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This Article Figures Only Full Text Full Text (PDF) Supplemental Data All Versions of this Article: AJPH.2007.131425v1 99/6/1053    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Google Scholar Articles by Joseph, J. G. Articles by Subramanian, S. PubMed PubMed Citation Articles by Joseph, J. G. Articles by Subramanian, S. Related Collections Pregnancy Mental Health Prevention African Americans/Blacks Smoking Cessation Secondhand Smoke

Jill G. Joseph, MD, PhD, Ayman A. E. El-Mohandes, MD, MPH, Michele Kiely, DrPH, M. Nabil El-Khorazaty, PhD, Marie G. Gantz, PhD, Allan A. Johnson, PhD, LN, Kathy S. Katz, PhD, Susan M. Blake, PhD, LCP, Maryann W. Rossi, PhD and Siva Subramanian, MD

Jill G. Joseph is with the Children's Research Institute, Children's National Medical Center, Washington, DC. Ayman A E. El-Mohandes and Susan M. Blake are with the Department of Prevention and Community Health, George Washington University, Washington, DC. Michele Kiely is with the Division of Epidemiology, Statistics and Prevention Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD. M. Nabil El-Khorazaty and Marie G. Gantz are with the Statistics and Epidemiology Unit, Research Triangle Institute International, Rockville, MD. Allan A. Johnson is with the Nutritional Sciences Department, Howard University, Washington, DC. Kathy S. Katz and Siva Subramanian are with the Pediatrics Department, Georgetown University, Washington, DC. Maryann W. Rossi is with the Pediatrics Department, Children's National Medical Center, Washington, DC.

Correspondence: Requests for reprints should be sent to Michele Kiely, DrPH, Eunice Kennedy Shriver National Institute of Child Health and Human Development/NIH, 6100 Executive Blvd, Rm 7B-05, Rockville, MD 20852-7510 (e-mail: kielym{at}nih.gov).

Objectives. We evaluated the efficacy of a primary care intervention targeting pregnant African American women and focusing on psychosocial and behavioral risk factors for poor reproductive outcomes (cigarette smoking, secondhand smoke exposure, depression, and intimate partner violence).

Methods. Pregnant African American women (N = 1044) were randomized to an intervention or usual care group. Clinic-based, individually tailored counseling sessions were adapted from evidence-based interventions. Follow-up data were obtained for 850 women. Multiple imputation methodology was used to estimate missing data. Outcome measures were number of risks at baseline, first follow-up, and second follow-up and within-person changes in risk from baseline to the second follow-up.

Results. Number of risks did not differ between the intervention and usual care groups at baseline, the second trimester, or the third trimester. Women in the intervention group more frequently resolved some or all of their risks than did women in the usual care group (odds ratio = 1.61; 95% confidence interval = 1.08, 2.39; P = .021).

Conclusions. In comparison with usual care, a clinic-based behavioral intervention significantly reduced psychosocial and behavioral pregnancy risk factors among high-risk African American women receiving prenatal care.