Reducing Psychosocial and Behavioral Pregnancy Risk Factors: Results of a Randomized Clinical Trial Among High-Risk Pregnant African American Women

• Published in: American journal of public health (1971) 2009-06, Vol.99 (6), p.1053-1061
• Main Authors: Joseph, Jill G, El-Mohandes, Ayman A. E, Kiely, Michele, El-Khorazaty, M. Nabil, Gantz, Marie G, Johnson, Allan A, Katz, Kathy S, Blake, Susan M, Rossi, Maryann W, Subramanian, Siva
• Format: Article
• Language: English
• Subjects: African Americans; African Americans - psychology; Alcohol use; Babies; Behavior; Behavior modification; Behavior Therapy - methods; Biological and medical sciences; Birth weight; Births; Clinical trials; Collaboration; Counseling - methods; Depressive Disorder - diagnosis; Depressive Disorder - prevention & control; Depressive Disorder - therapy; Domestic violence; Drug use; Female; Gynecology; Humans; Infant mortality; Intervention; Interviews; Low income groups; Medical sciences; Mental depression; Mental health; Mental health care; Minority & ethnic groups; Miscellaneous; Obstetrics; Pregnancy; Pregnancy - ethnology; Pregnancy - psychology; Pregnancy Outcome; Prenatal care; Prenatal Care - methods; Primary care; Primary Health Care - methods; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression Analysis; Research and Practice; Risk Factors; Risk Reduction Behavior; Smoking; Smoking - adverse effects; Smoking - psychology; Smoking Cessation - methods; Smoking Prevention; Social psychology; Spouse Abuse - diagnosis; Spouse Abuse - prevention & control; Spouse Abuse - psychology; Suicides & suicide attempts; Tobacco smoke; Tobacco Smoke Pollution - adverse effects; Tobacco Smoke Pollution - prevention & control; Treatment Outcome; Womens health; Young Adult
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2007.131425

We evaluated the efficacy of a primary care intervention targeting pregnant African American women and focusing on psychosocial and behavioral risk factors for poor reproductive outcomes (cigarette smoking, secondhand smoke exposure, depression, and intimate partner violence). Pregnant African American women (N = 1044) were randomized to an intervention or usual care group. Clinic-based, individually tailored counseling sessions were adapted from evidence-based interventions. Follow-up data were obtained for 850 women. Multiple imputation methodology was used to estimate missing data. Outcome measures were number of risks at baseline, first follow-up, and second follow-up and within-person changes in risk from baseline to the second follow-up. Number of risks did not differ between the intervention and usual care groups at baseline, the second trimester, or the third trimester. Women in the intervention group more frequently resolved some or all of their risks than did women in the usual care group (odds ratio = 1.61; 95% confidence interval = 1.08, 2.39; P = .021). In comparison with usual care, a clinic-based behavioral intervention significantly reduced psychosocial and behavioral pregnancy risk factors among high-risk African American women receiving prenatal care.