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Abstract

Background: Surveys of women in prenatal care at busy clinics in Detroit, Michigan have reported 12.5% continue to drink during pregnancy (Flynn et al, 2003) and women in substance abuse treatment programs in Wayne County, MI have an incidence rate for Fetal Alcohol Syndrome (FAS) of 4 in 1,000 births, double the national prevalence rate of FAS. The goal of the current study was to intervene with women at high risk for an alcohol-exposed pregnancy using techniques of Brief Motivational Interviewing (BMI) in a verbal and written format. Methods: One third (33%) of 1,784 women screened at Detroit Department of Health and Wellness Promotion (DHWP) primary health care clinics and HIV/AIDS-STD clinic were found to be at risk of an alcohol exposed pregnancy defined as binge drinking (at least 4 drinks per occasion) or heavy drinking (8 or more drinks per week) in the last three months, while they were having sex with inconsistent or no contraception. This intervention utilized Brief Motivational Interviewing (BMI) and developed written materials based on the principles of BMI to 1) assess readiness for change, 2) strengthen motivation to change, and 3) provide an individualized change plan. For women who received the Individual Level Intervention (n = 77), four sessions of BMI were conducted (two in-person, two via telephone) over a six-month period. A Self-Guided Change version of the intervention (Community Level Intervention) was offered for women (n = 327) who preferred to utilize the materials at home and receive two follow-up telephone calls following baseline interview, also during a six-month period. Results: Both strategies, based on principles of Motivational Interviewing, have been shown to be effective in reducing drinking and increasing contraceptive use. Out of the 404 women participating in the program, 310 (77%) women completed at least one follow-up and were included in the analyses. Overall, 59.9% of the women enrolled in both interventions were no longer at risk for an alcohol-exposed pregnancy at the end of the intervention six months later. Conclusion: Brief Motivational Interviewing, delivered verbally or in a written format, is an effective method of reducing women’s risky behaviors for an alcohol exposed pregnancy. The Individual Level Intervention that included 2 face-to-face sessions resulted in less attrition than the Self-Guided Change version which relied on phone and mail contact only.

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