Lyn Blackshaw, John Anderson, Lesa Dixon-Gray, Emily Havel Oregon BALANCE

BALANCE Birth control Birth control ALcohol ALcohol Awareness Awareness Negotiating Negotiating Choices Choices Effectively Effectively

Binge Drinking A pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 percent or above. A pattern of drinking alcohol that brings blood alcohol concentration (BAC) to 0.08 percent or above. For a typical adult, this pattern corresponds to consuming 5 or more drinks (male) or 4 or more drinks, (female) in about two hours. For a typical adult, this pattern corresponds to consuming 5 or more drinks (male) or 4 or more drinks, (female) in about two hours. National Institute on Alcohol Abuse and Alcoholism (NIAAA)

The Dangers of Binge Drinking For Women  Death or injury due to falls, fires, drowning, or a drunk driving crash. Pregnancy or sexually transmitted diseases due to unintended sexual activity. (Frequent binge drinkers are five times more likely to have unplanned and unprotected sex.) Pregnancy or sexually transmitted diseases due to unintended sexual activity. (Frequent binge drinkers are five times more likely to have unplanned and unprotected sex.) Being the victim of rape, date rape or other assault. Being the victim of rape, date rape or other assault. Death from alcohol poisoning. Death from alcohol poisoning.

The Dangers of Risky Drinking and Sex When a woman engages in risky or binge drinking, is sexually active and doesn’t use birth control, she is at greater risk for: When a woman engages in risky or binge drinking, is sexually active and doesn’t use birth control, she is at greater risk for: Becoming pregnant Becoming pregnant Having a baby with birth defects or brain damage caused by heavy drinking, such as Fetal Alcohol Syndrome Having a baby with birth defects or brain damage caused by heavy drinking, such as Fetal Alcohol Syndrome

Over half of all pregnancies in the United States are unplanned.

Most women who drink alcohol will continue to drink until their pregnancy is confirmed, four to eight weeks after conception. (CD Summary Sept 2007) (CD Summary Sept 2007)

Background Alcohol is a leading preventable cause of birth defects in the United States. Alcohol is a leading preventable cause of birth defects in the United States. Many women continue to drink alcohol during the early critical weeks of gestation before they know they are pregnant. Many women continue to drink alcohol during the early critical weeks of gestation before they know they are pregnant. Some women continue to drink alcohol throughout their pregnancy, unaware that it can harm their baby. Some women continue to drink alcohol throughout their pregnancy, unaware that it can harm their baby.

Project Summary  Increase knowledge and awareness of the risks and consequences of an alcohol exposed pregnancy among sexually active and binge drinking college women.  Using a Motivational Interviewing approach, encourage participants to set and maintain declared goals to decrease their drinking and increase their effective use of birth control methods.

The Desired Outcomes Reduced risk of alcohol exposed pregnancies among at-risk women as measured by: Improved birth control Improved birth control Reduced binge drinking Reduced binge drinking

Motivational Interviewing  Refers to a counseling approach developed by clinical psychologists Professor William R Miller, Ph.D. and Professor Stephen Rollnick, Ph.D.  A client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence.

Motivational Interviewing  Motivational interviewing is non-judgmental, non-confrontational and non-adversarial. The approach attempts to increase the client's awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behavior in question. The approach attempts to increase the client's awareness of the potential problems caused, consequences experienced, and risks faced as a result of the behavior in question.

Why College Women? The higher a woman’s educational level, the more likely she is to drink. The higher a woman’s educational level, the more likely she is to drink. Of all Oregon women ages who reported drinking: Of all Oregon women ages who reported drinking: 65% are college graduates 65% are college graduates 25% had not completed high school 25% had not completed high school (Oregon Behavioral Risk Factor Surveillance System) (Oregon Behavioral Risk Factor Surveillance System)

College Students and Alcohol In a 2005 nationwide survey, 44.8% of college students were classified as binge drinkers In a 2005 nationwide survey, 44.8% of college students were classified as binge drinkers Binge drinking peaks from ages 18 to 23 Binge drinking peaks from ages 18 to SAMHSA National Survey on Drug Use and Health

The Locations Participants from the University of Oregon (16,674 undergraduate students, 52% women ) Participants from the University of Oregon (16,674 undergraduate students, 52% women ) Western Oregon University (4,459 undergraduate students, 58% women ) Western Oregon University (4,459 undergraduate students, 58% women )

The Interviewers Three interventionists with master’s level training in counseling Three interventionists with master’s level training in counseling Provided counseling to participants in the form of two motivational interviewing sessions Provided counseling to participants in the form of two motivational interviewing sessions Received monthly clinical supervision and ongoing Motivational Interviewing training Received monthly clinical supervision and ongoing Motivational Interviewing training

The Materials Blood Alcohol Level Chart Blood Alcohol Level Chart Birth Control Flip Chart Birth Control Flip Chart Participant Guide Participant Guide Information about alcohol and birth control Information about alcohol and birth control Drink size information Drink size information Drink costs and calories Drink costs and calories

Blood Alcohol Table (Women) After 1 hour of drinking and Body Weight After 1 hour of drinking and Body Weight Number of Drinks

Useless Observation  Statistics show that teen pregnancy drops off significantly after age 25. (Mary Acer, Republican state senator from Colorado Springs) (Mary Acer, Republican state senator from Colorado Springs)

The Screening Questions 1. During the past 3 months, was there ever a time when you consumed 4 or more alcoholic drinks on any one drinking occasion? 2. During the past 3 months, was there ever a time when you consumed 8 or more alcoholic drinks in one week? 3. As far as you know, are you physically able to get pregnant?

