Implementing a Prospective Study of Women Seeking Abortion in the United States: Understanding and Overcoming Barriers to Recruitment

Alcoholism Clin & Exp Res

Wilsnack

Foster

et al. 2014

Self Cite

Background There is little information about pregnancy-related changes in alcohol use and factors contributing to changes among women with unwanted pregnancies. This study describes changes in alcohol use from before pregnancy recognition to during pregnancy and identifies important predictors of alcohol use severity among women with unwanted pregnancies. Methods Data are from the Turnaway Study of 956 women seeking pregnancy termination at 30 U.S. facilities between 2008 and 2010, some of whom were denied care because they were past the gestational limit of the facility where they were recruited and were still pregnant at the baseline interview, one week after termination-seeking. Predictors of alcohol use severity (a latent variable) were identified. Results 56% of the total sample reported any alcohol use the month before pregnancy recognition, with 23% reporting six or more drinks on an occasion. Among the total sample, 35% of those drinking before pregnancy recognition had quit and 20% had reduced one week after termination seeking. Among those denied terminations and still pregnant, 71% had quit and 14% had reduced. In a multivariate model predicting alcohol severity, younger age, still pregnant, one or more previous births, later gestation, childhood physical abuse, and marijuana and other drug use were associated with lower severity; having completed college, tobacco use, and recent physical violence were associated with higher severity. Conclusions The proportion of the total sample drinking before pregnancy recognition is similar to national samples of women of childbearing age while the proportion binge drinking appears higher. Of women denied terminations who were still pregnant, the proportion having quit is similar to other populations of pregnant women. More research is needed to examine whether pregnant women may be substituting alcohol for marijuana and other drugs. Interventions focusing on alcohol use severity during pregnancy may need to also focus on tobacco.

Section: Methodsmentioning

confidence: 99%

Section: Limitationsmentioning

confidence: 99%

Alcohol Use Before and During Unwanted Pregnancy

Alcoholism Clin & Exp Res

Wilsnack

Foster

et al. 2014

Self Cite

“…It is likely a consequence of the study requesting contact information and including 11 interviews over five years. As only 3% of potential participants declined participation after going through the informed consent process and learning that surveys would include questions about substance use (33), it is unlikely that non-participation is related to substance use.…”

Section: Discussionmentioning

confidence: 99%

“…Eligible sites had the highest gestational age limit of any provider within 150 miles. Details about the study sites have been described in detail elsewhere (33-35). …”

Section: Methodsmentioning

confidence: 99%

Which women are missed by primary health-care based interventions for alcohol and drug use?

Ralph

Wilsnack

et al. 2016

Addictive Behaviors

Background Women of reproductive age who binge drink or have alcohol-related problem symptoms (APS) and who do not use contraception are considered at risk of an alcohol-exposed pregnancy (AEP). In the U.S., efforts to prevent AEPs focus largely on delivering interventions in primary health care settings. While research suggests that these interventions are efficacious for women reached, it is unclear to what extent these interventions are likely to reach women at risk of AEPs. Methods Data are from the Turnaway Study, a study of 956 women seeking pregnancy termination at 30 U.S. facilities between 2008 and 2010, some of whom received and some of whom were denied terminations because they were past the gestational limit. We examined associations between binge drinking, APS, and drug use prior to pregnancy recognition and having a usual source of health care (USOC). Results Overall, 59% reported having a USOC. A smaller proportion with than without an APS reported a USOC (44 vs. 60%, p<.05) and a smaller proportion using than not using drugs reported a USOC (51 vs 61%, p<.05). This pattern was not observed for binge drinking. In multivariate analyses, an APS continued to be associated with lack of a USOC, while drug use was no longer associated with lack of a USOC. Conclusions As more than 40% did not have a USOC, with higher proportions among women with an APS, primary health-care based approaches to AEP prevention seem unlikely to reach the majority of women who have an APS and are at risk of an unintended pregnancy.

“…Written informed consent was obtained from all study participants. Study design details have been published previously (Dobkin et al, 2014; Gould et al, 2012; Upadhyay et al, 2014). …”

Section: Methodsmentioning

confidence: 99%

Moderators and mediators of the relationship between receiving versus being denied a pregnancy termination and subsequent binge drinking

Drug and Alcohol Dependence

Subbaraman

Delucchi

et al. 2016

Background Women who terminate pregnancies drink more subsequent to the pregnancy than women who give birth, including women who give birth after seeking to terminate a pregnancy. Methods Data are from the Turnaway Study, a prospective, longitudinal study of 956 women who sought to terminate pregnancies at 30 U.S. facilities. This paper focuses on the 452 women who received terminations just below facility gestational limits and 231 who were denied terminations because they presented just beyond facility gestational limits. This study examined whether baseline characteristics moderate the relationship between termination and subsequent binge drinking and whether stress, feelings about the pregnancy, and number of social roles mediate the relationship. Results Only having had a previous live birth modified the termination-binge drinking relationship. Among women with previous live births, binge drinking was reduced among women carrying to term compared to terminating the pregnancy. Among women who had not had a previous live birth, however, the reduction in binge drinking among those denied termination was not sustained over time, and binge drinking of those who had and had not had terminations converged by 2.5 years. Neither stress, negative emotions, nor social roles mediated effects on binge drinking. Positive emotions at one week mediated effects on binge drinking at six months, although positive emotions at two years did not mediate effects on binge drinking at 2.5 years. Conclusions Higher levels of binge drinking among those who terminate pregnancies do not appear due to stress or to negative emotions. Only parous women – and not nulliparous women – denied terminations experienced sustained reductions in binge drinking over time.