Culture and COVID-19 Related Impacts on Alcohol-Exposed Pregnancy Risk Among Urban American Indian and Alaska Native Young Adults: A Path Analysis.

Abstract

Purpose: We investigated the influence of COVID-19 pandemic-related factors and cultural identification on indicators of alcohol-exposed pregnancy (AEP) risk among urban American Indian and Alaska Native (AIAN) youth ages 16-20.

Methods: Path analysis was used to evaluate associations among measures collected at baseline of the Native WYSE CHOICES, an intervention study to reduce AEP risk among urban AIAN youth. Data were collected nationally from 439 female-at-birth AIAN youth (mean age 18.1 years) residing in urban areas.

Results: Identification with Native American culture and heritage was significantly and positively associated with self-efficacy to abstain from alcohol (β = 0.178; p < .001), and, indirectly, significantly and negatively associated with the risk of AEP (β = -0.046; p = .001). Alternatively, distress about the pandemic's consequences for Native American communities and experiencing economic impacts exacerbated by the COVID-19 pandemic were significantly and negatively associated with self-efficacy to abstain from alcohol (respectively: β = -0.165, p < .01; β = -0.126, p < .01) and, indirectly, significantly and positively associated with risk of AEP (respectively: β = 0.043, p < .01; β = 0.033, p < .05).

Discussion: Results underscore the protective role that connectedness to Native American culture and heritage plays directly and indirectly in AEP risk potential. Conversely, the experience of economic barriers and distress over loss of Native American population and culture are direct and indirect risk factors for potential AEP risk. Development of future AEP interventions for urban AIAN young adults should consider Native American cultural identification, historical trauma, and economic impacts in program design and implementation.