The proposed project is a partnership between prevention scientists and the Cherokee Nation Behavioral Health Services to create, implement and evaluate a new, integrated community-level intervention designed to prevent underage drinking and associated negative consequences among American Indian and white youth living in rural high-risk underserved communities. This trial will take place in northeastern Oklahoma, an area suffering from high rates of poverty and substantial health disparities. The proposed intervention builds directly on the results of multiple previous experiments with two distinct approaches-community environmental change and brief intervention and referral-evaluated alone and in combination using a factorial design. Direct- action community organizing, documented as effective in multiple previous randomized trials, will be used to address community issues related to alcohol use and commercial and social access to alcohol among adolescents. Our design and implementation of brief interventions differs in a fundamental way from typical implementations. Instead of SBIRT implemented in select limited numbers of clinics, emergency departments or schools, we will design a community-wide SBIRT intervention. The population-level brief interventions will include five key components: (1) brief one-on-one screening and motivational interviewing sessions, (2) gatekeeper training, (3) peer leader training, (4) family postcard campaign, and (5) community-wide media campaign. Five key research design elements optimize causal inference and experimental evaluation of the intervention effects: (1) a controlled interrupted time-series design, (2) random selection of towns, (3) random assignment to study condition, (4) a factorial design, and (5) multiple comparison groups. The primary design feature of this randomized trial is a controlled interrupted time-series design. The large number of repeated measures (a time-series) substantially increases internal validity (i.e., strength of causal inference) as well as statistical power over conventional pre/post community trial designs. Repeated assessments will measure implementation fidelity for each intervention component, and measure key proximal as well as the primary ultimate outcomes through survey, observation and archival sources. The primary study sample will include all high-school students within study towns. Weekly and monthly measurements will produce a time-series design with observations of youth nested within town over the four-year period. In addition to repeated cross-sectional samples, we will use participant identifiers to track the embedded cohorts over the four years. This innovative project, involving a strong partnership between established prevention scientists and leaders of the Cherokee Nation Behavioral Health Services, has the potential to transform alcohol prevention research and practice. Despite advances in prevention science and practices in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youth. The proposed project will provide a rigorous evaluation of a new, integrated community-level preventive intervention.

Public Health Relevance

The proposed project is a close partnership between prevention scientists and the Cherokee Nation Behavioral Health Services to create, implement and evaluate a new, integrated community-level intervention designed to prevent underage drinking and associated negative consequences among multi-ethnic youth living in rural, high-risk underserved communities. The intervention will include community strategies to reduce access to alcohol and high-risk situations, and community-wide implementation of brief interventions and referral. This innovative project has the potential to transform alcohol prevention research and practice, as the U.S. continues to struggle with significant alcohol-related risks and consequences among youth.

Agency
National Institute of Health (NIH)
Institute
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Type
Research Project (R01)
Project #
7R01AA020695-06
Application #
9173488
Study Section
Special Emphasis Panel (ZAA1-DD (02))
Program Officer
Scott, Marcia S
Project Start
2011-09-15
Project End
2016-06-30
Budget Start
2016-01-01
Budget End
2016-06-30
Support Year
6
Fiscal Year
2015
Total Cost
$1,010,744
Indirect Cost
$297,174
Name
Emory University
Department
Psychology
Type
Schools of Public Health
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Wagenaar, Alexander C; Livingston, Melvin D; Pettigrew, Dallas W et al. (2018) Communities mobilizing for change on alcohol (CMCA): secondary analyses of a randomized controlled trial showing effects of community organizing on alcohol acquisition by youth in the Cherokee nation. Addiction 113:647-655
Livingston, Melvin D; Komro, Kelli A; Wagenaar, Alexander C et al. (2018) Effects of Alcohol Interventions on Other Drug Use in the Cherokee Nation. Am J Public Health 108:259-261
Komro, Kelli A (2018) 25 Years of Complex Intervention Trials: Reflections on Lived and Scientific Experiences. Res Soc Work Pract 28:523-531
Komro, Kelli A; Livingston, Melvin D; Wagenaar, Alexander C et al. (2017) Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation. Am J Public Health 107:453-459
Garrett, Brady A; Livingston, Bethany J; Livingston, Melvin D et al. (2017) The Effects of Perceived Racial/Ethnic Discrimination on Substance Use Among Youths Living in the Cherokee Nation. J Child Adolesc Subst Abuse 26:242-249
Komro, Kelli A; Livingston, Melvin D; Garrett, Brady A et al. (2016) Similarities in the Etiology of Alcohol Use Among Native American and Non-Native Young Women. J Stud Alcohol Drugs 77:782-91
Lynne-Landsman, Sarah D; Kominsky, Terrence K; Livingston, Melvin D et al. (2016) Alcohol Sales to Youth: Data from Rural Communities Within the Cherokee Nation. Prev Sci 17:32-9
Lynne-Landsman, Sarah D; Komro, Kelli A; Kominsky, Terrence K et al. (2016) Early Trajectories of Alcohol and Other Substance Use Among Youth From Rural Communities Within the Cherokee Nation. J Stud Alcohol Drugs 77:238-48
Komro, Kelli A; Livingston, Melvin D; Kominsky, Terrence K et al. (2015) Fifteen-minute comprehensive alcohol risk survey: reliability and validity across American Indian and White adolescents. J Stud Alcohol Drugs 76:133-42
Komro, Kelli A; Wagenaar, Alexander C; Boyd, Misty et al. (2015) Prevention trial in the Cherokee Nation: design of a randomized community trial. Prev Sci 16:291-300