Preventing Alcohol Exposed Pregnancy among Urban Native Young Women During the COVID-19 Pandemic

新冠肺炎对美国印第安人和阿拉斯加原住民社区的破坏性影响 记录充分，重点放在保留社区，通常是农村和偏远地区。然而，更多 超过72%的AIAN人居住在城市环境中，这是该种族群体的大多数，但也有一小部分--通常不到 1%--大多数城市社区。许多城市AIAN人与部落社区和文化紧密相连 做法，通常在城市和预订之间旅行，以参加家庭活动或 重要的文化庆典和仪式。然而，这一群体可能会体验到不同的文化， 与那些生活在保留环境中的人相比，大流行对社会和经济的影响。那些 差异可能是酒精暴露怀孕(AEP)风险的关键。普通人群中的早期数据 表明年轻人饮酒增加，妇女获得有效避孕措施的机会减少。这个 两者的结合可能会增加AEP的风险，对于城市AIAN年轻女性--通常是局部有限的 资源--这种风险可能特别高。然而，随着研究努力争先恐后地监测大多数 在大流行中脆弱不堪，这一人群往往变得看不见。我们对地震的影响知之甚少 新冠肺炎，酒精使用，性行为，或避孕措施使用的变化，以评估城市中的风险 艾伦。同样，我们对这些年轻女性如何能够找到韧性和 他们社区的力量，以克服大流行带来的困难或参与 疫苗的承诺。我们的项目，Native Wyse Choose，使用随机试验来评估一种文化 适当的AEP预防计划转化为AIAN城市年轻女性(16岁- 20)全国。有了我们的研究基础设施，我们就有机会利用行为的变化， 城市青年妇女、她们的家庭和社区的态度和看法 不断变化的大流行动态。我们将(1)包括额外的调查措施，全国样本为 700以了解四个主要领域不断演变的大流行病：(A)新冠肺炎病、风险暴露和安全；(B) 社会和经济影响；(C)新冠肺炎疫苗的态度、经验和地位；以及(D)文化和经济影响 历史创伤的冲击。为了将这些发现与背景联系起来，我们将(2)对 参与者是根据基线调查答复有目的地挑选出来的。最大限度地洞察 大流行的经验和获得及时、即时的洞察力，我们将招募和面试年轻的 来自我们随机对照试验样本的女性(n=32)，超过2年。我们还将定期采访选定的参与者(n=8) 随着大流行情况的变化，两年多的间隔时间纵向记录了他们的经历。使用 这种质化的设计--即横截面的洞察力，辅之以城市AIAN Young的纵向视角 妇女在不断变化的环境中的旅程--我们将能够整合我们的统计结果 在一个灵活的解释框架内。

The devastating impact of COVID-19 on American Indian and Alaska Native (AIAN) communities has been well-documented, with substantial focus on reservation communities, often rural and remote. However, more than 72% of AIANs reside in urban settings, a majority of the racial group, but a small fraction – often less than 1% - of most urban communities. Many urban AIANs are tightly connected to tribal communities and cultural practices, commonly traveling between urban areas and reservations to participate in family events or important cultural celebrations and ceremonies. However, this group is likely to experience different cultural, social, and economic impacts of the pandemic compared to those living in reservation settings. Those differences are likely critical to alcohol-exposed pregnancy (AEP) risk. Early data in the general population indicate increased alcohol use by youth, and decreased access to effective contraception among women. The combination is likely to increase risk of AEP, and for urban AIAN young women – often with limited local resources – that risk may be especially elevated. Yet, as research efforts scramble to monitor risk of the most vulnerable in a pandemic, this demographic often becomes invisible. We know little about the impact of COVID-19, the changes in alcohol use, sexual activity, or contraceptive use to assess risk among urban AIANs. Similarly, we know little about the way in which these young women are able to find resilience and strength in their communities to overcome the hardships presented by the pandemic or to engage in the promise of vaccines. Our project, Native WYSE CHOICES, uses a randomized trial to evaluate a culturally appropriate AEP prevention program translated to a smartphone app for urban AIAN young women (ages 16- 20) nationally. With our research infrastructure in place, we have the opportunity to tap shifts in behaviors, attitudes, and perceptions of urban AIAN young women, their families, and communities as they navigate the changing dynamics of the pandemic. We will (1) include additional survey measures with a national sample of 700 to capture the evolving pandemic in four main areas: (a) COVID-19 disease, risk exposure, and safety; (b) social and economic impacts; (c) COVID-19 vaccine attitudes, experience, and status; and (d) cultural and historical trauma impacts. To contextualize these findings, we will (2) conduct in-depth interviews with participants purposively selected based on baseline survey responses. To maximize insights in the diversity of experience of the pandemic and gain timely, in-the-moment, insights, we will recruit and interview young women from our RCT sample (n=32) over 2 years. We will also interview selected participants (n=8) at regular intervals over 2 years to capture their experiences longitudinally as circumstances of the pandemic shift. With this qualitative design – i.e. cross-sectional insights complemented by a longitudinal view of urban AIAN young women’s journey through the changing circumstances – we will be able to integrate our statistical findings within an agile interpretive frame.