One-month outcomes of a culturally tailored alcohol-exposed pregnancy prevention mobile app among urban Native young women: A randomized controlled trial of Native WYSE CHOICES

Background

The majority of alcohol-exposed pregnancy (AEP) prevention programs for Native women have focused on at-risk adult women residing in rural tribal communities; however, over 70% of the Native population resides in urban areas. Moreover, Native young women universally—regardless of risk status—may benefit from culturally tailored resources. We hypothesized that urban Native young women who engaged with Native WYSE CHOICES (NWC), a culturally tailored AEP prevention intervention delivered by mobile phone app, would report reduced risk of AEP at the 1-month follow-up compared to those who engaged with a comparison condition.

Methods

From August 2021 to January 2023, we recruited 439 urban Native young women (ages 16–20) nationally to a randomized controlled trial administered fully virtually including most recruitment, data collection and intervention engagement. Participants were randomly assigned to the NWC app or an alternative app. We used linear and logistic regression analyses to predict scores on 1-month outcome variables by study arm assignment.

Results

Results of regression analyses predicting scores on 1-month outcomes by study arm showed trending intervention effects on measures of AEP knowledge (p = 0.06), alcohol use with sexual activity (p = 0.10), and an AEP risk index (p = 0.12). At 1-month follow-up, intervention group participants reported greater AEP knowledge, lower likelihood of alcohol-involved sexual activity in the past month, and lower scores on an AEP risk index compared to the comparison group.

Conclusions

The NWC app produced trending changes in key areas of knowledge and behavior that may result in reduced AEP risk among urban Native young women. These findings suggest that the NWC app holds promise for addressing AEP in Native populations. Small changes in these areas may result in lifelong changes in the current generation that impact the health and wellbeing of generations to come.