Adaptive Text Messaging Intervention for Postpartum Risky Drinking

Risky drinking is prevalent among women of reproductive age. More than half of women who reduce their alcohol use during pregnancy return to pre-pregnancy levels three months after giving birth. The postpartum period is a time of high risk for increases in alcohol use, due to fluctuating hormones, lack of sleep and the stress of caring for a newborn. Risky drinking can impair a mother’s ability to care for her baby. It is associated with increased risk of child abuse, neglect and poor long-term child outcomes.

While treatments for risky drinking exist, postpartum women may be unlikely to seek formal treatment due to stigma and fear of child protective services involvement. Text messaging is a promising strategy for reaching this population of risky drinkers, as it is convenient and anonymous, and can reach large numbers of people at relatively low cost.

While text messaging interventions for alcohol use exist, no program is specifically tailored to the unique population of postpartum women. We are developing a just-in-time adaptive text messaging intervention for postpartum risky drinkers that includes evidence-based behavior change interventions based on motivational interviewing and cognitive behavioral therapy.

Messages will target coping skills and motivation to avoid drinking, and will be adaptively tailored to fluctuations in stress, negative mood and self-efficacy. Development of the adaptive intervention will occur in partnership with postpartum women via iterative cycles of testing and user feedback. We will also conduct a pilot micro-randomized trial to assess feasibility of design and methods and obtain preliminary data to support a larger trial to test program impacts on risky drinking behavior.

• Prevent Child Abuse New Jersey
• Johns Hopkins Bloomberg School of Public Health