Background Although screening and brief intervention (SBI) for unhealthy alcohol use has demonstrated efficacy in some trials, its implementation has been limited. Technology-delivered approaches are a promising alternative, particularly during pregnancy when the importance of alcohol use is amplified. The present trial evaluated the feasibility and acceptability of an interactive, empathic, video-enhanced, and computer-delivered SBI (e-SBI) plus three separate tailored mailings, and estimated intervention effects. Methods We recruited 48 pregnant women who screened positive for alcohol risk at an urban prenatal care clinic. Participants were randomly assigned to the e-SBI plus mailings or to a control session on infant nutrition, and were reevaluated during their postpartum hospitalization. The primary outcome was 90-day period-prevalence abstinence as measured by timeline follow-back interview. Results Participants rated the intervention as easy to use and helpful (4.7-5.0 on a 5-point scale). Blinded follow-up evaluation at childbirth revealed medium-size intervention effects on 90-day period prevalence abstinence (OR = 3.4); similarly, intervention effects on a combined healthy pregnancy outcome variable (live birth, normal birthweight, and no NICU stay) were also of moderate magnitude in favor of e-SBI participants (OR=3.3). As expected in this intentionally under-powered pilot trial, these effects were non-significant (p = .19 and .09, respectively). Conclusions This pilot trial demonstrated the acceptability and preliminary efficacy of a computer-delivered screening and brief intervention (e-SBI) plus tailored mailings for alcohol use in pregnancy. These findings mirror the promising results of other trials using a similar approach, and should be confirmed in a fully-powered trial.

Electronic screening and brief intervention (e-SBI) approaches for substance use have shown early promise. This trial was designed to replicate previous findings from a single 20-minute e-SBI for drug use among postpartum women. A total of 143 postpartum, primarily low-income African-American women meeting criteria for drug use, were randomly assigned to either a tailored e-SBI or a time-matched control condition. Blinded follow-up evaluation 3- and 6-months following childbirth revealed strong effects for confirmed illicit drug use abstinence at the 3-month observation (OR = 3.3, p = .01), as did hair analysis at 6 months (OR = 4.8, p = .018). Additional primary outcomes suggested small to moderate effect sizes in favor of the e-SBI, but did not reach significance. This result replicates previous findings but fails to show durable effects. Assessment reactivity, e-SBI design, and possible extension of e-SBI via tailored messaging all merit careful consideration.

Introduction and Aims Most women cut down or quit alcohol use during pregnancy, but return to pre-pregnancy levels of use after giving birth. Universal screening and brief intervention (SBI) for alcohol use has shown promise, but has proven challenging to implement and has rarely been evaluated with postpartum women. This trial evaluated a single 20-minute, electronic SBI (e-SBI) for alcohol use among postpartum women. Design and Methods In this parallel group randomised trial, 123 postpartum, low-income, primarily African-American women meeting criteria for unhealthy alcohol use were randomly assigned to either a tailored e-SBI (n=61) or a time-matched control condition (n=62), with follow-up at 3 and 6 months. Hypotheses predicted that 7-day point-prevalence abstinence and drinking days would favour the e-SBI condition. Results No group differences were significant. Blinded follow-up evaluation revealed 7-day point prevalence of 75% for the e-SBI condition vs. 82% for control at 3 months (odds ratio = 1.6) and 72% vs. 73%, respectively, at 6 months. Drinking days in the past 90 and mean number of drinks per week also showed no significant differences. Discussion and Conclusions This pilot trial failed to support a single-session e-SBI for alcohol use among postpartum women, although findings at the three month time point suggested that greater power might confirm transient effects of the e-SBI. As efficacy is likely to vary with e-SBI content and approach, future research should leverage technology’s reproducibility and modularity to isolate key components.

Objective To examine the relative prevalence of marijuana and tobacco use among low-income post-partum women, using self-report, urine, and hair testing data; and to further explore perceptions of the substances among postpartum women by evaluating perceived risk and monetary cost of prenatal marijuana versus tobacco use. Methods Data from two studies were available for a total of 100 (Study 1) and 50 (Study 2) low-income, primarily African-American post-partum women. Study 1 participants completed brief self-report measures of substance use as well as urine and hair samples; study 2 participants completed a brief opinion survey regarding the risks and monetary costs of prenatal marijuana use. Results In Study 1, the self-reported prevalence of any tobacco or marijuana use in the past three months was 17% and 11%, respectively. However, objectively-defined marijuana use was more prevalent than self-reported tobacco use: 14% tested positive for marijuana by urinalysis, and 28% by hair analysis. Study 2 participants were more likely to believe that there is a safe level of marijuana use during pregnancy, and nearly half believed that using marijuana during pregnancy was less expensive than smoking cigarettes. Conclusion Marijuana use may be as or more prevalent than tobacco use among low-income, African-American pregnant women. These findings may in part be attributable to perceptions of roughly equivalent cost and the lack of a clear public health message regarding prenatal marijuana use, combined with growing pro-marijuana advocacy. A broader public health response to address prenatal marijuana use, along with other substances of abuse, is needed.

Background and aimsThe accuracy of current screening instruments for identification of substance use in pregnancy is unclear, particularly given methodological shortcomings in existing research. This diagnostic accuracy study compared five existing instruments for ability to identify illicit drug, opioid and alcohol use, under privacy expectations consistent with applied practice and using a gold standard incorporating toxicological analysis.DesignProspective cross‐sectional screening accuracy study.SettingThree sites encompassing four prenatal care clinics in the United States.ParticipantsConvenience sample of 1220 racially, ethnically and socio‐economically diverse pregnant women aged 18 years and over.MeasurementsIn Phase I, participants completed the five screening instruments in counterbalanced order. Instruments included the Substance Use Risk Profile—Pregnancy (SURP‐P), CRAFFT (acronym for five‐item screener with items related to car, relax, alone, forget, friends and trouble), 5Ps (parents, peers, partner, pregnancy, past), Wayne Indirect Drug Use Screener (WIDUS) and the National Institute on Drug Abuse (NIDA) Quick Screen. In Phase II, participants provided a urine sample and completed a calendar recall‐based interview regarding substance use. These screeners were tested, using receiver operating characteristic (ROC) analysis and accuracy statistics, against a reference standard consisting of substance use in three classes (illicit drugs, opioids and alcohol), considered positive if use was evident via 30‐day calendar recall or urine analysis.FindingsThree hundred and fifteen of 1220 participants (26.3%) met reference standard criteria for positivity. The single‐item screening questions from the NIDA Quick Screen showed high specificity (0.99) for all substances, but very poor sensitivity (0.10–0.27). The 5Ps showed high sensitivity (0.80–0.88) but low specificity (0.35–0.37). The CRAFFT, SURP‐P and 5Ps had the highest area under the curve (AUC) for alcohol (0.67, 0.66 and 0.62, respectively), and the WIDUS had the highest AUC for illicit drugs and opioids (0.70 and 0.69, respectively). Performance of all instruments varied significantly with race, site and economic status.ConclusionsOf five screening instruments for substance use in pregnancy tested (Substance Use Risk Profile—Pregnancy (SURP‐P), CRAFFT, 5Ps, Wayne Indirect Drug Use Screener (WIDUS) and the National Institute on Drug Abuse (Quick Screen), none showed both high sensitivity and high specificity, and area under the curve was low for nearly all measures.