| Risks By Preconception Care Content Area | Criteria for Identification of Risk | Goal Behavior and Definition of Risk Resolution |
|---|---|---|
| A. Emotional and mental health | ||
| 1. History of diagnosis of anxiety | Selection of “anxiety” in response to, “Have you been diagnosed with any of the following conditions? Check all that apply.” | Talking to a doctor about treatment for anxiety* |
| 2. History of diagnosis of depression | Selection of “depression” in response to, “Have you been diagnosed with any of the following conditions? Check all that apply.” | Talking to a doctor about treatment for depression* |
| 3. Potential depression | PHQ-2 score ≥3 | Talking with a doctor about depression* |
| 4. History of diagnosis of bipolar disorder | Selection of “bipolar disorder” in response to, “Have you been diagnosed with any of the following conditions? Check all that apply.” | Talking to a doctor about treatment for bipolar disorder* |
| 5. Family history psychiatric conditions (depression, anxiety, schizophrenia, bipolar disorder) | Report of family member or partner's family member ever diagnosed with anxiety, bipolar, depression, or schizophrenia | Talking to a doctor about the history of mental illness is your family* |
| 6. Stress | 4-Item Perceived Stress Scale score ≥8 | Finding ways to manage your stress† |
| B. Environmental issues | ||
| 1. Living near toxic waste or a “superfund” site | “Yes” in response to, “Do you live near a toxic waste site or “superfund site'?” | Talking to a doctor about living near a toxic waste site* |
| 2. Exposure to lead | After indicating exposure to lead, either “no” in response to, “Have you been tested?”; or “I had too much lead in my blood” in response to, “What was the result?” and “no” in response to, “Have you been treated?” | Talking to a doctor about getting your blood lead concentrations tested* |
| 3. Reported exposure to potentially toxic household chemicals | Selection of any chemical in response to, “In your home(s), have you or your partner been exposed to any of the following? Check all that apply: solvents (oil based paints), heavy metals (lead), paint-stripping chemicals (with methylene chloride), jewelry making or metal tempering, pesticides, herbicides, rodenticides, removal of old paint or wallpaper from walls containing lead-based paint, non-latex-based paints that are solvent based and contain metals for pigments and antifoulant agents.” | Talking to a doctor about how to make your home safer* |
| 4. Frequently eating food from cans with a white plastic lining | “Yes” or “don't know” in response to, “Do you frequently eat foods that come from metal cans that have a white plastic lining, like canned soup or vegetables?” | Talking to a doctor about avoiding cans with white plastic lining* |
| 5. Frequently drinking from plastic water bottles | “Yes” in response to, “Do you frequently drink water from plastic bottles?” | Talking to a doctor about checking plastic water bottles to make sure they are safe* |
| 6. At risk for toxoplasmosis | “Yes” in response to, “Do you ever clean a cat's litter box?” or indicating intake of “raw or very undercooked meats or fish” | Talking to a doctor about preventing toxoplasmosis* |
| 7. Untested well water in the home | “Yes” in response to, “Do you have well water in your home?,” then “no” or “don't know” in response to, “Has it been tested?” | Talking to a doctor about getting your well water tested* |
| 8. Reported workplace exposure to chemicals or dangers | Selection of any job listed in response to, “Does your job or your partner's job fall into any of the following categories? Check all that apply: lab and clinical health care work, printing, dry-cleaning, jewelry making or metal tempering, jobs that use pesticides, herbicides, rodenticides, solvents (oil-based paints), heavy metals (lead), paint-stripping agents, lead-based paints or non-latex-based paints that are solvent based and contain metals for pigments” | Talking to a doctor about how to be safer at work* |
| C. Genetic health history | ||
| 1. Ethnicity-based genetic health risk based on ancestry | Selection of any ethnicity listed in response to, “What is your blood ancestors' ethnic/racial/geographic background? Please check all that apply: White, European, Ashkenazi Jewish, French Canadian, Cajun, African, Mediterranean, Asian” | Talking with a doctor about health problems based on your ethnicity* |
| 2. Family history of a genetic health condition | Selection of any of the health conditions listed in response to, “Has anyone in your family or your partner's family ever had (including parents, grandparents, siblings, aunts, uncles, cousins) any of the following?: Chromosomal disorders, deafness, facial clefts (cleft palate), sickle cell disease or trait, thalassemia, developmental delay/mental retardation, blood clots, cancer, neural tube defects (eg, spina bifida), heart disease, vision loss inherited from family member, sudden infant death syndrome, early infant death, muscular dystrophy, cystic fibrosis, family history of other congenital malformations or birth defects” | Talking with a doctor about your family's health history* |
