A Culturally Competent Community Outreach Program As a Component of a Successful Multilevel Community Intervention to Reduce Underage Drinking in American Indian Communities

Introduction: Underage drinking is an important public health issue for American Indian/Alaska Native (AI/AN) adolescents, as it is for teens of all ethnicities. A 4-year multilevel community intervention to reduce underage drinking in nine contiguous Southern California American Indian (AI) rural reservation communities was carried out from 2008 - 2011. The intervention was associated with significant reductions in past 30 day and heavy episodic (³ 5 drinks in 2 hours) drinking. This poster describes the characteristics of the culturally competent community outreach component of that multi-level intervention, its efficacy relative to the other components of the intervention, and data consistent with a proposed mechanism of action of the multilevel intervention.

Methods: The community outreach component of the multilevel intervention was designed and implemented by young adult AI/AN researchers using a Community Based Participatory Research approach. Presentations using clinical and scientific information on the risks of underage drinking were combined with traditional arts activities and discussion of historical trauma tailored to age group and venue. At the conclusion of the intervention, a survey of adults and youth assessed, for each component of the intervention, whether an individual was aware of the component and, if aware, whether he or she took action to reduce underage drinking (adults) or reduced their drinking (youth). Additional questions assessed whether the intervention as a whole (all components) moved individuals along the transtheoretical model of stages of behavior change from pre-contemplation to action to reduce drinking.

Results: Total presentation-activities was 298. A survey of adults and youth assessing efficacy of the community outreach component found that for adults (n=120) 65% were aware of the outreach activities, and, of these, 76% of those who were aware took action to reduce youth drinking. For youth (n=100) 74% were aware, and, of these, 29 % of those youth who were drinkers reduced their drinking. The community outreach component was as or more effective than the other components. For the multilevel intervention as a whole, taking action (OR, p-value) to reduce youth drinking was associated with movement along the transtheoretical model of stages of behavior change from pre-contemplation to contemplation (adults: 6.04, 0.001; youth: 18.10, 0.001) and contemplation to preparation (adults: 18.1, 0.006; youth: 9.5, 0.027).

Conclusions: Culturally competent community outreach for both adults and youth as part of a multilevel community intervention to reduce AI underage drinking appears to be effective, including for adults and youth in the pre-contemplation stage of behavior change.