Golfo K. Tzilos, Ph.D. - US grants

[unreadable] DESCRIPTION (provided by applicant): The risks and costs associated with alcohol use disorders are well documented. These costs are only multiplied when problem drinking takes place during pregnancy; maternal alcohol abuse places children at significant risk, both prenatally, and postnatally. However, the perinatal period also represents a unique opportunity in terms of capitalizing on natural readiness to change. Further, brief motivational interventions have shown tremendous promise in terms of potential contact with large proportions of persons with substance use disorders via the primary care system. Despite the significant promise of brief interventions, several obstacles exist. First, there is limited information available regarding factors that moderate or mediate brief motivational interventions. Second, there is significant difficulty disseminating such interventions cost-effectively into the community; numerous obstacles, including time and resources, have limited the extent to which these interventions have been implemented. The proposed study will address these needs by utilizing a computer-based brief intervention that could greatly facilitate replication in the community. In conducting this study, the applicant will take advantage of the unique training opportunities available at the Substance Abuse Research Division of the Department of Psychiatry and Behavioral Neurosciences of Wayne State University, including the mentorship of Steven Ondersma, Ph.D, an expert on computer-based brief motivational interventions in the perinatal period, as well as an advisory committee including Drs. Robert Sokol and Sandra Jacobson, experts in the area of alcohol and fetal-alcohol spectrum disorders research. The specific aims of this project are to: (1) Recruit a sample of 100 ethnically diverse pregnant women endorsing problem alcohol use (scoring positive on the T-ACE alcohol screen), and randomly assign participants to intervention (computer-based brief intervention) or control (assessment only) conditions; (2) measure change in alcohol consumption (frequency, quantity, and binge use) 30 days following the single-session intervention; (3) evaluate the extent to which executive functioning moderates the association between intervention and outcomes. [unreadable] [unreadable] The existence of a brief computer-based intervention within the prenatal community would enable professionals in primary care or other settings to have a meaningful impact on substance use within their setting. Further, there is promising evidence that the application of brief interventions to women in the prenatal period offers substantial benefits to both the woman and her unborn child. [unreadable] [unreadable] [unreadable]

DESCRIPTION (provided by applicant): HIV/STI and alcohol/drug use during pregnancy are both associated with numerous negative consequences for the woman and the developing fetus. While pregnancy has been recognized as a window of opportunity in which to intervene, very few interventions exist that target both of these risks, and virtually none target both risks during pregnancy. The proposed research project will develop and assess an innovative, computer- delivered screening, brief intervention and referral to treatment (SBIRT) approach, the Health Check-up for Expectant Moms, which will address barriers in early identification and intervention with women at risk for HIV/STI primarily, integrating substance use given the well-supported relationship between these risks during pregnancy. This research addresses three priorities in line with NICHD's mission and Scientific Vision: (1) promoting research to develop interventions that influence a range of behaviors and health outcomes, (2) developing and enhancing personalized treatment that targets pregnant women, and (3) decreasing the potential for poor birth outcomes among women at greatest risk. The R21 will accomplish these objectives by developing and pilot testing a tailored, motivationally enhanced HIV/STI and alcohol/drug use risk reduction intervention that incorporates motivational interviewing and is consistent with the Information-Motivation- Behavior (IMB) model of HIV risk behavior, which posits that HIV/STI risk behavior is determined by an individual's information about HIV/STI transmission and prevention, motivation to reduce risk for HIV/STI infection, and mastery of behavioral skills necessary to reduce risk. The Health Check-up for Expectant Moms is a computer-delivered, brief intervention (one session plus a booster session) that is theory-driven and derived from empirical support. The R21 proposes two distinct phases to assess the Health Check-up for Expectant Moms in low-income pregnant women who are at risk for HIV/STI and alcohol/drug use. During the Development Phase, the research team will develop the software for the computer-delivered intervention and conduct informant interviews and an open trial with 10 participants. During the Pilot Study Phase, we will conduct a two-group, randomized controlled study with a sample of 50 pregnant women endorsing HIV/STI and alcohol/drug use risk. In the Revision Phase, we will conduct exit interviews, and revise the intervention, recruitment and research procedures in anticipation of preparing an R01 application to test the efficacy of the intervention in a larger clinical trial. Results of this program of research are expected to inform the development of integrated HIV/STI and alcohol/drug use interventions that are cost-effective, high-reaching and widely disseminable within prenatal care.