| 3. Personal history of a genetic health condition | Selection of any of the health conditions listed in response to, “Have you or your partner ever had any of the following conditions? Check all that apply: Chromosomal disorders, deafness, facial clefts (cleft palate), sickle cell disease or trait, thalassemia, developmental delay/mental retardation, blood clots, cancer, neural tube defects (eg, spina bifida), heart disease, vision loss, inherited from family member, family history of other congenital malformations or birth defects” | Talking with a doctor about your health history or your partner's health history* |
| 4. Need to learn family health history | Selection of “don't know” in response to, “Has anyone in your family or your partner's family ever had (including parents, grandparents, siblings, aunts, uncles, cousins) any of the following? (See list of conditions listed under “Family history of genetic health condition”) | Talking with a doctor about your family's health history* |
| D. Health care and programs | ||
| 1. Does not have primary care physician | “No” in response to, “Do you have a primary care provider? (PCP being a general doctor that you would see once a year for checkups and for illness); or selection of “emergency room” in response to, “When you do need medical care, do you usually go to your PCP or to the emergency room?” | Choosing a PCP* |
| 2. Inadequate health insurance | “No” in response to, “Does your health insurance get you the health care you need?” | Getting better health insurance* |
| 3. Does not have health insurance | No” in response to, “Do you have health insurance?” | Getting health insurance* |
| 4. Not been to dentist in over a year | “No” in response to, “Have you been to the dentist in the past year?” | Going to the dentist* |
| 5. Inadequate financial resources | “Yes” in response to, “Is it difficult to pay bills, like rent, water, heat, or electricity?” or selecting any of the following programs in response to, “Do you use any of these assistance programs?”: Medicaid (including Mass Health), health safety net or free care, Temporary assistance to needy families (welfare), food stamps, housing assistance, energy assistance, Women Infants and Children | Applying for programs to help pay your bills* |
| E. Health conditions and medicines | ||
| 1. History of diagnosis of asthma | Selection of “asthma” as a diagnosed health issue | Talking to a doctor about your asthma* |
| 2. History of diagnosis of disability | ”Yes” in response to, “Do you have a disability?” (Disability specified as a physical or intellectual disability in which case extra care from a doctor is required.) | Talking with a doctor about your disability* |
| 3. History of diagnosis of hypertension (high blood pressure) | Selection of “hypertension (high blood pressure)” as a diagnosed health issue | Following your treatment plan for your blood pressure† |
| 4. Currently taking any over-the-counter medicines | “Yes” in response to, “Do you take any ‘over-the-counter’ medications?” | Talking to a doctor about your “over-the-counter” medicines* |
| 5. History of diagnosis of prediabetes | Selection of “prediabetes” as a diagnosed health issue | Following your treatment plan for pre diabetes† |
| 6. Currently taking a prescription medication | “Yes” in response to, “Do you take any medicines prescribed by a doctor?” | Telling a doctor about your prescription medications* |
| 7. History of diagnosis of rheumatoid arthritis | Selection of “rheumatoid arthritis” as a diagnosed health issue | Talking to a doctor about your RA* |
| F. Immunizations and vaccines | ||
| 1. Need hepatitis B vaccine | Selection of “no” or “don't know” to, “Have you received a vaccination for hepatitis B?” | Talking with a doctor about getting the hepatitis B vaccine* |
| 2. Unsure of immunization record | “No” in response to, “Do you know about any of the immunizations you have gotten in the past?” | Talking with a doctor about getting the immunizations you need* |
| 3. Need varicella vaccine | Selection of “no” or “don't know” to, “Have you received a vaccination for varicella (2 doses) or ever had the chicken pox?” | Talking with a doctor about getting the varicella, or chicken pox, vaccine* |
| 4. Need influenza vaccine | Selection of “no” or “don't know” to, “Have you received a vaccination for influenza (flu) this year for flu season (October through April)?” | Talking with a doctor about getting the flu vaccine* |
| 5. Need human papillomavirus vaccine | Selection of “No” or “Don't Know” to, “Have you received a vaccination for HPV in 3 doses (ever)?” | Talking with a doctor about getting the HPV vaccine ± |
| 6. Need measles, mumps, and rubella vaccine | Selection of “no” or “don't know” to, “Have you received a vaccination for measles, mumps and rubella (in childhood)?” | Talking with a doctor about getting the MMR vaccine* |
