BACKGROUND AND OBJECTIVE: Alcohol use by adolescents is widespread and is connected to a number o... more BACKGROUND AND OBJECTIVE: Alcohol use by adolescents is widespread and is connected to a number of negative health and social outcomes. Adolescents receiving emergent care for injuries are often linked with risky use of alcohol. The trauma system has widely adopted the use of screening, brief intervention, and referral to treatment (SBIRT) for preventing alcohol-related injury recidivism and other negative outcomes. The purpose of this article is to review the evidence around SBIRT with adolescent patients in acute care settings. METHODS: This article reviews 7 randomized controlled trials evaluating risky drinking interventions among adolescent patients in acute care settings. All studies took place in the emergency departments of level I trauma centers. RESULTS: Four of the 7 studies reviewed demonstrated a significant intervention effect; however, no one intervention reduced both alcohol consumption and alcohol-related consequences. Two of these 4 studies only included patients a...
Little is known about the influence of prepartum menthol cigarette use on postpartum smoking abst... more Little is known about the influence of prepartum menthol cigarette use on postpartum smoking abstinence or how race/ethnicity might moderate this relationship. The current study addressed that gap by testing these relationships among racially/ethnically diverse women who quit smoking during pregnancy (N = 244; 33% African American, 31% Latina, 36% White). Methods: Continuation ratio logit models were used to examine the effects of prepartum menthol cigarette use on biochemically confirmed, continuous abstinence through 26 weeks postpartum using an intent-to-treat approach. Analyses controlled for age, race/ethnicity, partner status, income, education, treatment, number of prequit cigarettes smoked per day, time to the first cigarette of the day, and time (Week 8 or 26 data collection timepoint). An additional model tested the moderating effects of race/ethnicity by including an interaction term. Results: Prepartum menthol cigarette use was not significantly associated with postpartum smoking abstinence in the overall sample. However, the interaction between menthol use and race/ethnicity was significant (p = .02). Among White women, menthol use was associated with significantly lower odds of maintaining postpartum smoking abstinence (p = .03; odds ratio = .19 [.04-.89]), and the effect approached significance among African American women (p = .08). This study provides the first evidence that prepartum menthol cigarette use may increase the risk of postpartum smoking relapse among White, and possibly African American, women who quit smoking during or immediately before pregnancy. Results suggest that White and African American prepartum menthol users may require different or more intensive
The literature has failed to form a consensus on the association between alcohol use and unsafe s... more The literature has failed to form a consensus on the association between alcohol use and unsafe sex among samples of men who have sex with men (MSM). Although drinking behavior may not be causally related to unsafe sex, it is possible that alcohol use plays a role in sexual scripts. In this paper, we assessed the role that alcohol use plays in the sexual experiences of HIV-seropositive MSM in terms of sexual script theory. An ethnically diverse sample (81% men of color) of HIV-positive MSM with alcohol use disorders from the New York City metropolitan area was recruited from a variety of settings frequented by such men. A critical incident measure was used to qualitatively assess contextual issues regarding participants' most recent incident of unsafe sex while under the influence of alcohol. Qualitative analysis revealed three basic sexual scripts involving alcohol: routine, spontaneous, and taboo. Each script had its own sources of risk for unsafe sex. Interventions targeting alcohol use and unsafe sex should be sensitive to the role that alcohol plays in the sexual scripts of HIV-positive MSM. There is substantial empirical evidence to indicate that as many as one in three HIV-seropositive men who have sex with men (MSM) report unprotected anal sex with HIV-negative or serostatus-unknown sexual partners (Colfax et al.
