The Efficacy of a Multicultural Prevention Intervention among Urban American Indian Youth in the Southwest U.S.

This study explored how a non-targeted group of ethnic minority youth might or might not benefit from a prevention intervention focused on other cultural groups. The study specifically evaluated the effects of an evidence-based drug prevention curriculum with a sample of urban American Indian youth in the southwest U.S., most of whom self-reported multi-ethnic heritages. Using growth curve modeling, this research examined the developmental trajectory of drug use for these youth, and compared it with the trajectory of youth from other racial/ethnic groups at pre-intervention, post-intervention, and two follow up time periods. Results indicate that alcohol and marijuana use increased from pre-intervention across subsequent time periods for all youth. The drug use of the American Indian youth in the treatment group increased on some measures. Specifically, they reported a steeper trajectory in the amount and frequency of alcohol and marijuana use compared to the youths in the treatment groups with other racial/ethnic identifications. The implications of these findings for the development of culturally grounded prevention programs for multi-ethnic, urban American Indian youth are discussed. Editors’ Strategic Implications: This research provides a specific example, but also makes a strong global argument, for the need to develop and evaluate prevention programs that are culturally grounded in the worldview of the target group.     

Integrating Community-Engagement and a Multiphase Optimization Strategy Framework: Adapting Substance Use Prevention for American Indian Families

Initiation of substance use often occurs earlier among American Indian (AI) youth than among other youth in the USA, bringing increased risk for a variety of poor health and developmental outcomes. Effective prevention strategies are needed, but the evidence base remains thin for this population. Research makes clear that prevention strategies need to be culturally coherent; programs with an evidence base in one population cannot be assumed to be effective in another. However, guidance on effective adaptation is lacking. This paper reports on cultural adaptation of an evidence-based program utilizing the multiphase optimization strategy (MOST) framework embedded within a community-engaged process to evaluate intervention components. The Strengthening Families Program for Parents and Youth 10-14 was adapted to become the Thiwáhe Gluwá?’akapi Program for American Indian youth and families. Three program components were evaluated for their effectiveness with regard to outcomes (youth substance use, theoretical mediators of program effects on substance use, and program attendance) in a sample of 98 families (122 youth and 137 adults). Consistent with the MOST framework, the value of components was also evaluated with regard to efficiency, economy, and scalability. Expanding on the MOST framework for cultural adaptation, we also considered the results of the MOST findings regarding the acceptability of each component from the perspectives of community members and participants. The promise of a strategic component-based approach to adapting evidence-based interventions is discussed, including the benefits of engaging community to ensure relevance and considering both cultural and scientific rationale for each component to enhance impact.

     

Children's safety on American Indian farms: information and recommendations

It is estimated that 1.2 million youth younger than age 20 live on farms; American Indian children constitute an important but understudied subset of this at-risk group. Despite documented risks of injuries and death among children who live and work on farms and a descending trend in the overall reported fatalities among youth who live and/or work on farms, very little is known about the agriculture-related injury and fatality experience of American Indian youth. Limited data indicate that drowning, motor vehicles, and poisonings are leading causes of unintentional mortality and morbidity for this group, although the attribution to agricultural exposure is not evident. The scant available data indicate a need to look more closely at agricultural work, bystander exposures, and other farm events that put American Indian youth at risk of illness, injury, or death compared to factors more fully reported for majority youth in the agriculture population, in order to guide intervention and prevention programs that are appropriate and acceptable to this vulnerable population.     