| 7. Need tetanus-diphtheria-pertussis vaccine | Selection of “no” or “don't know” to, “Have you received a vaccination for tetanus, diphtheria, and pertussis once when you were 11 to 12 years old and/or another after you turned 18 years old?” | Talking with a doctor about getting the Tdap vaccine* |
| 8. Need tetanus vaccine | Selection of “no” or “don't know” to, “Have you received a tetanus booster vaccination within the past 10 years?” | Talking with a doctor about getting the tetanus vaccine* |
| G. Infectious diseases | ||
| 1. At risk for hepatitis C | “Yes” in response to any of the following: “Have you received blood products or organs before 1992?”; “Are you a health care worker?”; “Do you work in a correctional institution, like a jail?”; “Have you ever stayed overnight in a jail?”; “Do you have a tattoo or body piercing that you got in your home or someone else's home?” “Yes” or “don't know” in response to, “Have any of your sexual partners had hepatitis C?” | Talking with a doctor about getting tested for hepatitis C* |
| 2. At risk for malaria | “No” in response to, “If you traveled to Central America, South America, Africa, Asia, Eastern Europe, the South Pacific, or the Caribbean in the future, would you take antimalarial medicine?” | Talking with a doctor about how to prevent malaria* |
| 3. At risk for sexually transmitted infection | “Yes” in response to any of the following: “Do you work in a correctional institution, like a jail?”; “Have you ever stayed overnight in a jail?”; “Has a doctor or nurse ever told you that you have gonorrhea?”; “Have you ever been paid for sex, or had sex for drugs?”; “Have you ever used illicit drugs (street drugs), including marijuana?” | Talking with a doctor about getting tested for STIs and finding out how to prevent them* |
| “Yes” or “don't know” in response to, “Have you ever had unprotected sex? (meaning vaginal intercourse without a condom, oral sex without a condom, or anal sex without a condom)”; “Have any of your sexual partners been diagnosed with an STI?”; “Have any of your sexual partners had syphilis or herpes?”; “Have any of your male sexual partners had sex with men?” | ||
| 4. At risk for TB | “Yes” in response to, “Are you a healthcare worker?”; “Do you work in a correctional institution, like a jail?”; “Have you ever stayed overnight in a jail?”; “Were you born in Latin America, Caribbean, Africa, Asia, Eastern Europe, or Russia?”; “Yes” or “don't know” in response to, “Have you been in contact with someone who has tuberculosis (TB)?” | Talking with a doctor about getting tested for TB* |
| 5. At risk for cytomegalovirus | “Yes” in response to, “Do you work in a daycare, nursery school, or kindergarten?”; “Are you often in contact with children under 6 years old?” | Talking to a doctor about how to prevent cytomegalovirus* |
| 6. Sexually active and not been tested for sexually transmitted infections | “No” (and still sexually active) in response to, “Have you ever been tested for an STI, including chlamydia, syphilis, HIV, and others?” | Talking with a doctor about getting tested for STIs* |
| 7. Not born in the United States | “Yes” in response to, “Were you born in a country other than the United States?” | Talking with a doctor about being born in another country* |
| 8. History of diagnosis of gonorrhea, chlamydia, or syphilis | “Yes” in response to, “Has a doctor or nurse ever told you that you have (any) STIs?” (selection of gonorrhea, chlamydia, or syphilis) | Talking to a doctor about getting treated for chlamydia, syphilis, or gonorrhea* |
| 9. History of diagnosis of HIV | “Yes” in response to, “Has a doctor or nurse ever told you that you have HIV?” | Talking to a doctor about getting treated for HIV* |
| 10. History of diagnosis of herpes | “Yes” in response to, “Has a doctor or nurse ever told you that you have genital herpes?” | Talking to a doctor about getting treated for herpes* |
| 11. Tuberculosis | “Yes” in response to, “Has a doctor or nurse ever told you that you have tuberculosis (TB)?” | Talking to a doctor about getting treated for TB* |
| H. Men and health care | ||
| 1. Partner does not have a primary care physician | “No” or “don't know” to, “Does your partner have a primary care doctor (PCP), which is a doctor he would see for checkups or if he was sick?” | Telling your partner that he should choose a PCP* |
| 2. Partner has not been to a doctor in >1 year | “No” or “don't know” to, “Has your partner been to the doctor in the past year?” | Telling your partner that he should go to the doctor* |
| 3. Partner not counseled on reproductive life plan | “No” or “don't know” to, “Has your partner been counseled on his reproductive life plan (plan about birth control and when he wants to have children in the future)?” | Telling your partner to talk to his doctor about his reproductive life plan (like birth control)* |
| I. Nutrition and activity | ||
