Secondary Analysis of the Choices Plus Efficacy Study: Examining the Role of Acculturation Among Latina/x Women on Uptake of Effective Contraception to Reduce Risk of Alcohol-Exposed Pregnancy

Background: Alcohol consumption during pregnancy can lead to deleterious outcomes for the pregnancy and the fetus, including increased risk of miscarriage, preterm birth, and a range of lifelong disabilities that fall under the umbrella of Fetal Alcohol Spectrum Disorders (FASD). Given approximately 40% of pregnancies are unplanned and women may be consuming alcohol before they realize they are pregnant, interventions during the preconception period are essential. Preconception interventions have demonstrated efficacy in reducing the risk of alcohol-exposed pregnancies (AEP), with these studies illustrating that women tend to adopt contraception more often than reducing drinking to reduce this risk. Existing efficacy trial data studying preconception interventions targeting AEP, particularly with diverse populations, hold promise for better understanding how to tailor these interventions to improve outcomes for women from varied cultural backgrounds. Choices Plus, a CDC funded randomized-controlled trial that recruited a diverse sample, included an acculturation measure, and found a two-session intervention was efficacious in reducing the risk of alcohol- and tobacco-exposed pregnancy, provides a rich data set for better understanding the potential impact of acculturation on contraceptive uptake in a subsample of Latina/x women. Given well-documented cultural differences in contraceptive use among Latina/x women due to cultural and religious beliefs, exploring whether these differences continue to exist after receiving the Choices Plus intervention may provide important information for future adaptations based on acculturation. Women aged 18-44 were enrolled in this study if they were at risk of AEP.

Method: Existing data from the Choices-Plus randomized controlled trial was used to examine the predictive value of acculturation using the 12-item Short Acculturation Scale for Hispanics at baseline (using 2.99 cutoff to determine low and high levels) on risk of pregnancy (yes/no) at 9 months following the Choices Plus two-session preconception intervention. The analytic sample consisted of Latina/x women who received the Choices-Plus intervention only (N=59).

Results: The average age of Latina/x women in the Choices Plus intervention arm was 28.5 (SD = 7.13), and the sample was primarily white (93%) with 29% born out of the U.S. The average number of years lived in the U.S. ranged from 10 to 26 years, with an average of 18.6 years (SD = 5.4). Most of the sample (84.2%) had an income of less than $30,000 per year. Background variables were not associated with use of contraception among Latina/x women in the sample, so these variables were not controlled. Lower levels of acculturation predicted lower levels of contraception use to prevent pregnancy 9 months after the Choices Plus intervention (p=.035).

Implications: These results suggest that acculturation among Latina/x women receiving a preconception intervention may influence contraception uptake, which may require more targeted support to reduce alcohol use or help facilitate access to contraception if preferred for Latina/x women with lower levels of acculturation.