Motivational interviewing + feedback intervention to reduce alcohol-exposed pregnancy risk among college binge drinkers: determinants and patterns of response

Abstract

Many college women are at risk for pregnancy, and binge drinking college women are often at risk for alcohol-exposed pregnancy. Brief interventions with sustainable outcomes are needed, particularly for college women who are binge drinking, at risk for pregnancy, and at increased risk of alcohol-exposed pregnancy. Two-hundred-twenty-eight women at a Mid-Atlantic urban university at risk for alcohol-exposed pregnancy enrolled in the randomized clinical trial, and 207 completed the 4 month follow-up. The BALANCE intervention used Motivational Interviewing plus feedback to target drinking and contraception behaviors. Main outcome measures included (1) the rate of risk for alcohol-exposed pregnancy, (2) the rate of risk drinking, and (3) the rate of pregnancy risk. At 4-month follow-up, the rate of alcohol-exposed pregnancy risk was significantly lower in the intervention (20.2%) than the control condition (34.9%), (P < .02). Assignment to the intervention condition halved the odds of women remaining at risk for alcohol-exposed pregnancy, while not receiving the intervention doubled the odds of continued alcohol-exposed pregnancy risk (OR = 2.18; 95% CI = 1.16-4.09). A baseline history of blackouts, continued high blood alcohol drinking days at 1 month, and continued risk for pregnancy at 1 month independently contributed to a multivariate model of continued alcohol-exposed pregnancy risk at 4 month follow-up. BALANCE reduced alcohol-exposed pregnancy risk, with similar outcomes to longer interventions. Because early response predicted sustained alcohol-exposed pregnancy risk reduction, those who fail to achieve initial change could be identified for further intervention. The BALANCE intervention could be adopted into existing student health or university alcohol programs. The risks of unintended pregnancy and alcohol-exposed pregnancy among binge drinking women in college merit greater prevention efforts.

Fig 1

BALANCE study flowchart

Fig 2

Alcohol-exposed pregnancy risk and routes to reduced risk at 1 and 4 month follow-ups. Changed both means changed to 100% effective contraception AND no binge drinking nor more than 7 drinks/week. Changed contraception means changed from ineffective (absent, improper, inconsistent, or ineffective methods of contraception) to using an effective method on all episodes of vaginal intercourse during the month prior to the 4 month follow-up. Changed drinking means changed from binge and/or more than 7 drinks per week to drinking below risk levels, with no binges and averaging fewer than 7 drinks per week during the month prior to the 4 month follow-up. Changed neither means that neither drinking nor contraception behavior improvements met the thresholds for risk reduction

Fig 3

Patterns of treatment response among control and intervention women. Non-responders never achieved alcohol-exposed pregnancy risk reduction. Relapsers achieved reduced risk status at 1 month but were at risk at 4 months. Improvers were at risk for alcohol-exposed pregnancy at 1 month but no longer at risk at 4 months. Maintained responders achieved alcohol-exposed pregnancy risk reduction at 1 month and maintained it at 4 months