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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Drinking During Pregnancy.

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Strategy. Screening and Brief Intervention

Approach. Support preconception and prenatal programs that combine the use validated alcohol screening tools with brief interventions designed to motivate women to abstain from alcohol use during pregnancy

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Overview. Alcohol screening plus a brief intervention is an evidence-based primary care tool that has been shown to prevent or reduce alcohol consumption during pregnancy.[1] After screening for excessive alcohol use, a brief motivational intervention is used to encourage participants to reduce their alcohol consumption [1,2,3] Referral to treatment can be added to the screening and brief intervention to further bolster the likelihood that pregnant women will abstain from consuming alcohol.[4,5] Whether delivered in person or administered electronically, this strategy can help motivate women of reproductive age to abstain from drinking and reduce the number of alcohol-exposed pregnancies.[5,6]

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Direct Care (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Individual/Family-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of programs partnered with Title V adopting validated alcohol screening tools and evidence-based brief interventions. (Measures spread of best practices) Number of providers trained to administer alcohol screening and brief interventions. (Assesses scale of workforce development)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of providers reporting competency in delivering alcohol screening and brief intervention. (Assesses workforce capacity) Percent of brief interventions providing appropriate resources and referrals. (Evaluates responsiveness to community needs)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of community-based organizations partnered with to promote alcohol screening. (Measures cross-sector collaboration) Number of programs establishing ongoing implementation support mechanisms. (Assesses sustainability infrastructure) Number of individuals demonstrating increased knowledge after alcohol screening and intervention. (Shows cognitive impacts) Number of alcohol-related birth outcomes prevented through early intervention. (Projects averted adverse consequences)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of individuals, segmented by key variables, screened for alcohol use in affiliated programs. (Evaluates delivery) Percent of care sites in communities facing significant challenges with implementing regular alcohol screening. (Assesses focus on understanding challenges) Percent decrease in alcohol use during pregnancy across all groups. (Shows impact on behavioral health) Percent reduction in adverse birth outcomes attributable to prenatal alcohol exposure, assessed by key characteristics. (Demonstrates mitigation of negative health outcomes)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Luong, J., Board, A., Gosdin, L., Dunkley, J., Thierry, J. M., Pitasi, M., & Kim, S. Y. (2023). Alcohol Use, Screening, and Brief Intervention Among Pregnant Persons - 24 U.S. Jurisdictions, 2017 and 2019. MMWR. Morbidity and mortality weekly report, 72(3), 55–62.

[2] US Preventive Services Task Force, Curry, S. J., Krist, A. H., Owens, D. K., Barry, M. J., Caughey, A. B., Davidson, K. W., Doubeni, C. A., Epling, J. W., Jr, Kemper, A. R., Kubik, M., Landefeld, C. S., Mangione, C. M., Silverstein, M., Simon, M. A., Tseng, C. W., & Wong, J. B. (2018). Screening and Behavioral Counseling Interventions to Reduce Unhealthy Alcohol Use in Adolescents and Adults: US Preventive Services Task Force Recommendation Statement. JAMA, 320(18), 1899–1909.

[3] Mitchell, A. M., Porter, R. R., Pierce-Bulger, M., & McKnight-Eily, L. R. (2020). Addressing Alcohol Use in Pregnancy. The American journal of nursing, 120(7), 22–24.

[4] Martino, S., Ondersma, S. J., Forray, A., Olmstead, T. A., Gilstad-Hayden, K., Howell, H. B., Kershaw, T., & Yonkers, K. A. (2018). A randomized controlled trial of screening and brief interventions for substance misuse in reproductive health. American journal of obstetrics and gynecology, 218(3), 322.e1–322.e12

[5] Yonkers, K. A., Dailey, J. I., Gilstad-Hayden, K., Ondersma, S. J., Forray, A., Olmstead, T. A., & Martino, S. (2020). Abstinence outcomes among women in reproductive health centers administered clinician or electronic brief interventions. Journal of substance abuse treatment, 113, 107995.

6] Tzilos Wernette, G., Plegue, M., Kahler, C. W., Sen, A., & Zlotnick, C. (2018). A Pilot Randomized Controlled Trial of a Computer-Delivered Brief Intervention for Substance Use and Risky Sex During Pregnancy. Journal of women's health (2002), 27(1), 83–92.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.