Critical Issues for Substance Abuse Prevention Targeting American Indian Youth

This paper examines prevention programs targeting alcohol and other drug use among American Indian youth. We start with a review of what is known about substance use by this population. We provide consideration of specific prevention programs for Indian youth within these frameworks: Cognitive/Information Dissemination, Affective Education, Social Influence, and Personal and Social Skills Training. A particular focus is on the manner in which issues of culture are incorporated into prevention programs. A detailed overview of the diversity of the American Indian population is presented and its implications for prevention work with Indian youth are discussed. A major conclusion is that there is not one type of prevention program that is likely to work with American Indian youth since there is no such thing as a typical American Indian.     

Etiology and Prevention of Substance Use Among Asian American Youth

Among populations identified by the U.S. Bureau of the Census, it is anticipated that the Asian/Pacific Islander (API) population will experience the greatest change between 1990 and 2050 (U.S. Bureau of the Census. [1996, February]. Current population reports. Series P25-1130. Washington, DC: U.S. Government printing office). Limited studies focus on APIs as a racial group and still fewer disaggregate samples to specific ethnic Asian subgroupings. This paper begins with definitions of the API communities, then examines rates of adolescent drug use, risk and protective factors, and preventive intervention effectiveness focused on API communities. The limited epidemiological data suggest that in general, APIs are at a relatively lower risk for drug use than youth from most other ethnic groups. However, the available data also suggest that use may not be as low as generally assumed with rates for alcohol use, smoking, and some illicit drugs being equal to or exceeding those of African Americans and European Americans. Despite the paucity of available data on particular Asian subgroups, the available data demonstrate that there are differences among API subgroups, underscoring the importance of identifying Asian subgroups when studying substance use and when planning prevention and treatment. The limited data examining the etiology of drug use across API subgroups suggests that some of the risk and protective factors derived from majority based research may also be predictors for these populations. These data support the utility of examining the generalizability of existing tested prevention approaches among different API communities. Finally, further efforts should be made to encourage and support the evaluation of community-based programs that already target and deliver services to API youth.     

Families of Persons With Substance Use and Mental Disorders: A Literature Review and Conceptual Framework*

Abstract: There are significant knowledge gaps concerning the experiences of families of persons with co‐occurring substance and mental disorders and the impact of families on treatment of individuals with these disorders. This paper presents a conceptual framework for examining family involvement of adults in treatment for co‐occurring substance and mental disorders. An overview of the characteristics, problems, and needs of these individuals and their family members is presented. The extant literature pertaining to our conceptual framework is reviewed with focus on predictors of family involvement with clients, predictors of family member involvement in clients’ treatment, and consequences of family involvement for client treatment outcomes. Gaps in the research literature and implications for future research and practice are discussed.     

Substance dependent American Indian veterans: a national evaluation.

Demographic, clinical, and treatment episode characteristics of 3,087 American Indian veterans discharged from Department of Veterans Affairs hospitals in fiscal year 1991 were examined. Substance use disorders were diagnosed in 46.3 percent of discharged American Indians, compared with 23.4 percent of discharged veterans overall. More than 97 percent of American Indian substance use diagnoses were for alcohol dependence, while rates of other drug use disorders were low. Substance dependent American Indians were younger, and more likely to be male and unmarried, than nondependent American Indians. Psychiatric disorders, particularly personality disorders, depression, and posttraumatic stress disorders, were more prevalent among American Indians diagnosed with substance use disorders, than among nondependent American Indians. American Indians with substance use disorders were similar demographically to the general population of substance dependent veterans. Rates of diagnosed psychiatric disorders and drug dependencies other than alcohol were lower among American Indians receiving substance (alcohol or drug) use diagnoses than among the general population of substance dependent veterans. Rates of rehospitalization following discharge were higher in substance-abusing American Indian veterans than among their counterparts. Potential explanations for these findings are discussed.     

Protective Factors as a Unifying Framework for Strength-Based Intervention and Culturally Responsive American Indian and Alaska Native Suicide Prevention

Prevention Science - The ongoing challenge of American Indian and Alaska Native (AIAN) youth suicide is a public health crisis of relatively recent historical origin inadequately addressed by...     

Familias Unidas for Health and Wellness: Adapting an Evidence-Based Substance Use and Sexual Risk Behavior Intervention for Obesity Prevention in Hispanic Adolescents

We describe the adaptation of Familias Unidas, an evidence-based substance use and sexual risk behavior intervention, for obesity prevention in Hispanic adolescents. Intervention developers and experts in pediatric obesity, exercise physiology, dietetics, and the local parks system provided input for changes. Hispanic families also provided input through a series of 21 focus groups conducted before, during, and after an initial pilot test of the adapted intervention. After transcribing audiotaped sessions, we used a general inductive approach and Dedoose qualitative software to derive themes. Results indicated the need for improved health-related family functioning, enhanced nutrition education and skill building, increased family engagement in physical activity, and stronger links between family and environmental supports. Parents who participated in the pilot test expressed high enthusiasm for hands-on nutrition training and reported improvements in family functioning. Adolescents liked outdoor physical activities but wanted parents to be more engaged in joint physical activity sessions. The adapted intervention maintains fidelity to Familias Unidas’ core theoretical elements and overall structure, but also includes content focused on physical activity and nutrition, adolescent participation in physical activity sessions led by park coaches, and joint parent-adolescent participation in physical activity and nutrition skill-building activities.     

