Effects of the “Circle of Life” HIV-prevention program on marijuana use among American Indian middle school youths: a group randomized trial in a Northern Plains tribe

ABSTRACT

Background: Early substance use threatens many American Indian/Alaska Native (AI/AN) communities, as it is a risk factor for maladaptive use and adverse health outcomes. Marijuana is among the first substances used by AI/AN youth, and its use becomes widespread during adolescence. Interventions that delay or reduce marijuana use hold the promise of curbing substance disorders and other health risk disparities in AI/AN populations. Objectives: We evaluated the effectiveness of the Circle of Life (COL) program in reducing marijuana use among young AI adolescents. COL is a culturally tailored, theory-based human immunodeficiency virus (HIV) and sexually transmitted disease (STD) intervention shown to delay sexual initiation among AI youths. Methods: We conducted secondary analyses of data from a school-based group randomized trial conducted between 2006 and 2007 in all 13 middle schools on a rural, Northern Plains reservation (N = 635, 47% female). We used discrete-time survival analysis (DTSA) to assess COL effectiveness on risk of marijuana initiation among AI youths and latent growth curve modeling (LGCM) to evaluate effects on frequency of marijuana use over time. Results: DTSA models showed that the overall risk of marijuana initiation was 17.3% lower in the COL group compared to the control group. No intervention effect on frequency of marijuana use emerged in LGCM analyses. Conclusion: COL is a multifaceted, culturally tailored, skills-based program effective in preventing marijuana uptake among AI youth.

KEYWORDS:

• American Indian
• youth
• marijuana use
• intervention
• prevention

Acknowledgements

We thank the schools and the tribal community for their ongoing support and are grateful to the parents, guardians, and youths who gave so generously of their time. This project reflects the dedicated work of the project staff, led by Jennifer Desserich, and community members Angela Sam, and Cindy Wheeler, without whom the extensive data collection necessary to this longitudinal project would not have been possible. We acknowledge the support of the National Institute of Mental Health (R01 MH069086; Kaufman, PI); the Bureau of Indian Education, Division of Performance and Accountability; the National Institute on Drug Abuse (R01 DA027665; Whitesell, PI); and the Office of Adolescent Health (TP2AH000003; Kaufman, PI). The views expressed are solely those of the authors and do not necessarily represent the policies of any supporting agencies.

Financial disclosures

The authors report no relevant financial conflicts.

Notes

¹ This specification was used by Muthén and Curran (1997) for model identification purposes.