Computer-Delivered Alcohol Screening and Brief Intervention Shows Promise Among Pregnant Women
Tablet computers offer the potential to improve alcohol screening and brief intervention (SBI) implementation in busy clinical settings, such as prenatal clinics. Researchers conducted a small pilot randomized trial to assess computer-delivered alcohol SBI in pregnant women, 28 weeks gestation or less, with a positive alcohol screen.* Eligible women were randomized to: 1) a 20-minute, highly interactive, tailored alcohol intervention via tablet computer, followed by 3 tailored mailings over the remainder of pregnancy; or 2) a 20-minute, moderately interactive, control intervention focused on infant nutrition. The outcomes were feasibility and acceptability of the intervention, 90-day abstinence, and healthy birth (combination of live birth, normal birth weight, no neonatal intensive care needed).
- Of 524 pregnant women screened, 48 were enrolled and randomized (81% African American, 54% aged 18–25 years, 25% with DSM-IV alcohol abuse or dependence).
- Women in the intervention group were satisfied with the helpfulness, ease of use, and respectfulness of the intervention (scores 4.7–5.0 on a 5-point Likert scale).
- Compared with controls, the intervention group reported more abstinence at 90 days (90% versus 74%) and had a higher rate of healthy births (83% versus 61%), but neither difference was statistically significant.
*Positive T-ACE screener (≥ 2 affirmative answers to the following: “Tolerance: How many drinks does it take to make you feel high? Have people annoyed you by criticizing your drinking? Have you ever felt you ought to cut down on your drinking? Eye-opener: Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?”), plus drinking weekly or more often over past 4 weeks of pregnancy, OR ≥ 4 drinks at least monthly during year before pregnancy.
Comments:
This intervention appeared to be very acceptable to pregnant women and has the potential to overcome some of the barriers to alcohol SBI in prenatal settings. However, as the authors discuss, this pilot study was not powered for efficacy. A fuller assessment of the intervention’s impact on prenatal alcohol use and birth outcomes will await a larger, adequately powered trial.
Kevin L. Kraemer, MD, MSc
Reference:
Ondersma SJ, Beatty JR, Svikis DS, et al. Computer-delivered screening and brief intervention for alcohol use in pregnancy: a pilot randomized trial. Alcohol Clin Exp Res. 2015;39(7):1219–1226.