Studies of Substance Abuse with Interventions for the Youth of Native American Indian Community #16

Community empowerment is one approach that is community based in its theoretical underpinnings and has been used to develop substance abuse prevention for Native American youth (Petoskey et al., 1998; Rowe, 1997). Generally, this method utilizes multiple strategies to increase knowledge about drugs and alcohol throughout a community and to change community norms regarding use. Often the initial step in the community empowerment approach is the development of a core group composed of community members who serve as leaders, role models, and decision makers regarding the implementation of prevention strategies. Petoskey et al. (1998) described the Parent, School and Community Partnership Program, a project that aimed to reduce alcohol, tobacco, and other drug (ATOD) use among Native American youth living on or near three reservations in northern Wisconsin and Minnesota. A major component of this program was the Red Cliff Wellness School Curriculum, a culturally focused, skills based substance abuse curriculum that was designed to be implemented by classroom teachers in Grades 4 through 12. In addition, the project involved the following: (a) the training of a small group of community members to be leaders and facilitators regarding community health, (b) a community curriculum offered to all members and designed to increase community involvement and problem solving around ATOD issues, and (c) teacher training in the implementation of the school-based curriculum. Outcome variables such as past-month substance use; attitudes toward use and perceptions of harmfulness; and attitudes toward school, academic achievement, absenteeism, and cultural involvement were assessed prior to curriculum implementation, at the end of the program year, and at 1-year follow-up. Comparison data were provided by similar schools that had agreed to collect data during Years 1 and 2 in order to receive the curriculum in Year 3. Although past-month alcohol use increased for both groups at follow-up, the authors reported a significant two-way interaction of site and time, indicating some slowing in the rise in alcohol use for participants in the intervention group. At all three data collection points, students who received the intervention reported lower levels of past-month marijuana use. Past-month cigarette use increased for both groups over time; however, this outcome was not a specific target of the intervention. Although there were no significant differences in likelihood to accept alcohol from friends between groups, students from the intervention group were less likely to accept marijuana at 1-year follow-up. Interestingly, these authors also found that increased frequency of attendance at powwows was associated with increased use of substances. Cultural affiliation has often been perceived as a protective factor, yet this study found a sex difference in the relationship between Indian identity and substance use:

Increased Indian identity was associated with decreased use in girls and increased use in boys. Rowe (1997) described the Target Community Partnership Project, an effort that utilized the community empowerment approach to address substance abuse with a Native American tribe in Washington State. Strategies used in this project included (a) creating partnerships among community members, professional services staff, and tribal departments; (b) implementing a process of ongoing training for the community around ATOD issues; (c) organizing community-wide alcohol- and drug-free events; (d) enhancing health, welfare, and youth services for those individuals with substance abuse or children affected by substance-abusing parents; and (e) advocating for new tribal policies restricting the use and abuse of drugs and alcohol. Several types of quantitative and qualitative outcomes were assessed over the course of approximately 4 years with adult and youth surveys conducted in the first and last years. Some of these included adult perception of harm from drugs and alcohol (as measured by an anonymous community survey), youth perception of harm from alcohol (as measured by a school survey), number of individuals referred to substance abuse treatment, number of families receiving services for alcohol and drug-related parenting problems, community perceptions of improvements in drug and alcohol use and drug dealing, community perception of social changes, tribal staff perception of changes in community norms, tribal policies related to ATOD, number of sober adults in the community, current youth alcohol use, current peer alcohol use, and number of alcohol and drug-related juvenile and adult arrests. Although the author described many positive overall changes in the community, including improved social conditions, a shift in social norms regarding drugs and alcohol, the creation of new policies and laws around substance use, and increased collaboration among tribal organizations, no significant change was found in adults’ perceived harmfulness of ATOD use. Because the sample of youth surveyed for quantitative data was likely too small to discern significant change over time, the only significant outcome was an increase in the number of friends that youth reported did not expect them to drink. In addition, Rowe indicated an increase in the number of individuals reportedly seeking abstinence. Although the numbers of drug- and alcohol related arrests, substance-related referrals, and referrals of families for services all increased, the author suggested that this was an indication of improved awareness among community members rather than an indication of rising use. Dorpat (1994) described a multi-arm prevention program implemented by the Puyallup Tribe of Indians, a tribe that inhabits a primarily urban reservation located in Tacoma, Washington. Although a description of the program does not indicate that its format was intentionally based on any particular community-based theory, the nature of the program’s development and content appears similar to other community-based interventions reported here.

PRIDE (Positive Reinforcement in Drug Education) was a prevention program conceived and developed through the guidance of the Puyallup Tribal Council and local school administration. Its four components included (a) development of students’ cultural identity through both curricular and extracurricular instruction and activities in the schools; (b) implementation of a school-based prevention curriculum dealing with health awareness, drug and alcohol awareness, refusal skills, and life skills; (c) enforcement of a security policy for reducing in-school drug use and development of a drug-free environment on school campuses; and (d) coordinated counseling, referral, and/or case management services for those students identified as drug users. Although the author reported that a formal process evaluation supported program efficacy, only one post intervention student survey was described in terms of outcome evaluation. This survey demonstrated high rates of expected school completion and positive attitudes about health among students. The survey also indicated 22% of high school students reported drinking to get drunk. The author compared this with a public school survey conducted separately from the study in which 46% of local high school juniors reported drinking to get drunk once per month. Although these outcomes appear positive, efficacy is difficult to establish without baseline or comparison group data.