Understanding how change occurs for women of childbearing age : the role of depression and marijuana use on reducing alcohol consumption

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Alcohol and marijuana are reportedly two of the most pervasively used substances in the United States among women of childbearing age (18-44 years). About 10–50% of childbearing-aged women report drinking alcohol and are at risk of an Alcohol-Exposed Pregnancy (AEP). As for marijuana use, about 9.5% of women of childbearing age report marijuana use in the past month, and use has been steadily increasing since 2007. Further compounding concerns for women include mental health disorders like depression. Among women of childbearing age, studies have estimated that about 8-16% suffer from depression. Furthermore, it is all too common for both substance use and mental health disorders to co-occur. Comorbid substance use and mental health disorders among women of childbearing age have emerged as a particularly significant area of concern. However, a key obstacle in further understanding the relationship between these disorders among women, in general, is that women either do not report, or under-report substance abuse and mental health symptoms, and may not be aware of the concerns associated with substance use while at risk for pregnancy. Therefore, it is critical to find a setting where women can receive information about alcohol- and substance-exposed pregnancies, while also identifying and treating these co-occurring disorders. This dissertation explores the feasibility of meeting these needs through primary care settings. Primary care, identified as an “opportunistic setting,” is often the first setting substance use and mental disorders are detected and addressed. However, comorbidity in primary care has not been explored in detail, more so for women of childbearing age, and requires further examination. Alcohol use, marijuana use, and depression are all critical issues for childbearing-aged women, and often occur concurrently, yet research is limited and needs further attention. Therefore, this dissertation aims to better understand comorbid alcohol use and depression, and comorbid alcohol use and marijuana use among women of childbearing age presenting in primary care. To do so, this dissertation draws upon the Transtheoretical Model of Change to study a sample of women from the CDC-funded CHOICES Plus study who were at risk of an AEP.



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