Contextual Effects On a Community Intervention to Prevent Suicide and Alcohol Abuse Risk with Yup'ik Alaska Native Youth

Introduction: The Elluam Tungiinun and Yupiucimta Asvairtuumallerkaa projects developed community interventions for youth using a CBPR process in different rural Yup’ik communities in the same region. The interventions originating in the same local protective factors model and promoted reasons for valuing one’s life and reflective processes about alcohol consequences among youth.

Contextual factors interacted with intervention factors to shape implementation and impact across communities. Community 1 experienced a recent history of suicide, while Community 2 had not. As a marker of contrasting community acculturative experience, youth in Community 1 had more limited Yup’ik language proficiency, while in Community 2, Yup’ik was more widely spoken. Funding in Community 1 allowed for a one-year process of entry that included needs assessment and setting community health priorities. In Community 2, funding limitations resulted in more abbreviated entry in time and reach. Funding in Community 1 permitted modest honorariums for youth participation as part of its intervention development process, while funding in Community 2 did not.

Methods: Fifty-four of approximately 100 age eligible youth in Community 1 participated in the intervention research, and 53 of approximately 100 youth in Community 2 participated.

Results:  In Community 1, medium dose,  response effects (d = .30-.50), with dose defined as number of intervention activities attended by each youth, were found in growth in measures of intermediate protective factors on individual, family, and community levels, and in protective factors from suicide and alcohol as ultimate outcome variables.  In Community 2, medium size dose response effects were found for growth in the individual-level intermediate protective factor only, and smaller, nonsignificant dose response effects were found in ultimate outcome variables. These contrasting impacts can be explained by differences in contextual and intervention factors.

Discussion: Intervention in Community 1 included an immediate response to recent youth suicides, and the traditional cultural elements of the intervention provided heightened contrast to many existing organized youth activities, while in Community 2, intervention was not an acute response to immediate events, and its cultural activities blended to a greater degree with existing youth activities. Results suggest these contextual factors interacted with the extended time period and more intensive outreach of entry and honorariums in Community 1, permitting greater community awareness and mobilization.