***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Alcohol-exposed pregnancies ( AEPs ) are a preventable cause of birth defects and developmental disabilities for which many women are at risk . The initial 5-session Project CHOICES intervention was found to prevent AEPs . In the ensuing decade , there have been several additional CHOICES-like studies . This study , Project Healthy CHOICES , had 2 objectives : ( i ) to compare outcomes for students versus nonstudents ; and ( ii ) to test a self-administered mail-based version of the Project CHOICES intervention . METHODS A r and omized controlled trial ( RCT ) compared 2 interventions for women of childbearing age ( 18 to 44 ) who were at risk of an AEP : ( i ) motivational feedback based on Project CHOICES and ( ii ) information only . Advertisements recruited 354 women ( 145 college students ; 209 nonstudents ) at risk of an AEP . Intervention and study material s were available in English and Spanish . Of the 354 women , 44 % were minorities ( 25 % identified as Hispanics ) . RESULTS At the 6-month follow-up , the interventions did not differ and there was no Intervention by Student Study interaction . However , over the entire 6-month follow-up , significantly more students ( 68 % ) than nonstudents ( 46 % ) were not at risk of an AEP ( 2.1 odds ratio ; confidence interval = 1.47 to 2.95 ) . For all groups , risk reduction occurred primarily through effective contraception . CONCLUSIONS There was no significant difference between the 2 interventions . However , over the entire 6-month follow-up interval , college students were significantly more likely than nonstudents to not be at risk of an AEP and to use effective contraception . While the student groups had significantly higher reduced risk of AEP outcomes , there was also substantial risk reduction for women in the information only condition . These results suggest that the most effective AEP prevention efforts would be to inform women at risk that they could become pregnant . Because about half of all pregnancies are unplanned , identifying women at risk and preventing the risk of AEPs should be a public health priority BACKGROUND Fetal alcohol spectrum disorders ( FASD ) comprise a continuum of lifelong outcomes in those born prenatally exposed to alcohol . Although studies have shown no differences in rates by race , FASD is of particular concern for American Indian communities . One tribally run prevention program is the Oglala Sioux Tribe ( OST ) CHOICES Program , which is modeled after the evidence -based CHOICES program that was focused on preconceptional prevention of alcohol-exposed pregnancy ( AEP ) by reducing risky drinking in women at risk for pregnancy and /or preventing unintended pregnancy . METHODS The OST CHOICES Program was made culturally appropriate for American Indian women and implemented with 3 communities , 2 on the reservation and 1 off . Data on drinking , sexual activity , and contraception use were collected at baseline and 3 and 6 months postintervention . Data were analyzed using descriptive statistics , 1-way analysis of variance , and a r and om intercept generalized estimating equation model . RESULTS A total of 193 nonpregnant American Indian women enrolled in the OST CHOICES Program  , and all were at risk for AEP because of binge drinking and being at risk for an unintended pregnancy . Fifty-one percent of participants completed both 3- and 6-month follow-ups . Models showed a significant decrease in AEP risk from baseline at both 3- and 6-month follow-ups , indicating the significant impact of the OST CHOICES intervention . Women in the OST CHOICES Program were more likely to reduce their risk for AEP by utilizing contraception , rather than decreasing binge drinking . CONCLUSIONS Even with minor changes to make the CHOICES intervention culturally and linguistically appropriate and the potential threats to program validity those changes entail , we found a significant impact in reducing AEP risk . This highlights the capacity for the CHOICES intervention to be implemented in a wide variety of setting s and population ABSTRACT Background : Postpartum contraception is especially important for women who use alcohol and other substances , given the risk of possible rapid repeat pregnancy and prenatal substance exposure . However , little is known about postpartum contraceptive use among women with substance use histories . Objective : To characterize postpartum contraceptive  initiation , 24-month continuation , and rapid repeat pregnancy among women who used substances during pregnancy . Methods : This is a secondary analysis of 161 pregnant women who enrolled in a r and omized clinical trial to treat substance use in pregnancy and completed at least one follow-up assessment . Women were eligible if they were less than 28 weeks gestation and reported alcohol or illicit drug use within the past 30 days . Participants were recruited from two hospital-based OB/GYN clinics between 2006 and 2010 , and completed assessment s at delivery and 3- , 12- , and 24-months postpartum . Results : Past 30-day use of any substance ( not including tobacco ) was 52.4 % , 58.3 % , and 59.8 % at 3- , 12- , and 24-month follow-up , respectively . Marijuana was the most commonly reported illicit substance ( as high as 48.1 % ) . Rates of any contraceptive use were 71.3 % , 66.7 % and 65.3 % at 3- , 12- , and 24-month follow-up , respectively ; DepoProvera and condoms were the most common methods . Rapid repeat pregnancy occurred in 28 % of participants by 24-month follow-up . Conclusions / Importance : Postpartum contraceptive use among substance using women was at or near 70 % , which is comparable to other sample s of postpartum women . Innovative efforts are needed to promote effective contraceptive use among postpartum women in general and among those who use substances in particular BACKGROUND The study was conducted to determine whether perceived racial , economic and gender discrimination has an impact on contraception use and choice of method . METHODS We analyzed the first 2,500 women aged 14 - 45 years enrolled in the Contraceptive CHOICE Project , a prospect i ve cohort study aim ed to reduce barriers to obtaining long-acting reversible contraception . Items from the " Experiences of Discrimination " ( EOD ) scale measured experienced race- , gender- and economic-based discrimination . RESULTS Overall , 57 % of women reported a history of discrimination . Thirty-three percent reported gender- or race-based discrimination , and 24 % reported discrimination attributed to socioeconomic status ( SES ) . Prior to study enrollment , women reporting discrimination were more likely to report any contraception use ( 61 % vs. 52 % , p<.001 ) but were more likely to use less effective methods ( e.g. ,  barrier methods , natural family planning or withdrawal ;  41 % vs. 32 % , p<.001 ) . In adjusted analyses , gender- , race- or SES-based discrimination were associated with increased current use of less effective methods [ adjusted risk ratio ( aRR ) 1.22 , 95 % confidence interval ( CI ) 1.06 - 1.41 ; aRR 1.25 , CI 1.08 - 1.45 ; aRR 1.23 , CI 1.06 - 1.43 , respectively ] . After enrollment , 66 % of women with a history of experience of discrimination chose a  long-acting reversible contraceptive method ( intrauterine device  or implantable )  and 35 % chose a  depo-medroxyprogesterone acetate or contraceptive pill , patch or ring .  CONCLUSIONS Discrimination negatively impacts a woman 's use of contraception . However , after financial and structural barriers to contraceptive use were eliminated , women with EOD overwhelmingly selected effective methods of contraception . Future interventions to improve access and utilization of contraception should focus on eliminating barriers and targeting interventions that encompass race- , gender- and economic-based discrimination Objective To document the contraceptive choices and continuation rates for different contraceptives in a group of pregnant women who use opiates . Methods A prospect i ve study set in a large city in the north of Engl and that looked at 40 pregnant women who used opiates in the index pregnancy . The study involved review ing the records from the patients ' general practitioners with information on the continuation rates of the chosen method of contraception and any related problems . Results The women given Depo-Provera ® ( n = 14 ) did not continue the method after the first injection . Those given implants ( n = 20 ) had a 95 % continuation rate at a mean follow-up of over 11 months . Conclusions Implants had a good continuation rate when used for postnatal contraception in women who used opiates in pregnancy .  Depo-Provera may not be a suitable choice since all the women who chose this contraceptive method failed to continue with it Home visitation interventions show promise for helping at-risk mothers , yet few programs have been developed and evaluated specifically for alcohol and drug-abusing pregnant women . This study examines outcomes among 216 women enrolled in the Washington State Parent-Child Assistance Program , a three-year intervention program for women who abuse alcohol and drugs during an index pregnancy . Pretest-posttest comparison was made across three sites : the original demonstration ( 1991–1995 ) , and the Seattle and Tacoma replications ( 1996–2003 ) . In the original demonstration , the client group performed significantly better than controls . Compared to the original demonstration , outcomes at replication sites were maintained ( for regular use of contraception and use of reliable method ; and number of subsequent deliveries ) , or improved ( for alcohol/drug treatment completed ; alcohol/drug abstinence ; subsequent delivery unexposed to alcohol/drugs ) . Improved outcomes at