Who Wants to Quit? Characteristics of American Indian Youth Who Seek Smoking Cessation Intervention

No group is more at-risk for tobacco-related health disparities than are American Indian youth. Little is known about their readiness to quit smoking and the extent to which cessation programs may require cultural tailoring related to recruitment, implementation, or content. This study identifies unique characteristics of American Indian teen smokers who enrolled in a school-based smoking cessation program, Not On Tobacco (called N-O-T). Using data from N-O-T intervention trials conducted in North Carolina between 2001 and 2004, the present study (a) describes the characteristics of American Indian participants (n = 91); (b) determines if basic demographics and smoking history affect intervention readiness; and (c) compares findings with non-Native participants (n = 138) enrolled in N-O-T within the same state. Upon enrollment, 80% of the sample reported that they planned to quit smoking in the next 1–6 months. We found significant differences between American Indian and non-Native youth on smoking history, with non-Natives smoking with greater intensity and frequency. Contrary to previous reports, American Indian youth in this study smoked with less intensity and were more ready to quit smoking than non-Native youth. Results reveal previously unreported characteristics of American Indian teen smokers. Study findings may advance the development of effective marketing, recruitment, and programming among American Indian teen smokers into cessation programs, particularly N-O-T, which is the only teen smoking cessation program which includes an adaptation specifically for American Indians.     

Patterns of Alcohol Use Among Ethnically Diverse Black and Hispanic Urban Youth

Adolescent alcohol use remains a pressing problem. Identifying which groups are at greater risk of alcohol use helps in understanding the etiology of drinking and the development of alcohol prevention programs. Little epidemiologic information regarding alcohol use among inner-city minority adolescents is available. This study examined the relationship between patterns of alcohol use and ethnic group, a black group consisting primarily of African-Americans and Caribbean/West Indians and a Hispanic group of predominantly Puerto Ricans and Dominicans, among urban youth. Hispanic youth reported greater experience with alcohol than black youth. Dominican adolescents drank more frequently, drank more per drinking occasion, and planned to drink more in the future than Puerto Rican adolescents. Similarly, Caribbean/West Indian youth drank more frequently, became drunk more often, drank more per drinking occasion, and planned to drink more in the future relative to African-American youth. In general, gender did not moderate the relationship with alcohol. This study indicates that only considering ethnic group membership is not sufficient because there were important subgroup differences in patterns of alcohol use for both Hispanics and Blacks. Implications for prevention are discussed.     

Applying the Theory of Reasoned Action to Understanding Teen Pregnancy with American Indian Communities

Objectives American Indian girls have higher teen pregnancy rates than the national rate. Intervention studies that utilize the Theory of Reasoned Action have found that changing attitudes and subjective norms often leads to subsequent change in a variety of health behaviors in young adults. The current study goal is to better understand sexual decision-making among American Indian youth using the Theory of Reasoned Action model and to introduce ways to utilize attitudes and subjective norms to modify risky behaviors. Methods The project collected qualitative data at a reservation site and an urban site through 16 focus groups with American Indian young people aged 16–24. Results Attitudes towards, perceived impact of, and perception of how others felt about teen pregnancy vary between American Indian parents and non-parents. Particularly, young American Indian parents felt more negatively about teen pregnancy. Participants also perceived a larger impact on female than male teen parents. Conclusions There are differences between American Indian parents and non-parents regarding attitudes towards, the perceived impact of, and how they perceived others felt about teen pregnancy. Teen pregnancy prevention programs for American Indian youth should include youth parents in curriculum creation and curriculum that addresses normative beliefs about teen pregnancy and provides education on the ramifications of teen pregnancy to change attitudes.     

Trends in drug use among American Indian students and dropouts, 1975 to 1994.

OBJECTIVES: This 20-year surveillance project tracks the trends in substance abuse among American Indian students and examines the observed patterns to discover implications for prevention and treatment. The current phase of this work includes data on drug use among Indian school dropouts. METHODS: Anonymous drug use surveys are administered annually to a nationally representative sample of 7th- to 12th-grade Indian youths residing on or near reservations. An adjustment for dropouts is made to provide estimates for the entire age cohort. RESULTS: Indian youth continue to show very high rates of drug use compared with their non-Indian peers. The trends in rates during the last 20 years parallel those of non-Indian youth. While overall drug use may be decreasing, about 20% of Indian adolescents continue to be heavily involved with drugs, a proportion that has not changed since 1980. Adjustment for school dropouts increases the estimate for the entire age cohort. CONCLUSIONS: Indian youth, particularly school dropouts, remain at high risk for drug use. The similarity to trends for non-Indians indicates that prevention strategies effective with other youth can be effective with this population.     

