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PEDIATRICS Vol. 111 No. 5 May 2003, pp. 1131-1135

Reducing the Risk of Alcohol-Exposed Pregnancies: A Study of a Motivational Intervention in Community Settings

The Project CHOICES Intervention Research Group*

Objectives. To test the feasibility and impact of a motivational intervention in reducing drinking and/or increasing effective contraception in women who are at risk for an alcohol-exposed pregnancy.

Methods. A multisite single-arm pilot study was conducted in 6 community settings in 3 large cities. A total of 2384 women were screened for eligibility; 230 were eligible on the basis of their alcohol use and lack of contraception. Of the eligible women, 190 consented and were enrolled, and 143 (75.3%) completed the 6-month follow-up. The intervention consisted of 4 manual-guided motivational counseling sessions delivered by mental health clinicians and 1 contraceptive counseling session delivered by a family planning clinician. Outcome measures include intervention completion rates, alcohol use (frequency, quantity, and bingeing), contraceptive use and effectiveness, and risk for alcohol-exposed pregnancy.

Results. Among women who completed the 6-month follow-up, 68.5% were no longer at risk of having an alcohol-exposed pregnancy; 12.6% of women who completed the program reduced drinking only; 23.1% used effective contraception only; and 32.9% reported both. Results were consistent across the 6 diverse high-risk settings.

Conclusions. This study provides evidence that providing 4 sessions of motivational interviewing plus a contraception counseling session is feasible and strongly suggests that this intervention can decrease the risk of alcohol-exposed pregnancy in women in high-risk settings. Additional investigation in a randomized controlled trial is warranted.

Key Words: fetal alcohol syndrome • motivational interviewing • alcohol-related disorders • alcohol • pregnancy • mental health • women’s health

Abbreviations: FAS, fetal alcohol syndrome • ARND, alcohol-related neurodevelopmental disorder • MI, motivational interviewing • AEP, alcohol-exposed pregnancy • AUDIT, Alcohol Use Disorders Identification Test • BSCQ, Brief Situational Confidence Questionnaire • BSCQ-T, Brief Situational Confidence Questionnaire-Temptation

Received for publication Oct 2, 2002; Accepted Dec 4, 2002.


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