Top

Published in:

01-02-2018

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

Authors: James Allen, Stacy M. Rasmus, Carlotta Ching Ting Fok, Billy Charles, David Henry, Qungasvik Team

Published in: Prevention Science | Issue 2/2018

Abstract

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.

Available only for authorised users

In Community 2, youth entered in two cohorts and the second cohort comparison term is dropped.

Allen, J., Mohatt, G. V., Rasmus, S. M., Hazel, K., Thomas, L., Lindley, S., & People Awakening Team (2006). The tools to understand: Community as co-researcher on culture specific protective factors for Alaska natives. Journal of Prevention and Intervention in the Community, 32, 41–59. doi:10.1300/J005v32n01_04.CrossRefPubMed

Allen, J., Levintova, M., & Mohatt, G. (2011). Suicide and alcohol related disorders in the U.S. Arctic: Boosting research to address a primary determinant of health disparities. International Journal of Circumpolar Health, 70, 473–487.CrossRefPubMedPubMedCentral

Allen, J., Fok, C. C. T., Henry, D., Skewes, M., & People Awakening Team. (2012). Umyuangcaryaraq “reflecting”: Multidimensional assessment of reflective processes about the consequences of alcohol use among Yup’ik Alaska Native youth. American Journal of Drug and Alcohol Abuse, 38, 468–475. doi:10.3109/00952990.2012.702169.CrossRefPubMedPubMedCentral

Allen, J., Mohatt, G. V., Beehler, S., & Rowe, H. (2014a). People Awakening: Collaborative research with Alaska Native rural communities to address alcohol use disorders and suicide health disparities. American Journal of Community Psychology, 54, 100–111. doi:10.1007/s10464-014-9647-1.CrossRefPubMedPubMedCentral

Allen, J., Mohatt, G. V., Fok, C. C. T., Henry, D., Burkett, R., & People Awakening Team. (2014b). A protective factors model for alcohol abuse and suicide prevention among Alaska Native youth. American Journal of Community Psychology, 54, 125–139. doi:10.1007/S10464-014-9661-3.CrossRefPubMedPubMedCentral

Ayunerak, P., Alstrom, D., Moses, C. Charlie, J., & Rasmus, S. M. (2014). Yup’ik culture and context in southwest Alaska: Community member perspectives of tradition, social change, and prevention. American Journal of Community Psychology, 54, 91–99.

Barlow, A., Tingey, L., Cwik, M., Goklish, N., Larzelere-Hinton, F., Lee, A., Suttle, R., Mullany, B., & Walkup, J. T. (2012). Understanding the relationship between substance use and self-injury in American Indian youth. American Journal of Drug and Alcohol Abuse, 38, 403–408. doi:10.3109/00952990.2012.696757.CrossRefPubMed

Bond, T., & Fox, C. (2007). Applying the Rasch model: Fundamental measurement in the human sciences (2nd ed.). Mahwah: LEA.

Clifford, A. C., Doran, C. M., & Tsey, K. (2013). A systematic review of suicide prevention interventions targeting indigenous peoples in Australia, United States, Canada and New Zealand. BioMed Central Public Health, 13, 463. doi:10.1186/1471-2458-13-463.CrossRefPubMedPubMedCentral

Fienup-Riordan, A. (2000). Hunting tradition in a changing world: Yup’ik lives in Alaska. New Brunswick: Rutgers University Press.

Fok, C. C. T., Allen, J., Henry, D., Mohatt, G. V., & People Awakening Team. (2012). The Multicultural Mastery Scale for youth: Multidimensional assessment of culturally mediated coping strategies. Psychological Assessment, 24, (2), 313–327. doi:10.1037/a0025505.

