Parenting in 2 Worlds Intervention: Cultural Engagement As an Outcome and Moderator in Strengthening Urban American Indian Families

Purpose: Maintaining and re-engaging with traditional cultural heritage is often cited as a potent factor in improving the wellbeing of American Indian (AI) communities. Culturally appropriate, evidence-based prevention programs are often unavailable to the growing majority of AIs who live in cities (>60%). Parenting in 2 Worlds (P2W), a culturally grounded parenting intervention, was created to strengthen protective factors among urban AI families and reduce youth substance use and sexual health risks. Employing community-based participatory research in urban AI communities with diverse tribal backgrounds, a multi-stage cultural program adaptation process uncovered and systematically incorporated common AI cultural values and parenting practices into the P2W curriculum. This presentation reports on the cultural engagement of the P2W participants as an outcome of the intervention and as a moderator of its effects on family functioning and health risks.

Methods: Data come from 575 parents of AI children (ages 10-17) in a randomized controlled trial in three Arizona cities.  Parents were recruited through urban Indian centers and randomized to P2W or to an informational family health curriculum, Healthy Families in 2 Worlds (HF2W).  Both P2W and HF2W consisted of 10 workshops delivered weekly by AI community facilitators.  Parents received incentives for participating in each workshop ($15), and 98% consented to complete self-administered questionnaires. Pretests occurred at the first workshop and posttests at the last workshop, measuring parenting skills, family functioning, youth and parent risk behaviors, and identification/engagement with traditional AI heritage/culture. Tests of the efficacy of P2W versus HF2W were analyzed through baseline adjusted regression models in Mplus using FIML estimation to adjust for attrition, including random effects (site, facilitator), and controlling dosage (# workshops attended). Moderated treatment effects of pretest cultural engagement were tested with mean centered interactions.

Results: Compared to parents in HF2W, those in P2W reported significantly larger pretest to posttest increases in AI ethnic identity, positive bicultural identification, and AI spirituality.  In tests of moderation, these increases in cultural engagement were significantly larger for P2W participants who were less culturally engaged at pretest. In addition, P2W parents with lower baseline AI ethnic identity reported significantly larger desired intervention effects on their child’s antisocial behavior, their own substance use, and parent-child communication about sex.

Conclusions: Culturally adapted parenting interventions like P2W can effectively build on indigenous cultural heritage to promote wellbeing of AI parents and their children.