Motivational interviewing + feedback intervention to reduce alcohol-exposed pregnancy risk among college binge drinkers: determinants and patterns of response
Many college women are at risk for pregnancy, and binge drinking college women are often at risk for alcohol-exposed pregnancy. Brief interventions with sustainable outcomes are needed, particularly for college women who are binge drinking, at risk for pregnancy, and at increased risk of alcohol-exposed pregnancy. Two-hundred-twenty-eight women at a Mid-Atlantic urban university at risk for alcohol-exposed pregnancy enrolled in the randomized clinical trial, and 207 completed the 4 month follow-up. The BALANCE intervention used Motivational Interviewing plus feedback to target drinking and contraception behaviors. Main outcome measures included (1) the rate of risk for alcohol-exposed pregnancy, (2) the rate of risk drinking, and (3) the rate of pregnancy risk. At 4-month follow-up, the rate of alcohol-exposed pregnancy risk was significantly lower in the intervention (20.2%) than the control condition (34.9%), (P < .02). Assignment to the intervention condition halved the odds of women remaining at risk for alcohol-exposed pregnancy, while not receiving the intervention doubled the odds of continued alcohol-exposed pregnancy risk (OR = 2.18; 95% CI = 1.16–4.09). A baseline history of blackouts, continued high blood alcohol drinking days at 1 month, and continued risk for pregnancy at 1 month independently contributed to a multivariate model of continued alcohol-exposed pregnancy risk at 4 month follow-up. BALANCE reduced alcohol-exposed pregnancy risk, with similar outcomes to longer interventions. Because early response predicted sustained alcohol-exposed pregnancy risk reduction, those who fail to achieve initial change could be identified for further intervention. The BALANCE intervention could be adopted into existing student health or university alcohol programs. The risks of unintended pregnancy and alcohol-exposed pregnancy among binge drinking women in college merit greater prevention efforts.
KeywordsAlcohol-exposed pregnancy Motivational interviewing Personalized feedback College binge drinking Contraception Unintended pregnancy
We thank Mary D. Nettleman, now at Michigan State University, who initiated the study, Betty Anne Johnson, Virginia Commonwealth University, and the staff of the VCU Student Health services, who facilitated recruitment of college students, Sally Brocksen, now at Appalachian State University, who managed the data for the study, Tawana Olds, Jill Clarida and Kimberly Karanda for recruiting and conducting counseling sessions, and Danielle Hughes and Mary Q. Lewis for assistance with data collection and data management. We thank the UVA Center for Addiction Research and Education Writers’ Task Force for their review of an earlier draft of the manuscript. Funding for this study was provided by cooperative agreement MM-0044-02 between the AAMC, CDC, and VCU. The funders had no role in study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the paper for publication. Investigator effort was also supported by NIMH K01 MH01688 and NIAAA R01 AA14356 and the NIH had no role in study design, data collection, analysis, and interpretation, writing of the report, or decision to submit for publication.
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