Fok, C. C. T., Allen, J., Henry, D., & People Awakening Team. (2014). The Brief Family Relationships Scale: An adaptation of the relationship dimension of the Family Environment Scale. Assessment, 21(1), 67–72

Fok, C. C. T., & Henry, D. (2015). Increasing the sensitivity of measures to change. Prevention Science, 16, 978–986. doi:10.1007/s11121-015-0545-z.CrossRefPubMedPubMedCentral

Fok, C. C. T., Henry, D., & Allen, J. (2015). Research designs for intervention research with small samples II: Stepped wedge and interrupted time-series designs. Prevention Science, 16, 967–977. doi:10.1007/s11121-015-0569-4.CrossRefPubMed

Gone, J. P. (2012). Indigenous traditional knowledge and substance abuse treatment outcomes: The problem of efficacy evaluation. American Journal of Drug and Alcohol Abuse, 38, 493–497. doi:10.3109/00952990.2012.694528.CrossRefPubMed

Hawkins, E. H., Cummins, L. H., & Marlatt, G. A. (2004). Preventing substance abuse in American Indian and Alaska Native youth: Promising strategies for healthier communities. Psychological Bulletin, 130, 304–323. doi:10.1037/0033-2909.130.2.304.CrossRefPubMed

Hedeker, D. G., & Gibbons, R. D. (2006). Longitudinal data analysis. Hoboken: Wiley.

Henry, D., Allen, J., Fok, C. C. T., Rasmus, S., Charles, B., & Team, P. A. (2012). Patterns of protective factors in an intervention for the prevention of suicide and alcohol abuse with Yup’ik Alaska Native youth. American Journal of Drug and Alcohol Abuse, 38, 476–482. doi:10.3109/00952990.2012.704460.CrossRefPubMedPubMedCentral

Henry, D., Fok, C. C. T., & Allen, J. (2015). Why small is too small a term: Prevention science for health disparities, culturally distinct groups, and community-level intervention. Prevention Science, 16, 1026–1032. doi:10.1007/s11121-015-0577-4.CrossRefPubMedPubMedCentral

Henry, D. B., Tolan, P. H., & Gorman-Smith, D. (2005). Cluster analysis in family psychology research. Journal of Family Psychology, 19, 121–132.CrossRefPubMed

Hopkin, C. R., Hoyle, R. H., & Gottfredson, N. C. (2015). Maximizing the yield of small samples in prevention research: A review of general strategies and best practices. Prevention Science, 16, 950–955. doi:10.1007/s11121-014-0542-7.CrossRefPubMedPubMedCentral

Hull-Jilly, D. M. C. & Casto, L. D. (2013). State epidemiologic profile on substance use, abuse and dependency–2007-2011. Alaska Department of Health and Social Services. Retrieved from http://dhss.alaska.gov/dph/Epi/Documents/01-Internal/injury/sa/SubstanceAbuseEpiProfile_2013.pdf.

John, G. & Edison. J. T. (2014) Collaborative measurement development as a tool in CBPR: Measurement development and adaptation within the cultures of communities. American Journal of Community Psychology, 54, (1–2):112–124.

Linehan, M. M., Goodstein, A. J., Nielsen, S. L., & Chiles, J. A. (1983). Reasons for staying alive when you are thinking about killing yourself: The Reasons for Living Inventory. Journal of Consulting and Clinical Psychology, 51, 276–286. doi:10.1037/0022-006X.51.2.276.

Middlebrook, D. L., LeMaster, P. L., Beals, J., Novins, D. K., & Manson, S. M. (2001). Suicide prevention in American Indian and Alaska Native communities: A critical review of programs. Suicide and Life Threating Behavior, 31, 132–149. doi:10.1521/suli.31.1.5.132.24225.CrossRef

Mohatt, G. V., Fok, C. C. T., Henry, D., People Awakening Team, & Allen, J. (2014). Feasibility of a community intervention for the prevention of suicide and alcohol abuse with Yup’ik Alaska Native youth: The Elluam Tungiinun and Yupiucimta Asvairtuumallerkaa studies. American Journal of Community Psychology, 54, 153–169. doi:10.1007/s10464-014-9646-2.CrossRefPubMedPubMedCentral

Moos, R. H., & Moos, B. S. (1994). Family Environment Scale (3rd ed.). Palo Alto: Consulting Psychologists Press.

Oetting, E. R., & Beauvais, F. (1990). Adolescent drug use: Findings of national and local surveys. Journal of Consulting and Clinical Psychology, 58, 385–394. doi:10.1037/0022-006x.58.4.385.CrossRefPubMed

Osman, A., Kopper, B. A., Barrios, F. X., & Osman, J. R. (1996). Brief Reasons for Living Inventory for Adolescents (BRFL-A). Journal of Abnormal Child Psychology, 24, 433–443. doi:10.1007/bf01441566.

