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Palimaru AI, Brown RA, Dickerson DL, Kennedy D, Johnson CL, D'Amico EJ. Mixed Methods Evaluation of Satisfaction with Two Culturally Tailored Substance use Prevention Programs for American Indian/Alaska Native Emerging Adults. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2024; 25:330-346. [PMID: 37923885 PMCID: PMC10891245 DOI: 10.1007/s11121-023-01612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
American Indian/Alaska Native (AI/AN) communities are disproportionately affected by the opioid epidemic. AI/AN emerging adults (ages 18-25) in urban areas are at particularly high risk, with the overdose death rate among urban-dwelling AI/AN people 1.4 times higher than rural-dwelling AI/AN people. Despite these challenges, there are no evidence-based culturally tailored prevention or intervention programs to address opioid, alcohol and other drug use among urban AI/AN emerging adults. This study focused on understanding AI/AN emerging adults' experiences with two culturally tailored programs addressing opioid, cannabis, and alcohol use as part of the randomized controlled trial for Traditions and Connections for Urban Native Americans (TACUNA) in order to enhance feasibility of this intervention. Using a convergent mixed methods design at 3-month follow-up, we collected satisfaction and experience ratings and written narratives (total n = 162; intervention n = 77; control n = 85) from a sample of urban-dwelling AI/AN emerging adults who participated in both programs. We analyzed data through simultaneous examination of qualitative and quantitative data. The quantitative ratings show that both programs were rated highly. The qualitative data contextualized these ratings, illustrating pathways through which specific components were perceived to cause desired or observed behavioral change in participants. Among the elements that mattered most to these participants were the convenience of the virtual format, having a comfortable and safe space to share personal stories, and learning new information about their social networks. Negative comments focused on workshop length and inconvenient scheduling. This is one of the first studies to explore participant satisfaction and experience with culturally tailored substance use programming among a historically marginalized and understudied population. It is important to consider the voices of urban-dwelling AI/AN people in program development because hidden factors, such as limited financial resources, limited time, and misalignment with cultural values may prevent existing programs from being feasible.
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Affiliation(s)
- Alina I Palimaru
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Ryan A Brown
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - David Kennedy
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
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Kennedy DP, Brown RA, D'Amico EJ, Dickerson DL, Johnson CL, Malika N, Rodriguez A, Arvizu-Sanchez V. Social Networks, Cultural Pride, and Historical Loss Among Non-Reservation American Indian / Alaska Native Emerging Adults. RESEARCH SQUARE 2023:rs.3.rs-3547685. [PMID: 38045309 PMCID: PMC10690312 DOI: 10.21203/rs.3.rs-3547685/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Health disparities among American Indian/Alaska Native (AI/AN) populations in the United States are the result of historical traumas, such as colonization, forced relocation, and federal policies focused on cultural assimilation. Culturally-tailored health interventions aim to address intergenerational trauma by emphasizing cultural strengths and building positive social connections. In this article, we explore the social network characteristics of participants of the first culturally-tailored health intervention for AI/AN emerging adults (18-25) living outside of tribal lands. Participants (N = 150; 86% female) were recruited across the United States via social media and completed online egocentric network interviews prior to the start of intervention workshops. Participants' networks were diverse in composition and structure. They were primarily composed of family and friends, were people they had regular contact with, were similar age, and provided participants with support. We tested for significant associations between network characteristics, individual characteristics (age, gender, travel to reservations, speaking tribal languages, etc.) and two dependent measures: 1) cultural pride and belongingness and 2) thoughts of historical loss. Multiple regression results show that higher proportions of network members who discussed AI/AN identity with participants and having more network members who engage in traditional practices was associated with stronger cultural pride and belongingness. Higher proportions of network members having discussion of AI/AN identity with participants was also associated with more frequent thoughts of historical loss. Controlling for network factors, no individual characteristics were associated with either dependent variable. We discuss implications for the development of culturally-tailored health interventions.
