Abstract of Distinction: Using MOST to Evaluate Adaptation of an Early Substance Use Prevention Program for American Indian Youth and Families

Introduction: American Indian (AI) youth often initiate substance use early, elevating risk for poor developmental outcomes and substance use disorder. Early prevention is needed, but evidence about effective practices for this population is scant. Creative approaches must leverage evidence from other populations and strengthen scientific methods for adapting prevention programs to meet the needs of AI communities. This study combined a Community-Based Participatory Research approach and a Multiphase Optimization Strategy (MOST) design to build a prevention program for Northern Plains AI youth.

Methods: The Iowa Strengthening Families Program for Parents and Youth 10-14 (SFP 10-14) was adapted through an iterative process with community advisors and program developers, creating the Thiwáhe Gluwáš’akapi (TG; “Strengthening Families”) program. Cultural kinship teachings were incorporated, reinforcing messages about family connections, roles, and responsibilities. Using MOST, three additional adaptations were explored: (1) tribal language for kinship terms; (2) Facebook groups to reinforce program messages, and (3) removing substance use session.

The TG program was implemented with 20 groups of families (N=141 families, 220 adults, 193 youth) in 12 rural communities around a Northern Plains reservation, from September 2015 to December 2017. Intervention groups were randomly assigned to MOST conditions. Up to 2 adults and 2 youth per family were surveyed: Baseline (1-2 weeks prior to program), post-program (1-2 weeks after program), and follow-up (6 months after program).

Results: Baseline surveys were completed by 197 adults and 170 youths. The majority of adults (73%) were female and ages ranged from 19-78 (M=40.3, sd=10.8). Fifty percent were mothers of participating youth; 17% fathers; and 12% grandmothers. Among youth, 47% were female; average age was 11.6 (sd=1.3); and grade level ranged from 4-9. Most youth (84%) reported getting As or Bs in school; 84% were participating with their primary female caretaker and 39% with their primary male caretaker. Data collection will be complete in January 2018, and outcome analyses will be presented.

Conclusions: This study leveraged prevention science and cultural traditions to develop an early substance use prevention program for AI youth and families, helping to fill a significant gap in resources for addressing developmental risk in this population. Utilization of the MOST design enabled a strategic approach to evaluating program components and refining the intervention for future implementation, but not without costs. Challenges with the MOST design in a complex, community-based intervention will be discussed, including maintaining fidelity with multiple versions of the program implemented concurrently.