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Background: Alcohol consumption during pregnancy is the leading cause of preventable birth defects in the USA. Alcohol also contributes to increased sexual risk taking. Women attending STD clinics likely constitute a population at high risk for an alcohol-exposed pregnancy (AEP).
Objectives: To evaluate the feasibility of reducing AEP risk in women attending urban STD clinics, using the CHOICES brief intervention.
Methods: During 13 months (9/2010 – 9/2011), two STD clinics (in Baltimore and Denver) screened visits for eligible women: heterosexually active, aged 18 - 44, not using effective contraception, and drinking alcohol at high-risk levels (>3 standard drinks on one occasion or >7 in one week), during the last three months. At-risk women were offered the CHOICES intervention, consisting of two motivational interviewing-based sessions with a trained interventionist, to explore contraceptive and alcohol use. Free family planning visits were offered to participants. Women were re-interviewed about contraceptive and alcohol use for the preceding 90 days, at three and six months after the first session. Reduced risk for AEP was defined as drinking below high-risk levels, using effective contraception, or both.
Results: 9279 female visits were conducted during this time, with 7316 (79%) receiving screening. 930 (13%) met all eligibility criteria. Of eligible women, 270 (29%) enrolled; 190 of those (70%) stayed or returned for session 1, and of those, 103 (54%) returned for session 2 and 102 (54%) attended a family planning visit. Of women reaching the follow-up windows, rates of reduced AEP risk at 3 and 6 months were 70% (61/87) and 69% (35/51).
Conclusions: Women entering the intervention had reduced risk for AEP.
Implications for Programs, Policy, and Research: STD clinics can effectively screen for women at risk for AEP, which is common in this population. The CHOICES brief intervention can motivate behavior change that lowers the risk for AEP.