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预防酒精暴露妊娠:针对大学生和非大学生的自我管理版“选择计划”的随机对照试验。

Preventing Alcohol-Exposed Pregnancies: A Randomized Controlled Trial of a Self-Administered Version of Project CHOICES with College Students and Nonstudents.

作者信息

Sobell Linda Carter, Sobell Mark B, Johnson Kenneth, Heinecke Nicholas, Agrawal Sangeeta, Bolton Burt

机构信息

College of Psychology, Nova Southeastern University, Fort Lauderdale, Florida.

College of Osteopathic Medicine, Health Professions Division, Nova Southeastern University, Fort Lauderdale, Florida.

出版信息

Alcohol Clin Exp Res. 2017 Jun;41(6):1182-1190. doi: 10.1111/acer.13385. Epub 2017 May 2.

Abstract

BACKGROUND

Alcohol-exposed pregnancies (AEPs) are a preventable cause of birth defects and developmental disabilities for which many women are at risk. The initial 5-session Project CHOICES intervention was found to prevent AEPs. In the ensuing decade, there have been several additional CHOICES-like studies. This study, Project Healthy CHOICES, had 2 objectives: (i) to compare outcomes for students versus nonstudents; and (ii) to test a self-administered mail-based version of the Project CHOICES intervention.

METHODS

A randomized controlled trial (RCT) compared 2 interventions for women of childbearing age (18 to 44) who were at risk of an AEP: (i) motivational feedback based on Project CHOICES and (ii) information only. Advertisements recruited 354 women (145 college students; 209 nonstudents) at risk of an AEP. Intervention and study materials were available in English and Spanish. Of the 354 women, 44% were minorities (25% identified as Hispanics).

RESULTS

At the 6-month follow-up, the interventions did not differ and there was no Intervention by Student Study interaction. However, over the entire 6-month follow-up, significantly more students (68%) than nonstudents (46%) were not at risk of an AEP (2.1 odds ratio; confidence interval = 1.47 to 2.95). For all groups, risk reduction occurred primarily through effective contraception.

CONCLUSIONS

There was no significant difference between the 2 interventions. However, over the entire 6-month follow-up interval, college students were significantly more likely than nonstudents to not be at risk of an AEP and to use effective contraception. While the student groups had significantly higher reduced risk of AEP outcomes, there was also substantial risk reduction for women in the information only condition. These results suggest that the most effective AEP prevention efforts would be to inform women at risk that they could become pregnant. Because about half of all pregnancies are unplanned, identifying women at risk and preventing the risk of AEPs should be a public health priority.

摘要

背景

酒精暴露妊娠(AEP)是出生缺陷和发育障碍的一个可预防原因,许多女性面临这种风险。最初的五节“选择计划”干预措施被发现可预防AEP。在随后的十年里,又有几项类似“选择计划”的研究。这项名为“健康选择计划”的研究有两个目标:(i)比较学生与非学生的干预结果;(ii)测试“选择计划”干预措施的自我管理邮件版本。

方法

一项随机对照试验(RCT)比较了针对有AEP风险的育龄女性(18至44岁)的两种干预措施:(i)基于“选择计划”的动机性反馈;(ii)仅提供信息。通过广告招募了354名有AEP风险的女性(145名大学生;209名非学生)。干预和研究材料有英文和西班牙文版本。在这354名女性中,44%是少数族裔(25%为西班牙裔)。

结果

在6个月的随访中,两种干预措施没有差异,且不存在学生研究与干预的交互作用。然而,在整个6个月的随访期间,没有AEP风险的学生(68%)显著多于非学生(46%)(优势比=2.1;置信区间=1.47至2.95)。对于所有组,风险降低主要通过有效的避孕措施实现。

结论

两种干预措施之间没有显著差异。然而,在整个6个月的随访期间,大学生比非学生更有可能没有AEP风险并使用有效的避孕措施。虽然学生组AEP结果的风险显著降低,但仅提供信息组的女性风险也有大幅降低。这些结果表明,最有效的AEP预防措施是告知有风险的女性她们可能怀孕。由于大约一半的怀孕是意外怀孕,识别有风险的女性并预防AEP风险应是公共卫生的优先事项。

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