title: Comparing prenatal providers' approaches to four different risks: alcohol, tobacco, drugs, and domestic violence.
abstract: 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.
authors.affiliation: Division of Behavioral Sciences, University of California, San Francisco, CA 94117, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Herzig
authors.forename: Dung
authors.initials: D
authors.lastname: Huynh
authors.forename: Paul
authors.initials: P
authors.lastname: Gilbert
authors.forename: Dale W
authors.initials: DW
authors.lastname: Danley
authors.forename: Rebecca
authors.initials: R
authors.lastname: Jackson
authors.forename: Barbara
authors.initials: B
authors.lastname: Gerbert
mesh_terms: 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*