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D'Amico EJ, Kennedy DP, Malika N, Klein DJ, Brown RA, Rodriguez A, Johnson CL, Schweigman K, Arvizu-Sanchez V, Etz K, Dickerson DL. Risk and protective factors of social networks on alcohol, cannabis, and opioid use among urban American Indian/Alaska Native emerging adults. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2023; 37:657-669. [PMID: 37023284 PMCID: PMC10440259 DOI: 10.1037/adb0000918] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVES Assess associations between social networks and urban American Indian/Alaska Native emerging adults' alcohol, cannabis, and opioid use and intentions. METHOD American Indian/Alaska Native participants ages 18-25 (N = 150; 86% female) were recruited across the United States from 12/20 to 10/21 via social media. Participants named up to 15 people whom they talked with most over the past 3 months and reported who (a) used alcohol and cannabis heavily or used other drugs (e.g., opioid use), (b) engaged in traditional practices, and (c) provided support. They also reported past 3-month alcohol, cannabis, and opioid use and intentions to use. RESULTS Having a higher proportion of network members engaging in regular cannabis and heavy alcohol use (but not other drugs) was associated with more frequent cannabis use and stronger cannabis use intentions. Participants with higher proportions of members engaging in heavy alcohol use, regular cannabis use, or other drug use and who did not engage in traditional practices were more likely to report cannabis use and greater intentions to use cannabis and drink alcohol. In contrast, participants with higher proportions of network members engaging in traditional practices and who did not report heavy alcohol use, regular cannabis use, or other drug use were less likely to report intentions to use cannabis or drink alcohol. CONCLUSIONS Findings emphasize what many studies have shown among various racial/ethnic groups-having network members who use substances increases the chance of use. Findings also highlight that traditional practices may be an important part of the prevention approach for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine
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Schick MR, Egan A, Nalven T, Spillane NS. Primary Socialization Theory and American Indian Adolescents' Intentions to Use Substances. Subst Use Misuse 2023; 58:1598-1605. [PMID: 37469038 PMCID: PMC10530191 DOI: 10.1080/10826084.2023.2236210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Intentions to use substances are a robust risk factor for future substance use. Primary Socialization Theory (PST), with its focus on relational factors, is well-suited to provide insight into American Indian adolescents' intentions to use substances given the importance of relationships in American Indian communities. The goal of the present study was to examine the role of PST-related factors (i.e., parental monitoring, peer pressure, attitudes toward school) on likelihood of intending to use substances (i.e., alcohol, cigarettes, cannabis, other drugs) among American Indian adolescents. American Indian participants (N = 8,950, 50.7% females) were recruited as a part of the Our Youth, Our Future survey, an ongoing surveillance of substance use among 7th-12th graders attending school on or near reservations. Parental monitoring was found to be associated with decreased likelihood of intending to use alcohol (aOR = 0.97, 95%CI [0.96, 0.99]), cigarettes (aOR = 0.96, 95%CI [0.94, 0.98]), cannabis (aOR = 0.95, 95%CI [0.94, 0.96]), and other drugs (aOR = 0.94, 95%CI [0.92, 0.96]). Peer pressure was associated with increased likelihood of intending to use alcohol (aOR = 1.68, 95%CI [1.59, 1.78]), cigarettes (aOR = 1.73, 95%CI [1.60, 1.86]), cannabis (aOR = 1.81, 95%CI [1.71, 1.92]), and other drugs (aOR = 1.40, 95%CI [1.26, 1.56]). More positive attitudes toward school were associated with decreased likelihood of intending to use alcohol (aOR = 0.93, 95%CI [0.91, 0.94]), cigarettes (aOR = 0.92, 95%CI [0.90, 0.94]), cannabis (aOR = 0.90, 95%CI [0.88, 0.91]), and other drugs (aOR = 0.96, 95%CI [0.93, 0.99]). Results support incorporating social relationships into interventions aiming to prevent substance use initiation, including promoting positive parental monitoring, peer interactions, and school attitudes.
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Affiliation(s)
- Melissa R. Schick
- Division of Prevention and Community Research, Yale School of Medicine, New Haven CT 06511
- PATHS Lab, University of Rhode Island Department of Psychology, Kingston RI 02881
| | - Alana Egan
- PATHS Lab, University of Rhode Island Department of Psychology, Kingston RI 02881
| | - Tessa Nalven
- PATHS Lab, University of Rhode Island Department of Psychology, Kingston RI 02881
| | - Nichea S. Spillane
- PATHS Lab, University of Rhode Island Department of Psychology, Kingston RI 02881
