Prevention Trial in the Cherokee Nation: Building Partnerships and Transcending Boundaries

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, especially among vulnerable rural and American Indian youth. The Prevention Trial in the Cherokee Nation is a partnership between prevention scientists and Cherokee Nation Behavioral Health to create, implement and evaluate a new, integrated community-level intervention designed to prevent underage drinking and associated negative consequences among American Indian and other youth living in rural high-risk underserved communities.  The primary partnership between Cherokee Nation Behavioral Health and prevention scientists at the University of Florida is augmented with partnerships with Oklahoma public school districts, the Oklahoma Department of Human Services, and the Muskogee Neighbors Building Neighborhoods.  Together these organizations are implementing a complex preventive intervention trial within six rural communities in northeastern Oklahoma, within the jurisdictional area of the Cherokee Nation. The intervention builds directly on results of multiple previous trials of two conceptually distinct approaches.  The first is an updated version of CMCA, an established community environmental change intervention, and the second is CONNECT, our newly developed population-wide intervention based on screening, brief intervention and referral to treatment research. CMCA direct-action community organizing is used to address community norms and practices related to alcohol use and commercial and social access to alcohol among adolescents. The new CONNECT intervention, using NIAAA’s guidelines for alcohol screening and brief intervention for youth and incorporating motivational interviewing (MI), is delivered within high schools by CONNECT Coaches hired as school service providers through the Department of Human Services. Six key research design elements optimize causal inference and experimental evaluation of intervention effects, including a controlled interrupted time-series design, purposive selection of towns, random assignment to study condition, nested cohorts as well as repeated cross-sectional observations, a factorial design crossing two conceptually distinct interventions, and multiple comparison groups. The purpose of this presentation is to describe (1) the strong partnership between prevention scientists and behavioral health leaders within the Cherokee Nation, (2) development and sustainability of their partnerships with other state and local partners, (3) the intervention and research design, and (4) preliminary process outcomes from this ongoing community trial.