Evaluation of an optimized intervention to prevent early substance use among American Indian youth: Examination of expanded impacts on youth and parents

University Of Colorado Denver, Aurora CO

Investigators

Linked publications, trials & patents

Abstract

PROJECT SUMMARY (See instructions): It is imperative that we continue to innovate ways to address inequities that challenge the health and wellbeing of American Indian (AI) youth, families, and communities. The COVID-19 pandemic disproportionately impacted Indigenous communities in the U.S. and made inequities broadly visible, but these inequities are not new. The history of oppression of Indigenous people and attempts at cultural eradication through federal policies and broken treaties has disrupted cultures and communities, and research suggests that this disruption is at the root of elevated substance use problems in these communities. AI youth initiate substance use earlier than most other youth in the U.S. and the links between early initiation and both concurrent developmental disruption and progression to problematic patterns of use are strong. The need for early prevention among AI youth is clear, and evidence suggests that leveraging the cultural strengths may be a particularly effective path toward prevention. We have been working with partners on a Northern Plains Reservation since 2009 to understand risk factors for early initiation of substance use and to develop a culturally grounded prevention program for young adolescents. We have developed and are testing the Thiwáhe Gluwáš’akapi (TG) program for young AI adolescents that reinforces family, cultural and community connections. Through a multiphase optimization trial (TG1 study), we gathered preliminary evidence of the effectiveness of TG; in a randomized controlled trial (TG2 study), we tested the effectiveness of the optimized TG program. This project (TG3 Study) moves this work forward through a hybrid implementation-effectiveness study. First, it will maximize what can be learned from data collected in the TG2 study by lengthening the follow-up period for participating youth and families to four years post-intervention and utilizing Bayesian small sample quantitative analytic methods. Second, this study will build on what was learned in the TG2 study about program delivery to foster the transition from research-based to community-based implementation, engaging existing community organizations to deliver TG to families across the reservation and gathering systematic data on implementation processes and outcomes. This study will expand our understanding of TG program effects, result in a better understanding of the optimal fit for the sustained delivery of the TG program on the Pine Ridge Reservation and begin developing infrastructure for long term program implementation.