Paula, A. Deborah, A. Charles, M. James, C. Stacy, M. R. (2014) Yup'ik culture and context in southwest Alaska: community member perspectives of tradition, social change, and prevention. American Journal of Community Psychology, 54, (1–2):91–99.

Ramsay, J. O., & Silverman, B. W. (2005). Functional data analysis (2nd ed.). New York: Springer.

Rasmus, S. M., Charles, B., & Mohatt, G. V. (2014). Creating Qungasvik (a Yup’ik intervention “toolbox”): Case examples from a community-developed and culturally-driven intervention. American Journal of Community Psychology, 54, 140–152. doi:10.1007/s10464-014-9651-5.CrossRefPubMedPubMedCentral

Raudenbush, S. W., & Bryk, A. S. (2002). Hierarchical linear models (2nd ed.). Thousand Oaks: Sage.

Seale, J. P., Shellenberger, S., & Spence, J. (2006). Alcohol problems in Alaska natives: Lessons from the Inuit. American Indian and Alaska Native Mental Health Research, 13, 1–31. doi:10.5820/aian.1301.2006.1.CrossRefPubMed

Srinivasan, S., Moser, R. P., Willis, G., Riley, W., Alexander, M., Berrigan, D., & Kobrin, S. (2015). Small is essential: Importance of subpopulation research in cancer control. American Journal of Public Health, 105, 371–373. doi:10.2105/ajph.2014.302267.CrossRef

Trickett, E. J., Beehler, S., Deutsch, C., Green, L. W., Hawe, P., McLeroy, K., et al. (2011). Advancing the science of community-level interventions. American Journal of Public Health, 101, 1410–1419. doi:10.2105/Ajph.2010.300113.CrossRefPubMedPubMedCentral

Trickett, E.J., Trimble J.E., Allen J. (2014) Most of the story is missing: Advocating for a more complete intervention story. American Journal of Community Psychology 54, (1–2):180–186

Trimble, J. E., Scharrón-del Rio, M., & Casillas, D. M. (2010). The itinerant researcher: Ethical and methodological issues in conducting cross-cultural mental health research. In D. C. Jack & A. Ali (Eds.), Cultural perspectives on women’s depression: Self-silencing, psychological distress and recovery (pp. 73–95). New York: Oxford.

Whitbeck, L. B., Walls, M. L., & Welch, M. L. (2012). Substance abuse prevention in American Indian and Alaska Native communities. American Journal of Drug and Alcohol Abuse, 38, 428–435. doi:10.3109/00952990.2012.695416.CrossRefPubMed

Wyman, P. A., Henry, D., Knoblauch, S., & Brown, C. H. (2015). Designs for testing group-based interventions with limited numbers of social units: The dynamic wait-listed and regression point displacement designs. Prevention Science, 16, 956–966. doi:10.1007/s11121-014-0535-6.CrossRefPubMedPubMedCentral

Title: Multi-Level Cultural Intervention for the Prevention of Suicide and Alcohol Use Risk with Alaska Native Youth: a Nonrandomized Comparison of Treatment Intensity
Authors: James Allen
Stacy M. Rasmus
Carlotta Ching Ting Fok
Billy Charles
David Henry
Qungasvik Team
Publication date: 01-02-2018
Publisher: Springer US
Published in: Prevention Science / Issue 2/2018
Print ISSN: 1389-4986
Electronic ISSN: 1573-6695
DOI: https://doi.org/10.1007/s11121-017-0798-9

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

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

Abstract

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 2/2018

Examining the Highs and Lows of the Collaborative Relationship Between Technical Assistance Providers and Prevention Implementers

Policy and Prevention Approaches for Disordered and Hazardous Gaming and Internet Use: an International Perspective

School, Friends, and Substance Use: Gender Differences on the Influence of Attitudes Toward School and Close Friend Networks on Cannabis Involvement

Testing the Amotivational Syndrome: Marijuana Use Longitudinally Predicts Lower Self-Efficacy Even After Controlling for Demographics, Personality, and Alcohol and Cigarette Use

Quality Matters: Implementation Moderates Student Outcomes in the PATHS Curriculum

Predictors of Adult Marijuana Use Among Parents and Nonparents