Unlike other interventions that focus on tackling one risk behavior at a time, a new pilot study is taking a bundled approach to risk reduction. Danielle Parrish, an assistant professor at the University of Houston (UH) Graduate College of Social Work (GCSW) and a clinical social worker, has received a $100,000 grant from the National Institutes of Health (NIH) to conduct the substance use-focused research targeting adolescent females.
The population of this pilot study includes 30 at-risk young women, ages 14-17, on intensive probation with the Harris County, Texas Juvenile Probation Department. “What we’ve found with this group is that substance use is very frequent,” says Parrish, “and that it tends to sort of become co-morbid with other risk.”
The risk behaviors that the study is targeting include:
· Smoking; Parrish says that each participant in this study smokes.
· Drinking at risky levels, which Parrish explains to be more than 7 drinks in a week, and four or more drinks on any one occasion.
· Unplanned pregnancy; Parrish says they want to work with the girls “so if they’re having sex they’re using effective contraception, and that they are using a condom to protect from HIV if they’re engaging in sex.” She says when talking about sexual activity, research staff is are encouraging the girls to use condoms, but they also talk about abstinence as an option.
With the bundled intervention, Parrish aims to determine if it is possible to target multiple risk behaviors at the same time. “Ideally,” she says, “it will affect all the risk behaviors. But even if there’s a decrease in some of the behaviors, we’ve at least reduced the risk profile.”
Parrish says this long line of research started as an epidemiological survey to determine how many women were at risk of alcohol-exposed pregnancy. The researchers identified women who were at risk in various settings from primary care, jail, treatment programs, and in community samples. The goal of that study was to reduce fetal alcohol spectrum disorders.
According to Parrish, in their next stage of work, they focused on conducting a feasibility study where they were examining CHOICES, a prevention intervention consisting of four sessions plus a physician consultation about birth control. The goals of this study were similar— to reduce risky drinking and to prevent unplanned pregnancy.
“That particular intervention with the four sessions and the referral for birth control has been widely disseminated through SAMHSA. The manual is available online,” she says.
The intervention Parrish is using is an adaptation of CHOICES, developed by Mary Velasquez, PhD, an associate dean of research and director at the Health Behavior Research and Training Institute (HBRT) at the University of Texas. CHOICES, used with women in high-risk settings, was funded by the Centers for Disease Control and Prevention (CDC).
Velasquez’s project, titled “Project CHOICES: A Randomized Clinical Trial for Prevention of Fetal Alcohol Syndrome Among High-Risk Women,” was a four-year study completed in 2004. The publication of research findings, “Preventing Alcohol-exposed Pregnancies: A Randomized Controlled Trial,” appeared in the January 2007 issue of the American Journal of Preventive Medicine, for which Velasquez and her research team received the CDC’s prestigious Charles C. Shepard Science Award (June 2008).
“It’s called CHOICES because you can either reduce your risk of alcohol-exposed pregnancy by reducing your drinking, or by using effective contraception,” Parrish explains.
After the original CHOICES studies, funds were received to test adapted models of the original intervention, such as Project CHOICES+, which is being led by Velasquez as the principal investigator. Project CHOICES+ is being implemented in the two hospitals and 11 community health clinics of the Harris County Hospital District (HCHD). This study includes women in primary care settings and aims to reduce the risk of alcohol and nicotine exposed pregnancy. CHOICES+ involves two sessions, plus a referral for a birth control visit and a referral for smoking cessation.
The reason that the adapted versions now consist of two sessions is because was observed in a preliminary analysis that the women in the study who completed only two sessions had outcomes that were just as positive as the women who completed four, Parrish explains.
The researchers also noticed that a lot of the women who were drinking at risky levels were also smoking. That is the reason why the smoking cessation component was added to the adapted version of the intervention.
Parrish’s study, titled, “Choices- Teen: A Bundled Risk Reduction Intervention for Juvenile Justice Females,” is built the current study that’s going on at Harris Health. She says she is “really taking it and looking at a high-risk adolescent population where we know that they are at very high risk of alcohol- and nicotine-exposed pregnancy.”
She says that about 30% of the girls in this setting either have been pregnant or are currently pregnant and many of them are drinking, smoking and/or using other substances.
In the current study that Parrish is conducting, the CHOICES model is being adapted and focused towards younger females. The intervention uses motivational interviewing techniques and targets the risk behaviors throughout the program. “It uses things like decisional balance, trying to develop how people deal with any resistance they have in terms of changing their behavior, looking at their profiles in terms of their temptations and confidence for changing each of the behaviors,” Parrish explains.