Is culturally based prevention effective? Results from a 3-year tribal substance use prevention program. (December 2018)

• Record Type: Journal Article
• Authors: Kelley, Allyson; Fatupaito, Bethany; Witzel, Morgan
• Is Part Of: Evaluation and program planning. Volume 71(2018)
• Page Start: 28
• Page End: 35
• Publication Date: 2018-12
• Subjects: American Indian Youth -- Substance use -- Community -- Culture -- Evaluation; Health planning -- Periodicals; Medical care -- Evaluation -- Periodicals; 362.1068
• DOI: 10.1016/j.evalprogplan.2018.07.001
• Languages: English
• ISSNs: 0149-7189

Abstract

Highlights: Youth substance use is a major public health concern. Evaluation of youth substance use prevention programs is needed to understand the aspects of programming that make a program effective or not effective. This mixed methods evaluation focuses on lowering substance use, increasing community readiness, and increasing the reach of prevention messages through culturally-based prevention. The evaluation of these outcomes occurred over a 3-year period in six American Indian communities in the Rocky Mountain Region. This is the first published evaluation of substance use prevention programming efforts. This evaluation found that American Indian youth who participate in culturally-based prevention activities report higher levels of social support compared with American Indian youth who do not participate in these activities. Substance use is a multi-faceted problem facing our communities, families, schools, and nation. Innovative, effective, culturally-based prevention and evaluation is needed to prevent substance use. Results from this outcome evaluation show that culturally-based prevention program is successful in reducing risk factors associated with substance use in American Indian youth. Community members, tribal leaders, and site coordinators feel that these reductions are likely due to the community-driven approach of prevention, where community members design and implement universal prevention strategies that are culturally-tailored and contextually based. Lessons learned from this 3-year outcome evaluation may help other tribal communities and state / federal prevention programs. First, meet communities where they are at. Understand that community readiness to support and implement prevention activities varies by time, place, and culture. Second, used the best available data and be mindful that many communities are frustrated with completing surveys and not seeing actions or interventions that address their needs and concerns. Third, if one evaluation approach does not work, try another one. Fourth, seek community feedback often using a variety of methods. Disseminate evaluation results and updates to community members using methods that are appropriate for the community. Abstract: American Indian youth substance use is a major public health concern. To date, there has been limited evaluation of American Indian youth substance use prevention programs. Evaluation of prevention programs is necessary to understand the aspects of programming that are effective or not effective. This mixed-methods evaluation focuses on select outcomes of a 3-year culturally-based prevention program located in six American Indian communities in the Rocky Mountain Region. The goals of the prevention program are to reduce binge drinking by 30% and increase community readiness by 1-point over a 5- year period. In the first year of the program, community members worked with program staff to develop an evaluation plan that would measure the following outcomes: lowering substance use, increasing community readiness, and increasing the reach of prevention messaging through culturally based prevention. The primary research questions this outcome evaluation sought to answer were as follows: 1) Are there differences in American Indian youth who participate in culturally-based prevention activities compared with American Indian youth who do not participate in these activities? 2) Was the prevention program effective in increasing community readiness over a 3-year period? 3) Did community involvement in prevention activities increase overtime? Results from this evaluation indicate that substance use was similar among intervention (n = 200) and non-intervention youth (n = 369). This was somewhat surprising because Intervention youth reported higher levels of social support and community connections than non-intervention group youth. Community readiness decreased −.81 point from 2015 to 2017. The reach of prevention activities increased 365% from 2015 to 2017. We provide lessons learned that may help other communities as they document outcomes related to prevention efforts. Substance use is a multi-faceted problem facing our communities, families, schools, and nation. Innovative, effective, culturally-based prevention programs like the one highlighted in this paper underscore the need for primary prevention strategies.