Health Check-Up for Expectant Moms: Technology-Based Intervention for Improving Well Being of Rural Pregnant Women - PROJECT SUMMARY Alcohol, tobacco, and other drug use (ATOD), sexual health risks, and postpartum depression (PPD) are common and significant interrelated factors that are associated with poor health consequences for pregnant women and their infants, especially among rural, under-resourced communities. Thus, there is an urgent need to simultaneously address these health risks together during this vulnerable time. While pregnancy has been recognized as a window of opportunity in which to intervene, there are no empirically supported interventions tailored to specifically address these growing public health concerns together in rural women during pregnancy and postpartum. The objective of this R01 study is to fill this critical gap by building upon our promising R21/R01 findings by (1) partnering with a community advisory board to adapt and optimize the existing Health Check-up for Expectant Moms (HCEM) web-delivered Screening, Brief Intervention and Referral to Treatment or Prevention (SBIRT/P) program to include the interconnected risks of tobacco use and postpartum depression (PPD) among rural pregnant women (herein referred to as HCEM+), and (2) testing the efficacy of the HCEM+ in reducing ADOT, STI, and PPD risk more than a time and information matched control condition in rural pregnant women seeking prenatal care. This research addresses cross-cutting priorities in line with NIDA’s Strategic Plan to advance science on drug use: (1) prioritizing research to combat stigma and improve engagement in treatment, (2) developing and enhancing culturally responsive and tailored interventions, and (3) delivering care for substance use and co-occurring health conditions such as STIs and mental illness. We propose a two-group, randomized controlled trial in which a sample of 250 high-risk rural pregnant women attending prenatal care will be assigned to either (a) a web-delivered, two-session SBIRT/P plus two booster sessions consistent with motivational interviewing and informed by the Information-Motivation-Behavior (IMB) model, the HCEM+, or (b) a web-delivered control condition. Web-delivered follow-up assessments will occur at 8 and 24 weeks antenatally, and at 6 weeks postpartum, extending outcomes to the postpartum period. Specific Aim 1 is to test the hypothesis that HCEM+, compared to an attention, time and information matched control condition, will reduce unprotected sexual occasions and ADOT use among at-risk pregnant women during pregnancy at 2 and 6-months follow-up, and will increase treatment engagement. Specific Aim 2 is to test the hypothesis that HCEM+, compared to control, will reduce STIs and ADOT use at 6 weeks postpartum and will result in better birth outcomes and reduced rates of PPD. An economic evaluation of the costs of the HCEM+ will occur to guide future implementation and dissemination. Results of this program of research are expected to inform the development of a practical, cost-effective, high-reaching web-delivered SBIRT/P program tailored to reach high-risk rural and under-resourced women with extended impact to the postpartum period.
