Date of Award

January 2021

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)



First Advisor

Kimberly Yonkers


Background: In the United States, nearly 12% of women report alcohol use during pregnancy despite recommendations of complete abstinence by government agencies and professional medical organizations. Multiple public health and screening interventions are effective in promoting increased knowledge and abstinence amongst pregnant women. However, the interventions generally provide broad, non-specific content, and the messaging is not directly tailored to the specific motivations and barriers that women face when making decisions about alcohol use during pregnancy. Since tailoring content and messages can improve effectiveness of interventions, a deeper qualitative investigation into the context surrounding alcohol use during pregnancy is warranted. Methods: We conducted qualitative 1.5-2hr focus groups in New Haven in order to better understand the reasons behind alcohol use during pregnancy. We also discussed the motivations as well as barriers women faced when attempting to abstain during pregnancy. We analyzed the focus groups in Dedoose using a grounded theory approach. Utilizing the discovered themes, we created, tested (using a survey) and elicited informal feedback on 12 preliminary text messages specifically addressing the concerns women brought up. Results: Our qualitative study of 5 focus groups with 31 participants, aged 19-57, of whom 28/31 (90.3%) used alcohol during pregnancy, showed that alcohol use during pregnancy is a result of multiple biological, social, psychological and systemic factors. Themes of personal characteristics, social pressures, unmet mental health needs, and governmental concerns were pertinent in all questions asked during the focus groups. Participants also detailed specific techniques that they personally found helpful when attempting to abstain during pregnancy. In response to the preliminary messages, women found 5/12 (41.6%) messages to be effective and others to be neutral. They also provided invaluable feedback about modifying the language of the messages. Conclusion: Based on the themes elicited, we propose a model that shows these factors serving as both promoters of alcohol use as well as barriers to abstaining. We detail specific points of intervention that can be targeted using text messages. We describe the approach of creating and improving the messages, based on participant feedback.


This is an Open Access Thesis.

Open Access

This Article is Open Access