Project CHOICES developed an integrated behavioral intervention for prevention of prenatal alcoho... more Project CHOICES developed an integrated behavioral intervention for prevention of prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. Settings included primary care, university-hospital based obstetrical/gynecology practices, an urban jail, substance abuse treatment settings, and a media-recruited sample in three large cities. The intervention was based on motivational interviewing and targeted both adoption of effective contraception and reduction of alcohol use. Treatment included 4 manual-guided sessions delivered by mental health clinicians and 1 contraceptive counseling session delivered by a family planning clinician. This paper describes the rationale for treatment; the use of motivational interviewing and the transtheoretical model for a dualfocused approach to behavior change; the development of the Project CHOICES intervention; development of the study protocol and treatment manual; and selection, training, supervision, and monitoring of study counselors. Implications for future applications of the intervention are discussed. Drinking alcohol during pregnancy can cause a number of birth defects, mild to severe mental retardation, and learning, emotional, and behavioral problems. It can also cause effects involving the heart, face, and other organs (American Academy of Pediatrics, 2000). The term "fetal alcohol spectrum disorder" (FASD) is used to describe the many problems associated with exposure to alcohol before birth. The most severe of these is fetal alcohol syndrome (FAS), a combination of abnormal facial features, neurodevelopmental disorders, and growth deficits. Consuming alcohol during pregnancy also increases the risk of miscarriage, low birth weight, and stillbirth (Sokol, Delaney-Black, & Nordstrom, 2003). FAS and FASD are significant and costly medical and societal problems that have been identified as health care priorities by the
Multiple health behavior change (MHBC) intervention trials to date have only considered behaviors... more Multiple health behavior change (MHBC) intervention trials to date have only considered behaviors that were targeted. Research has yet to consider how untargeted behaviors can affect change in behaviors directly targeted by an intervention or how changes in targeted behaviors might lead to changes in other, untargeted behaviors. This study addresses these gaps with a secondary analysis of change in risk drinking (targeted behavior) and smoking (behavior that was not addressed) in the efficacy trial of CHOICES, an intervention for the prevention of alcohol-exposed pregnancies. Measures included the Timeline Followback for daily alcohol consumption and questions about smoking behavior. Participants were women of childbearing age who were at risk of alcohol-exposed pregnancy at baseline. Baseline smokers were less likely to change their drinking behavior than baseline non-smokers at nine months (n = 579) with Odds Ratio (OR) of 0.681 (95% CI = 0.471-0.985); 41.1% of smokers vs 50.6% of...
Background & Purpose: Project CHOICES Efficacy Trial was a multisite study to test an interventio... more Background & Purpose: Project CHOICES Efficacy Trial was a multisite study to test an intervention for the prevention of alcohol-exposed pregnancy (AEP). The intervention was based on Motivational Interviewing and the Transtheoretical Model (TTM). One goal of the CHOICES intervention was to reduce drinking in women at risk of an AEP by targeting the constructs of the TTM that have been found to be associated with successful change. The CHOICES intervention targeted the TTM processes of change, posited to be the mechanisms through which individuals move through the motivational stages of change. In addition, a goal of the CHOICES intervention was to increase the cons and decrease the pros for drinking, decrease temptation and increase confidence to avoid drinking at risk levels (Velasquez, Ingersoll, Sobell, et al., 2010). In the current study, a secondary analysis using Profile Analysis was conducted to compare TTM alcohol construct profiles of women who received the CHOICES interve...
Journal of Consulting and Clinical Psychology, 2016
Objective-To examine mechanisms of the treatment effect for CHOICES, a motivational intervention ... more Objective-To examine mechanisms of the treatment effect for CHOICES, a motivational intervention to reduce risk of alcohol exposed pregnancy (AEP). Grounded in constructs from the Transtheoretical Model (TTM) and Motivational Interviewing (MI), the intervention targeted: risk drinking (>4 drinks/day or >7 drinks/week); ineffective contraception; and AEP risk (both behaviors). The experiential and behavioral processes of change (POC), posited to describe the mechanisms through which individual behavior change occurs, were examined. It was hypothesized that each of the targeted treatment outcomes at 9-month follow-up would be mediated by the experiential POC at 3-months, and that these would then be mediated by the behavioral POC at 9-months. Method-830 women at-risk for AEP were randomized to CHOICES (Information Plus Counseling; IPC) condition (n=416) or Information Only (IO) condition (n=414). Primary outcomes and proposed mediators (POC) were assessed at 3-and 9-months. Path analyses using weighted least squares estimation with mean-and variance-adjusted chi-square statistic were conducted separately for each outcome. Results-Model fit indices indicated good fit, and the indirect effect of treatment on outcome via POC was significant for hypothesized models predicting risky drinking and ineffective contraception. The indirect effect of treatment on AEP risk through POC for ineffective contraception was significant, but the indirect effect of POC for risky drinking was not.
Prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disab... more Prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities in the United States.A randomized controlled trial (2002–2005; data analyzed 2005–2006) of a brief motivational intervention to reduce the risk of an alcohol-exposed pregnancy (AEP) in preconceptional women by focusing on both risk drinking and ineffective contraception use.A total of 830 nonpregnant women, aged 18–44 years, and currently at risk for an AEP were recruited in six diverse settings in Florida, Texas, and Virginia. Combined settings had higher proportions of women at risk for AEP (12.5% overall) than in the general population (2%).Participants were randomized to receive information plus a brief motivational intervention (n=416) or to receive information only (n=414). The brief motivational intervention consisted of four counseling sessions and one contraception consultation and services visit.Women consuming more than five drinks on any day or more than eight drinks per week on average, were considered risk drinkers; women who had intercourse without effective contraception were considered at risk of pregnancy. Reversing either or both risk conditions resulted in reduced risk of an AEP.Across the follow-up period, the odds ratios (ORs) of being at reduced risk for AEP were twofold greater in the intervention group: 3 months, 2.31 (95% confidence interval [CI]=1.69–3.20); 6 months, 2.15 (CI=1.52–3.06); 9 months, 2.11 (CI=1.47–3.03). Between-groups differences by time phase were 18.0%, 17.0%, and 14. 8%, respectively.A brief motivational intervention can reduce the risk of an AEP.
Purpose: Research has established that depression inhibits behavior change but offers little insi... more Purpose: Research has established that depression inhibits behavior change but offers little insight into howthis inhibition occurs. The transtheoretical model (TTM) of behavior change features markers of change that have been shown to interact in a consistent fashion when one changes a behavior: pros outweigh cons (decisional balance), confidence outweighs temptation (self-efficacy), and use of the processes of change is high. Deviation from this profile is consistently associated with unsuccessful change attempts. The current study clarifies the impact of depression on alcohol change by comparing profiles of performance on the TTM markers between depressed and non-depressed women in the CDC-funded CHOICES efficacy trial, which tested an intervention targeting reduction in alcohol consumption and/or adoption of effective contraception as avenues to reduce risk of alcohol exposed pregnancy (AEP). We hypothesized that: 1) non-depressed women would be more likely than depressed women ...
The CHOICES Plus trial tested a bundle of services in predominantly low income primary care setti... more The CHOICES Plus trial tested a bundle of services in predominantly low income primary care settings, addressing risky drinking, smoking, and ineffective contraception among 'at risk' women. After nine months, women assigned to the intervention had a significantly lower risk of alcohol-and tobacco-exposed pregnancies than women assigned to brief advice. Targeting interventions at women before they become pregnant could shift the focus in clinical practice from treatment of substance-exposed pregnancies to prevention of a major (and costly) public health concern. Research analysis This entry is our analysis of a study added to the Effectiveness Bank. The original study was not published by Findings; click Title to order a copy. Free reprints may be available from the authors-click prepared e-mail. Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text The Summary conveys the findings and views expressed in the study. Below is a commentary from Drug and Alcohol Findings.
Objective: The purpose of this study was to present nationally representative findings on the pre... more Objective: The purpose of this study was to present nationally representative findings on the prevalence and co-occurrence of alcohol use and serious psychological distress among women aged 18-44 years, as well as their access to health care. Methods: A total of 24,900 women aged 18-44 years participated in the National Health Interview Survey (NHIS) during the years 2003-2005. Using data from the cross-sectional survey, we estimated the prevalence and co-occurrence of alcohol use and serious psychological distress among this population; this association was examined using logistic regression. Health care access among women who used alcohol and had serious psychological distress was characterized by co-occurring status. Results: During the study period, the estimated annual prevalence was 4.1% for heavier alcohol use, 56.0% for non-heavier use, 39.8% for nonuse, and 3.6% for serious psychological distress among women aged 18-44 years. Women who experienced serious psychological distress were at an increased likelihood for alcohol use, particularly heavier use. Alcohol use and serious psychological distress co-occurred among an estimated 1.1 million women of childbearing age in the United States annually. Most women, regardless of their co-occurring status, reported being treated by clinicians in various health care settings during the previous 12 months. Conclusions: Alcohol use is common among women of childbearing age who experience serious psychological distress. The findings of this study provide support for enhancing efforts toward integrated assessment and intervention among women who have such co-occurring risk factors.