Screening Questions Cont. 4. Have you had sexual intercourse during the past 3 months? 5. When you had sexual intercourse in the past three months how often did you use contraceptives?

The Participants U of O WOUTotal Number of women completing screening Number of women screened eligible Number of women eligible who provided contact information Number of women who completed first set of core questions Number of women who completed second core questions

The Recruitment Before Don’t Open This (>9/15/2007) During Don’t Open This – 661 responses Reached through Don’t Open This – 32% Reached through other means – 68% 180 responses Fact card or poster Website Campus paper Bar or restaurant RadioClass Dorm or sorority 210 responses Health center Friend or acquaintance Other (not specified or no answer) 444 responses

The Ages UOWOUtotals %47.8%41.1% %43.5%40.4% %8.7%18.5% 100%

The Intervention  Session Face-to-Face (60 minutes)  Reminder phone call 1 month later  Session Face-to-Face (20 minutes)  3 months after Session 1 Incentives: U of O: Gift cards given after Session 1 and at the end of the intervention WOU: One gift card after Session 2

Session 1 Comments  “ Drinking is part of the culture.”  “I consider myself a light drinker.”  “I’m not interested in changing my drinking behavior.”

Session 1 Participant acknowledged that she blacked out last Friday but she felt that since other students drink much more than she does that she doesn’t have a problem. Participant acknowledged that she blacked out last Friday but she felt that since other students drink much more than she does that she doesn’t have a problem. Interviewer note: She seems to be a high risk drinker, frequently binging but not identifying this as an area of her life that she would like to change. Interviewer note: She seems to be a high risk drinker, frequently binging but not identifying this as an area of her life that she would like to change.

Alcohol Use Most Drinks in One Day, 30-day retrospective Mean Session Session P = 0.005, N = 214

Alcohol Use Instances of 4 or More Drinks, 30-day retrospective Mean Session Session P = 0.016, N = 214

Readiness to Drink Less Readiness to drink 3 or less (scale 1-10) Mean Session Session P = 0.017, N = 205

Readiness to Use Birth Control Scale of 1-10 Mean Session Session P = 0.70, N = 208

Effective Birth Control Use n = 215 Used any method Used all methods effectively Session 1 98%82% Session295%79% P = 0.10 P = 0.27

Not At-Risk* for Alcohol Exposed Pregnancy 30-day and 3-month retrospective 3 months 30 days Interview 1 Interview 2 Interview 1 Interview (82%) 178 (83%) 183 (85%) 185 (86%) * As defined by the CDC at the grantees meeting: no instances of risky drinking or effective use of birth control. In our data risky drinking is 4 or more drinks in a row, effective use of birth control is at least one method used effectively. P = 0.88 P = 0.77 N = 215

Session 2 Comments “I didn’t know about early term pregnancies being affected. I told a friend who thought she might be pregnant. I also noticed that I’m monitoring. Is it time to stop or not? We’ve had a few big parties and I kept thinking about this. So, when I am enjoying being buzzed at 3 then I realize that I probably don’t need a 4th.” --Participant “I didn’t know about early term pregnancies being affected. I told a friend who thought she might be pregnant. I also noticed that I’m monitoring. Is it time to stop or not? We’ve had a few big parties and I kept thinking about this. So, when I am enjoying being buzzed at 3 then I realize that I probably don’t need a 4th.” --Participant “After our conversation I really am conscious of how much I drink each time I’m out with friends. I haven’t gone past three drinks in a long time and I try to drink them slowly. I’ve been listening to my body and I’ve started to talk to some of my friends about alcoholism.” --Participant “After our conversation I really am conscious of how much I drink each time I’m out with friends. I haven’t gone past three drinks in a long time and I try to drink them slowly. I’ve been listening to my body and I’ve started to talk to some of my friends about alcoholism.” --Participant

Session 2 “I didn’t think this study would have affected me as much as it did.” –Participant “I didn’t think this study would have affected me as much as it did.” –Participant “I did talk to a few friends about the interview…I do remember being really excited after the interview. I have decided that drinking is too much of a high risk game to take lightly…….I’ve figured out that getting completely drunk (to the point of not remembering what happened) is never again going to be an option for me EVER.” ---Participant “I did talk to a few friends about the interview…I do remember being really excited after the interview. I have decided that drinking is too much of a high risk game to take lightly…….I’ve figured out that getting completely drunk (to the point of not remembering what happened) is never again going to be an option for me EVER.” ---Participant

The Results Women who said the BALANCE interview and Blood Alcohol Table got them thinking and being more careful – 95 (93%) Women who said the BALANCE interview and Blood Alcohol Table got them thinking and being more careful – 95 (93%) Women who discussed what they had learned in Balance with their friends – 39 (38%) Women who discussed what they had learned in Balance with their friends – 39 (38%) Those who claimed to have reduced their drinking at the Second Interview – 52 (51%) Those who claimed to have reduced their drinking at the Second Interview – 52 (51%)

The Results BALANCE documented a decrease in drinking in the intervention population BALANCE documented a decrease in drinking in the intervention population Birth control use was high, however effective use was lower Birth control use was high, however effective use was lower Women who completed both Women who completed both interviews showed approximately the same risk of AEP

The Conclusion Participants claimed to use birth control effectively. Participants claimed to use birth control effectively. Alcohol use among women in this program was high. Alcohol use among women in this program was high. Increasing effective use of birth control and further reductions in drinking would decrease risk of AEP. Increasing effective use of birth control and further reductions in drinking would decrease risk of AEP.

For More Information Contact:  Lesa Dixon-Gray, Project Coordinator office office  John Anderson, Data Manager  Emily Havel, Office of Family Health  