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，在妊娠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损害后果是众所周知的，新的研究记录了有害影响（例如，婴儿死亡率增加）的产前大麻使用。这一点尤其令人担忧，因为大麻的使用正在上升。由于许多妇女使用这些物质时并不知道自己怀孕，因此在孕前期间进行干预对于预防物质暴露妊娠（SEP）至关重要。自雇人士主要集中在经济资源较低的妇女中，缺乏解决育龄妇女这些问题的服务。初级保健环境提供了一个机会，使这一难以接触到的人群参与进来，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。涉及敏感信息的面对面干预（例如，物质使用和性行为）可能会限制披露，并从忙碌的实践中汲取资源。更重要的是，最近的研究表明，披露物质使用，特别是大麻， 通过基于计算机的干预与面对面的干预进行改善。因此，需要创新和具有成本效益的方法，可以很容易地集成到现实世界的医疗环境。自我指导的、基于计算机的干预措施可以改善披露情况，提高效率和效益。我们之前关于预防酒精和烟草暴露妊娠的简短动机干预的工作取得了良好的结果，但在随访时使用大麻始终与显着较差的干预结果相关。因此，为了最大限度地减少SEP，需要解决先入为主的大麻使用问题。这项针对360名育龄妇女的及时、实用的随机对照研究将比较由电脑平板电脑提供的Choices 4 Health干预、由顾问提供的Choices 4 Health干预和Brief Advice的疗效;所有这些干预的目标都是降低SEP（饮酒低于风险水平、戒烟、大麻戒烟和/或有效避孕）。次要结果包括艾滋病毒风险降低和成本效益。我们相信，这项工作符合在一线医疗环境中提供有效和高效的物质使用筛查和治疗的需要，并将对目前的孕前护理标准产生重大影响。

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.