There is growing concern about alcohol consumption among women of childbearing age. Studies have estimated that 50% of women, ages 18-44, used alcohol and 12.5 % reported binge drinking in the last month. Because approximately 50% of pregnancies are unplanned and many women do not realize they are pregnant until several weeks or even months after conception, fetal alcohol exposure may occur early in pregnancy, a critical time of increased susceptibility to the effects of alcohol. In addition, Project CHOICES, a study of a preconceptional approach to preventing alcohol-exposed pregnancies (AEP), found that over 70% of the women at risk of AEP were smokers. Given that a substantive body of evidence documents the deleterious effects of smoking while pregnant, interventions to reduce AEP and promote other healthy prenatal behaviors should also target smoking cessation.

This randomized controlled study, Project CHOICES+, will determine the efficacy of the Project CHOICES intervention plus a referral to an evidence-based smoking cessation program in reducing the risk of alcohol and tobacco exposed pregnancies. Specifically, we will examine the effect of the Project CHOICES+ intervention compared to Treatment as Usual (TAU) in: reducing alcohol use below established risk levels; increasing consistent use of effective contraception; increasing engagement in smoking cessation treatment and increasing smoking cessation. In addition, our examination of the incremental costs of the CHOICES + intervention (e.g., staff time, materials, administrative services, total medical charges pre- and post-intervention) will provide a basis for future cost/benefit analyses that will inform policymakers and healthcare organizations of the potential benefits of implementing Project CHOICES+. Results from this study will inform and advance future efforts in the service of promoting healthy prenatal behavior and reducing the prevalence of alcohol and tobacco-exposed pregnancies.

Project CHOICES+ will be implemented in the two hospitals and 11 community health clinics of Harris County Hospital District (HCHD), the public healthcare system that serves the approximately 3.86 million residents of Harris County, Texas, the third most populous county in theUnited States.

This study builds upon Dr. Velasquez’s previous CDC-funded project, ” Project CHOICES: A Randomized Clinical Trial for Prevention of Fetal Alcohol Syndrome Among High-Risk Women,” a four-year study completed in 2004. The publication of research findings, “Preventing Alcohol-exposed Pregnancies: A Randomized Controlled Trial,” appeared in the January 2007 issue of the American Journal of Preventive Medicine, for which Dr. Velasquez and her research team received CDC’s prestigious Charles C. Shepard Science Award (June 2008). This award recognizes excellence in scientific achievement by identifying the most outstanding publications of CDC/Agency for Toxic Substances and Disease Registry scientists in peer-reviewed journals during the previous year.