A new computer program that provides brief informational counseling to high-risk pregnant women was found to significantly reduce their reported use of alcohol and marijuana use during the prenatal period. The intervention, called Health Checkup for Expectant Moms (HCEM), was tested in a recent randomized clinical trial, led by Golfo Tzilos Wernette, Ph.D., Assistant Professor in the Departments of Family Medicine and Psychiatry, and her colleagues at Brown University.
The intervention provided instructional and motivational videos and interactive written information in a single 60-minute core session. That core session was followed by a 15-minute booster session that was delivered within a month of the core session. Participants in the study included pregnant women who had recently reported engaging in an STI-risk behavior, including sex without the use of a condom, current use of alcohol or illicit drugs, or at-risk for use of substances. Fifty women total were randomized into either the HCEM intervention or the control condition--which was a matched computer session matched for time and information.
Participants who received the HCEM intervention reported a significant reduction in the use of any marijuana or alcohol during the four-month prenatal study period compared to participants in the control group. The drop was dramatic, with a 54% reduction in the HCEM group compared to a 16% reduction in the control group. There was also a 27% reduction in rates of reported condomless sex in the intervention group, compared to 5% in the control. However, this difference was not found to be significant.
Findings from the trial were published recently in the Journal of Women’s Health.
"The findings support the preliminary efficacy of HCEM to reduce the risky behaviors of alcohol/marijuana use during pregnancy. There is evidence that computer-based brief interventions can reduce substance use in adults," notes lead author Tzilos Wernette.
Why the medium matters
Traditional motivational STI preventive interventions are composed of multiple, in-person sessions. This approach places time and transportation demands on patients, many of whom are low-income and face a number of obstacles to treatment. The brief, computer-delivered nature of the HCEM intervention reduces some of those key barriers. The intervention was found to be acceptable by participants; both the content and the software delivery system received very high rates of acceptability, ranging between 6.3 and 6.8 on a 1-7 scale. The intervention was also deemed feasible, with 49 out of 50 participants completing the 4-month follow-up assessment.
"A technology-delivered brief intervention is a low-cost intervention that has a number of strengths for working with women in the perinatal period. It can be tailored to meet the unique needs of pregnant women, and it can be readily integrated into prenatal health care settings," Tzilos Wernette adds.
According to the authors, the private, individualized nature of HCEM sessions may also encourage disclosure of risky behaviors.
"The use of computer assisted self-interview to obtain information about STI risk behaviors, including alcohol/drug use, has been empirically supported in terms of encouraging disclosure."
Hair samples were collected at baseline and follow-up to corroborate self-reported drug use. Of the valid hair samples for marijuana use, 87% conformed to participants' self-reported disclosure of marijuana use. The researchers plan to continue using the hair measure to corroborate self-reported drug use in their next larger study.
A growing problem in need of new solutions
Major health organizations have emphasized the risks and intervention opportunities associated with STI rates among pregnant women. Childbearing women are among the most rapidly expanding groups infected by STIs in the United States, and alcohol/drug use and sexual risk taking contribute significantly to the acquisition of STIs. To address these intersecting health issues, the Centers for Disease Control and Prevention (CDC) and the American Congress of Obstetricians and Gynecologists (ACOG) have identified the prenatal period as an ideal period for focused STI prevention and behavior change.
“STIs are at a record high in the United States, and STI risk is an increasingly critical health problem for pregnant women who can pass these infections on to their babies. Adverse effects of prenatal STIs can include low birth weight, miscarriage and stillbirth,” Tzilos Wernette adds.
Tzilos Wernette and her colleagues believe that the Health Checkup for Expectant Moms (HCEM) intervention will have the potential to foster behavior change during this critical period. The pilot study points to the preliminary efficacy of the intervention. Their next steps will be a larger study to test HCEM with a larger and more diverse sample.
Article citation: Tzilos Wernette G, Plegue M, Kahler CW, Sen A, Zlotnick C. A Pilot Randomized Controlled Trial of a Computer-Delivered Brief Intervention for Substance Use and Risky Sex During Pregnancy. J Women's Health. 2017 Oct 5, ePub ahead of print. doi: 10.1089/jwh.2017.6408
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