Jessica R. Beatty

Computer-delivered screening and brief intervention (e-SBI) for postpartum drug use: A randomized trial☆

Electronic screening and brief intervention (e-SBI) approaches for substance use have shown early promise. This trial was designed to replicate previous findings from a single 20-minute e-SBI for drug use among postpartum women. A total of 143 postpartum, primarily low-income African-American women meeting criteria for drug use, were randomly assigned to either a tailored e-SBI or a time-matched control condition. Blinded follow-up evaluation 3- and 6-months following childbirth revealed strong effects for confirmed illicit drug use abstinence at the 3-month observation (OR=3.3, p=.01), as did hair analysis at 6months (OR=4.8, p=.018). Additional primary outcomes suggested small to moderate effect sizes in favor of the e-SBI, but did not reach significance. This result replicates previous findings but fails to show durable effects. Assessment reactivity, e-SBI design, and possible extension of e-SBI via tailored messaging all merit careful consideration.

Commission Versus Receipt of Violence During Pregnancy: Associations With Substance Abuse Variables

The tendency for women to report both commission and receipt of violence is an understudied phenomenon. In particular, little is known about individual differences as a function of commission vs. receipt of partner violence among pregnant women. Using a sample of 78 cohabiting low-SES pregnant women, the current study examines three violence subtypes based on self-report (primarily commission of violence, primarily receipt of violence, and no report of violence) and investigated differences in a range of other risk factors among these subtypes. In this sample, 47% reported higher levels of intimate partner violence (IPV) perpetration than victimization; 14% reported more IPV victimization than perpetration; and 39% reported no IPV. Results demonstrate clear differences between women reporting IPV and those not reporting IPV and clear differences between IPV subtypes in terms of partner substance use, with women reporting primarily receipt of violence also reporting more drug and alcohol abuse by their partners. Although preliminary, these findings suggest that the commission of violence may be more common during pregnancy than the receipt of violence, but that risks for these two subgroups are similar.

Acceptability of a Computerized Brief Intervention for Alcohol Among Abstinent But At-Risk Pregnant Women

BACKGROUND Limitations in time and training have hindered widespread implementation of alcohol-based interventions in prenatal clinics. Also, despite the possibility of underreporting or relapse, many at-risk women report that they quit drinking after pregnancy confirmation so that interventions focusing on current drinking may seem unnecessary. The Computerized Brief Intervention for Alcohol Use in Pregnancy (C-BIAP) was designed to (a) be implemented via a handheld device in prenatal clinics, and (b) use a modified brief intervention strategy with women who screen at-risk but report no current drinking. METHODS The authors administered the C-BIAP to 18 T-ACE (Tolerance, Annoyance, Cut Down, and Eye Opener)-positive pregnant African American women who provided quantitative and qualitative feedback. RESULTS The C-BIAP received high ratings of acceptability; qualitative feedback was also positive overall and suggested good acceptance of abstinence themes. CONCLUSIONS Technology may be a feasible and acceptable method for brief intervention delivery with pregnant women who do not report current drinking.

A randomized study of the effect of anonymity, quasi-anonymity, and Certificates of Confidentiality on postpartum women's disclosure of sensitive information

BACKGROUND Under-reporting of substance use and other sensitive information is a substantial threat to internal study validity, particularly during the perinatal period. Anonymous approaches are associated with greater disclosure but are incompatible with longitudinal follow-up. Alternative approaches include use of a U.S. Federal Certificate of Confidentiality (CoC) and quasi-anonymous methods, in which there is no link between name and data. However, the relative effect of these procedures on disclosure is unknown. This randomized study was designed to evaluate the effects of consent condition (anonymous, quasi-anonymous, CoC, and traditional confidentiality) on disclosure of sensitive information among postpartum women. METHODS Participants were 200 postpartum, primarily African-American women who were randomly assigned to one of the four consent conditions and completed a brief computer-delivered assessment of alcohol and drug use, sexual risk, intimate partner violence, and emotional distress. RESULTS Participants in the anonymous and quasi-anonymous conditions disclosed significantly more sensitive information than those in the traditional consent condition. In contrast, no advantage in overall disclosure was observed for the CoC condition. This result was largely consistent across specific content areas with the exception of emotional distress, disclosure of which was unrelated to consent condition. CONCLUSIONS Although use of a CoC has limited impact on disclosure, the quasi-anonymous method may increase disclosure to a similar extent as full anonymity. Quasi-anonymous approaches should be considered when under-reporting is likely, a context in which the disadvantages of this approach must be balanced against its advantages.

