Screening and Telephone-Based Intervention for Unhealthy Alcohol Use in a Diverse Federally Qualified Health Center System in Texas.

Background: Screening and brief intervention (BI) can reduce risky alcohol use but has not been widely implemented in primary care settings. We sought to implement a screening and telephone-based program within a Federally Qualified Health Center (FQHC).

Design: Prior to this program, adult patients were routinely screened using AUDIT-C with no further systematic follow-up.

Multi-Level Approaches to Fetal Alcohol Spectrum Disorders Prevention Education and Training for Health Professionals.

Background: Alcohol-exposed pregnancies, which can lead to fetal alcohol spectrum disorders (FASDs), is one of the most common preventable causes of lifelong intellectual and developmental disabilities in the U.S. Healthcare teams can play a critical role in preventing FASDs; however, they are currently unprepared to do so.

Answering a Call to Action: Reducing Fetal Alcohol Spectrum Disorders Using a Healthcare Champion Model.

Prenatal alcohol exposure and fetal alcohol spectrum disorders (FASDs) remain critical public health issues. Alcohol use in pregnancy is a leading preventable cause of birth defects, developmental disabilities, and learning disabilities. Alcohol screening and brief intervention (SBI) is effective at reducing excessive alcohol use.

Increased risk for alcohol- and other substance-exposed pregnancies among women who smoke tobacco: A secondary analysis of a primary care-based intervention.

Introduction: Among women at risk for alcohol-exposed pregnancies (AEP), smoking tobacco may be associated with increased severity of alcohol use, and risk for tobacco-exposed and other substance-exposed pregnancies (TEPs/SEPs). Our secondary data analysis of the 'CHOICES Plus' intervention trial explored AEP and SEP risk by smoking status.

Methods: Eligible women (N=261) were recruited from 12 primary care clinics in a public healthcare system, not pregnant, aged 18-44 years, drinking >3 drinks/day or >7 drinks/week, sexually active, and not using effective contraception.

Processes of change in preventing alcohol-exposed pregnancy: Replication of a mediation analysis.

Objective: Further test mechanisms of the CHOICES intervention by replicating analyses of the experiential and behavioral processes of change (POC) for alcohol and for contraception as mediators of the intervention for reducing risk of alcohol-exposed pregnancy (AEP) using data from a more recent trial, CHOICES Plus (CP).

Method: As in the prior study, replication models examined indirect paths from intervention to experiential POC for alcohol at 3 months, to behavioral POC at 9 months, to risky drinking and risk of AEP at 9 months and experiential POC for contraception at 3 months, to behavioral POC at 9 months, and to ineffective contraception and risk of AEP at 9 months. To test the temporal relationship, additional models examined the indirect path from behavioral POC for alcohol and POC for contraception at 3 months, to the experiential POC at 9 months, and to risk of AEP at 9 months.

Reasons and obstacles for changing risky drinking behavior among Latinas at risk of an alcohol-exposed pregnancy.

This study examined reasons and obstacles for changing risky alcohol use behavior among Latina adults at risk of an alcohol-exposed pregnancy. Using qualitative methods, data from CHOICES Plus intervention sessions of Latinas ( = 59) were analyzed. Reasons for wanting to change risky alcohol use centered on health, parenting, interpersonal conflict, control, and risk of harm.

Alcohol Screening, Brief Intervention, and Referral to Treatment (SBIRT) for Girls and Women.

Females ages 12 and older are the fastest growing segment of alcohol consumers in the United States, with the past decade showing a 16% increase in alcohol use per 12-month period and a 58% increase in high-risk drinking (i.e., > 3 drinks in a day and/or > 7 drinks in a week) per 12-month period.

The Role of Acculturation and Alcohol Problems on Frequency of Cannabis Use Among Latinas at Risk of an Alcohol-Exposed Pregnancy.

Along with alcohol, cannabis is one of the most commonly used substances among women of childbearing age. Recent studies indicate detrimental effects of prenatal cannabis use. Because many women use these substances before realizing they are pregnant, these serious health consequences for women and their offspring are of great concern.

Profiles of behavior change constructs for reducing alcohol use in women at risk of an alcohol-exposed pregnancy.

