Funded Pilot Projects
Exploring alcohol use and pregnancy among American Indian and Alaska Native women
Abuse of alcohol and drugs, both before and during pregnancy, is associated with unintended pregnancy, late or no use of prenatal care, low birth weight, preterm birth, and both maternal and infant mortality. American Indian and Alaska Native (AI/AN) women face numerous sexual, reproductive, perinatal, and maternal health disparities compared to non-Hispanic white (NHW) women, yet data that speak to these disparities are scarce and limited. Key indicators related to AI/AN women are frequently omitted from national reports, such as the Centers for Disease Control and Prevention’s (CDC’s) Healthy People initiatives, due to inadequate sample sizes and reporting. Some smaller studies that have focused on individual indigenous and tribal communities have found that alcohol use and binge drinking among AI/AN women remains high, but that this varies by community.
Few studies have examined pre-pregnancy and prenatal experiences related to alcohol use among AI/AN women. I propose a multi-methods study to address these questions with three Specific Aims. First, I will perform a quantitative, multistate analysis using Pregnancy Risk Assessment Monitory System (PRAMS) data to estimate alcohol use and screening before and during pregnancy to understand patterns of use, screening, and counseling. Second, I will examine risk factors related to alcohol use before and during pregnancy, and how those factors differ for AI/AN women compared to a matched sample of NHW women in the PRAMS data. Third, in collaboration with investigators from Research Project 1 of the Native Center for Alcohol Research and Education, I will conduct focus groups to explore cultural norms, structural stigma, and social messages surrounding alcohol and pregnancy among 30 AI/AN women in urban and rural communities.
This study will use secondary data from multiple states and communities (Alaska, Washington, Oklahoma, New Mexico, and the Great Plains Tribal Council) and years (2014-2017) to assemble adequate sample sizes for analyses. Descriptive statistics of AI/AN and NHW women will be calculated and reported. Multiple regression modeling will be performed to determine risk factors for each outcome of interest (i.e., pre-pregnancy alcohol use, prenatal alcohol use, prenatal binge drinking) and compared between AI/AN and NHW women. Qualitative data will be analyzed for salient themes related to alcohol and pregnancy among AI/AN communities. Findings from this study will provide valuable information about alcohol use and pregnancy among Native women and inform development of culturally appropriate interventions.
NCARE Liaison: Dr. Michelle Sarche
Lucy Hebert, PhD
Luciana (Lucy) Hebert, PhD, is an Assistant Research Professor at the Institute for Research and Education to Advance Community Health (IREACH) and the Elson S. Floyd College of Medicine at Washington State University. She is an adolescent and women’s health researcher with expertise in family planning, maternal and child health, and sexual and reproductive health. She has formal training in demography and expertise in qualitative and quantitative data collection and analysis. She also serves on the IREACH Methods Core.
Real-time breathalyzer monitoring and contingency management for alcohol use in American Indian women
Fetal alcohol spectrum disorders (FASDs) manifest in a continuum of wide-ranging and devastating physical, neuropsychological, and behavioral deficits in children exposed to alcohol in utero. FASDs are a particularly grave public health concern in American Indian (AI) populations, as pregnant AI women are most likely to report prenatal binge drinking compared to other US racial and ethnic groups. As a result, the AI population is up to 10 times more likely than the general population to suffer from FASDs (2.0 vs. 0.2 per 1,000 births). Nonetheless, AI women have limited access to culturally appropriate evidence-based interventions for alcohol use in pregnancy. Few randomized controlled trials have examined alcohol interventions in AI populations to date, with only one targeting women of reproductive age and none targeting pregnant women. Contingency management (CM) is an effective behavior modification intervention in which financial or non-financial incentives are contingent on achieving an observable health goal. In order to increase its reach, CM is increasingly delivered using mobile technologies, including internet- and smartphone-based interventions. Our pilot data and studies conducted by others indicate that mobile alcohol monitoring (MAM) and CM are effective in increasing abstinence and reducing alcohol use in the general population, as well as decreasing smoking in pregnant women, but no study has tested a CM+MAM protocol for AI pregnant and postpartum women. In Washington, the Parent-Child Assistance Program (PCAP) provides case management and home visits to pregnant and parenting women at risk for having children with FASDs and has increased alcohol treatment completion and reduced self-reported alcohol use. While PCAP has been successful in reducing drug and alcohol use, the program has never systematically included CM or MAM interventions. PCAP is therefore an ideal setting to implement a culturally appropriate CM+MAM protocol for prenatal and postpartum alcohol use in AI women. We propose to develop and test a CM+MAM protocol to be used as an adjunctive treatment in home-based case management settings, such as PCAP, among AI women. We will first convene key subject area experts to revise our CM+MAM protocol and determine cultural appropriateness of CM+MAM for alcohol reduction or abstinence among AI women. Next, using a 9-week ABA (non-contingent, contingent, non-contingent) within-subjects design, we will evaluate feasibility, acceptability, and efficacy of CM+MAM on alcohol use reduction and abstinence among 15 AI women enrolled in PCAP. The proposed research responds to the National Institute on Alcohol Abuse and Alcoholism’s goals by developing an effective prevention and treatment strategy that addresses the physical, behavioral, and social consequences of alcohol misuse among mothers at risk for having children with FASDs.
