# Randomized Trial of an Intervention for Preventing Alcohol Exposed Pregnancy among Women in a Remote Reservation Community

> **NIH NIH P60** · WASHINGTON STATE UNIVERSITY · 2022 · $197,418

## Abstract

ABSTRACT RESEARCH PROJECT 1
Fetal alcohol spectrum disorder (FASD) prevalence is up to 10 times higher in American Indians and Alaska
Natives (AI/ANs) than in the general US population, yet FASD is 100% preventable. Even moderate alcohol use
during pregnancy can affect fetal growth and behavioral outcomes. Alcohol use disorders and binge drinking in
women are among the strongest risk factors for FASD in their offspring. AI/ANs have the highest prevalence of
alcohol use disorders among US racial and ethnic groups, and are the most likely to engage in binge drinking
during pregnancy. A growing consensus indicates that prevention of alcohol-exposed pregnancy must begin
before conception. One promising approach is the Changing High-risk Alcohol Use and Increasing Contraception
Effectiveness Study (CHOICES), which combines motivational interviewing with contraception counseling for
non-pregnant women. In a randomized trial, women receiving CHOICES were 36% more likely to have reduced
risk for alcohol-exposed pregnancies after 6 months than women receiving usual care, but the trial did not enroll
AI/ANs or rural women. Although the Centers for Disease Control and Prevention has recommended its
dissemination, the public health value and cost-effectiveness of CHOICES in AI/ANs is unknown. We propose a
randomized controlled trial of an adapted intervention – Native-CHOICES – to reduce risk of alcohol exposed
pregnancies in AI/ANs. We will enroll 350 AI/AN women living on the Cheyenne River Sioux Indian Reservation
in South Dakota who are 18-44 years old, have prevalent alcohol use disorders or other risky drinking behaviors,
are not currently pregnant, and are sexually active but not using effective contraception. Native-CHOICES will
consist of 2 motivational interviewing sessions plus 1 contraceptive counseling session over 4 weeks, with
supportive electronic messaging for 3 months to increase perceived social connectedness and support for
modifying drinking behavior and using contraception. It uses a wait-list control design in which participants will
be randomized to receive either usual care plus Native-CHOICES (intervention) or usual care only (control). Our
Specific Aims are to: 1) Test the effectiveness of Native-CHOICES vs. usual care for reducing alcohol-exposed
pregnancy risk (less risky drinking, effective contraception, or both) over 6 months; 2) Use surveys and interviews
to evaluate Native-CHOICES’ reach, acceptability, and sustainability; and 3) Conduct cost-benefit and cost-
effectiveness analyses for a comprehensive economic evaluation of Native-CHOICES vs. usual care. FASD
treatment is expensive and prevention is critical to reducing this tragic and avoidable public health problem. Ours
will be the first randomized controlled trial to prevent alcohol-exposed pregnancies in AI/ANs, and the first trial
of CHOICES for rural women of any race. Testing in rural AI/ANs is important because this population faces
unique barriers to accessing hea...

## Key facts

- **NIH application ID:** 10310685
- **Project number:** 5P60AA026112-05
- **Recipient organization:** WASHINGTON STATE UNIVERSITY
- **Principal Investigator:** DEDRA S BUCHWALD
- **Activity code:** P60 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $197,418
- **Award type:** 5
- **Project period:** 2017-12-15 → 2024-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10310685

## Citation

> US National Institutes of Health, RePORTER application 10310685, Randomized Trial of an Intervention for Preventing Alcohol Exposed Pregnancy among Women in a Remote Reservation Community (5P60AA026112-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10310685. Licensed CC0.

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