Choices4Health: Intervention to Prevent Substance-exposed Pregnancy (C4H)

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The University of Texas System (UT)




Prenatal Alcohol Exposure
Prenatal Marijuana Exposure
Prenatal Tobacco Exposure


Behavioral: Person-delivered C4H
Behavioral: Brief Advice
Behavioral: Computer tablet-delivered C4H

Study type


Funder types




Details and patient eligibility


This is a 4-year randomized, controlled study to test the efficacy of the CHOICES4Health-T (C4H-T) delivered by a computerized tablet, CHOICES4Health-C (C4H-C), delivered by a counselor, and brief advice (BA), on reducing preconception substance-exposed pregnancy risk (i.e. drinking below risk levels; tobacco and marijuana cessation; effective contraception use) among women (aged 18-44) presenting to the 13 primary care clinics that serve adults within the Harris Health System. Given the natural fit between contraceptive and HIV prevention counseling the CHOICES4Health interventions will also target HIV sexual risk behaviors.

Full description

A randomized group design (N = 240) will be used to test the efficacy of the C4H-C and C4H-T interventions relative to Brief Advice (BA) to reduce the risk of substance-exposed pregnancy) SEP in preconception women of childbearing age. Follow-up assessments will be conducted at 3, 6, and 9 months. Each of the substances targeted in this study (risk drinking, cigarette smoking, and marijuana use) is commonly used relative to other substances and is singly or jointly associated with risk for poor fetal outcomes. Thus, women who are not using effective contraception (i.e., use of effective birth-control methods during all vaginal intercourse) and have any one or more substance-risk behaviors in the 30 days before intake will be eligible for the study. Urn randomization will be used to stratify women on all three substance-risk behaviors to ensure a balanced number of women presenting with alcohol-exposed pregnancy (AEP), tobacco-exposed pregnancy (TEP), and marijuana-exposed pregnancy (MEP) risks across the three study conditions. To address risk distribution for women who present with more than one risk behavior the urn randomization will also be programmed to balance single risk and multiple risk women across the study conditions. In sum, the urn randomization will include four assignment criteria: AEP, TEP, MEP, and multiple risks. Finally, different numbers of women will be needed for each type of substance-exposed pregnancy risk in order to provide sufficient power for the investigator's analytic tests. For example, approximately 25% more women at risk of AEP are required than for TEP to attain the same power. The investigators will include over sampling rules and stopping rules to ensure adequate recruitment for AEP, TEP, and MEP.


219 patients




18 to 44 years old


Accepts Healthy Volunteers

Inclusion and exclusion criteria

Inclusion Criteria: Women who:

  • are 18-44 years old;
  • have no condition causing infertility (e.g., tubal ligation, hysterectomy, menopause);
  • are not pregnant or planning to become pregnant in the next 12 months;
  • are available for the follow-up period;
  • had vaginal intercourse during the previous 30 days with a fertile man and did not use effective contraception every time AND are drinking at risk levels (more than 3 drinks/day or more than 7 drinks/week); OR are reporting marijuana use in the previous month, OR are currently smoking cigarettes (at least weekly use) during the 30-day baseline period.

Exclusion Criteria: Women who:

  • have severe cognitive, and/or psychiatric impairment that precludes cooperation with study protocol, per judgment of the C4H interventionist or research staff;
  • are unable to read, write, and speak English or Spanish;
  • are unable or unwilling to meet study requirements, including followup assessments.

Trial design

Primary purpose




Interventional model

Parallel Assignment


Single Blind

219 participants in 3 patient groups

Computer tablet-delivered C4H
Experimental group
Two session CHOICES4Health intervention delivered by a computer tablet to address no use or ineffective use of contraception, and risky alcohol use, or cigarette smoking, or marijuana use.
Behavioral: Computer tablet-delivered C4H
Person-delivered C4H
Experimental group
Two session CHOICES4Health intervention delivered by a counselor to address no use or ineffective use of contraception, and risky alcohol use, or cigarette smoking, or marijuana use.
Behavioral: Person-delivered C4H
Brief Advice
Active Comparator group
Women will receive advice and educational material from a research assistant about risk drinking, smoking, marijuana, and contraception, depending on their specific risk behaviors, as well as information about women's health. In addition, the women will receive referrals to the Harris Health System's SBIRT clinic if needed.
Behavioral: Brief Advice

Trial documents

Trial contacts and locations



Data sourced from

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