Preventing Alcohol Exposed Pregnancy among Urban Native Young Women During the COVID-19 Pandemic

The devastating impact of COVID-19 on American Indian and Alaska Native (AIAN) communities has been well-documented, with substantial focus on reservation communities, often rural and remote. However, more than 72% of AIANs reside in urban settings, a majority of the racial group, but a small fraction - often less than 1% - of most urban communities. Many urban AIANs are tightly connected to tribal communities and cultural practices, commonly traveling between urban areas and reservations to participate in family events or important cultural celebrations and ceremonies. However, this group is likely to experience different cultural, social, and economic impacts of the pandemic compared to those living in reservation settings. Those differences are likely critical to alcohol-exposed pregnancy (AEP) risk. Early data in the general population indicate increased alcohol use by youth, and decreased access to effective contraception among women. The combination is likely to increase risk of AEP, and for urban AIAN young women - often with limited local resources - that risk may be especially elevated. Yet, as research efforts scramble to monitor risk of the most vulnerable in a pandemic, this demographic often becomes invisible. We know little about the impact of COVID-19, the changes in alcohol use, sexual activity, or contraceptive use to assess risk among urban AIANs. Similarly, we know little about the way in which these young women are able to find resilience and strength in their communities to overcome the hardships presented by the pandemic or to engage in the promise of vaccines. Our project, Native WYSE CHOICES, uses a randomized trial to evaluate a culturally appropriate AEP prevention program translated to a smartphone app for urban AIAN young women (ages 16- 20) nationally. With our research infrastructure in place, we have the opportunity to tap shifts in behaviors, attitudes, and perceptions of urban AIAN young women, their families, and communities as they navigate the changing dynamics of the pandemic. We will (1) include additional survey measures with a national sample of 700 to capture the evolving pandemic in four main areas: (a) COVID-19 disease, risk exposure, and safety; (b) social and economic impacts; (c) COVID-19 vaccine attitudes, experience, and status; and (d) cultural and historical trauma impacts. To contextualize these findings, we will (2) conduct in-depth interviews with participants purposively selected based on baseline survey responses. To maximize insights in the diversity of experience of the pandemic and gain timely, in-the-moment, insights, we will recruit and interview young women from our RCT sample (n=32) over 2 years. We will also interview selected participants (n=8) at regular intervals over 2 years to capture their experiences longitudinally as circumstances of the pandemic shift. With this qualitative design - i.e. cross-sectional insights complemented by a longitudinal view of urban AIAN young women's journey through the changing circumstances - we will be able to integrate our statistical findings within an agile interpretive frame.