Caron Zlotnick

Background: Sexually transmitted infections (STIs) are at a record high in the United States and are a significant health problem for childbearing women. Rates of substance use, particularly cannabis and opioid use, have increased in recent years and are linked to negative health consequences for pregnant women and their infants. Addressing these health concerns together during this vulnerable time is a priority. Objective: This study aims to test whether the Health Check-Up for Expectant Moms (HCEM), an innovative, theory-driven, technology-delivered, and fully automated brief intervention, reduced condomless sex and STI risk, alcohol, or drug use, compared to a control condition in pregnant women seeking prenatal care. Methods: We recruited a sample of 176 pregnant women (all were at risk for alcohol or drug use or STIs during pregnancy) from clinics and using social media campaigns (Facebook and Instagram) in the state of Michigan and randomized them to the motivational interviewing-consistent HCEM intervention or to an attention-, time-, and information-matched control condition delivered using the same technology platform. We followed these women at 2 and 6 months after the initial intervention visit. Primary outcomes included self-report assessment of alcohol, drug, or cannabis use and unprotected sexual occasions during pregnancy. Results: A total of 88 women were randomized to the intervention, and 88 to the control condition. Cannabis use was the most prevalent substance reported during pregnancy; a total of 35.2% (62/176) reported recent use (within the last 90 days) at baseline, with 10.2% (18/176) reporting use in the month prior to baseline. There were significant reductions in alcohol and cannabis use over time during pregnancy (at 2 and 6 months compared to baseline) in both HCEM and control groups; however, these reductions were not significantly different between conditions (time-by-arm interaction), and most were sustained from spontaneous reductions reported in the month before study enrollment. Moreover, there were no statistically significant differences in the change pattern of condomless sex across the groups at either follow-up. Conclusions: There are many potential benefits of a technology-delivered approach to support the behavioral health of pregnant women in a private and convenient way. Our sample was largely low-risk, and as such, an intervention effect may have been impossible to observe given substantial self-change. Future trials are needed to examine efficacy in other samples of pregnant women with a higher risk of current alcohol or drug use. Trial Registration: ClinicalTrials.gov NCT03826342; https://clinicaltrials.gov/study/NCT03826342 International Registered Report Identifier (IRRID): RR2-10.2196/30367

BACKGROUND Sexually transmitted infections (STIs) are at a record high in the United States and are a significant health problem for childbearing women. Rates of substance use, particularly cannabis and opioid use, have increased in recent years and are linked to negative health consequences for pregnant women and their infants. Addressing these health concerns together during this vulnerable time is a priority. OBJECTIVE This study aims to test whether the Health Check-Up for Expectant Moms (HCEM), an innovative, theory-driven, technology-delivered, and fully automated brief intervention, reduced condomless sex and STI risk, alcohol, or drug use, compared to a control condition in pregnant women seeking prenatal care. METHODS We recruited a sample of 176 pregnant women (all were at risk for alcohol or drug use or STIs during pregnancy) from clinics and using social media campaigns (Facebook and Instagram) in the state of Michigan and randomized them to the motivational interviewing-consistent HCEM intervention or to an attention-, time-, and information-matched control condition delivered using the same technology platform. We followed these women at 2 and 6 months after the initial intervention visit. Primary outcomes included self-report assessment of alcohol, drug, or cannabis use and unprotected sexual occasions during pregnancy. RESULTS A total of 88 women were randomized to the intervention, and 88 to the control condition. Cannabis use was the most prevalent substance reported during pregnancy; a total of 35.2% (62/176) reported recent use (within the last 90 days) at baseline, with 10.2% (18/176) reporting use in the month prior to baseline. There were significant reductions in alcohol and cannabis use over time during pregnancy (at 2 and 6 months compared to baseline) in both HCEM and control groups; however, these reductions were not significantly different between conditions (time-by-arm interaction), and most were sustained from spontaneous reductions reported in the month before study enrollment. Moreover, there were no statistically significant differences in the change pattern of condomless sex across the groups at either follow-up. CONCLUSIONS There are many potential benefits of a technology-delivered approach to support the behavioral health of pregnant women in a private and convenient way. Our sample was largely low-risk, and as such, an intervention effect may have been impossible to observe given substantial self-change. Future trials are needed to examine efficacy in other samples of pregnant women with a higher risk of current alcohol or drug use. CLINICALTRIAL ClinicalTrials.gov NCT03826342; https://clinicaltrials.gov/study/NCT03826342 INTERNATIONAL REGISTERED REPORT RR2-10.2196/30367

