Adapting and Testing the be Under Your Own Influence Communications Campaign in American Indian Communities: Challenges, Lessons Learned, and Preliminary Findings

Introduction: This paper discusses preliminary findings, challenges, and lessons learned for “Prevention of Substance Use Among Middle School Youth”, funded under PAR-11-346 Interventions for Health Promotion and Disease Prevention in Native American Populations. This project adapts and tests effectiveness of an anti-drug and alcohol communications campaign – Be Under Your Own Influence (BUYOI) – among 7^th graders who attend schools on or near American Indian (AI) reservations. BUYOI has been effective in reducing uptake of marijuana among youth in multi-ethnic communities, but has not been adapted and tested for AI youth.

Methods: Six communities were recruited to participate, with three randomly assigned to control and three to the intervention. The intervention targets 7^th graders using 11^th grade role models to deliver BUYOI messages which reframe substance use as impairing aspirations and personal autonomy. Activities in the first two years focused primarily in the intervention communities. They included formation of and meeting with community advisory committees (CACs), obtaining appropriate tribal IRB and school board approvals, hiring local community liaisons, conducting youth focus groups, collecting and evaluating previous campaign materials with CACs, adapting and refining campaign messages and materials, selecting and training role models, and adapting and testing the online youth survey. 

Results: Challenges began immediately with difficulty in recruitment and retention of communities. Subsequent challenges included low attendance at CACs and other meetings, difficulties with hiring processes due to university requirements, incomplete adherence to consent procedures, dropout of liaisons and student role models, changes in school leadership, difficulties with university payments to CAC members and liaisons, and mismatched timelines between researchers, the funder, Tribal IRBs, and tribal communities/schools.  Amid these challenges, however, a great deal has been accomplished. We discuss lessons learned and recommendations for working in AI reservation communities, including allowing for significant face-to-face time and relationship building. In regards to the intervention, CAC members and tribal youth found the BUYOI messages compelling and culturally appropriate, though visual and wording adaptations reflecting reservation life were necessary.

Conclusions: Adaptation of the intervention posed fewer challenges than building the foundation from which to work, resolving institutional conflicts, and keeping the project moving forward.  Flexibility, practicality, and trust were identified as key elements to establishing relationships and institutional arrangements and adapting and implementing the intervention.