Be Under Your Own Influence (BUYOI): Effectiveness of a Culturally-Adapted Drug Prevention Campaign Targeting Young American Indian Adolescents

Introduction: American Indian (AI) youth, particularly those living on or near reservations, exhibit earlier initiation of substance use (SU) relative to their non-AI peers. Alarmingly, early SU initiation is a strong risk-factor for the later development of SU disorders. Despite this critical issue impacting AI communities, few effective and culturally-relevant interventions targeting early SU initiation among AI youth exist. BUYOI (Be Under Your Own Influence) is a previously validated intervention designed to reduce early SU initiation by bolstering teens’ sense of autonomy and self-determination. Using event history analysis, this study examined the effectiveness of a culturally-adapted version of BUYOI in reducing risk of first-time alcohol use (AU), alcohol intoxication (AX), and cannabis use (CU) among young AI youth.

Methods: 5 middle-schools located on/near reservations (Northern Plains and Southwest regions) participated in the present study. 3 schools were randomly assigned to receive BUYOI (N_AIstudents=321) and 2 schools were assigned to a control condition (N_AIstudents=176). Students completed a questionnaire at 4 time-points during the study period (Fall and Spring semester of their 7^th and 8^th grade years), which included measures of their SU, autonomy and future aspirations. Three discrete-time hazard models were used to estimate the effects of gender, BUYOI exposure, autonomy and aspirations on students’ risk of first-time AU, AX, and CU during the study period.

Results: Gender was a significant predictor of initiation risk across all three outcomes, with boys demonstrating significantly lower risk relative to girls. Personal autonomy predicted lower risk across all 3 outcomes, while aspirations predicted lower risk of first time AX and CU. Importantly, students attending schools assigned to receive BUYOI evinced lower risk of first-time AX and AU during the study period; however, BUYOI exposure was unrelated to first-time CU. Finally, gender interacted with BUYOI exposure to predict first-time AX. Boys exposed to BUYOI had a lower risk of first-time AX relative to boys with no exposure; by contrast, BUYOI had no significant impact on AX initiation among girls.

Discussion: The current findings provide preliminary support for the effectiveness of a culturally-adapted version of BUYOI in preventing early SU initiation among AI youth, particularly in the case of alcohol use and intoxication. However, more research is needed to better understand and account for gender differences in intervention effectiveness among AI youth. Notably, our findings highlight the role of autonomy and future aspirations in SU initiation, suggesting both serve as important modifiable protective factors against early SU initiation within AI communities.