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Kennedy DP, D'Amico EJ, Brown RA, Palimaru AI, Dickerson DL, Johnson CL, Lopez A. Feasibility and acceptability of incorporating social network visualizations into a culturally centered motivational network intervention to prevent substance use among urban Native American emerging adults: a qualitative study. Addict Sci Clin Pract 2022; 17:53. [PMID: 36180896 PMCID: PMC9523629 DOI: 10.1186/s13722-022-00334-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background Coupling social network visualizations with Motivational Interviewing in substance use interventions has been shown to be acceptable and feasible in several pilot tests, and has been associated with changes in participants’ substance use and social networks. The objective of this study was to assess acceptability and feasibility of an adaptation of this behavior change approach into a culturally centered behavior change intervention for American Indian/Alaska Native (AI/AN) emerging adults living in urban areas. AI/AN populations experience high rates of health disparities and substance use. Although 70% of AI/AN people live outside of tribal lands, there are few culturally tailored health interventions for these AI/AN populations. Social networks can both increase and discourage substance use. Leveraging healthy social networks and increasing protective factors among urban AI/AN emerging adults may help increase resilience. Methods We conducted thirteen focus groups with 91 male and female participants (32 urban AI/AN emerging adults ages 18–25, 26 parents, and 33 providers) and one pilot test of the three workshop sessions with 15 AI/AN emerging adults. Focus group participants provided feedback on a proposed workshop-based intervention curriculum that combined group Motivational Interviewing (MI) and social network visualizations. Pilot workshop participants viewed their own social networks during group MI sessions focused on substance use and traditional practices and discussed their reactions to viewing and discussing their networks during these sessions. We used a combination of open coding of focus group and workshop session transcripts to identify themes across the group sessions and content analysis of comments entered into an online social network interview platform to assess the extent that participants had an intuitive understanding of the information conveyed through network diagrams. Results Focus group and pilot test participants reacted positively to the intervention content and approach and provided constructive feedback on components that should be changed. Themes that emerged included feasibility, acceptability, relevance, understandability, and usefulness of viewing personal network visualizations and discussing social networks during group MI workshops. Workshop participants demonstrated an intuitive understanding of network concepts (network composition and structure) when viewing their diagrams for the first time. Conclusions Social network visualizations are a promising tool for increasing awareness of social challenges and sources of resilience for urban AI/AN emerging adults. Coupled with Motivational Interviewing in a group context, social network visualizations may enhance discussions of network influences on substance use and engagement in traditional practices. Trial Registration: ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020
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Affiliation(s)
- David P Kennedy
- RAND Corporation, 1776 Main St., 2138, Santa Monica, CA, 90401, USA.
| | | | - Ryan A Brown
- RAND Corporation, 1776 Main St., 2138, Santa Monica, CA, 90401, USA
| | - Alina I Palimaru
- RAND Corporation, 1776 Main St., 2138, Santa Monica, CA, 90401, USA
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA, 90025, USA
| | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
| | - Anthony Lopez
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
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Woods C, Kim B, Guo K, Nyguen T, Taplayan S, Aronowitz T. Factors That Influence Substance Use Among American Indian/Alaskan Native Youth: A Systematic Mixed Studies Review. J Am Psychiatr Nurses Assoc 2022; 28:37-57. [PMID: 34396829 DOI: 10.1177/10783903211038050] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The American Indian/Alaskan Native (AI/AN) mortality rate from illicit drug use was 22.7%, double that of the general population between 2007 and 2009. Fifteen percent of AI/AN youth reported receiving treatment for substance use compared with 10% of non-AI/AN peers. OBJECTIVE The purpose was to explore the factors that influence substance use among AI/AN youth. METHOD We performed a systematic review using a results-based convergent synthesis design. Eight electronic databases were searched for articles published between 2014 and 2019 using the search terms "Native American youth," "Native American adolescent," "Native Youth," "substance use," "substance misuse," and "substance abuse." The Mixed Methods Appraisal Tool was used to appraise the studies. RESULTS Forty-seven studies met the inclusion criteria (44 quantitative, one qualitative, and two mixed-methods studies). The results were organized using the ecological systems model and included evaluation of both protective and risk factors related to AI/AN youth substance use. Three system levels were found to influence substance use: individual, micro- and macrosystems. The individual systems-level coping mechanisms played a key role in whether AI/AN youth initiated substance use. Family, school, and peer factors influence the microsystem level. At the macrosystem level, community environmental factors were influential. CONCLUSION The major factor linking all the systems was the influence of a connected relationship with a prosocial adult who instilled future aspirations and a positive cultural identity. Findings of this systematic mixed studies review will assist in intervention development for AI/AN youth to prevent substance misuse.