Co-Investigator: Dr. Celestina Barbosa-Leiker
NCARE Liaisons: Dr. Michael McDonell & Dr. Sterling McPherson
Ekaterina Burduli, PhD
Dr. Ekaterina Burduli is an Assistant Professor in the College of Nursing at Washington State University. Dr. Burduli’s primary research focuses on the birth satisfaction and birth outcomes of women who use substances during pregnancy and the development of novel interventions for pregnant women with substance use disorders. Dr. Burduli’s work will lead to a better and more thorough examination of the birth experience among substance-using mothers and holds great promise to identify points of intervention, improve health outcomes for both mother and child, and ultimately, reduce health disparities for substance-using pregnant women. She has more than 16 peer-reviewed publications and has contributed to and led numerous grants. Dr. Burduli also has a high level of statistical methodology expertise in psychometrics, structural equation modeling, and clinical trial data analysis.
Pathways to recovery among urban Alaska Native and American Indian people with long-term abstinence from alcohol
Alaska Native and American Indian (ANAI) people experience dramatic alcohol-related health disparities compared to the general US population, yet have some of the highest rates of abstinence in the nation. This includes many ANAIs in sustained remission from alcohol use disorder (AUD) who have been abstinent for at least a year. Understanding how ANAIs with a history of AUD achieved abstinence could inform development of culturally appropriate and effective interventions. However, data are sparse on AUD recovery in ANAI populations. Research in rural ANAI communities has examined AUD recovery among individuals with long-term abstinence to identify protective factors against AUD risk. While these studies led to strengths-based, multilevel AUD prevention strategies in rural ANAI communities, they did not inform treatment of AUD. Further, no such data exists for urban settings, which is concerning since more than 70% of ANAIs reside in urban areas and this figure is growing. The substantial geographic, material, and sociocultural differences between rural and urban environments highlight the need to understand the recovery process in the urban environment. We propose a qualitative pilot study to begin addressing this need. This study will examine the experiences of ANAIs recovering from AUD with at least 3 years of alcohol abstinence in Anchorage, Alaska. As Alaska’s most populous city with a large ANAI community (>20,000) representing all 229 AN and many AI tribes, Anchorage is an ideal setting to study urban ANAI recovery from AUD. Moreover, because alcohol-related mortality among ANAI people in Anchorage is substantially higher than in the overall US population, studying the city’s ANAIs with AUD in sustained remission will contribute to an understanding of what promotes or hinders this positive outcome. Specifically, we will describe how diverse ANAI adults with AUD achieved recovery with at least 3 years of abstinence in the urban setting. First, we will conduct semi-structured, in-depth interviews with 20 ANAI individuals to collect narratives of abstinence and recovery from AUD. We will enroll participants across a wide range of ANAI tribes, genders, and ages who represent as many ANAI cultural and geographic communities as possible in the pilot study’s relatively small sample. Second, we will use interpretative phenomenological analysis to identify common patterns of experience, events, and resources that enabled urban ANAI adults with AUD to attain abstinence. The study will result in an in-depth description of the range of strategies and supports that participants recount in their recovery narratives, as well as themes of how participants attained meaningful and sustained AUD recovery in the urban context. This pilot project will result in important new knowledge about the AUD recovery process among urban ANAI people. The next stage of this research will be to use the pilot study findings to either culturally adapt an extant intervention or to develop a new one, if none exist to address an identified need.
Co-Investigator: Dr. Jennifer Shaw
NCARE Liaison: Dr. Dennis Donovan
Kate Lillie, PhD
Kate Lillie, PhD, is a Researcher at Southcentral Foundation in Anchorage, Alaska. Dr. Lillie has been involved with several behavioral health studies among Alaska Native and American Indian people, including studies on suicide prevention and substance misuse. Her primary expertise and training are in quantitative data collection and analysis. Dr. Lillie is Athabascan and has resided in Alaska most of her life.
Feasibility and impact of distance American Indian peer recovery coaches
The use of peer recovery coaches (PRCs) in assisting with alcohol addiction recovery has been expanding but research regarding their methods and impact has been limited. This study is designed to overcome many of the limitations of previous PRC research including unclear/inconsistent PRC role definitions, lack of a control group/randomization, no attention control group, no verification of relapses, no evaluation of distance-delivered PRC services, and no comparison of AI outcomes in various settings. We currently have a trial of AI PRCs delivering services in urban settings (n=30) and are comparing their impact to an attention control group (n=30). This proposal would add two arms to the current study to examine the delivery of PRC services through distance technology to a rural (n=30) and reservation (n=30) setting for individuals recovering from alcohol addiction. The overall goal of this program of research is to systematically evaluate the implementation and outcomes of AI-specific PRCs in a way that will facilitate optimization of AI PRC services for widespread adoption. The aims of the proposed study are to: 1. evaluate the feasibility of distance-delivered PRC services with people recovering from alcohol addiction to rural and reservation samples, 2. compare the number of relapses between the rural, reservation, urban, and attention control groups, and 3. measure and evaluate strategies used by PRCs in a rural and reservation setting. The primary outcomes that will be examined include daily breathalyzer results and self-reported alcohol use. Additional variables will include cravings/response to cravings, readiness/motivation to quit, alcohol self-efficacy, and sobriety activities (cultural, self-help, and family/friends contact).
Nick Guenzel, PhD, APRN
Nick Guenzel, PhD, APRN, is an Assistant Professor at the University of Nebraska Medical Center in the College of Nursing. He is a psychiatric mental health nurse practitioner and teaches in the UNMC psychiatric nurse practitioner program. He has conducted research with American Indian communities with a particular focus on addiction. Specifically, he seeks to draw on the ways that American Indian values and traditions can facilitate recovery from addiction.