Comparing prenatal providers' approaches to four different risks: alcohol, tobacco, drugs, and domestic violence.
OBJECTIVE
We explored prenatal care providers' methods for addressing four behavioral risks in their pregnant patients: alcohol use, smoking, drug use, and domestic violence.


METHODS
We used qualitative, purposively sampled, focus group data.


METHODS
Groups met in professional focus group settings.


METHODS
We conducted six focus groups (five with OB/Gyn physicians, one with nurse practitioners and certified nurse midwives), with a total of N = 49.


METHODS
The moderator used a focus group guide with open-ended questions, with probes where appropriate.


RESULTS
Providers' discussions reflected differences in how they approach each risk, including: (1) ambivalence about abstinence messages for alcohol; (2) relative comfort and confidence about assessing smoking and counseling to reduce smoking; (3) disparities across practice settings for toxicology screening for drugs; and (4) discomfort and pessimism with domestic violence. Investigators also analyzed providers' statements for each risk within the framework of the "Five A's" construct (Assess, Advise, Agree, Assist, and Arrange) for evaluating risk behavior interventions.


CONCLUSIONS
A comparison of each risk across the Five A's illuminates the gaps between recommended and actual prevention methods and suggests directions for development of interventions and educational efforts.
Herzig
Karen
K
Division of Behavioral Sciences, University of California, San Francisco, CA 94117, USA.
Huynh
Dung
D
Gilbert
Paul
P
Danley
Dale W
DW
Jackson
Rebecca
R
Gerbert
Barbara
B
D000328:Adult; D000428:Alcohol Drinking / Q000517:prevention & control*; D003376:Counseling / Q000379:methods*; D017579:Domestic Violence / Q000517:prevention & control*; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011247:Pregnancy; D011248:Pregnancy Complications; D011295:Prenatal Care; D012307:Risk Factors; D012309:Risk-Taking; D012495:San Francisco; D016540:Smoking Cessation; D000074606:Smoking Prevention; D012944:Social Support; D019966:Substance-Related Disorders / Q000517:prevention & control*