Community-Specific Risk and Protective Factors for Risky Alcohol Consumption in American Indian Women of Reproductive Potential: Informing Interventions

Abstract

Objective: To explore the effect of community-specific risk and protective factors on risky alcohol consumption and vulnerability to having an alcohol-exposed pregnancy in women within a Southern California American Indian community. Methods: A sample of 343 American Indian women of childbearing age was enrolled in a study of risky drinking. All participants completed a questionnaire including alcohol consumption, other health behaviors, the T-ACE risky alcohol consumption screen and the PHQ-9 to measure depression and functionality. A subset of 80 women additionally answered focus group-derived questions about why they choose or do not choose to drink. Results: Risk and protective factors varied among sample subgroups. Broadly, factors affecting risk and protection included: depression, perception of other women’s drinking, children/family, perception of risk to the unborn child, and feeling pressured to drink. Women’s drinking was highly influenced by female friends and relatives. Women were most likely to drink with a girlfriend. Nearly 40% of all participants asked felt pressured to drink. Depression was associated with riskier alcohol consumption, less effective contraception, and testing positive for risky drinking using the T-ACE screen. Depressed women were more likely to binge drink because of stress, trauma, and “to escape my problems”, and more likely to have been exposed to trauma including sexual assault. Conclusions: Interventions should incorporate community-specific factors. In the present sample, two separate strategies are indicated by the data: an information campaign to increase women’s awareness of true social norms and the risks of prenatal alcohol-exposure; and screening for and treating depression.

Substance and Behavioral Addictions among American Indian and Alaska Native Populations

“…Depressive symptoms and clinical depression are significantly associated with substance use among AIAN [ 30 , 48 ]. Psychosis, personality, and other mood disorders (e.g., posttraumatic stress disorder) are intricately linked with substance use and dependence as well [ 49 , 50 , 51 ].…”

“…Parental and other family members’ substance use was associated with increased likelihood of substance use among AIAN youth [ 48 , 64 , 65 ]. The role of social modeling, permissive attitudes toward substance use, diminished monitoring, and on rare occasions, parental offering of drugs and alcohol, provide possible explanations for the association between family substance use and SUD among AIAN youth [ 31 , 48 ].…”

“…Parental and other family members’ substance use was associated with increased likelihood of substance use among AIAN youth [ 48 , 64 , 65 ]. The role of social modeling, permissive attitudes toward substance use, diminished monitoring, and on rare occasions, parental offering of drugs and alcohol, provide possible explanations for the association between family substance use and SUD among AIAN youth [ 31 , 48 ]. Specifically, for some AIAN youth it is difficult to refuse drug or other substance offers when they come from parents and other family members or when tobacco products are offered during a ceremony [ 32 , 66 ].…”

Preconception interventions to reduce the risk of alcohol‐exposed pregnancies: A systematic review

“…This is also consistent with the recent review of pregnancy interventions (Erng et al, 2020), which also noted limited focus on wider contextual factors, which may maintain alcohol use and, in this case, may contribute to contraceptive decision making. For instance, Montag et al (2019) found that alcohol use in women of reproductive age within a Southern California American Indian community was strongly influenced by female friends and relatives. Deutsch (2019) using data ( n = 2,097) from the U.S National Longitudinal Study of Adolescent to Adult Health highlighted that women who had experienced intimate partner violence reported higher levels of alcohol use and lower birth control use and were at increased risk of an AEP.…”

The Prevalence of Fetal Alcohol Spectrum Disorders in An American Indian Community

“…The heterogeneous American Indian Alaska Native (AIAN) populations of the U.S. differ substantially in patterns of alcohol consumption, use of contraception, as well as preferences, cultural practices and traditions [4,5,6,7,8,9]. For this reason, it is reasonable to assume that the prevalence of FASD might differ by specific AIAN population as well.…”