Prevention Trial in the Cherokee Nation: Outcomes from a Multi-Level Preventive Intervention to Reduce Alcohol Use Among Adolescents

Introduction:  The Prevention Trial in the Cherokee Nation (PTCN) is a partnership between prevention scientists and Cherokee Nation Behavioral Health to evaluate the effectiveness of a multi-level intervention designed to prevent underage alcohol use and alcohol-related consequences among youth living in the Cherokee Nation Tribal Jurisdictional Service Area (CN-TJSA). We combined two distinct interventions: CONNECT, a school based intervention adapted from prior screening, brief intervention, and referral to treatment (SBIRT) research; and CMCA, a community organizing intervention targeting social and commercial alcohol access for adolescents.

Methods:  Six communities from the CN-TJSA were randomized to either a control, CMCA only, CONNECT only, or CMCA and CONNECT condition.  Quarterly surveys were collected on a cohort of 9^th and 10^th graders through their 11^th and 12^th grade year. Students received a small cash incentive for each survey they completed with and additional incentive for completing all the surveys for which they were eligible during the school year. Response rates ranged from 83%-90% over 12 survey waves. The change in probability of past 30-day alcohol use and past 30-day heavy drinking was modeled using weighted generalized estimating equations using PROC GENMOD in SAS v9.3. All models were weighted to account for pre-study differences between intervention conditions. Multiple imputation was used to account for loss to follow-up.

Results: Forty-six percent of students indicated they were American Indian (of which 80% were Cherokee), including 22% who reported being AI only and 20% both AI and White. Forty-six percent reported being White only. Based on quarterly surveys over a three-year period, high school students exposed to the CMCA intervention only, the CONNECT intervention only, and both interventions combined showed a significant reduction in the probability over time of both 30-day alcohol use and 30-day heavy drinking compared to students in the control condition, with some variation over the 2.5-year intervention period.

 Conclusions: Our results suggest that CMCA and CONNECT can be effective interventions for the reduction of alcohol use among Native American and other youth living in rural high-risk underserved communities. However, there are challenges to sustaining intervention effects.