BACKGROUND AND OBJECTIVE: Alcohol use by adolescents is widespread and is connected to a number o... more BACKGROUND AND OBJECTIVE: Alcohol use by adolescents is widespread and is connected to a number of negative health and social outcomes. Adolescents receiving emergent care for injuries are often linked with risky use of alcohol. The trauma system has widely adopted the use of screening, brief intervention, and referral to treatment (SBIRT) for preventing alcohol-related injury recidivism and other negative outcomes. The purpose of this article is to review the evidence around SBIRT with adolescent patients in acute care settings. METHODS: This article reviews 7 randomized controlled trials evaluating risky drinking interventions among adolescent patients in acute care settings. All studies took place in the emergency departments of level I trauma centers. RESULTS: Four of the 7 studies reviewed demonstrated a significant intervention effect; however, no one intervention reduced both alcohol consumption and alcohol-related consequences. Two of these 4 studies only included patients a...
Little is known about the influence of prepartum menthol cigarette use on postpartum smoking abst... more Little is known about the influence of prepartum menthol cigarette use on postpartum smoking abstinence or how race/ethnicity might moderate this relationship. The current study addressed that gap by testing these relationships among racially/ethnically diverse women who quit smoking during pregnancy (N = 244; 33% African American, 31% Latina, 36% White). Methods: Continuation ratio logit models were used to examine the effects of prepartum menthol cigarette use on biochemically confirmed, continuous abstinence through 26 weeks postpartum using an intent-to-treat approach. Analyses controlled for age, race/ethnicity, partner status, income, education, treatment, number of prequit cigarettes smoked per day, time to the first cigarette of the day, and time (Week 8 or 26 data collection timepoint). An additional model tested the moderating effects of race/ethnicity by including an interaction term. Results: Prepartum menthol cigarette use was not significantly associated with postpartum smoking abstinence in the overall sample. However, the interaction between menthol use and race/ethnicity was significant (p = .02). Among White women, menthol use was associated with significantly lower odds of maintaining postpartum smoking abstinence (p = .03; odds ratio = .19 [.04-.89]), and the effect approached significance among African American women (p = .08). This study provides the first evidence that prepartum menthol cigarette use may increase the risk of postpartum smoking relapse among White, and possibly African American, women who quit smoking during or immediately before pregnancy. Results suggest that White and African American prepartum menthol users may require different or more intensive
The literature has failed to form a consensus on the association between alcohol use and unsafe s... more The literature has failed to form a consensus on the association between alcohol use and unsafe sex among samples of men who have sex with men (MSM). Although drinking behavior may not be causally related to unsafe sex, it is possible that alcohol use plays a role in sexual scripts. In this paper, we assessed the role that alcohol use plays in the sexual experiences of HIV-seropositive MSM in terms of sexual script theory. An ethnically diverse sample (81% men of color) of HIV-positive MSM with alcohol use disorders from the New York City metropolitan area was recruited from a variety of settings frequented by such men. A critical incident measure was used to qualitatively assess contextual issues regarding participants' most recent incident of unsafe sex while under the influence of alcohol. Qualitative analysis revealed three basic sexual scripts involving alcohol: routine, spontaneous, and taboo. Each script had its own sources of risk for unsafe sex. Interventions targeting alcohol use and unsafe sex should be sensitive to the role that alcohol plays in the sexual scripts of HIV-positive MSM. There is substantial empirical evidence to indicate that as many as one in three HIV-seropositive men who have sex with men (MSM) report unprotected anal sex with HIV-negative or serostatus-unknown sexual partners (Colfax et al.