replication sites are not attributable to enrolling lower-risk women . Public policies and programs initiated over the study period may have had a positive effect on outcomes . Study findings suggest that this community-based intervention model is effective over time and across venues Many college women are at risk for pregnancy , and binge drinking college women are often at risk for alcohol-exposed pregnancy . Brief interventions with sustainable outcomes are needed , particularly for college women who are binge drinking , at risk for pregnancy , and at increased risk of alcohol-exposed pregnancy . Two-hundred-twenty-eight women at a Mid-Atlantic urban university at risk for alcohol-exposed pregnancy enrolled in the r and omized clinical trial , and 207 completed the 4 month follow-up . The BALANCE intervention used Motivational Interviewing plus feedback to target drinking and contraception behaviors . Main outcome measures included ( 1 ) the rate of risk for alcohol-exposed pregnancy , ( 2 ) the rate of risk drinking , and ( 3 ) the rate of pregnancy risk . At 4-month follow-up , the rate of alcohol-exposed pregnancy risk was significantly lower in the intervention ( 20.2 % ) than the control condition ( 34.9 % ) , ( P < .02 ) . Assignment to the intervention condition halved the odds of women remaining at risk for alcohol-exposed pregnancy , while not receiving the intervention doubled the odds of continued alcohol-exposed pregnancy risk ( OR = 2.18 ; 95 % CI = 1.16–4.09 ) . A baseline history of blackouts , continued high blood alcohol drinking days at 1 month , and continued risk for pregnancy at 1 month independently contributed to a multivariate model of continued alcohol-exposed pregnancy risk at 4 month follow-up . BALANCE reduced alcohol-exposed pregnancy risk , with similar outcomes to longer interventions . Because early response predicted sustained alcohol-exposed pregnancy risk reduction , those who fail to achieve initial change could be identified for further intervention . The BALANCE intervention could be adopted into existing student health or university alcohol programs . The risks of unintended pregnancy and alcohol-exposed pregnancy among binge drinking women in college merit greater prevention efforts A significant number of college women are at risk for alcohol-exposed pregnancy ( AEP ) owing to binge drinking paired with using contraception ineffectively . This article describes a r and omized controlled trial of a one-session motivational interviewing-based intervention to reduce AEP risk among college women and presents 1-month outcomes demonstrating the early impact of this intervention . There were 228 female students from a mid-Atlantic urban university enrolled in the trial . Eligibility criteria were being in the age range of 18 - 24 years and being at risk for AEP .  Risk for AEP was defined as having sexual intercourse with a man in the past 90 days while using contraception ineffectively ( no use , incorrect use of an effective method , or use of an ineffective method only ) ; drinking at risky levels was defined as engaging in at least one binge in the past 90 days or consuming an average of eight st and ard drinks per week . One-month outcome data were available for 212 of the 228 enrolled women ( a follow-up rate of 93 % ) , with complete data available for 105 women assigned to the control condition and 94 assigned to the intervention condition . At 1-month follow-up , 15 % of the control subjects and 25 % of the intervention women reported no risk drinking , a significant difference favoring the intervention group . Significantly fewer control subjects ( 48 % ) used effective contraception  at 1-month follow-up as compared with intervention women ( 64 % ) , chi(2)(1 ) = 5.1 , p < .03 . Significantly more intervention 
    Output:
    
Interventions based on behavior change theory yielded an increase in the initiation of effective contraception as compared with provision of written information material s. The effect was more pronounced when the intervention provided on-site contraceptive counseling and free access to birth control .
Financial incentives also seemed to effectively increase women 's contraception intake .
Case management interventions including pregnant and postpartum women with heavy levels of substance use showed promising results in terms of initiation of contraception , but rates of unintended pregnancy over long-term follow-up were nevertheless elevated .
Finally , some interventions integrated family planning services into specialized centers taking care of pregnant and postpartum women with substance abuse .
All interventions with a primary or secondary focus on the prevention of unintended pregnancy in women using psychoactive substances short-term improvements in contraception intake , but it is unclear if these effects last or have any impact on unintended pregnancy rates in the long-term