Attempts to undermine tobacco control: tobacco industry "youth smoking prevention" programs to undermine meaningful tobacco control in Latin America

We sought to understand how the tobacco industry uses "youth smoking prevention" programs in Latin America. We analyzed tobacco industry documents, so-called "social reports," media reports, and material provided by Latin American public health advocates. Since the early 1990s, multinational tobacco companies have promoted "youth smoking prevention" programs as part of their "Corporate Social Responsibility" campaigns. The companies also partnered with third-party allies in Latin America, most notably nonprofit educational organizations and education and health ministries. Even though there is no evidence that these programs reduce smoking among youths, they have met the industry's goal of portraying the companies as concerned corporate citizens and undermining effective tobacco control interventions that are required by the World Health Organization Framework Convention on Tobacco Control.     

Comprehensive Quality Programming and Accountability: Eight Essential Strategies for Implementing Successful Prevention Programs

This article presents strategies that can be used to improve the state of the practice of prevention programs. Although these strategies have broad application to all forms of prevention and intervention programs, this article focuses on the application of such strategies to youth and family prevention programs. If positive changes in the lives of the youth and families in our communities are to be realized, it is imperative that effective and quality prevention programs reach these populations. We present a series of eight specific strategies, collectively referred to as Comprehensive Quality Programming (CQP), and an overview of an effective method for using such strategies to continuously improve programs. The use of CQP will be illustrated with three examples, including an evaluation of a school-based mentoring program.     

Native American childhood obesity prevention interventions: a systematic review

Native American populations are at higher risk for becoming obese and suffering from obesity-related illness compared with other populations. Concurrently, prevention methods have not been successful with this group, especially intervention attempts aimed at children, which have been few and ineffective. The purpose of this systematic review was to evaluate the effectiveness and methodologies of childhood obesity prevention interventions targeting Native American youth, and to make recommendations to future researchers and practitioners. Seven databases (Medline, Academic Search Premier, CINAHL, ERIC, Health Source Nursing, PsychINFO, and Sport Discus) were utilized to retrieve articles, using four sets of keywords; 1. Children AND Obesity AND Native American AND Program; 2. Children AND Obesity AND Native American AND Intervention; 3. Children AND Obesity AND Indian AND Program; and 4. Children AND Obesity AND Indian AND Intervention. Overall, six articles were found and evaluated for salient findings and key methodological issues such as use of theory, intervention duration, research design, outcome measures, process evaluation, and validated measures. Results indicated that theory was seldom used in planning the interventions, process evaluations were used some of the time, and half of the interventions were smaller pilot studies. This review suggests that there have been few interventions targeting obesity prevention among Native American youth over the past decade. Recommendations for enhancing such programs are discussed.     

Confirmed Recall and Perceived Effectiveness of Tobacco Countermarketing Media in Rural Youth

This study was the first to examine rural youth’s responses to ten television and radio tobacco countermarketing ads aired during a 13-week field campaign conducted in a U.S. Northern Plains state. A post-campaign survey of 391 girls and boys aged 12–17 years and including 58 American Indian youth provided information about their confirmed recall (CR) of the ads; and for recalled ads, their ratings of the ads’ perceived effectiveness (PE). Results were that controlling for age and smoking risk, both American Indian and white girls and boys had the highest CR for the television ad Artery and for the radio ad ABC. Artery shows fatty deposits being squeezed from a deceased smoker’s aorta, and ABC presents a former smoker speaking through his electro-larynx. Among the television ads, PE ratings were highest for the ad Artery in both boys and girls. Among the radio ads, boys rated ABC highest, whereas girls rated Joe DoBoer highest—an ad that discusses mouth lesions that developed from using smokeless tobacco. An analysis of race/ethnicity differences in PE for the ad Artery and ABC indicated American Indian and white youth considered these ads equally effective. These findings indicate certain TV and radio ads depicting graphic health harms from tobacco—especially the TV ad Artery and the radio ad ABC—are highly recalled and perceived as effective by both American Indian and white girls and boys from a rural region. Future research is needed to better understand which individual- and media-level factors increase the likelihood that anti-tobacco ads will be effective in reducing youth tobacco use.     