Using data from Project CHOICES, a randomized controlled trial to test an intervention to prevent alcohol-exposed pregnancies, this study examined process of change profiles composed of Transtheoretical Model of Change (TTM) constructs for alcohol. The primary purpose was to identify a profile of TTM variables associated with reduced drinking. Participants (n = 570) were women at risk of an alcohol-exposed pregnancy recruited from high risk settings.

Changing multiple health risk behaviors in CHOICES.

Multiple health behavior change (MHBC) intervention trials to date have only considered behaviors that were targeted. Research has yet to consider how untargeted behaviors can affect change in behaviors directly targeted by an intervention or how changes in targeted behaviors might lead to changes in other, untargeted behaviors. This study addresses these gaps with a secondary analysis of change in risk drinking (targeted behavior) and smoking (behavior that was not addressed) in the efficacy trial of CHOICES, an intervention for the prevention of alcohol-exposed pregnancies.

Associated factors of readiness to change in young adult risky drinkers.

Background: Readiness to change alcohol use has been associated with a number of predictors including emotional distress, drinking severity, and consequence severity, as well as with static demographic factors such as gender and race/ethnicity.

Objective: To examine the relationships among these variables and readiness to change alcohol use in young adults.

Methods: Structural equation modeling was used to test pathways of readiness to change in 1,256 young adult patients (78% male/22% female) ages 18-29 who were provided screening, brief intervention and referral to treatment (SBIRT) as part of a Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Capacity Expansion Project.

Preventing Alcohol and Tobacco Exposed Pregnancies: CHOICES Plus in Primary Care.

Introduction: Alcohol and tobacco use are common among U.S. women, yet if used during pregnancy these substances present significant preventable risks to prenatal and perinatal health.

A Comparison of Profiles of Transtheoretical Model Constructs of Change among Depressed and Nondepressed Women at Risk for an Alcohol-Exposed Pregnancy.

Introduction: The efficacy of a series of interventions to reduce risk of alcohol-exposed pregnancies is well-established, yet some subsets of women remain at risk. For instance, in CHOICES, a randomized clinical trial of an intervention to prevent alcohol-exposed pregnancy, nondepressed women reduced risk drinking at roughly twice the rate of women with depression (49% vs. 24%).

Motivation for Treatment and Motivation for Change in Substance-Dependent Patients with Co-Occurring Psychiatric Disorders.

The aims of this study were to examine the relationship between motivation for treatment and for change, and to explore their role in the prediction of treatment completion. The sample was composed of 560 predominantly polydrug-using inpatients with co-occurring psychiatric disorders. Motivation for treatment was assessed with the Motivation for Treatment Scales, and motivation for change was measured with the Readiness to Change Questionnaire.

Pharmacists Who Screen and Discuss Opioid Misuse With Patients: Future Directions for Research and Practice.

Background: Prescription opioid (PO) abuse has reached epidemic proportions in the United States, and pharmacies are locations from which these medications are often diverted. This study identifies factors associated with pharmacists who currently screen and discuss PO misuse with patients.

Methods: A secondary data analysis of a cross-sectional Web-based survey that was sent to pharmacists was conducted.

A multisite randomized controlled trial of brief intervention to reduce drinking in the trauma care setting: how brief is brief?

Objective: Determine the efficacy of 3 brief intervention strategies that address heavy drinking among injured patients.

Background: The content or structure of brief interventions most effective at reducing alcohol misuse after traumatic injury is not known.

Methods: Injured patients from 3 trauma centers were screened for heavy drinking and randomly assigned to brief advice (n = 200), brief motivational intervention (BMI) (n = 203), or BMI plus a telephone booster using personalized feedback or BMI + B (n = 193).

Construct validity of the short inventory of problems among Spanish speaking Hispanics.

Objective: Research on ethnic health disparities requires the use of psychometrically sound instruments that are appropriate when applied to ethnically diverse populations. The Short Inventory of Problems (SIP) assesses alcohol-related consequences and is often used as a measure to evaluate intervention effectiveness in alcohol research; however, whether the psychometric properties of this instrument are comparable across language and ethnicity remains unclear.

Method: Multi-group confirmatory factor analysis (MGCFA) was used to test for the invariance of the measurement structure of the SIP across White Non-Hispanic English speaking (N=642), Hispanic English speaking (N=275), and Hispanic Spanish speaking (N=220) groups.

Brief intervention and social work: a primer for practice and policy.