A Randomized Trial of the Effects of Anonymity and Quasi Anonymity on Disclosure of Child Maltreatment-Related Outcomes Among Postpartum Women

Anonymity may facilitate disclosure of maltreatment-related variables among parents, particularly in the perinatal period. This study was conducted in order to (a) confirm the effect of anonymity on commonly used measures in the field of child maltreatment; (b) examine the extent to which quasi anonymity (in which identifying information is collected but not linked to research data) can also facilitate disclosure on maltreatment-related measures; and (c) examine potential explanatory mechanisms of any association between level of anonymity and disclosure. This study further sought to evaluate these associations in the perinatal period, a crucial point for intervention that is also a time when rates of disclosure may be particularly low. A total of 150 postpartum, primarily African American women were randomly assigned to conditions involving traditional confidentiality, quasi anonymity, or full anonymity. Overall, disclosure on maltreatment-related measures was more than twice as likely for participants in the anonymous condition; quasi anonymity resulted in similar but somewhat smaller increases in disclosure. Anonymous methods may be greatly underutilized in child maltreatment research, and quasianonymous methods show promise as an alternative for longitudinal designs.

Technology to Augment Early Home Visitation for Child Maltreatment Prevention: A Pragmatic Randomized Trial:

Early home visitation (EHV) for child maltreatment prevention is widely adopted but has received inconsistent empirical support. Supplementation with interactive software may facilitate attention to major risk factors and use of evidence-based approaches. We developed eight 20-min computer-delivered modules for use by mothers during the course of EHV. These modules were tested in a randomized trial in which 413 mothers were assigned to software-supplemented e-Parenting Program (ePP), services as usual (SAU), or community referral conditions, with evaluation at 6 and 12 months. Outcomes included satisfaction, working alliance, EHV retention, child maltreatment, and child maltreatment risk factors. The software was well-received overall. At the 6-month follow-up, working alliance ratings were higher in the ePP condition relative to the SAU condition (Cohen’s d = .36, p < .01), with no differences at 12 months. There were no between-group differences in maltreatment or major risk factors at either time point. Despite good acceptability and feasibility, these findings provide limited support for use of this software within EHV. These findings contribute to the mixed results seen across different models of EHV for child maltreatment prevention.

A randomised trial of a computer‐delivered screening and brief intervention for postpartum alcohol use

INTRODUCTION AND AIMS Most women cut down or quit alcohol use during pregnancy, but return to pre-pregnancy levels of use after giving birth. Universal screening and brief intervention for alcohol use has shown promise, but has proven challenging to implement and has rarely been evaluated with postpartum women. This trial evaluated a single 20-min, electronic screening and brief intervention (e-SBI) for alcohol use among postpartum women. DESIGN AND METHODS In this parallel group randomised trial, 123 postpartum, low-income, primarily African-American women meeting criteria for unhealthy alcohol use were randomly assigned to either a tailored e-SBI (n = 61) or a time-matched control condition (n = 62), with follow-up at 3 and 6 months. Hypotheses predicted that 7-day point-prevalence abstinence and drinking days would favour the e-SBI condition. RESULTS No group differences were significant. Blinded follow-up evaluation revealed 7-day point prevalence of 75% for the e-SBI condition versus 82% for control at 3 months (odds ratio = 1.6) and 72% versus 73%, respectively, at 6 months. Drinking days in the past 90 and mean number of drinks per week also showed no significant differences. DISCUSSION AND CONCLUSIONS This pilot trial failed to support a single-session e-SBI for alcohol use among postpartum women, although findings at the 3-month time point suggested that greater power might confirm transient effects of the e-SBI. As efficacy is likely to vary with e-SBI content and approach, future research should leverage technologys reproducibility and modularity to isolate key components. [Ondersma SJ, Svikis DS, Thacker LR, Beatty JR, Lockhart N. A randomised trial of a computer-delivered screening and brief intervention for postpartum alcohol use. Drug Alcohol Rev 2016;35:710-718].

