Regular prenatal visits offer opportunities to deliver and reinforce risk-reduction messages regarding substance use (including tobacco, alcohol, and illicit drugs) and intimate partner violence (IPV). Because health care providers may lack time, comfort, and/or skill to conduct these efforts, innovative approaches are needed to capitalize on these opportunities. Computer programs are increasingly used to assess patient risks and deliver individualized preventive interventions. We propose to conduct a randomized, controlled trial to determine if a brief, interactive, multimedia intervention for pregnant women can 1) improve the frequency of patient-provider discussions regarding risks related to smoking, alcohol, illicit drug use, and IPV; and 2) reduce women's risks related to these topics. To capitalize on physicians' credibility, the multimedia intervention will be delivered by an actor-portrayed """"""""video doctor"""""""" programmed to respond to participant input, simulating a live interview. Pregnant women who speak English or Spanish and who receive prenatal care at one of the three study sites will be screened by a """"""""video nurse"""""""" for substance use and IPV risks. Four hundred and fifty pregnant women who report one or more of the four risks will be randomly assigned to an Intervention or a Control Group. Intervention Group patients will receive the Prenatal Preventive Health Intervention, consisting of a multimedia brief intervention presented by a """"""""video doctor"""""""" and a provider alert. The multimedia program will be presented over four prenatal visits and will be tailored to patients', risks and readiness to change. The provider alert, detailing participants' risks and suggesting appropriate interventions, will be placed in patients' medical records immediately following each session for use by prenatal health care providers during the woman's regular appointment. Women assigned to the Control Group will receive the usual care offered in their health care settings. To determine the effect of the Prenatal Preventive Health Intervention on patient-provider discussions and patients' risks, we will compare self-reported discussions, risks, and readiness to change at baseline and at the final intervention session. We expect that participants in the Intervention Group will show significant increases in patient-provider discussions and readiness to change their risk behaviors and reductions in risk behaviors compared with similar participants in the Control Group.