Most individuals in need of help for alcohol use disorders do not receive care. Screening and brief intervention (SBI) is an evidence-based practice for reducing at-risk drinking and alcohol-related risk behaviors. Health care reform sets the stage for a large expansion of SBI to individuals in the United States.

Treatment utilization and unmet treatment need among Hispanics following brief intervention.

Background: In a large randomized trial examining ethnic differences in response to a brief alcohol intervention following an alcohol-related injury, we showed that Hispanics, but not non-Hispanics, were more likely to reduce alcohol intake in comparison with treatment as usual (Addiction 105:62, 2010). The current study evaluates whether the observed improvements in drinking outcomes previously reported among Hispanics following brief intervention might be related to prior or subsequent treatment utilization.

Methods: This study is a secondary analysis of data collected in a randomized clinical trial that evaluated ethnic differences in the effect of a brief motivational intervention (BMI) on alcohol use among medical inpatients admitted for alcohol-related injury.

Ethnic differences in the effect of drug use and drug dependence on brief motivational interventions targeting alcohol use.

Background: We examined the effects of baseline drug use and dependence on alcohol use outcomes following brief motivational intervention for at-risk drinking (BMI-ETOH).

Methods: HLM models were developed to test the interaction of drug use and dependence with BMI-ETOH for alcohol use among Hispanic (n=539), Caucasian (n=667), and black (n=287) patients admitted to a Level-1 trauma center who screened positive for alcohol misuse.

Results: Analyses of an interaction of drug dependence and BMI-ETOH at baseline showed significant positive effects among Hispanics but not Caucasians or Blacks at six- and 12-months for percent days abstinent (6-month: B=0.

Trauma healthcare providers' knowledge of alcohol abuse.

Background: Brief alcohol interventions for patients in trauma settings have demonstrated significant reductions in drinking behaviors, injury related risk behaviors, and subsequent arrests for driving while intoxicated. However, although a number of surveys have examined the knowledge and attitudes of trauma center personnel regarding alcohol problems, the knowledge and attitudes toward alcohol misuse, screening, and intervention services among various trauma care personnel within an individual trauma center have not been investigated. The purpose of this study was to examine provider knowledge and attitudes related to screening and brief intervention for alcohol problems in a single Level-I trauma center.

Characteristics and factors associated with the risk of a nicotine exposed pregnancy: expanding the CHOICES preconception counseling model to tobacco.

The preconception counseling model tested in the CDC funded Project CHOICES efficacy trial to reduce the risk of an alcohol-exposed pregnancy (AEP) could be extended to smokers to prevent a nicotine-exposed pregnancy (NEP), when pharmacotherapy can be provided safely and disclosure of these risk behaviors is more likely. The CHOICES model, which incorporates motivational interviewing, encourages reduction of AEP risk by decreasing risky drinking or using effective contraception; in the efficacy trial, most women chose both options. We conducted a secondary analysis of the CHOICES epidemiologic survey data (N = 2,672) (Project CHOICES Research Group in Am J Prev Med 23(3), 166-173, 2002) to identify the prevalence of risk of NEP and the factors associated with this risk using logistic regression modeling procedures.

The mixed evidence for brief intervention in emergency departments, trauma care centers, and inpatient hospital settings: what should we do?

Background: This qualitative review is based on a symposia presented at the 2009 annual conference of the Research Society on Alcoholism (Baird et al., 2009; Field et al., 2009; Monti et al.

The effectiveness of brief intervention among injured patients with alcohol dependence: who benefits from brief interventions?

Background: Research investigating the differential effectiveness of Brief Motivational Interventions (BMIs) among alcohol-dependent and non-dependent patients in the medical setting is limited. Clinical guidelines suggest that BMI is most appropriate for patients with less severe alcohol problems. As a result, most studies evaluating the effectiveness of BMI have excluded patients with an indication of alcohol dependence.

The role of ethnic matching between patient and provider on the effectiveness of brief alcohol interventions with Hispanics.

Background: Evaluating the effectiveness of treatments such as brief alcohol interventions among Hispanics is essential to effectively addressing their treatment needs. Clinicians of the same ethnicity as the client may be more likely to understand the culture-specific values, norms, and attitudes and, therefore, the intervention may be more effective. Thus, in cases in which Hispanic patients were provided intervention by a Hispanic clinician improved drinking outcomes were expected.