Background: Alcohol consumption during pregnancy is the leading cause of preventable neurocognitive deficits in the USA. Women attending STD clinics constitute a population at high risk for an alcohol-exposed pregnancy (AEP). CDC sponsored a demonstration project to evaluate the feasibility of reducing AEP risk in women attending STD clinics, using the CHOICES short intervention.
Methods: During 31 months (9/2010 – 3/2013), 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, comprising 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: 17316 female visits were conducted during this time, with 12893 (74%) receiving screening. 1731 (10%) met all eligibility criteria. Of eligible women, 480 (28%) enrolled; 383 of those (80%) received at least one intervention session, and 235 (61%) attended a family planning visit. Of women reached for follow-up, rates of reduced AEP risk at 3 and 6 months were 65% (136/208) and 70% (138/197).
Conclusions: Women receiving the intervention had reduced risk for AEP. 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. Both clinics are sustaining CHOICES by training public health department personnel outside of the STD clinics to deliver the intervention.