| 1. Bad diet or food choices | Response of <5 daily servings of fruits and vegetables; “yes” in response to, “Do you tend to snack on junk food (chips, soda, candy, desserts) most days?” | Eating a healthier diet (≥5 servings of fruits and veggies each day and/or less junk food)† |
| 2. Use of caffeine | “Yes” to, “Do you drink caffeinated drinks like coffee, tea, soda, or energy drinks?” | Cutting back to a safe amount of caffeine (<200 mg a day)† |
| 3. Self-reported potential eating disorder | “Yes” to, “Do you think you might have an eating disorder, like anorexia or bulimia?” | Talking to a doctor about your eating disorder* |
| 4. Not enough exercise (<30 min/d, 5 d/wk) | “No” in response to, “Do you exercise or take part in regular activity, like walking or biking, 5 days a week for a minimum of 30 minutes?” | Getting the recommended amount of exercise (30 minutes, 5 days a week)† |
| 5. At risk for toxic concentrations of mercury | “Yes” to, “Do you eat fish more than twice a week? (Certain types of fish may have high levels of mercury, which could cause health problems.)” | Talking to a doctor about limiting the amount of fish you eat to the safe amount* |
| 6. Use of herbal or weight-loss supplements | “Have you ever taken herbs (like chamomile or ginseng), herbal teas, home remedies, or weight-loss products for your health?” | Talking to a doctor about your herbal medicines* |
| 7. At risk for listeriosis | “Yes” to, “Do you eat unpasteurized dairy products or cheese; soft cheeses like feta, blue cheese, brie, goat cheese, or queso fresco?”; “Do you eat hot dogs or deli meat?” | Talking to a doctor about preventing listeriosis* |
| 8. Not using multivitamin with folic acid or folic acid supplement | Selection of “none,” “don't know,” or “foods with folic acid” (without also selecting “folic acid pill” or “multivitamin with folic acid”) in response to, “What way(s) do you get folic acid?” | Taking a multivitamin or folic acid pill daily† |
| 9. Not taking calcium supplement | Not selecting “calcium” in response to, “Do you take any of the following vitamins or minerals?” | Getting more calcium† |
| 10. Not taking iron supplement | Not selecting “iron” in response to, “Do you take any of the following vitamins or minerals?” | Getting more iron† |
| 11. Need more omega-3 fatty acids in diet | Indicating no intake of walnuts, olive oil, or fatty fish | Eating more foods with omega-3 fatty acids† |
| 12. Not taking supplement of vitamin D | Not selecting “vitamin D” in response to, “Do you take any of the following vitamins or minerals?” | Getting more vitamin D† |
| 13. Overweight (BMI ≥ 30 kg/m2) | BMI ≥30 kg/m2, based on self-reported height and weight | Starting a healthy eating and exercise plan to manage your weight† |
| 14. Possibly taking too much vitamin A | Selection of vitamin A in response to, “Do you take any of the following vitamins or minerals?” | Talking to a doctor about getting a safe amount of vitamin A* |
| J. Relationships | ||
| Interpartner violence | (Any below) | |
| 1. Does not feel safe | “Yes” in response to, “Are you afraid that someone you know may hurt you?”; “Are you ever afraid or nervous to go home?” | Taking action to feel safer† |
| 2. History or current emotional or verbal abuse | “Yes” in response to, “Have you ever felt nervous or scared because of the things that someone said to you?”; “Has anyone ever told you that you are a bad person, that you are useless or that you are worth nothing?” | Preparing to get out of an emotionally or verbally abusive relationship† |
| 3. History or current physical or sexual abuse | “Yes” in response to, “Have you ever been hit, slapped, kicked, or physically hurt in any way?”; “Has anyone ever made you do something sexual that you didn't want to do?” | Preparing to get out of a physically or sexually abusive relationship† |
| K. Reproductive health | ||
| 1. History of abortion | Selecting “≥1” in response to, “How many abortions (elective termination of pregnancy) have you had?” | Talking with a doctor about your experience with abortion* |
| 2. Prior cesarean deliveries | Selecting “≥1” in response to, “How many cesarean sections (c-sections) have you had?” | Talking with a doctor about your experience with cesarean delivery* |
| 3. Less than 3 months between past pregnancies | “Yes” to, “Have you ever gotten pregnant less than 3 months after the end of another pregnancy?” | Talking with a doctor about the short time between your pregnancies* |
| 4. Participant was born preterm or low birth weight | “Yes” or “don't know” to, “Were you born very early or very small?” | Telling a doctor that you were born with low birth weight or before term* |
| 5. Participant's mother born before term or with a low birth weight | “Yes” or “don't know” to, “When your mother was born, was she born very early or very small?” | Telling a doctor that your mother was born with a low birth weight or before term* |
| No/ineffective birth control | ||
| 6. No birth control | “No” in response to, “Do you use birth control on a regular basis?” | Using birth control† |
