Morbidity and mortality rates of many preventable conditions are disproportionately high in many AmericanIndian (Al) populations. Well documented health disparities for Al adults and youth related to abuse ofalcohol, tobacco, and illicit drugs extend to the growing urban Al population, who now constitute over 60% ofthe total Al population. Al youth report higher rates, earlier onset, more severe consequences, yet lessperceived risk of harm of substance use compared to their non-native counterparts. To thwart the early onsetand aftermath of substance abuse, primary prevention efforts have been undertaken with Al youth in severalU.S. regions. But programs have not explicitly targeted urban Al youth using rigorous culturally groundedprevention methods. The proposed study draws upon the project team's research on the etiology ofsubstance use among Al youth of the urban southwest to conduct translational research that recognizessalient risk and resiliency factors identified by these youth, social and relational contexts that expose them tosubstances, and their culturally appropriate drug resistance strategies.
The first aim of the study is to createa culturally grounded substance abuse prevention intervention targeting urban Al youth in 7th and 8th gradesthrough a modification of a SAMHSA Model universal prevention program, keepin it REAL. The adaptationwill employ emerging principles for adapting programs for new target populations in ways that increasecultural fit while maintaining fidelity to core program components. The intervention will be adapted, piloted,evaluated, culturally validated, and revised accordingly.
A second aim i s to test the feasibility and efficacy ofthe adapted substance abuse prevention intervention in a randomized control trial (RCT). EcodevelopmentalTheory provides the framework for understanding key influences on Al youths' substance use. Participatoryaction research methods will be used to adapt the intervention, including focus groups with key Al informants(adults and youth), working in collaboration with the designers of the original intervention and in coordinationwith the area's largest provider of social services to urban Indians. The RCT will be conducted in existinggroups for Al students enrolled in urban school districts. The resulting prevention intervention will addressthe needs of an under-served group severely affected by health disparities, and advance knowledge oneffective translational research strategies for adapting prevention interventions for ethnically diverse youth.
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