Culturally Grounded Prevention for Minority Youth Populations: A Systematic Review of the Literature

Contemporary prevention science has focused on the application of cultural adaptations of evidence-based prevention programs for minority youth populations. Far less is known about culturally grounded methods that are intended to organically develop prevention programs within specific populations and communities. This article systematically reviews recent literature on culturally grounded interventions used to prevent health disparities in ethnic minority youth populations. In this review, we assessed 31 peer-reviewed articles published in 2003 or later that fit inclusionary criteria pertaining to the development and evaluation of culturally grounded prevention programs. The evaluated studies indicated different approaches toward cultural grounding, as well as specific populations, geographic regions, and health issues that have been targeted. Specifically, the findings indicated that most of the studies focused on the development and evaluation of culturally grounded HIV/STI and substance abuse prevention programs for Mexican–American, African American, and American Indian/Alaska Native youth residing in the South or Southwestern US. These studies largely relied on community-based participatory or qualitative research methods to develop programs from the “ground up.” This review has implications for the development of future culturally grounded and culturally adapted prevention programs targeting underserved minority youth populations and geographic regions. Specifically, it identifies populations and regions where culturally grounded prevention efforts are underdeveloped or non-existent, providing some scientific direction for the future development of these types of programs.     

Working, sex partner age differences, and sexual behavior among African American youth

Participation in the workplace has been proposed as a potential structural-level HIV/STI prevention strategy for youth. Only a few cross-sectional studies have explored the effect of work during adolescence and young adulthood on sexual behavior and their results have been mixed. This study builds on this literature by exploring whether work influences youths’ sexual behavior in a cohort of African American youth (N = 562; 45% males; M = 14.5 years, SD = 0.6) followed from adolescence to young adulthood (ages 13–25 years). Using growth curve modeling, we tested whether working was associated with older sex partners. Then, we explored the association between sex partner age differences and sexual behaviors (i.e., number of sex partners, condom use, and frequency of sexual intercourse). Finally, we tested whether the relationship between sex partner age differences and sexual behaviors was confounded by working. Working greater number of hours was not significantly associated with having older sex partners. Sex partner age differences was associated with number of partners, condom use, and higher sex frequency. These associations were larger for females. Working was associated with higher sex frequency, after accounting for age differences. We discuss the implications of these findings for future research and program planning, particularly in the context of youth development programs.     

Risk and Protective Factors Associated With Lifetime Sexual Experience Among Rural,Reservation-Based American Indian Youth

Early sexual initiation is a catalyst for sexually transmitted infection and unintended pregnancy. American Indian/Alaska Native (AI/AN) youth initiate sex prior to age 13 more often than other U.S. youth, contributing to current inequalities in sexual health. Identifying what factors were associated with lifetime sexual experience among AI/AN youth can inform the development of primary prevention programming to delay sexual initiation, alleviate the costs of early sexual activity, and improve sexual health outcomes in this population. We analyzed cross-sectional data from 267 AI youth ages 13–19, recruited from a rural, reservation-based community. We used multivariate logistic regression models to estimate associations between independent variables and lifetime sexual experience (vaginal and/or anal sex) across the following categories: sociodemographic, knowledge, attitudes/perceptions, beliefs, intentions, skills, behaviors, and theoretical constructs. The sample was 56.2% female, mean age 15.1 years (SD?=?1.7), and 22.5% were sexually experienced. In our final model, condom use self-efficacy (attitude/perception factor) and intentions to remain abstinent until marriage (intention factor) were associated with lower odds of lifetime sexual experience. Age (sociodemographic factor), intention to have sex (intention factor), use of any contraception (behavior factor), and higher response efficacy (theoretical construct) were associated with lifetime sexual experience. Of these, intention to have sex was the strongest indicator. These results both corroborate and contrast with other research conducted among rural, reservation-based AI/AN youth. Our findings show programs targeting intentions may have the greatest impact among reservation-based AI youth, and justify program delivery stratified by age group in this setting.     

