SACRED Connections: A university-tribal clinical research partnership for school-based screening and brief intervention for substance use problems among Native American youth

ABSTRACT

Native American (NA) youth report higher rates of alcohol, marijuana, and drug use than U.S. adolescents from any other racial/ethnic group. Addressing this health disparity is a significant research priority across public health, minority health, and dissemination and implementation (D&I) sciences, underscoring the need for empirically-based interventions tailored for NA youth. Effective D&I with NA youth incorporates NA cultural values and involves tribal elders and stakeholders. SACRED Connections (NIDA R01DA02977) was a university-tribal research partnership that utilized a culturally derived Native-Reliance theoretical framework and a community-based participatory research (CBPR) approach. A significant objective of this randomized controlled trial was to close D&I gaps utilizing the RE-AIM Model and National Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care Standards (HHS, 2019).

Findings of this 5-year RCT revealed a statistically significant protective relationship between Native Reliance and baseline lifetime and past month alcohol and marijuana use; additionally, the likelihood of reporting marijuana use at 3 months post-intervention was significantly lower among the active condition than among the control condition. Implementation of a developmentally and NA culturally tailored brief protocol revealed: partnering with Native Americans and utilizing CBPR facilitated engagement with this hard-to-reach, underserved community; age and culture are associated with substance use severity among NA teens; a culturally adapted Motivational Interviewing (MI) brief intervention may be effective in reducing marijuana use among NA youth; the Native Reliance theory proved useful as a framework for working with this population; and RE-AIM proved helpful in conceptualizing health equity promoting D&I.

KEYWORDS:

• Native-American
• tribal
• youth
• adolescents
• CBPR
• motivational interviewing
• dissemination and implementation
• RE-AIM
• university-community partnership

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Acknowledgments

The authors would like to acknowledge NIDA (1R01DA029779-01A1; MPI’s: Wagner & Lowe), NIMHD (1U54MD012393-01; PI: Wagner), and the Training Institute on Dissemination and Implementation Research in Health (NCI & US Department of Veteran’s Affairs) funding, support, and training of this research project. They also extend gratitude to the staff of FIU-CBRI (including Robbert Langwerden for his assistance with the preparation of this manuscript), FSU-INRHE, and most importantly, to their tribal partners, elders, Community Advisory Board members, schools, participants, and project staff.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by the National Institute on Drug Abuse [1R01DA029779-01A1]; National Institute on Minority Health and Health Disparities [U54MD012393-01].