Transgender (trans) women are disproportionately impacted by adverse health outcomes compared to their cisgender counterparts, including mental health challenges, HIV and other sexually transmitted infections, and intimate partner violence (IPV). In response, we developed the Supporting Trans women, Affirmation, Relationships, and Sex (STARS) program-a peer-delivered intervention that aims to promote gender affirmation, empowerment, and HIV prevention for trans women who have experienced IPV. STARS comprises four ∼1-hr individual peer-counseling sessions delivered over 6 weeks focused on safety planning, resource referrals, and HIV prevention. We used a convergent, mixed methods, randomized controlled trial design to evaluate the program's feasibility, acceptability, and explore preliminary efficacy. Thirty-seven participants were randomly assigned to the intervention (n = 19) or a time- and attention-matched control (n = 18) and completed assessments at baseline, postintervention, and 4- and 6-month follow-up. Findings demonstrate high intervention satisfaction (M = 3.29, SD = 0.48, range [1-4]) and low attrition (5.26% at 6-month follow-up). Thematic analysis of exit interviews revealed strong qualitative endorsements of resource referrals, self-empowerment content, and peer counselor relationships. Findings from exploratory intent-to-treat analyses showed greater improvements in posttraumatic stress disorder symptoms (β = -.28; p = .019), depressive symptoms (β = -0.23; p = .037), and empowerment related to IPV safety (β = .23; p = .02) in the intervention compared to control. There were no between-group differences in instances of IPV (p = .45) or general self-efficacy (ps ≥ .39). HIV-vulnerable condomless anal sex was infrequent and insufficient to support a stable model estimation. These results provide initial empirical support for STARS as an effective intervention to improve mental health and self-empowerment outcomes among transfeminine individuals who have experienced IPV. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Participants in qualitative interviews designed to optimize the adaptation of a maternal postpartum depression intervention into a novel smartphone app noted that the app could be more useful if were delivered simultaneously to both parents; this calls for additional research on the feasibility and effectiveness of digital dyadic or stand-alone partner interventions to prevent postpartum depression.

The present study presents a longitudinal examination of the impact of cyber abuse (CA) on posttraumatic stress disorder (PTSD) severity among a racially diverse sample of women with intimate partner violence (IPV). Using data collected from a completed randomized control trial with women who sought safety in a domestic violence shelter (W-DVS; N = 172), we conducted a secondary data analysis. Participants completed measures of CA, PTSD severity, and other types of IPV at each time point. To examine predictors of the latent change factor, we estimated the influence of CA on each latent change factor while controlling for other (i.e., noncyber abuse) types of IPV and treatment condition across time. Initial results suggested that CA has a negative impact on PTSD severity over time for W-DVS, as CA predicted changes in PTSD severity across five time points when controlling for treatment condition and PTSD symptom severity at the previous time points. However, CA did not predict a change in symptom severity when controlling for other forms of (noncyber abuse) IPV. Although more CA is associated with more severe PTSD symptoms from the time women are in shelter to postshelter, 3, 9, and 15 months postshelter, this is no longer the case when overall IPV is considered. This study extends our understanding of how CA can exacerbate psychological health consequences, including PTSD severity, of W-DVS, suggesting that cyber abuse should be assessed in tandem with other IPV types rather than as a separate phenomenon. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

UNSTRUCTURED Participants in qualitative interviews designed to optimize the adaptation of a maternal postpartum depression intervention into a novel smartphone app noted that the app could be more useful if were delivered simultaneously to both parents; this calls for additional research on the feasibility and effectiveness of digital dyadic or stand-alone partner interventions to prevent postpartum depression.

