Examining the role of social determinants of health in alcohol-exposed pregnancy risk among American Indian women.

CONTEXT AND PURPOSE: Alcohol-exposed pregnancy (AEP) is a public health issue that impacts women from all backgrounds and nationalities. In particular, little is known about American Indian women at risk for AEP during the preconceptual period. The purpose of this paper is to characterize the social determinants of health among American Indian women at risk for AEP in the Great Plains. METHODS: Baseline data with American Indian women enrolled in a randomized controlled trial of a culturally modified version of CHOICES, an AEP risk reduction intervention, were analyzed. Eligibility included age (18-44), self-identification as American Indian, current risky drinking, and the ability to get pregnant but not currently pregnant. Social determinants of health metrics comprised the broad categories of economic and housing stability, health care access, and social and community context. RESULTS: A total of 404 women with a mean age of 31.9 were enrolled. Most were unemployed (77%) and half reported a total annual household income of less than $5,000. Most (78%) considered their housing situation secure, although 43% had experienced homelessness in the past 6 months. Participants placed high importance on Native values and practices and reported strong social connections and social support. CONCLUSIONS: This descriptive, cross-sectional study of American Indian women at risk for AEP highlighted the importance of queries on housing, economic factors, social support, and culture. Despite adverse social determinants of health, the fabric of social support and the importance of local cultural values was strong, factors that could be used in future AEP prevention efforts.