By intervening in primary care settings, this project seeks to prevent substance-exposed pregnancies (SEPs) among low-income women of childbearing age.

Significant morbidities for both women and infants result from the use of alcohol, tobacco, and marijuana during pregnancy. As many women of childbearing age use these substances while unaware of their pregnancy, intervention in the preconception period is vital to prevent substance-exposed pregnancies (SEP). SEPs are concentrated among women with lower financial resources, and currently services addressing these issues with women of childbearing age are lacking.

Primary care settings provide the opportunity to engage this hard-to-reach population in order to address interrelated problems including substance use, ineffective contraception, and HIV-risk behaviors with the goal of reducing SEPs. As disclosure of sensitive information like substance use and sexual behaviors may be limited with face-to-face interventions, innovative methods that are easily integrated into real-world medical settings are necessary. Additionally, recent research indicated the improvement in disclosure of substance use, particularly that of marijuana, with computer-based interventions verses face-to-face interventions. With these considerations in mind, the Choices4Health project is a practical and timely randomized controlled study of women of childbearing age within a primary care setting comparing the efficacy of the Choices4Health intervention delivered by a computerized tablet, the Choices4Health intervention delivered by a counselor, and Brief Advice.

This project builds on the previous work of Dr. Mary Velasquez, Dr. Kirk von Sternberg, and Dr. Stokes-Stephens regarding brief motivational interventions in the prevention of alcohol-and-tobacco-exposed pregnancies, and seeks to address preconception marijuana use to maximize SEP reduction. Choices4Health aligns with the need to offer innovative, cost-effective, and efficient substance use screening and treatment in front-line medical settings, and will impact standards of preconception care in a significant way.  This project also advances the improvement of preconception health for women of childbearing age, a nation-wide goal set by Healthy People 2020 in effort to reduce health disparities.