Little is known about how the interrelationships among posttraumatic stress disorder (PTSD) symptoms change throughout the treatment. We examined changes in PTSD symptoms among women who experienced intimate partner violence and received one of two evidence-based interventions. We conducted a secondary analysis of a completed randomized, double-blind clinical trial, which demonstrated efficacy in reducing PTSD symptoms. We used cross-lagged panel network analysis to identify the influential PTSD symptoms among women who had completed either the Helping to Overcome PTSD through Empowerment or an adapted version of person-centered therapy. We examined if a symptom's expected influence, a metric of interconnectedness, would predict overall PTSD symptom reductions at baseline, postshelter, posttreatment, and 6- and 12-months posttreatment. Women who showed more significant decreases in feeling upset and avoidance also demonstrated greater decreases in their overall PTSD symptoms at postshelter, posttreatment, and 6 and 12 months posttreatment. Findings indicate that changes in symptoms with high centrality result in larger PTSD network changes observed at both adjacent and future time points. Identifying and targeting symptoms with influential associations produce therapeutic cascades, resulting in symptom reductions. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Background: Sexual assault is prevalent on college campuses and most commonly is perpetrated by men. Problematically, there is a dearth of evidence-based prevention programs targeting men as perpetrators of sexual aggression. The Sexual Assault and Alcohol Feedback and Education (SAFE) program is an integrated alcohol and sexual assault prevention intervention for college men who engage in heavy drinking that aims to address sexual aggression proclivity and alcohol use outcomes by incorporating social norms theory, bystander intervention, and motivational interviewing. Objective: This study aims to examine the initial feasibility-, acceptability-, and efficacy-related outcomes of a randomized pilot trial of an integrated alcohol and sexual assault prevention program for college men who engage in heavy drinking. Methods: This study included 115 college men who engaged in heavy drinking, who were randomly assigned to the SAFE program or a mindfulness-based control condition (MBCC). The feasibility of implementation, adequacy of participant retention, fidelity and competency of program administration, and satisfaction and utility of the intervention were evaluated. The primary outcomes of alcohol use and sexual aggression were evaluated at 2 and 6 months after baseline. The secondary outcomes of perceived peer norms, risks for sexual aggression, and bystander intervention were also assessed. The extent to which the motivational interviewing session with personalized normative feedback facilitated changes in the proximal outcomes of drinking intentions, motivation to change, and self-efficacy was also examined. Results: The study procedures resulted in high program completion and retention (>80%), high fidelity to the program manual (>80% of the content included), high competency in program administration, and high ratings of satisfaction and program utility in addressing sexual relationships and alcohol use. Both groups reported declines in the number of drinks per week and number of heavy drinking days. Compared with the MBCC participants, the SAFE participants reported higher motivation to change alcohol use after the program, as well as greater use of alcohol protective behavioral strategies at 6 months. Compared with the MBCC participants, the SAFE participants also reported lower perceived peer engagement in sexual coercion, perceived peer comfort with sexism, and peer drinking norms at 2 and 6 months. However, no group differences were observed in sexual aggression severity, rape myth acceptance, or the labeling of sexual consent. Results regarding bystander intervention intentions were mixed, with the MBCC group showing decreased intentions at 2 months and the SAFE group reporting increased intentions at both 2 and 6 months. Conclusions: The findings provide promising evidence for the feasibility, acceptability, utility, and preliminary efficacy of the SAFE program in reducing alcohol use and positively influencing perceived peer norms and intentions for bystander intervention among college men who drink. Trial Registration: ClinicalTrials.gov NCT05773027; https://clinicaltrials.gov/study/NCT05773027

Background: The transition to parenthood is a period of major stressors and increased risk of anxiety for all parents. Though rates of perinatal anxiety are similar among women (4%-25%) and men (3%-25%), perinatal anxiety research on nonbirthing partners remains limited. Objective: We aimed to examine whether demographic characteristics or digital perinatal support preferences differed among nonbirthing partners with compared to without self-reported high parenthood-related anxiety. Methods: In this large cross-sectional study of nonbirthing partners using a digital perinatal health platform during their partner’s pregnancy, users reported their parenthood-related anxiety through a 5-item Likert scale in response to the prompt “On a scale of 1=None to 5=Extremely, how anxious are you feeling about parenthood?” High parenthood-related anxiety was defined as reporting being very or extremely anxious about parenthood. During the onboarding survey, in response to the question “Which areas are you most interested in receiving support in?” users selected as many support interests as they desired from a list of options. Chi-square and Fisher exact tests were used to compare demographic characteristics and support interests of nonbirthing partners with low versus high parenthood anxiety. Logistic regression models estimated the odds ratios (ORs), with 95% CIs, of high parenthood-related anxiety with each user characteristic or digital support interest. Results: Among 2756 nonbirthing partners enrolled in the digital platform during their partner’s pregnancy, 2483 (90.1%) were men, 1668 (71.9%) were first-time parents, 1159 (42.1%) were non-Hispanic White, and 1652 (50.9%) endorsed an annual household income of >US $100,000. Overall, 2505 (91.9%) reported some amount of parenthood-related anxiety, and 437 (15.9%) had high parenthood-related anxiety. High parenthood-related anxiety was more common among non-White nonbirthing partners: compared to those who identified as non-Hispanic White, those who identified as Asian, Black, or Hispanic had 2.39 (95% CI 1.85-3.08), 2.01 (95% CI 1.20-3.23), and 1.68 (95% CI 1.15-2.41) times the odds of high parenthood-related anxiety, respectively. Lower household income was associated with increased odds of reporting high parenthood anxiety, with the greatest effect among those with annual incomes of US $100,000 (OR 2.13, 95% CI 1.32-3.34). In general, nonbirthing partners were interested in receiving digital support during their partner’s pregnancy, but those with high parenthood-related anxiety were more likely to desire digital support for all support interests compared to those without high parenthood anxiety. Those with high parenthood-related anxiety had more than 2 times higher odds of requesting digital education about their emotional health compared to those without high parenthood-related anxiety (OR 2.06, 95% CI 1.67-2.55). Conclusions: These findings demonstrate the need for perinatal anxiety-related support for all nonbirthing partners and identify nonbirthing partners’ demographic characteristics that increase the odds of endorsing high parenthood-related anxiety. Additionally, these findings suggest that most nonbirthing partners using a digital health platform with high parenthood-related anxiety desire to receive perinatal mental health support.