Linking Reductions in Alcohol and Birth Control Use Risk Behavior to Prevention of Alcohol-Exposed Pregnancy: A...

The most popular alcohol-exposed pregnancy (AEP) prevention program (AEP-P) is a brief intervention that dually promotes reducing alcohol use and increasing birth control use. The primary outcome variable used to evaluate AEP-P involves aggregating behavioral change into a binary variable, despite differences in how AEP-P impacts each behavior. This study examined if all three possible AEP-P behavior-change outcomes (alcohol only (AO), birth control only (BCO), or both behaviors [BB]) are equally effective in preventing subsequent AEP itself.

We simulated implementing an AEP-P in a United States small metropolitan area under 252 different scenarios (policy tests), varying the (1) percent of the eligible population who changed AEP risk behavior; (2) proportion of AEP-P participants in AO, BCO, and BB groups; and (3) ratio of participants changing alcohol use to non-risky drinking or abstinence. We calculated the percent difference in next-year new cases of total AEP, high-risk AEP, and low-risk AEP for each policy test compared to a "no implementation" baseline.

Policies with higher BB proportions had larger reductions for total and high-risk AEP, with the 100% BB policy providing the highest reductions (5.58%-17.13% and 16.27%- 42.43% total and high-risk AEP, respectively). All policies increased low-risk AEP, except for the 100% BCO policy. Policies with higher BCO proportions resulted in lower increases in low-risk AEP, but lower reductions to high-risk AEP. Policy increases in low-risk AEP were driven by the fraction of people transitioning to abstention compared to non-risky drinking.

Study results suggested that different constructs of behavioral changes made during AEP-P confer different levels of preventing AEP itself. Using a binary AEP risk aggregate variable may bias our understanding of AEP-P preventative efficacy and inhibit further understanding of how to improve AEP-P.