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Preventing Alcohol-Exposed Pregnancies

Project CHOICES 
(Changing High-Risk AlcOhol Use and Increasing Contraception Effectiveness Study) Preventing Alcohol-Exposed Pregnancies Among High-Risk Women in Special Community-Based Settings 

In September 1997, CDC awarded cooperative agreements to three university grantees to develop brief interventions aimed at preventing alcohol-exposed pregnancies among women of childbearing age in special settings. The selected settings had access to relatively large numbers of women of childbearing age who drink at high-risk levels and do not use contraception effectively. The grantees, along with the special settings they worked in, were:

Nova Southeastern University in Ft. Lauderdale, Florida

• Adult and Pediatric Primary Care Centers in the North Brossard Hospital District of Ft. Lauderdale 

• Recruitment of a cohort of women concerned about problem drinking through media advertisement in the Ft. Lauderdale area 

University of Texas Health Sciences Center at Houston, School of Public Health in Houston, Texas

• Harris County Jail 

• Houston Recovery Campus 

Virginia Commonwealth University, Medical College of Virginia in Richmond, Virginia 

• Gynecology Outpatient Clinic of the Medical College of Virginia 

• South Richmond Health Center 

Funded grantees worked collaboratively with one another and CDC to develop a uniform study protocol for implementation in the six special settings. The objectives of the study were to:

• Characterize the women in the special high-risk settings.

• Reduce the rate of alcohol consumption among women who are not using contraception effectively and increase contraception effectiveness among women who do not reduce their alcohol consumption.

• Examine the relationship between selected process variables and study outcomes.
   

An epidemiologic survey, administered to approximately 500 women in each of the six settings, was conducted during the first phase of the study. The purpose of the survey is to characterize the overall population in the special settings in terms of prevalence and patterns of alcohol use, prevalence of characteristics associated with heavy alcohol use, reproductive health status (for example, parity, contraceptive practices, current sexual activity, and fertility), alcohol treatment histories, and history of psychiatric illnesses.

A common protocol for a behavioral intervention was developed, implemented, and evaluated in each of the six settings. A feasibility study designed to test the behavioral intervention was conducted from March 2000 until May 2001. Study participants (50 women from each of the six special settings) were provided a brief intervention of four sessions delivered over the course of eight weeks. The intervention consisted of the following:
 

• In-depth assessment of alcohol use and contraceptive use patterns. 

• Counseling about the consequences of alcohol use during pregnancy. 

• Brief advice and counseling for moderate-to-heavy drinkers to reduce intake levels, or referral to community treatment services for alcohol-dependent drinkers.

• Reproductive health education about contraceptive methods, provision of contraceptive services, and client follow-up. 

The final phase of Project CHOICES assessed the efficacy of this behavioral intervention further in a scientifically rigorous manner (through a randomized control group design). This phase began in 2002 and was completed in 2005.

Related Publications:

Floyd RL, Sobell M, Velasquez M, Ingersoll K, et al. Preventing alcohol-exposed pregnancies: a randomized controlled trial. American Journal of Preventive Medicine 2007;32(1):1-10. [Abstract]

Centers for Disease Control and Prevention. Motivational intervention to reduce alcohol-exposed pregnancies - Florida, Texas, and Virginia, 1997-2001. Morbidity and Mortality Weekly Report 2003;52(19):441-444. [Full text]

Project CHOICES Intervention Research Group. Reducing the risk of alcohol-exposed pregnancies: A study of a motivational intervention in community settings. Pediatrics 2003;111(5):1131-1135. [Abstract]

Project CHOICES Research Group. Alcohol-exposed pregnancy: Characteristics associated with risk. American Journal of Preventive Medicine 2002;23(3):166-173. [Abstract]

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