Preadolescent Drug Use Resistance Skill Profiles, Substance Use, and Substance Use Prevention

The aims of the current study were threefold: (1) specify the skills component of social influence prevention interventions for preadolescents, (2) examine the relationship between resistance skill profiles and substance use among preadolescents, and (3) evaluate whether subgroups of preadolescents based on their resistance skills and refusal confidence may be differentially impacted by the kiR prevention program. Latent class analysis showed a four-class model of 5th grader resistance skill profiles. Approximately half of preadolescents (53 %) were familiar with four prototypical resistance skills and showed confidence to apply these skills in real-world settings (highly competent profile); 15 % were familiar with resistance skills but had little confidence (skillful profile); 18 % were confident yet had little knowledge (confident profile); while 15 % had low knowledge and confidence (low competence profile). These skill profiles significantly predicted 8th grade recent substance use (2LL = ?2,262.21, df = 3, p = .0005). As predicted by theory, the highly competent skill profile reported lower mean recent substance use than the population sample mean use. Latent transition analysis showed that although patterns of transiting into the highly competent skill profile over time were observed in the expected direction, this pattern was not significant when comparing treatment and control. Identifying skill profiles that predict recent substance use is theoretically consistent and has important implications for healthy and substance-free development.     

Perspectives on Health Care Delivery Systems for American Indian Families

The national effort to improve services to children with special health care needs presents unique challenges for the delivery of services to American Indian families This study took place in New Mexico American Indian families whose children have special needs and health care providers were interviewed Their responses about obstacles to health care for their children and suggestions for improving services were examined Generally, both groups identified similar obstacles, although important differences between groups were noted The findings point to the need for understanding cultural barriers and the unique concerns of low income families living in rural areas This has important implications for planning changes in the health care system for American Indian children with special needs.     

Perspectives on Health Care Delivery Systems for American Indian Families

The national effort to improve services to children with special health care needs presents unique challenges for the delivery of services to American Indian families This study took place in New Mexico American Indian families whose children have special needs and health care providers were interviewed Their responses about obstacles to health care for their children and suggestions for improving services were examined Generally, both groups identified similar obstacles, although important differences between groups were noted The findings point to the need for understanding cultural barriers and the unique concerns of low income families living in rural areas This has important implications for planning changes in the health care system for American Indian children with special needs.     

Substance Use Among Asian-American Adolescents: Perceptions of Use and Preferences for Prevention Programming

Rarely has substance use prevention programming targeted Asian-American adolescents. Using a focus group methodology, we explored perceptions of substance use and preferences for prevention programming among 31 Asian-American adolescents in New York City. Participants considered substance use common in the community. Factors contributing to substance use among Asian-American adolescents (e.g., peer pressure, pressure to achieve, family factors, and community influence) were identified, and the need for prevention programs tailored for the Asian-American community was highlighted. Participants discussed preferred program content, delivery settings, and recruitment and retention strategies. Despite the favorable attitude for family-based prevention programming, participants raised potential issues concerning the feasibility of such a program. Study findings facilitate understanding of Asian-American adolescents' substance use behavior and shed light on prevention program development for this underserved population.     

Attitudes Towards Evidence-Based Practice in Substance Use Treatment Programs Serving American Indian Native Communities

The Journal of Behavioral Health Services & Research - The objective of this paper was to compare attitudes towards evidence-based practice (EBP) of substance use disorder treatment (SUDT)...     

Promoting Reduced and Discontinued Substance Use among Adolescent Substance Users: Effectiveness of a Universal Prevention Program

Efforts to address youth substance use have focused on prevention among non-users and treatment among severe users with less attention given to youth occupying the middle ground who have used substances but not yet progressed to serious abuse or addiction. Using a sample from 35 middle schools of 1,364 youth who reported using substances, this study examined the effectiveness of a universal youth substance use prevention program, the SAMHSA Model Program keepin' it REAL, in promoting reduced or recently discontinued alcohol, cigarette, and marijuana use. Discrete-time event history methods modeled the rates of reduced and recently discontinued use across four waves of data. Each substance (alcohol, cigarettes, and marijuana) was modeled separately. Beginning at the second wave, participants who reported use at wave 1 were considered at risk of reducing or discontinuing use. Since the data sampled students in schools, multi-level models accounted for the nesting of data at the school level. Results indicated that prevention program participation influenced the rates of reduced and recently discontinued use only for alcohol, controlling for baseline use severity, age, grades, socioeconomic status, ethnicity and gender. Among youth who reported use of alcohol in wave 1 (N=1,028), the rate of reducing use for program participants was 72% higher than the rate for control students. The rate of discontinuing use was 66% higher than the rate for control students. Among youth who reported use of one or more of the three substances in wave 1 (N=1,364), the rate of discontinuing all use was 61% higher for program participants than for control students. Limitations and implications of these findings and plans for further research are discussed.     

