Parenting in 2 Worlds for Urban American Indians: Immediate RCT Results of a Culturally Adapted Parenting Program

Purpose: The goal of this study was to strengthen protective family factors against substance use and risky sexual behaviors among urban American Indian (AI) youth through a culturally grounded parenting intervention, Parenting in 2 Worlds (P2W) that addressed the unique social and cultural worlds of urban AI families. P2W was developed through community-based participatory research in three urban AI communities with diverse tribal backgrounds. A multi-stage cultural adaptation process uncovered common teachings, cultural values and communication customs relating to parenting, and systematically incorporated them in the P2W curriculum. This presentation reports the immediate outcomes of P2W.

Methods: Data come from 607 parents of AI children (ages 10-17) in a randomized controlled trial of P2W in three Arizona cities.  Parents were recruited through the ausipices of urban Indan centers in their city, and were assigned to P2W or to an informational family health curriculum, Healthy Families in 2 Worlds (HF2W).  Both the P2W and HF2W curricula consisted of 10 workshops delivered weekly by AI community facilitators. All recruited parents received incentives for participating in each workshop ($15), and 98% of them consented to complete self-administered questionnaires. Pretests were administered at the first workshop and a post-test at the last workshop, measuring parenting skills, family functioning, youth risk behaviors, and cultural engagement. Tests of the efficacy of P2W versus HF2W were analyzed through baseline adjusted regression models, adjusting for random effects at the site and facilitator levels, using multiple imputation, and controlling for program dosage (# workshops attended). Intervention effect sizes were estimated with Cohen’s d.

Results: Most parents (77%) were female, either single (36%) or living with an unmarried partner (28%), and had annual incomes under $10,000 (56%). On average parents were 38 years old, had lived for 14 years on a reservation, and now resided in an urban area for 18 years. The parents were affiliated with 31 different AI tribes. Parents in P2W reported significant larger increases than parents in HF2W on measures of parental involvement and parental self-agency, use of positive parenting practices, communication with their children about safe sex, and strength of Native cultural identity and spirituality. P2W parents reported decreases in discipline problems, parent-child conflict, and child anti-social behavior. Most of these desired program effects for P2W achieved medium size.

Conclusions: Culturally adapted parenting interventions like P2W can effectively strengthen parenting practices, family functioning and cultural identity among urban AI families.