Prenatal exposure to substances of abuse is a significant public health problem in the United States. Alcohol use among women has increased over the past decade and the gender gap between men and women related to drinking continues to narrow, creating the potential for alcohol-related, adverse health effects, including alcohol-exposed pregnancy. Furthermore, there appears to be a change in drinking patterns when it comes to Hispanic women who are more highly acculturated. Despite this, few studies have examined the association between acculturation levels and decisions about alcohol and contraception use. This study utilizes the transtheoretical model of behavior change, the social cognitive model, and the social ecological model to understand the most relevant individual and systemic elements that affect behavior change. The current study analyzes data from a parent study, two-group randomized clinical trial of 261 women of reproductive age receiving services in primary care clinics receiving either CHOICES Plus or Brief Advice. The results showed differences between alcohol and contraception use outcomes for Hispanic versus non-Hispanic women. Repeated measures ANOVA revealed that acculturation was also associated with differences in some of the transtheoretical model constructs. Further research should explore differences in acculturation among Hispanic subgroups. The data also support existing literature that suggests the need for components of interventions to be adapted based on ethnicity and level of acculturation.