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Affiliation(s)
- Cedric Woods
- Cedric Woods, PhD, University of Massachusetts Boston, Boston, MA, USA
| | - BoRam Kim
- BoRam Kim, BSN, RN, University of Massachusetts, Boston, MA, USA
| | - Kristine Guo
- Kristine Guo, University of Massachusetts, Boston, MA, USA
| | - Tuyet Nyguen
- Tuyet Nugyen, University of Massachusetts Boston, MA, USA
| | - Sarin Taplayan
- Sarin Tapalyan, BSN, University of Massachusetts, Boston, MA, USA
| | - Teri Aronowitz
- Teri Aronowitz, PhD, APRN, FNP-BC, FAAN, University of Massachusetts Boston, Boston, MA, USA
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Bokan D, Dinić B, Čanković D, Čanković S, Nićiforović-Šurković O, Đurica B. Psychometric properties of the Serbian adaptation of the cannabis use intention questionnaire (CUIQ) among secondary medical school adolescents. JOURNAL OF SUBSTANCE USE 2021. [DOI: 10.1080/14659891.2021.1989508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dalibor Bokan
- Secondary Medical School “April 7th”, Novi Sad, Serbia
| | - Bojana Dinić
- Faculty of Phylosophy, University of Novi Sad, Novi Sad, Serbia
| | - Dušan Čanković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Sonja Čanković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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Zephier Olson MD, Dombrowski K. A Systematic Review of Indian Boarding Schools and Attachment in the Context of Substance Use Studies of Native Americans. J Racial Ethn Health Disparities 2019; 7:62-71. [DOI: 10.1007/s40615-019-00634-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 07/29/2019] [Accepted: 08/20/2019] [Indexed: 01/21/2023]
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Kelley A, Fatupaito B, Witzel M. Is culturally based prevention effective? Results from a 3-year tribal substance use prevention program. EVALUATION AND PROGRAM PLANNING 2018; 71:28-35. [PMID: 30092491 DOI: 10.1016/j.evalprogplan.2018.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 05/18/2018] [Accepted: 07/02/2018] [Indexed: 05/27/2023]
Abstract
American Indian youth substance use is a major public health concern. To date, there has been limited evaluation of American Indian youth substance use prevention programs. Evaluation of prevention programs is necessary to understand the aspects of programming that are effective or not effective. This mixed-methods evaluation focuses on select outcomes of a 3-year culturally-based prevention program located in six American Indian communities in the Rocky Mountain Region. The goals of the prevention program are to reduce binge drinking by 30% and increase community readiness by 1-point over a 5- year period. In the first year of the program, community members worked with program staff to develop an evaluation plan that would measure the following outcomes: lowering substance use, increasing community readiness, and increasing the reach of prevention messaging through culturally based prevention. The primary research questions this outcome evaluation sought to answer were as follows: 1) Are there differences in American Indian youth who participate in culturally-based prevention activities compared with American Indian youth who do not participate in these activities? 2) Was the prevention program effective in increasing community readiness over a 3-year period? 3) Did community involvement in prevention activities increase overtime? Results from this evaluation indicate that substance use was similar among intervention (n = 200) and non-intervention youth (n = 369). This was somewhat surprising because Intervention youth reported higher levels of social support and community connections than non-intervention group youth. Community readiness decreased -.81 point from 2015 to 2017. The reach of prevention activities increased 365% from 2015 to 2017. We provide lessons learned that may help other communities as they document outcomes related to prevention efforts. Substance use is a multi-faceted problem facing our communities, families, schools, and nation. Innovative, effective, culturally-based prevention programs like the one highlighted in this paper underscore the need for primary prevention strategies.
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Affiliation(s)
- Allyson Kelley
- Allyson Kelley & Associates PLLC, PO BOX 1682 Sandia Park, NM 87047, United States.
| | - Bethany Fatupaito
- Rocky Mountain Tribal Leaders Council, 711 Central Ave Suite 220, Billings MT 59105, United States
| | - Morgan Witzel
- Rocky Mountain Tribal Leaders Council, 711 Central Ave Suite 220, Billings MT 59105, United States
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Ford JD, Grasso DJ, Levine J, Tennen H. Emotion Regulation Enhancement of Cognitive Behavior Therapy for College Student Problem Drinkers: A Pilot Randomized Controlled Trial. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017; 27:47-58. [PMID: 30930609 PMCID: PMC6438385 DOI: 10.1080/1067828x.2017.1400484] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
This pilot randomized clinical trial tested an emotion regulation enhancement to Cognitive Behavior Therapy (CBT) with 29 college student problem drinkers with histories of complex trauma and current clinically significant traumatic stress symptoms. Participants received eight face-to-face sessions of manualized internet-supported CBT for problem drinking with or without trauma-focused emotion regulation skills (Trauma Affect Regulation: Guide for Education and Therapy, TARGET). Both interventions were associated with sustained (at one-month follow-up) reductions in self-reported drinking frequency, drinking related impairment, and heavy drinking in the past week, as well as post-traumatic stress disorder (PTSD) and complex PTSD symptoms, and improvement in self-reported emotion regulation. The enhanced intervention was associated with significantly greater sustained reductions in complex PTSD symptoms and resulted in medium/large effect size reductions in days of alcohol use (versus small effects by CBT). Emotion regulation enhancement of CBT for college student problem drinkers with interpersonal trauma histories warrants further investigation.
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Affiliation(s)
- Julian D. Ford
- University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030
| | - Damion J. Grasso
- University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030
| | - Joan Levine
- University of Connecticut, 269 Glwenbrook Rd., Storrs, CT 06269
| | - Howard Tennen
- University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030
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