Project CHOICES developed an integrated behavioral intervention for prevention of prenatal alcoho... more Project CHOICES developed an integrated behavioral intervention for prevention of prenatal alcohol exposure in women at high risk for alcohol-exposed pregnancies. Settings included primary care, university-hospital based obstetrical/gynecology practices, an urban jail, substance abuse treatment settings, and a media-recruited sample in three large cities. The intervention was based on motivational interviewing and targeted both adoption of effective contraception and reduction of alcohol use. Treatment included 4 manual-guided sessions delivered by mental health clinicians and 1 contraceptive counseling session delivered by a family planning clinician. This paper describes the rationale for treatment; the use of motivational interviewing and the transtheoretical model for a dualfocused approach to behavior change; the development of the Project CHOICES intervention; development of the study protocol and treatment manual; and selection, training, supervision, and monitoring of study counselors. Implications for future applications of the intervention are discussed. Drinking alcohol during pregnancy can cause a number of birth defects, mild to severe mental retardation, and learning, emotional, and behavioral problems. It can also cause effects involving the heart, face, and other organs (American Academy of Pediatrics, 2000). The term "fetal alcohol spectrum disorder" (FASD) is used to describe the many problems associated with exposure to alcohol before birth. The most severe of these is fetal alcohol syndrome (FAS), a combination of abnormal facial features, neurodevelopmental disorders, and growth deficits. Consuming alcohol during pregnancy also increases the risk of miscarriage, low birth weight, and stillbirth (Sokol, Delaney-Black, & Nordstrom, 2003). FAS and FASD are significant and costly medical and societal problems that have been identified as health care priorities by the
Multiple health behavior change (MHBC) intervention trials to date have only considered behaviors... more Multiple health behavior change (MHBC) intervention trials to date have only considered behaviors that were targeted. Research has yet to consider how untargeted behaviors can affect change in behaviors directly targeted by an intervention or how changes in targeted behaviors might lead to changes in other, untargeted behaviors. This study addresses these gaps with a secondary analysis of change in risk drinking (targeted behavior) and smoking (behavior that was not addressed) in the efficacy trial of CHOICES, an intervention for the prevention of alcohol-exposed pregnancies. Measures included the Timeline Followback for daily alcohol consumption and questions about smoking behavior. Participants were women of childbearing age who were at risk of alcohol-exposed pregnancy at baseline. Baseline smokers were less likely to change their drinking behavior than baseline non-smokers at nine months (n = 579) with Odds Ratio (OR) of 0.681 (95% CI = 0.471-0.985); 41.1% of smokers vs 50.6% of...
Background & Purpose: Project CHOICES Efficacy Trial was a multisite study to test an interventio... more Background & Purpose: Project CHOICES Efficacy Trial was a multisite study to test an intervention for the prevention of alcohol-exposed pregnancy (AEP). The intervention was based on Motivational Interviewing and the Transtheoretical Model (TTM). One goal of the CHOICES intervention was to reduce drinking in women at risk of an AEP by targeting the constructs of the TTM that have been found to be associated with successful change. The CHOICES intervention targeted the TTM processes of change, posited to be the mechanisms through which individuals move through the motivational stages of change. In addition, a goal of the CHOICES intervention was to increase the cons and decrease the pros for drinking, decrease temptation and increase confidence to avoid drinking at risk levels (Velasquez, Ingersoll, Sobell, et al., 2010). In the current study, a secondary analysis using Profile Analysis was conducted to compare TTM alcohol construct profiles of women who received the CHOICES interve...
Journal of Consulting and Clinical Psychology, 2016
Objective-To examine mechanisms of the treatment effect for CHOICES, a motivational intervention ... more Objective-To examine mechanisms of the treatment effect for CHOICES, a motivational intervention to reduce risk of alcohol exposed pregnancy (AEP). Grounded in constructs from the Transtheoretical Model (TTM) and Motivational Interviewing (MI), the intervention targeted: risk drinking (>4 drinks/day or >7 drinks/week); ineffective contraception; and AEP risk (both behaviors). The experiential and behavioral processes of change (POC), posited to describe the mechanisms through which individual behavior change occurs, were examined. It was hypothesized that each of the targeted treatment outcomes at 9-month follow-up would be mediated by the experiential POC at 3-months, and that these would then be mediated by the behavioral POC at 9-months. Method-830 women at-risk for AEP were randomized to CHOICES (Information Plus Counseling; IPC) condition (n=416) or Information Only (IO) condition (n=414). Primary outcomes and proposed mediators (POC) were assessed at 3-and 9-months. Path analyses using weighted least squares estimation with mean-and variance-adjusted chi-square statistic were conducted separately for each outcome. Results-Model fit indices indicated good fit, and the indirect effect of treatment on outcome via POC was significant for hypothesized models predicting risky drinking and ineffective contraception. The indirect effect of treatment on AEP risk through POC for ineffective contraception was significant, but the indirect effect of POC for risky drinking was not.
Prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disab... more Prenatal alcohol exposure is a leading preventable cause of birth defects and developmental disabilities in the United States.A randomized controlled trial (2002–2005; data analyzed 2005–2006) of a brief motivational intervention to reduce the risk of an alcohol-exposed pregnancy (AEP) in preconceptional women by focusing on both risk drinking and ineffective contraception use.A total of 830 nonpregnant women, aged 18–44 years, and currently at risk for an AEP were recruited in six diverse settings in Florida, Texas, and Virginia. Combined settings had higher proportions of women at risk for AEP (12.5% overall) than in the general population (2%).Participants were randomized to receive information plus a brief motivational intervention (n=416) or to receive information only (n=414). The brief motivational intervention consisted of four counseling sessions and one contraception consultation and services visit.Women consuming more than five drinks on any day or more than eight drinks per week on average, were considered risk drinkers; women who had intercourse without effective contraception were considered at risk of pregnancy. Reversing either or both risk conditions resulted in reduced risk of an AEP.Across the follow-up period, the odds ratios (ORs) of being at reduced risk for AEP were twofold greater in the intervention group: 3 months, 2.31 (95% confidence interval [CI]=1.69–3.20); 6 months, 2.15 (CI=1.52–3.06); 9 months, 2.11 (CI=1.47–3.03). Between-groups differences by time phase were 18.0%, 17.0%, and 14. 8%, respectively.A brief motivational intervention can reduce the risk of an AEP.
Purpose: Research has established that depression inhibits behavior change but offers little insi... more Purpose: Research has established that depression inhibits behavior change but offers little insight into howthis inhibition occurs. The transtheoretical model (TTM) of behavior change features markers of change that have been shown to interact in a consistent fashion when one changes a behavior: pros outweigh cons (decisional balance), confidence outweighs temptation (self-efficacy), and use of the processes of change is high. Deviation from this profile is consistently associated with unsuccessful change attempts. The current study clarifies the impact of depression on alcohol change by comparing profiles of performance on the TTM markers between depressed and non-depressed women in the CDC-funded CHOICES efficacy trial, which tested an intervention targeting reduction in alcohol consumption and/or adoption of effective contraception as avenues to reduce risk of alcohol exposed pregnancy (AEP). We hypothesized that: 1) non-depressed women would be more likely than depressed women ...
The CHOICES Plus trial tested a bundle of services in predominantly low income primary care setti... more The CHOICES Plus trial tested a bundle of services in predominantly low income primary care settings, addressing risky drinking, smoking, and ineffective contraception among 'at risk' women. After nine months, women assigned to the intervention had a significantly lower risk of alcohol-and tobacco-exposed pregnancies than women assigned to brief advice. Targeting interventions at women before they become pregnant could shift the focus in clinical practice from treatment of substance-exposed pregnancies to prevention of a major (and costly) public health concern. Research analysis This entry is our analysis of a study added to the Effectiveness Bank. The original study was not published by Findings; click Title to order a copy. Free reprints may be available from the authors-click prepared e-mail. Links to other documents. Hover over for notes. Click to highlight passage referred to. Unfold extra text The Summary conveys the findings and views expressed in the study. Below is a commentary from Drug and Alcohol Findings.
Objective: The purpose of this study was to present nationally representative findings on the pre... more Objective: The purpose of this study was to present nationally representative findings on the prevalence and co-occurrence of alcohol use and serious psychological distress among women aged 18-44 years, as well as their access to health care. Methods: A total of 24,900 women aged 18-44 years participated in the National Health Interview Survey (NHIS) during the years 2003-2005. Using data from the cross-sectional survey, we estimated the prevalence and co-occurrence of alcohol use and serious psychological distress among this population; this association was examined using logistic regression. Health care access among women who used alcohol and had serious psychological distress was characterized by co-occurring status. Results: During the study period, the estimated annual prevalence was 4.1% for heavier alcohol use, 56.0% for non-heavier use, 39.8% for nonuse, and 3.6% for serious psychological distress among women aged 18-44 years. Women who experienced serious psychological distress were at an increased likelihood for alcohol use, particularly heavier use. Alcohol use and serious psychological distress co-occurred among an estimated 1.1 million women of childbearing age in the United States annually. Most women, regardless of their co-occurring status, reported being treated by clinicians in various health care settings during the previous 12 months. Conclusions: Alcohol use is common among women of childbearing age who experience serious psychological distress. The findings of this study provide support for enhancing efforts toward integrated assessment and intervention among women who have such co-occurring risk factors.
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Papers by Mary Velasquez