| 7. Withdrawal method | Selection of “withdrawal” as birth control method used | Using a more reliable type of birth control† |
| 8. Other less effective birth control | Selection of Plan B (morning after pill), rhythm/natural family planning, or “other” as birth control method used | Using a more reliable type of birth control† |
| Poor birth outcome | (Any below) | |
| 9. History includes 1 or 2 miscarriage(s) | Indicating 1 or 2 in response to, “How many miscarriages have you had?” | Talking with a doctor about your experience with miscarriage* |
| 10. History of infant born with a low birth weight | “Yes” or “don't know” to, “Have you ever had a baby weighing 5.5 lb or less (or <2500 g) at birth?” | Talking with a doctor about your baby born with a low birth weight* |
| 11. History of preterm birth | “Yes” or “don't know” to, “Have you ever had a premature or preterm baby (born at least 3 weeks early)?” | Talking with a doctor about your preterm baby* |
| 12. History of infant in NICU | “Yes” to, “Have you ever had a baby that had to stay in an intensive care nursery (NICU)?” | Talking with a doctor about your child who was in the NICU* |
| 13. History of infant with a birth defect | “Yes” or “don't know” to, “Have you ever had a baby with a birth defect?” | Talking with a doctor about your child's birth defect* |
| 14. History of infant or child death | “Yes” to, “Have you ever had a child who died after he or she was born?” | Talking with a doctor about your child's death* |
| 15. History of stillbirth | Selecting “≥1” in response to, “How many stillbirths have you had?” | Talking with a doctor about your experience with stillbirth* |
| 16. Prenatal appointments | Not asked at time of baseline risk assessment; triggered during interactions with Gabby | Starting prenatal care* |
| 17. History of uterine anomalies | “Yes” or “don't know” to, “Have you ever had a problem(s) with your uterus (womb)?” | Talking with a doctor about the problems with your uterus* |
| 18. History of vaginal bleeding late in pregnancy | “Yes” to, “Have you ever had vaginal bleeding late in pregnancy?” | Talking with a doctor about your history of vaginal bleeding during pregnancy* |
| L. Substance Use | ||
| 1. Any illicit substance use in the last year | Selecting “≥1” in response to, “How many times in the past year have you used an illegal drug or used a prescription medication for non-medical reasons?” | Talking to a doctor about quitting drugs† |
| 2. Excessive alcohol (≥4 drinks in a day over the past year) | Selecting “≥4” in response to, “During the past 12 months, what was the largest number of alcoholic drinks that you drank in a single day?” | Cutting back to no more than 3 drinks at a time and cutting back to drinking no more than twice a week† |
| 3. Any current tobacco use | Selecting “I smoke, or use tobacco, regularly now”; “I smoke, or use tobacco, regularly now, but I've cut down”; or “I smoke, or use tobacco, every once in a while” in response to, “Which of the following best describes your tobacco use?” | Quitting tobacco† |
↵* Risk resolution was defined as the woman indicating that, “I've already talked to a doctor about it” (if risk was discussed with Gabby during the intervention) or “I have been working on this separately from Gabby” (if the risk was not discussed with Gabby during the intervention) when the risk-specific behavior was provided, after the following explanation: “Now we are going to go through the list of risks that were based on the health survey you took 6 months ago. I'll go through each item and please let me know if you: don't plan to talk to a doctor about it anytime soon, plan to talk to a doctor about it in the next 6 months, plan to talk to a doctor about it in the next month, have already talked to a doctor about it, or tell me if you don't think this risk should have been put on your list 6 months ago.”
↵† Risk resolution was defined as the woman indicating that, “I've done that at least once” or “I've been doing that for more than 6 months” (if risk was discussed with Gabby during the intervention) or “I have been working on this separately from Gabby” (if the risk was not discussed with Gabby during the intervention) when the risk-specific behavior was provided, after the following explanation: “Now we are going to go through the list of risks that were based on the health survey you took 6 months ago. I'll go through each item and please let me know if you don't plan to do it anytime soon, plan to do it in the next 6 months, plan to do it in the next month, have done it at least once, have been doing it for more than 6 months, or let me know if you don't think this risk should have been put on your list 6 months ago.”
BMI, body mass index; HIV, human immunodeficiency virus; MMR, measles, mumps, rubella; NICU, neonatal intensive care unit; PCP, primary care physician; PHQ-2, 2-item Patient Health Questionnaire; STI, sexually transmitted infection; TB, tuberculosis.