For the past 10 years we have focused on addressing two interrelated public health issues, alcohol use disorder (AUD) and suicide in 12-18 year old Yup'ik Alaska Natives (AN). AUD and suicide are among the leading causes of mortality among AN people and a significant health disparity in contrast to the U.S. general population (1). AN mortality rates from all alcohol-induced disorders between 2001 2005 were 53.8/100,000 in contrast to 6.3/100,000 for other ethnic groups in Alaska (2), while the age-adjusted rate for suicide is twice the national average (3). Overall, between 1960-95 AN suicide rates increased approximately 500% (4). More recent data indicate continuation of these trends and also identify cluster suicide behavior as a feature of AN youth suicide (5). Yup'ik community leaders have made addressing AUD and suicide among their highest priorities. In response, working with several communities, a community-based and led intervention (Qungasvik - toolbox) was designed. The intervention is designed to develop protective factors that will ultimately reduce the incidence of AUD and suicide. Our research leading up to the currently proposed study has shown that it is possible to: (1) deliver the intervention in remote rural communities; (2) obtain valid and reliable measures of two ultimate outcomes (i.e., Reflective Processes regarding alcohol consequences and Reasons for Life) and intermediate protective factors variables that underlie them; (3) show a dose-response effect: the more intervention sessions a person attends (dose) the stronger the measured protective factors (response); and (4) obtain a maximum protective effect from the intervention by lengthening the duration of the intervention from one to two years. The proposed study is an assessment of a modified version of the intervention and focuses on three specific aims (SA): (SA1) test Qungasvik intervention efficacy through impact on the two protective factors and to link those measures to direct measures of alcohol use and suicidal ideation; (SA2) examine the mechanisms of change in response to the intervention through growth in: (a) intermediate outcome measures of protective factors at the individual, family, peer, and community level; (b) social network characteristics of supportive relationships with elders, immediate and extended kinship relations, and community adults and describe social network change; and (c) using qualitative interviewing and grounded theory analysis techniques, describe process and impact of the intervention from community elder and parent perspectives; and (SA3) examine the fidelity of implementing the intervention.

Public Health Relevance

For the past 10 years we have focused on addressing two interrelated public health issues, alcohol use disorder (AUD) and suicide in 12-18 year old Yup'ik Alaska Natives (AN). Our ultimate goal with this project is to test the effectiveness of the Qungasvik (a Yup'ik word meaning `toolbox') intervention, aimed primarily at reducing the incidence of alcohol use disorder (AUD) and suicide in male and female 12-18 year old Yup'ik AN youth.

National Institute of Health (NIH)
National Institute on Alcohol Abuse and Alcoholism (NIAAA)
Research Project (R01)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Freeman, Robert
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
University of Alaska Fairbanks
Organized Research Units
United States
Zip Code
Allen, James; Rasmus, Stacy M; Fok, Carlotta Ching Ting et al. (2018) Multi-Level Cultural Intervention for the Prevention of Suicide and Alcohol Use Risk with Alaska Native Youth: a Nonrandomized Comparison of Treatment Intensity. Prev Sci 19:174-185
Stanley, Linda R; Swaim, Randall C; Kaholokula, Joseph Keawe'aimoku et al. (2017) The Imperative for Research to Promote Health Equity in Indigenous Communities. Prev Sci :
Philip, Jacques; Ford, Tara; Henry, David et al. (2016) Relationship of Social Network to Protective Factors in Suicide and Alcohol Use Disorder Intervention for Rural Yup'ik Alaska Native Youth. Interv Psicosoc 25:45-54
Fok, Carlotta Ching Ting; Henry, David; Allen, James (2015) Maybe Small Is Too Small a Term: Introduction to Advancing Small Sample Prevention Science. Prev Sci 16:943-9
Wexler, Lisa; Chandler, Michael; Gone, Joseph P et al. (2015) Advancing suicide prevention research with rural American Indian and Alaska Native populations. Am J Public Health 105:891-9
Henry, David; Dymnicki, Allison B; Mohatt, Nathaniel et al. (2015) Clustering Methods with Qualitative Data: a Mixed-Methods Approach for Prevention Research with Small Samples. Prev Sci 16:1007-16
Fok, Carlotta Ching Ting; Henry, David; Allen, James (2015) Research Designs for Intervention Research with Small Samples II: Stepped Wedge and Interrupted Time-Series Designs. Prev Sci 16:967-77
Henry, David; Fok, Carlotta Ching Ting; Allen, James (2015) Why Small is Too Small a Term: Prevention Science for Health Disparities, Culturally Distinct Groups, and Community-Level Intervention. Prev Sci 16:1026-32