This is a resubmission of a competing renewal of the grant entitled "A Community Trial to Prevent Inhalant Use in Alaska" (1 R01 DA015966). The original grant was designed as a feasibility study per NIH reviewers'request to develop and pilot-test an integrated Community Prevention Model (CPM) for Alaskan youth in the 5th - 7th grades to prevent the use of inhalants and ingestible harmful legal products (HLPs) to get high. This model consisted of community mobilization and environmental strategies that targeted retail outlets, homes, and schools, and a school-based prevention curriculum. As a result of the three-year feasibility study, intervention materials and research instruments have been developed and field tested in four Alaskan communities. Results from six publications and three manuscripts successfully implemented in the participating Alaskan communities, although there were concerns about it being too complex;and, there were sufficient changes in the key outcomes to warrant a full efficacy trial. In this application, we propose to test the efficacy of a condensed version of the CPM intervention consisting of community mobilization (CM) and environmental strategies (ES). The CM strategy is designed to enable community leaders and groups to take action. The ES in retail outlets, homes, and schools address community norms and values regarding youth use of HLPs, community adopted policies, restrictions and enforcement of these policies and restrictions, and retail, family, and school controls to reduce youth access to HLPs. The school based education curriculum has been dropped to reduce the complexity of a three-component CPM and to focus attention on the efficacy of environmental strategies in preventing HLPs use among youth. Commitments have been obtained from key community leaders in 16 remote rural (frontier) communities in Alaska that contain primarily a mixture of Caucasian or Alaska Native populations. The proximal outcomes are to and to reduce the availability of HLPs used in Alaskan frontier communities. The distal outcomes are to reduce the proportion of increase community readiness to implement environmental strategies to prevent HLP use, pre and early adolescents (5th, 6th, graders) who intend to or do experience inhaling or ingesting HLPs found in local retail outlets, homes, and schools. The research design is a five-year randomized control trial (RCT) in which eight pairs of matched frontier communities will be randomly assigned to experimental and control conditions. The 16 communities are located in various regions of the state, with population sizes that range from 536 to 5,937. This efficacy trial will integrate rigorous quantitative methods with participatory research principles consisting of community participation and collaboration that recognizes the unique cultural and 7th heritage of each study community. The significance of this study is its potential to produce an effective intervention to prevent youth's use of inhalants and other harmful legal products in remote rural and sustainable communities across the U.S.
The testing of the proposed Community Prevention Model under experimental conditions is particularly significant because there are few evidence-based prevention models for frontier communities like those in Alaska, western Texas, or northern Minnesota. Further, there are even fewer evidence-based prevention models that target use of inhalants and other harmful legal products. In addition, the integration of community mobilization and environmental strategies focusing on retail outlets, homes, and schools is innovative and invites the entire community to assume responsibility for youth substance abuse prevention rather than assuming it is the responsibility of only the school system.
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