Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation

American Indians (AIs) suffer from significant health disparities related to alcohol. Early prevention is critical, because early onset is a risk factor for problematic use into adulthood, and AIs have a higher rate of early onset than do other groups. In addition, rural youths and rural youths who are a racial minority in their community are at increased risk for alcohol use and getting drunk. Despite increased risk, rural communities and AI populations have been underrepresented in clinical and community trial research.6

To address this gap, the authors designed a trial with the Cherokee Nation that involved rural and racially diverse communities in northeastern Oklahoma in the 14-county jurisdictional service area of the Cherokee Nation, the second largest AI tribe in the United States.

The trial was initiated through a partnership between university-based prevention scientists and Cherokee Nation Behavioral Health psychologists. Together, they implemented a rigorous trial to evaluate the effectiveness of 2 distinct strategies to reduce underage drinking and associated consequences among youths living in rural, racially diverse communities within the Cherokee Nation. They selected 2 evidence-based strategies that are adaptable to local culture. Communities Mobilizing for Change on Alcohol (CMCA) is a community-organizing intervention designed to reduce alcohol access, use, and consequences among underage youths. Community organizing has been used effectively in multiple other health intervention trials and appeared to be an optimal strategy to engage diverse citizens in these multicultural communities. The second strategy, called CONNECT, was an individually delivered screening and brief intervention (SBI) in schools; it was supported by findings of a recent systematic review. They implemented SBI universally among all students along with motivational interviewing because it is responsive to individual student needs and readiness to change.

Among a sample of AI and White high school students in the boundaries of the Cherokee Nation, 2 preventive interventions, CMCA and CONNECT, significantly reduced the well-established typical adolescent developmental trajectory of upwardly trending alcohol use and heavy episodic use during the adolescent years. The student sample was nearly 50% AI, providing rigorous evidence of the effectiveness of 2 distinct alcohol prevention strategies for this high-risk population. Although the trial was not powered to test race-specific effects, secondary analyses revealed similar patterns of effects among AI youths as the full sample.

Population of focus: American Indian youth

Link to resource:

Date: 2017

Journal: American Journal of Public Health