and services to address these issues with women of childbearing age are lacking. Primary care settings afford an opportunity to engage this hard-to-reach population and address interrelated problems, including substance abuse, ineffective contraception and HIV-risk behaviors. Face-to-face interventions involving sensitive information (e.g., substance use and sexual behaviors) may limit disclosure and draw resources from busy practices. Even more importantly, recent research indicates that disclosure of substance use, particularly marijuana, is improved with computer-based vs. face-to-face interventions. Thus, innovative and cost-effective methods that can be easily integrated to real-world medical settings are needed. Self-guided, computer-based interventions could improve disclosure and be more effective and efficient. Our previous work on brief motivational interventions to prevent alcohol- and tobacco-exposed pregnancies has yielded favorable results, yet marijuana use at follow-up was consistently associated with significantly poorer intervention outcomes. Therefore, preconception marijuana use needs to be addressed for maximal SEP reduction. This timely and practical randomized controlled study of 360 women of childbearing age within a primary care setting will compare the efficacy of the Choices4Health intervention delivered by a computerized tablet, the Choices4Health intervention delivered by a counselor and Brief Advice; all with the goal of reducing SEP (drinking below risk levels, tobacco cessation, marijuana cessation, and/or effective contraception use). Secondary outcomes include HIV-risk reduction and cost effectiveness. We believe this work is aligned with the need to offer effective and efficient substance use screening and treatment in front- line medical settings and will have significant impact on current standards of preconception care.