 This randomized controlled study will examine the effect of the ChoicesPlus intervention compared to Treatment as Usual TAU in: reducing alcohol use below established risk levels; increasing consistent use of effective contraception; increasing engagement in smoking cessation treatment and increasing smoking cessation. In addition, our examination of the incremental costs of the ChoicesPlus intervention e.g., staff time, materials, administrative services, total medical charges pre- and post-intervention will provide a basis for future costbenefit analyses that will inform policymakers and healthcare organizations of the potential benefits of implementing ChoicesPlus. Results from this study will inform and advance future efforts in the service of promoting healthy prenatal behavior and reducing the prevalence of alcohol and tobacco-exposed pregnancies. 