Computer-delivered indirect screening and brief intervention for drug use in the perinatal period: A randomized trial

BACKGROUND Under-reporting of drug use in the perinatal period is well-documented, and significantly limits the reach of proactive intervention approaches. The Wayne Indirect Drug Use Screener (WIDUS) focuses on correlates of drug use rather than use itself. This trial tested a computer-delivered, brief intervention designed for use with indirect screen-positive cases, seeking to motivate reductions in drug use without presuming its presence. METHODS Randomized clinical trial with 500 WIDUS-positive postpartum women recruited between August 14, 2012 and November 19, 2014. Participants were randomly assigned to either a time control condition or a single-session, tailored, indirect brief intervention. The primary outcome was days of drug use over the 6-month follow-up period; secondary outcomes included urine and hair analyses results at 3- and 6-month follow-up. All outcomes were measured by blinded evaluators. RESULTS Of the 500 participants (252 intervention and 248 control), 36.1% of participants acknowledged drug use in the 3 months prior to pregnancy, but 89% tested positive at the 6-month follow-up. Participants rated the intervention as easy to use (4.9/5) and helpful (4.4/5). Analyses revealed no between-group differences in drug use (52% in the intervention group, vs. 53% among controls; OR 1.03). Exploratory analyses also showed that intervention effects were not moderated by baseline severity, WIDUS score, or readiness to change. CONCLUSIONS The present trial showed no evidence of efficacy for an indirect, single-session, computer-delivered, brief intervention designed as a complement to indirect screening. More direct approaches that still do not presume active drug use may be possible and appropriate.

Effects of narrator empathy in a computer delivered brief intervention for alcohol use

Computer-delivered, brief interventions (CDBIs) have been an increasingly popular way to treat alcohol use disorders; however, very few studies have examined which characteristics of CDBIs maximize intervention effectiveness. The literature has consistently demonstrated that therapist empathy is associated with reduced substance use in in-person therapy; however, it is unclear whether this principle applies to CDBIs. Therefore, the study aimed to examine whether the presence of an empathic narrator increased intentions to reduce heavy drinking in a CDBI. Results suggest that the presence of empathy increases motivation to reduce drinking, and makes participants feel more supported and less criticized.

Commercial Ethyl Glucuronide (EtG) and Ethyl Sulfate (EtS) Testing is Not Vulnerable to Incidental Alcohol Exposure in Pregnant Women

ABSTRACT Background: Ethyl Glucoronide (EtG) and Ethyl Sulfate (EtS) have shown promise as biomarkers for alcohol and may be sensitive enough for use with pregnant women in whom even low-level alcohol use is important. However, there have been reports of over-sensitivity of EtG and EtS to incidental exposure to sources such as alcohol-based hand sanitizer. Further, few studies have evaluated these biomarkers among pregnant women, in whom the dynamics of these metabolites may differ. Objectives: This study evaluated whether commercial EtG-EtS testing was vulnerable to high levels of environmental exposure to alcohol in pregnant women. Methods: Two separate samples of five nurses—one pregnant and the other postpartum, all of whom reported high levels of alcohol-based hand sanitizer use—provided urine samples before and 4–8 hours after rinsing with alcohol-based mouthwash and using hand sanitizer. The five pregnant nurses provided urine samples before, during, and after an 8-hour nursing shift, during which they repeatedly cleansed with alcohol-based hand sanitizer (mean 33.8 uses). The five postpartum nurses used hand sanitizer repeatedly between baseline and follow-up urine samples. Results: No urine samples were positive for EtG-EtS at baseline or follow-up, despite use of mouthwash and—in the pregnant sample—heavy use of hand sanitizer (mean of 33.8 uses) throughout the 8-hour shift. Conclusions/Importance: Current, commercially available EtG-EtS testing does not appear vulnerable to even heavy exposure to incidental sources of alcohol among pregnant and postpartum women.