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

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.