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Randomized Controlled Trial
. 2007 Mar;32(3):231-8.
doi: 10.1016/j.amepre.2006.11.003. Epub 2007 Jan 22.

Computer-based brief intervention a randomized trial with postpartum women

Steven J Ondersma  1 , Dace S Svikis, Charles R Schuster
Affiliations
Randomized Controlled Trial

Computer-based brief intervention a randomized trial with postpartum women

Steven J Ondersma et al. Am J Prev Med. 2007 Mar.

Erratum in

  • Am J Prev Med. 2007 Jun;32(6):549

Abstract

Background: Drug use among parenting women is a significant risk factor for a range of negative child outcomes, including exposure to violence, child maltreatment, and child behavior problems. Implementation of brief interventions with this population may be greatly facilitated by computer-based interventions.

Design: Randomized clinical trial with 4-month follow-up.

Setting/participants: Participants were 107 postpartum women recruited from an urban obstetric hospital primarily serving a low-income population. Women were randomized into assessment only versus assessment plus brief intervention conditions; 76 (71%) returned for follow-up evaluation.

Intervention: A 20-minute, single-session, computer-based motivational intervention (based on motivational interviewing methods), combined with two nontailored mailings and voucher-based reinforcement of attendance at an initial intake/treatment session.

Main outcome measures: Illicit drug use as measured by qualitative urinalysis and self-report.

Results: Frequency of illicit drug use other than marijuana increased slightly for the control group, but declined among intervention group participants (p<0.05, between-group Mann-Whitney U; d=0.50); the magnitude of intervention effects on changes in marijuana use frequency was similar, but did not reach statistical significance. Point-prevalence analysis at follow-up did not show significant group differences in drug use. However, trends under a range of assumptions regarding participants lost to follow-up all favored the intervention group, with most effect sizes in the moderate range (odds ratios 1.4 to 4.7).

Conclusions: Results tentatively support the efficacy of this high-reach, replicable brief intervention. Further research should seek to replicate these findings and to further develop the computer as a platform for validated brief interventions.

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Figures

Figure 1
Figure 1. Participant flow
*Approximately 10% (n =14) of baseline participants were selected for lack of drug use reporting or risk, and removed at follow-up, in order to enhance participant protection. Flow diagram shows drug-using participants only.
Figure 2
Figure 2. Mean self-reported drug use frequency at baseline and 4-month follow-up
Note. N =107; data missing at follow-up were replaced with baseline values. Frequency was reported on a 0–4 scale, where 0 = “Never” and 4 = “Daily or almost daily.”
Figure 3
Figure 3. Proportion of participants using drugs at 4-month follow-up, per self-report and/or urinalysis, by group (n =76)
Note. All comparisons were nonsignificant; a trend was observed for “any drug use,” χ (1) = 3.0, p =0.085.
See this image and copyright information in PMC

References

    1. Substance Abuse and Mental Health Services Administration. Overview of Findings from the 2004 National Survey on Drug Use and Health. Office of Applied Studies, NSDUH Series H-27, DHHS Publication No. SMA 05-4061; Rockville, MD: 2005.
    1. Lester BM, Andreozzi L, Appiah L. Substance use during pregnancy: time for policy to catch up with research. Harm Reduct J. 2004 Apr 20;1(1):5. - PMC - PubMed
    1. Ondersma SJ, Delaney-Black V, Covington CY, Nordstrom B, Sokol RJ. The Association Between Caregiver Substance Abuse and Self-Reported Violence Exposure Among Young Urban Children. J Trauma Stress. 2006;19:107–18. - PubMed
    1. Ondersma SJ. Predictors of neglect within low-SES families: The importance of substance abuse. Am J Orthopsychiatry. 2002 Jul;72(3):383–91. - PubMed
    1. Besinger BA, Garland AF, Litrownik AJ, Landsverk JA. Caregiver substance abuse among maltreated children placed in out-of- home care. Child Welfare. 1999;78(2):221–39. 3/1999. - PubMed

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