The Health in Pregnancy (HIP) Study

Regular prenatal visits offer opportunities to deliver and reinforce risk reduction messages
regarding tobacco, alcohol, or illicit drug use and domestic violence. Because health care
providers may lack the time, comfort, or skills to screen or counsel their patients about
these risks, innovative approaches are needed. Computer programs are increasingly used to
assess risky behaviors and deliver individualized preventive interventions. We have
designed a randomized, controlled trial to determine if a brief, interactive, multimedia
intervention delivered on a laptop computer and integrated into routine prenatal care can
reduce pregnant women's smoking, drinking, drug use, and experiences of domestic violence
compared to usual care. To capitalize on health care providers' credibility, the multimedia
intervention is delivered by an actor-portrayed "Video Doctor" programmed to respond to
participant input, simulating a live interview. Pregnant women who receive prenatal care
at one of the study sites and who consent to participate will be screened for substance use
and domestic violence prior to a regularly scheduled medical appointment. Women who report
one or more of these risks will be randomly assigned to the Intervention or Control group
according to a blocked, stratified randomization plan. Participants in the Intervention
group will receive the Health in Pregnancy (HIP) intervention, consisting of brief,
multimedia counseling presented by a "Video Doctor" and an educational worksheet. Their
provider will receive a "Cueing Sheet," which offers a brief summary of the patient's risk
profile and suggests counseling statements. Components of the multimedia program will be
tailored to each participant's risk profile and readiness to change. Women assigned to the
Control group will complete a risk assessment than receive the usual care offered by the
health care settings. Both Intervention and Control participants will complete two
follow-up risk assessments at consecutive medical visits approximately four weeks apart. At
the first follow-up session, Intervention participants will also receive "booster" risk
reduction messages from teh video doctor. To determine the effect of the HIP program on
patient-provider discussions, both Intervention and Control participants will complete a
post-interview after their medical appointment. The post-interview will also assess the
acceptability of the HIP program by participants. To determine the effect of teh program on
participants' risky behaviors we will compare self-reported discussions, behavior change,
and readiness to change at baseline and at a third session with the computer program. We
expect that participants in the Intervention group will show significant reductions in risky
behaviors compared to the Control group.

Inclusion Criteria:

- Age 18 or older

- English speaking

- Pregnant and receiving prenatal care at a participating study site.

Exclusion Criteria:

- >25 weeks gestation at baseline session.