Baseline Risk and Protective Factors Associated with Targeted Psychosocial and Behavioral Outcomes Among American Indian Adolescents Participating in a Randomized Trial of an Entrepreneurship Education Intervention

Introduction: American Indian (AI) communities seek strengths-based solutions to address the large burden of behavioral health disparities among adolescents. Entrepreneurship education may be a promising strategy to address individual- (connectedness, hope, life-skills) and community- (school attachment, employment) level protective factors to promote adolescent behavioral health.

Methods: The White Mountain Apache Tribe (Apache) and Johns Hopkins Center for American Indian Health developed the “Arrowhead Business Group” (ABG) youth entrepreneurship program that includes 16 sessions, 10 taught through a week-long residential camp, and 6 follow-on workshops by Apache community health workers, local entrepreneurs, and elders. ABG is being evaluated through a 2:1 randomized controlled trial with 24 months follow-up. This analysis explores bivariate associations between baseline risk and protective factors and the intervention’s primary outcomes: a) entrepreneurship knowledge, b) life skills self-efficacy, c) alcohol use, d) drug use, e) depression, and f) threats of violence to self/others.

Results: The sample (n=391) was 58% female, mean age 14.3 (SD 0.83), with 266 randomized to ABG and 125 control. At baseline, entrepreneurship knowledge was positively associated with hope of completing high school (Odds Ratio [OR]=3.69, p<0.000), and negatively associated with being threatened/injured at school (OR= -2.68, p<0.011), physical fighting (OR= -1.80, p<0.006), and attempting suicide in the past year (OR= -2.94, p<0.001). Life skills self-efficacy was positively associated with hope of completing high school (OR=1.09, p<0.000), and negatively associated with carrying guns (OR= 0.889, p<0.000), missing school (OR= -0.89, p<0.001), lifetime sexual experience (OR= -0.61, p<0.006), physical fighting (OR= -0.703, p<0.000), threatened/injured at school (OR= -0.96, p<0.001), and attempting suicide (OR= -1.002, p<0.000). Lifetime alcohol use was positively associated with older age (OR= 1.52, p<0.002), sexual experience (OR= 6.18, p<0.000), missing school (OR= 2.34, p<0.004), threatened/injured at school (OR= 3.52, p<0.000), physical fighting (OR= 3.61, p<0.000), and attempting suicide (OR= 4.73, p<0.000). Belief in completing high school was protective against alcohol use (OR= 0.57, p<0.015). The same risk and protective factors were identified for lifetime drug use. Females had higher odds of depression (OR= 1.57, p<0.05), as did those who missed school (OR= 4.39, p<0.000), were threatened/injured at school, (OR= 3.97, p<0.000), in a physical fight (OR= 1.72, p<0.02), or attempted suicide (OR= 7.09, p<0.000).

Conclusion: Findings support that targeting youth’s entrepreneurship knowledge, life skills self-efficacy, connectedness to school, and aspirations to complete high school may buffer against prevailing behavioral risks for AI adolescents—particularly substance use, depression and threat of violence to self/others.