Pregnancy and STD prevention counseling using an adaptation of motivational interviewing: a randomized controlled trial.

CONTEXT: Given levels of unintended pregnancy and STDs, an effective counseling intervention is needed to improve women's consistent use of effective prevention methods. METHODS: A sample of 764 women aged 16-44 who were at risk of unintended pregnancy were enrolled in a randomized controlled trial in North Carolina in 2003-2004. Intervention participants received pregnancy and STD prevention counseling, adapted from motivational interviewing, both at enrollment and two months later; controls received only a session of general health counseling. Levels of contraceptive use (categorized as high, low or none on the basis of the effectiveness of the method and the consistency of use) and barriers to use were measured at two, eight and 12 months; chi-square tests were used to compare selected outcomes between the groups. Rates of unintended pregnancy and chlamydia infection were assessed over the study period. RESULTS: At baseline, 59% of all participants reported a high level of contraceptive use, 19% a low level and 22% nonuse. At two months, the proportions of intervention and control participants who had improved their level of use or maintained a high level (72% and 66%, respectively) were significantly larger than the proportions who had reported a high level of use at baseline (59% and 58%, respectively). No significant differences were found between the groups at 12 months, or between baseline and 12 months for either group. During the study, 10-11% of intervention and control participants became pregnant, 1-2% received a chlamydia diagnosis and 7-9% had another STD diagnosed. CONCLUSIONS: Repeated counseling sessions may be needed to improve contraceptive decision-making and to reduce the risk of unintended pregnancy and STDs.

Acceptance and use of emergency contraception with standardized counseling intervention: results of a randomized controlled trial.

OBJECTIVE: The objective of this work was to evaluate the acceptance, use and recall of an optional advance prescription for emergency contraception (EC). MATERIALS AND METHODS: This study used as randomized controlled trial evaluating contraceptive counseling intervention with women aged 16-44 years who were at risk for unintended pregnancy (N=737). Intervention participants (n=365) received contraceptive counseling with optional advance EC prescription. Control women (n=372) received no contraceptive or EC counseling. Among intervention participants, initial acceptance and use of EC in first 2 months were evaluated. Among all participants, differences were evaluated between recall of EC discussion and use of EC. RESULTS: Among 365 intervention women, 336 received EC counseling and 51% of these 336 accepted advance EC prescription. At 2 months, among the women who had accepted EC, 6% had filled and used their prescription and 8% had filled but not used their prescription. At 12 months, intervention women were significantly more likely than controls to recall talking about EC (33% vs. 5%) and obtaining a prescription (38% vs. 6%), but there were no differences in the use of EC (6% vs. 6%). CONCLUSION: When the option is available for EC counseling, approximately half of women accepted advance prescription for EC. However, few women who received information and/or an advance prescription remembered discussing EC, filled the prescription or used EC over 12 months.

Applying motivational interviewing to contraceptive counseling: ESP for clinicians.

Healthcare providers are in a unique position to address women's risk of unintended pregnancy and sexually transmitted infections (STIs), yet evidence for effective counseling strategies is limited. One approach to developing effective contraceptive counseling methods may be the application of theory-based behavior counseling models. One such model, motivational interviewing (MI), is a promising approach for addressing risk-taking behaviors of many kinds. We propose application of MI to contraceptive counseling. This process, ESP, involves Exploring discrepancies between pregnancy intention and contraceptive use and between risk of STIs and condom use, Sharing information and Promoting behaviors to reduce risk. This model emphasizes the importance of identifying discrepancies between goals and behaviors and supporting women's confidence in using appropriate contraceptive methods

Use of program logic models in the Southern Rural Access Program evaluation.

The Southern Rural Access Program (SRAP) evaluation team used program logic models to clarify grantees' activities, objectives, and timelines. This information was used to benchmark data from grantees' progress reports to assess the program's successes. This article presents a brief background on the use of program logic models--essentially charts or diagrams specifying a program's planned activities, objectives, and goals--for evaluating and managing a program. It discusses the structure of the logic models chosen for the SRAP and how the model concept was introduced to the grantees to promote acceptance and use of the models. The article describes how the models helped clarify the program's objectives and helped lead agencies plan and manage the many program initiatives and subcontractors in their states. Models also provided a framework for grantees to report their progress to the National Program Office and evaluators and promoted the evaluators' visibility and acceptance by the grantees. Program logics, however, increased grantees' reporting requirements and demanded substantial time of the evaluators. Program logic models, on balance, proved their merit in the SRAP through their contributions to its management and evaluation and by providing a better understanding of the program's initiatives, successes, and potential impact.

Smoking, exercise and dietary behaviors among mothers of elementary school-aged children in a rural North Carolina county.

Tobacco use, poor diet, and physical inactivity are risk behaviors established during childhood and influenced by parents. Improving health habits of rural families poses particular challenges because resources may be limited in number and reach. To characterize the kinds of prevention programs needed by rural families, 501 surveys were mailed to caregivers of elementary school children living in a rural North Carolina county. Health behaviors, related attitudes, and demographic characteristics were assessed. Risk behaviors were defined as eating less than 5 fruits and vegetables a day, exercising less than 20 minutes 3 times a week, and being a smoker. Two hundred and sixty-one adults (55%) completed the surveys. Two hundred and forty-four (93%) were female, with a mean age of 37 years, 55% had a high school or less education, 89% reported at least one risk behavior, and 57% reported 2 or more risk behaviors. Female caregivers with multiple risk behaviors had lower educational levels (p < 0.007) and placed less importance on children's health behaviors (p < 0.009) than other caregivers. Female caregivers with multiple risk behaviors were no less confident they could change their behavior than those with only one risk behavior. The majority of female caregivers of elementary school children in this rural population engaged in and modeled multiple health risk behaviors for their children. Health promotion activities that address multiple risk factors and involve children are needed by young families in rural communities.

Incorporating genetic susceptibility feedback into a smoking cessation program for African-American smokers with low income.

PURPOSE: Markers of genetic susceptibility to tobacco-related cancers could personalize harms of smoking and motivate cessation. Our objective was to assess whether a multicomponent intervention that included feedback about genetic susceptibility to lung cancer increased risk perceptions and rates of smoking cessation compared with a standard cessation intervention. EXPERIMENTAL DESIGN: Our design was a two-arm trial with eligible smokers randomized in a 1:2 ratio to Enhanced Usual Care or Biomarker Feedback (BF). Surveys were conducted at baseline, 6, and 12 months later. The setting was an inner city community health clinic. African-American patients who were current smokers (n = 557) were identified by chart abstraction and provider referral. All smokers received a self-help manual and, if appropriate, nicotine patches. Smokers in the BF arm also were offered a blood test for genotyping the GST(3) gene (GSTM1), sent a test result booklet, and called up to four times by a health educator. Prevalent abstinence was assessed by self-report of having smoked no cigarettes in the prior 7 days at the 6- and 12-month follow-ups and sustained abstinence, i.e., not smoking at either follow-up or in-between. RESULTS: Smoking cessation was greater for the BF arm than the Enhanced Usual Care arm (19% versus 10%, respectively; P < 0.006) at 6 months but not at 12 months. CONCLUSIONS: Smokers agreed to genetic feedback as part of a multicomponent cessation program. Although the program increased short-term cessation rates compared with standard intervention, genetic feedback of susceptibility may not benefit smokers with high baseline risk perceptions.