Multi-Level Cultural Intervention for the Prevention of Suicide and Alcohol Use Risk with Alaska Native Youth: a Nonrandomized Comparison of Treatment Intensity

• Published in: Prevention science Vol. 19; no. 2; pp. 174 - 185
• Main Authors: Allen, James, Rasmus, Stacy M., Fok, Carlotta Ching Ting, Charles, Billy, Henry, David
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.02.2018; Springer Nature B.V
• Subjects: Adolescent; Alaska; Alaska Natives - psychology; Alcohol; Alcohol related disorders; Alcohol use; Alcoholism; Change agents; Child; Child and School Psychology; Community Networks; Community-Based Participatory Research; Community-based programs; Cultural differences; Disorders; Effectiveness; Effects; Experts; Female; Health disparities; Health Psychology; Humans; Indigenous peoples; Intervention; Male; Medicine; Medicine & Public Health; Participatory research; Prevention; Prevention programs; Protective factors; Psychometrics; Public Health; Qualitative research; Quantitative analysis; Risk; Rural areas; Rural communities; Sobriety; Substance use disorder; Suicide; Suicide Prevention; Suicides & suicide attempts; Surveys and Questionnaires; Underage Drinking - prevention & control; Youth; Alaska; United States > US; Community-based participatory research; American Indian/Alaska Native; Alcohol; Suicide; Community intervention
• ISSN: 1389-4986; 1573-6695
• DOI: 10.1007/s11121-017-0798-9

Suicide and alcohol use disorders are primary determinants of health disparity among Alaska Native people in contrast to the US general population. Qungasvik , a Yup’ik word for toolbox, is a strengths-based, multi-level, community/cultural intervention for rural Yup’ik youth ages 12–18. The intervention uses “culture as intervention” to promote reasons for life and sobriety in young people using local expertise, high levels of community direction, and community based staff. The intervention is grounded in local practices and adaptive to local cultural differences distinctive to rural Yup’ik communities. The current study compares the effectiveness of high-intensity intervention in one community (treatment), operationalized as a high number of intervention activities, or modules, implemented and attended by youth, contrasted to a lower intensity intervention in a second community (comparison) that implemented fewer modules. A Yup’ik Indigenous theory of change developed through previous qualitative and quantitative work guides intervention. In the model, direct intervention effects on proximal or intermediate variables constituting protective factors at the individual, family, community, and peer influences levels lead to later change on the ultimate prevention outcome variables of Reasons for Life protective from suicide risk and Reflective Processes about alcohol use consequences protective from alcohol risk. Mixed effects regression models contrasted treatment and comparison arms, and identified significant intervention effects on Reasons for Life ( d  = 0.27, p  < .05) but not Reflective Processes.