Alyson Leah Lavigne

Brief Intervention for Prenatal Alcohol Use: A Randomized Trial

OBJECTIVE: To test the effectiveness of a brief intervention in the reduction of prenatal alcohol consumption by women when a partner is included. METHODS: Randomized trial of a single session brief intervention given by the study nurse or principal investigator for 304 pregnant women and their partners. The women had positive T-ACE (Tolerance, Annoyed, Cut down, Eye-opener, an alcohol screening test) results and were at risk for alcohol consumption while pregnant. All completed initial diagnostic and postpartum interviews. RESULTS: Fewer than 20% of participants (median 11.5 weeks of gestation) were abstinent at study enrollment, averaging more than 1.5 drinks per episode. Nearly 30% had 2 or more drinks at a time while pregnant. Prenatal alcohol use declined in both the treatment and control groups after study enrollment, based on a 95% follow-up rate. Factors associated with increased prenatal alcohol use after randomization included more years of education, extent of previous alcohol consumption, and temptation to drink in social situations. Brief interventions for prenatal alcohol reduced subsequent consumption most significantly for the women with the highest consumption initially (regression coefficient, b = −0.163, standard error (b) = 0.063, P < .01). Moreover, the effects of the brief intervention were significantly enhanced when a partner participated (b = −0.932, standard error (b) = 0.468), P < .05). CONCLUSION: Pregnant women with the highest levels of alcohol use reduced their drinking most after a brief intervention that included their partners. Recommendations include consistent screening for prenatal alcohol use followed by diagnostic assessment when indicated, and if confirmed by other studies, a patient-partner brief intervention for the heaviest drinkers. LEVEL OF EVIDENCE: I

Rating Teachers Cheaper, Faster, and Better Not So Fast

Gargani and Strong claim to have developed and validated an observation system that requires only 4 hr of training, but one that can identify effective teachers using just 20 min of one video-taped lesson. They further contend that their six-item inventory requires little judgment from those who use it. They describe their instrument, the Rapid Assessment of Teacher Effectiveness (RATE), as better, faster, and cheaper than other available instruments. Although we find some aspects of their work (e.g., their work describing instrument development) as well done, we find, more generally, that their claims are premature and inflated. Their work suffers from several problems including inattention to relevant historical work, no demonstrated ecological validity, no working theory, and lacks a clear conception of what RATE is. At this stage of development, we rate RATE as having limited, if any, capacity for improving teaching.