Fetal Alcohol Syndrome Among Native American Adolescents: A Model Prevention Program

Alcohol is the most commonly used and abused substance among adolescents in the United States. Its abuse, in particular among Native American adolescents, has led to the highest incidence of Fetal Alcohol Syndrome in the nation. While absolutely preventable, FAS prevention efforts to date have been minimally successful in reducing its incidence. This multi-phased project surveyed prevention specialists and gatekeepers in major prevention programs in six states with large Indian populations and designed and evaluated a viable prevention strategy that targets Native American adolescents at highest risk of engaging in behaviors that lead to FAS births. The study indicated that a community-based prevention program targeting 6th through 8th grade students has the highest probability of success. Specific strategies, including types of communication media, materials and tools acceptable to the target population, as well as the role of parents, extended family, peers, and culture are discussed in some detail.     

School-Based Adolescent Drug Prevention Programs: 1998 Meta-Analysis

This paper reports on a meta-analysis of 207 universal school-based drug prevention programs that compared the self-reported drug use of treatment to control or comparison youth. Programs are classified into Interactive and Non-Interactive groups based on a combination of content and delivery method. Weighted categorical and weighted regression methods have been used to determine the attributes that most effectively reduce, delay, or prevent drug use, including program size, type of control group and leader, attrition, target drug, intensity, grade, special population and level of drug use. Program type and size are found to be significant predictors of effectiveness. Non-interactive lecture-oriented prevention programs that stress drug knowledge or affective development show small effects. Interactive programs that foster development of interpersonal skills show significantly greater effects that decrease with large-scale implementations. founder and principal investigator of Tobler Research Associates, passed away on February 15, 2000     

Preventing Youth Suicide: Potential “Crossover Effects” of Existing School-Based Programs

Notable increases in youth mental health problems combined with strains on the already stretched mental health workforce raise concerns that there will be an ensuing increase in youth suicide thoughts, behaviors, and even deaths. Schools are recognized as crucial settings for youth mental health support and suicide prevention activities, yet schools also face staff shortages and ever-increasing responsibilities for student well-being. Evidence is emerging that prevention programs originally designed to improve problem-solving skills and social-emotional functioning in youth have demonstrated downstream, “crossover effects,” that is, unanticipated benefits, on youth suicidal behavior. Relatively little research on crossover effects has been conducted within school settings, despite the strong potential for commonly administered programs to have an impact on later suicide risk. We review key suicide risk factors and their proposed mechanisms of action; we also discuss factors that may protect against suicide risk. We then identify upstream prevention programs targeting the same factors and mechanisms; these programs may hold promise for downstream, crossover effects on youth suicide risk. This paper is intended to provide a framework to help researchers, practitioners, and policymakers as they consider how to prevent youth suicide using existing school-based resources. Rigorous investigation of upstream prevention programs is urgently needed to determine ideal approaches schools and communities can deploy to prevent youth suicide.

     

The Application of Youth Substance Use Media Campaigns to Problem Gambling: A Critical Evaluation

ABSTRACT

Despite the negative impact that problem gambling poses on individuals and society there have been few gambling prevention campaigns specifically targeting youth. The authors review the literature on past and current drug, alcohol, and tobacco use prevention media campaigns, examining the similarities across 25 health communication programs with the aim of viewing their applicability for the prevention of youth problem gambling. Critical features of effective campaigns are identified and assessed in terms of their applicability for youth problem gambling. Recommendations for the design, implementation, and evaluation of a youth gambling media campaign are discussed.