CONNECT: Implementation of a School-Based Alcohol Screening and Brief Intervention for Youth in the Cherokee Nation

Mixed methods systematic review: Using a cultural validity assessment to evaluate prevention programs for Indigenous students

Implementing culturally appropriate school-based prevention programs with Indigenous students that leverage culture as a protective factor has the potential to revitalize and sustain cultural connections that have historically and systematically been destroyed in the United States. However, there is a dearth of literature synthesizing the effectiveness of school-based prevention programs that have been implemented with Indigenous students across contexts. As such, we conducted a mixed method systematic review to (a) evaluate school-based prevention programs with quantitative and/or qualitative data, (b) assess the use of Indigenous research methods, and (c) examine cultural and community validity. Studies were included if they were published between January 2010 and August 2022, reported quantitative and/or qualitative outcomes for a prevention program implemented in a K-12 school with Indigenous students, or examined an intervention that was designed for Indigenous students (even if there were non-Indigenous students in the study). We strategically included qualitative and mixed methods studies to ensure that cultural and community contexts were represented in this study and to contextualize quantitative findings. Our search resulted in the inclusion of 36 manuscripts describing 28 different interventions. There were 11 mixed methods, three qualitative, and 22 quantitative studies. Quality was assessed using the Mixed Methods Appraisal Tool (Hong et al., 2018) and a randomized controlled trials appraisal tool drawn from the Journal Article Reporting Standards (Appelbaum et al., 2018). Building on the work from Kūkea Shultz and Englert (2021), cultural validity was assessed by conceptualizing cultural validity into the two distinct domains of purposeful engagement and intentional privileging. Intervention effectiveness was evaluated and separated into three criteria (i.e., positive, null, and mixed) to determine if effectiveness varied based on intervention or study design. Most of the studies reported positive outcomes and effectiveness did not vary based on study design (i.e., quantitative, qualitative, and mixed methods) or intervention design (i.e., culturally grounded, culturally adapted or mainstream/no cultural adaptations). We discuss implications of systematic review findings as well as the importance of using mixed methods to understand and contextualize intervention effectiveness when conducting research that relates to identity and culture.

Psychological capital variables as protective factors in indigenous youth experiencing homelessness

Indigenous youth in the United States are at high-risk for experiencing homelessness related to adverse childhood experiences such as parental substance use and low educational attainment. Such experiences may lead to adverse physical and mental health issues; these youth also have positive attributes of psychological capita (hope, self-efficacy, resilience, optimism) that are related to health outcomes. The purpose of this secondary analysis was to describe demographic attributes and psychological capital in Indigenous youth experiencing homelessness (IYEH) who participated in a longitudinal intervention study related to safe sex behaviors and life satisfaction. From a total of 602, Indigenous participants (n = 111; mean age 21.25 ± 1.82 years) were recruited from drop-in centers in Austin, Texas and Columbus, Ohio. Data were collected immediately after the intervention and at 3- and 6-month intervals. For this analysis, only data collected at the final time-point were used. Valid scales with Cronbach alphas of 0.75-0.92 (Hope, Resilience, Optimism, Self-efficacy for Substance Refusal, Self-efficacy for Safer Sex, Safe Sex Behaviors, Social Connectedness, and Life Satisfaction) were used. The majority of the IYEH reported smoking, drinking, and using drugs. Psychological capital variables of hope, self-efficacy for negotiating safer sex, resilience, and optimism were significantly related to one another, but not to safe sex behaviors or intention to use condoms. Resilience and optimism were significantly related to social connectedness but not to other psychological capital variables. Life satisfaction was significantly associated with hope, resilience, and optimism. Findings have implications for further theory and research development.

Culturally Responsive Opioid and Other Drug Prevention for American Indian/Alaska Native People: a Comparison of Reservation- and Urban-Based Approaches

There are few substance use treatment and prevention programs for AI/AN people that integrate culturally based practices with evidence-based treatment and prevention. The National Institutes of Health's (NIH's) Helping to End Addiction Long-term (HEAL) Prevention Cooperative supports two projects focused on AI/AN populations. One focuses on youth ages 15 to 20 years living within the Cherokee Nation reservation, a multicultural rural area in northeastern Oklahoma, and the second focuses on emerging adults ages 18 to 25 years living in diverse urban areas. We provide a brief overview of the two prevention trials and a case comparison across approaches using the framework of promising practices for intervention science with Indigenous communities (Whitesell et al., 2020) related to (1) integration of Indigenous and academic perspectives to respond to community needs, (2) community partnership and engagement, (3) alignment with Indigenous cultural values and practices, (4) capacity building and empowerment, (5) implementation within complex cultural contexts, and (6) tribal oversight. Overall, these two projects highlight the importance of long-standing relationships with community partners, engaging the community at all levels to ensure that programming is culturally and developmentally appropriate, and having tribal and elder oversight. These practices are key to establishing trust and building confidence in research in these communities and ensuring that research can benefit AI/AN people. These studies showcase how strong partnerships can advance health and support the conduct of rigorous science to help pinpoint optimal health solutions by identifying efficacious, culturally grounded intervention strategies. Although the sovereign status of tribes demands this type of partnership, this research serves as a model for all community research that has a goal of improving health.

COVID-19 Medical-Religious Partnerships: Implementation of a Just-In-Time COVID-19 Training in Catholic Schools

The concept of Just-In-Time Training (JITT) is to provide critical information specific to a public health crisis, allowing individuals to understand and respond to an urgent situation. The design of the JITT curriculum appropriate for school-aged children during the COVID-19 pandemic is vital, as every individual has a role to play in mitigating the spread of SARS-CoV-2. When working with various communities, considering culture and religion is essential, as aligning values and beliefs with the JITT curriculum's objectives may significantly change the community's behavior toward a public health crisis. In this narrative, we describe how a JITT curriculum for the COVID-19 pandemic, created in Maryland, US, and implemented in a Catholic school system, aligned with core Catholic social teachings. This alignment allowed for implementing and delivering the COVID-19 curriculum in Maryland's Archdiocese Catholic school system, culminating in a medical-religious partnership that serves as a model for future public health crises.