Neuroimaging Methods for Adolescent Substance Use Disorder Prevention Science

Magnetic resonance imaging (MRI) methods safely provide in vivo indicators of cerebral macrostructure, microstructure, and activation that can be examined in relation to substance use disorder (SUD) risks and effects. This article will provide an overview of MRI approaches, including volumetric measures, diffusion tensor imaging, and functional MRI, that have been applied to studies of adolescent neuromaturation in relationship to risk phenotypes and adolescent SUD. To illustrate these applications, examples of research findings will be presented. MRI indicators have demonstrated that neurobiological maturation continues throughout adolescence. MRI research has suggested that variations in neurobiological maturation may contribute to SUD risk, and that substance use adversely influences adolescent brain development. Directly measured neurobiological variables may be viable preventive intervention targets and outcome indicators. Further research is needed to provide definitive findings on neurodevelopmental immaturity as an SUD risk and to determine the directions such observations suggest for advancing prevention science.     

Measuring Quality of Delivery in a Substance Use Prevention Program

The purpose of this study was to develop and validate an observation measure designed to capture teachers’ use of interactive teaching skills within the delivery of the All Stars substance use prevention program. Coders counted the number of times teachers praised and encouraged students, accepted and used students’ ideas, asked questions, self-disclosed personal anecdotes, and corrected student misbehavior. These teacher behaviors loaded on three factors: classroom management, acknowledgment, and student-centered methods. Classroom management was negatively related to student engagement. Acknowledgment was negatively related to students’ normative beliefs. Student-centered methods were positively related to student idealism and normative beliefs, and marginally predicted decreases in student marijuana use. Editors’ Strategic Implications: The authors provide a promising approach to studying pedagogical prevention approaches, and they also link teaching processes to student outcomes. This study of program delivery should be of general interest (i.e., not limited to substance use prevention) to practitioners and researchers.     

Adolescent Neurological Development and its Implications for Adolescent Substance Use Prevention

Recent technological advancements have facilitated the study of adolescent neurological development and its implications for adolescent decision-making and behavior. This article reviews findings from the adolescent neurodevelopment and substance use prevention literatures. It also discusses how findings from these two distinct areas of adolescent development can complement each other and be used to build more developmentally appropriate interventions for preventing adolescent substance use. Specifically, a combination of child-centered and family-based strategies is advocated based on extant neurological and prevention literature. Editors’ strategic implications: Researchers are encouraged to take up the authors’ challenge and study the links between adolescent neurological development/decision making ability and the long term efficacy of comprehensive interventions for preventing adolescent substance use.     

Reconceptualizing Efficacy in Substance Use Prevention Research: Refusal Response Efficacy and Drug Resistance Self-Efficacy in Adolescent Substance Use

The purpose of this study is to utilize the Extended Parallel Process Model (EPPM) to expand the construct of efficacy in the adolescent substance use context. Using survey data collected from 2,129 seventh-grade students in 39 rural schools, we examined the construct of drug refusal efficacy and demonstrated relationships among response efficacy (RE), self-efficacy (SE), and adolescent drug use. Consistent with the hypotheses, confirmatory factor analyses of a 12-item scale yielded a three-factor solution: refusal RE, alcohol-resistance self-efficacy (ASE), and marijuana-resistance self-efficacy (MSE). Refusal RE and ASE/MSE were negatively related to alcohol use and marijuana use, whereas MSE was positively associated with alcohol use. These data demonstrate that efficacy is a broader construct than typically considered in drug prevention. Prevention programs should reinforce both refusal RE and substance-specific resistance SE.     

Provider and State Perspectives on Implementing Cultural-Based Models of Care for American Indian and Alaska Native Patients with Substance Use Disorders

American Indians/Alaska Natives (AI/ANs) suffer disproportionate rates of substance use disorders compared to Americans overall. Providers serving AI/AN communities are drawing from a diverse toolkit of treatment strategies that incorporate Native worldviews and community-shared values in order to improve outcomes. This paper describes findings from interviews with 22 program directors and 18 representatives from Single State Authorities on substance abuse. Interviews assessed provider and state efforts to increase AI/AN client engagement and to improve the quality of care through culturally relevant interventions. Results suggested that providers employed flexibility and originality to cultural-based programs by broadening established practices, adopting outside traditions, and creating new ones to fit client needs. However, gaps in state–tribal collaborations and inter-group complexities such as staff-based tensions, a widening generational divide, and blurred consensus of “tradition” affect service delivery. Overall, respondents underlined the critical role culturally relevant care plays in individual and community healing.