Reducing psychosocial and behavioral pregnancy risk factors: results of a randomized clinical trial among high-risk pregnant african american women

Am J Public Health. 2009 Jun;99(6):1053-61. doi: 10.2105/AJPH.2007.131425. Epub 2009 Apr 16.


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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • African Americans / psychology*
  • Behavior Therapy / methods*
  • Counseling / methods
  • Depressive Disorder / diagnosis
  • Depressive Disorder / prevention & control
  • Depressive Disorder / therapy
  • Female
  • Humans
  • Pregnancy / ethnology*
  • Pregnancy / psychology*
  • Pregnancy Outcome
  • Prenatal Care / methods*
  • Primary Health Care / methods
  • Regression Analysis
  • Risk Factors
  • Risk Reduction Behavior
  • Smoking / adverse effects
  • Smoking / psychology
  • Smoking Cessation / methods
  • Smoking Prevention
  • Spouse Abuse / diagnosis
  • Spouse Abuse / prevention & control
  • Spouse Abuse / psychology
  • Tobacco Smoke Pollution / adverse effects
  • Tobacco Smoke Pollution / prevention & control
  • Treatment Outcome
  • Young Adult


  • Tobacco Smoke Pollution