Development and Implementation of a Culturally Centered Opioid Prevention Intervention for American Indian/Alaska Native Young Adults in California
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- RAND
- 入组人数
- 541
- 试验地点
- 6
- 主要终点
- Frequency of alcohol and marijuana use
研究概览
简要总结
This study responds to Request For Application-DA-19-035, HEAL (Helping End Addiction Long Term) initiative: Preventing OUD in Older Adolescents and Young Adults (ages 16-30) by developing and implementing a culturally centered intervention to address opioid use among urban AI/AN emerging adults in California. The primary goal of this study is to compare AI/AN emerging adults who receive TACUNA plus a Wellness Circle (WC) to those AI/AN emerging adults who receive an opioid education workshop on outcomes (e.g., opioid misuse and alcohol and other drug use) over a period of 12 months. TACUNA will be a motivational interviewing group intervention that incorporates traditional practices and discussion of how to cultivate healthy social networks and cultural worlds. The Wellness gathering will be for emerging adults and people in their social network, and will focus on how social networks and cultural connectedness influence healthy behaviors. Opioid education will focus on discussion of opioid misuse within the AI/AN urban community and ways to reduce use in a culturally appropriate manner. Investigators expect those who receive TACUNA + WG will report less opioid and AOD (alcohol and other drug) use frequency, fewer consequences, less time spent around peers who use opioids and AOD, and less perceived prevalence of peer use compared to opioid education over a period of 12 months. Also, investigators will evaluate the intervention's effects on secondary outcomes of social networks and cultural connectedness. Survey data is collected at baseline, 3-months, 6-months and 12-months. Longitudinal analyses will compare intervention participant and control participants on primary and secondary outcomes.
详细描述
Data from 2015 show that American Indians/Alaska Natives (AI/ANs) have the highest rates of diagnosis for opioid use disorders (OUD) and deaths from drug overdose. Misuse of prescription opioids, defined here as taking opioid medications in a manner or dose other than prescribed or for hedonic effects, and the use of heroin, have emerged as major public health concerns in the United States. Of particular concern is the prevalence of opioid use among emerging adults (ages 18-25) as this is a developmental period of heightened vulnerability and critical social, neurological, and psychological development.
Unique risk factors may predispose urban AI/AN young adults to use opioids, alcohol or other drugs. For example, experiences of acculturative stress directly and indirectly associated with historical trauma experienced by AI/ANs throughout U.S. history result in poor health outcomes. One U.S. law that has been postulated to contribute to various health disparities among urban AI/ANs is the Relocation Act of 1956. This Act financed the relocation of individual AIs and AI families to job training centers in designated U.S. cities. Rather than establishing economic stability, large numbers of AIs who moved to urban areas became unemployed, homeless, and disconnected from their community-based support networks. This relocation appears to have contributed to an inter-generational effect whereby successive generations of urban AIs and ANs continue to experience various health-related disparities. Our work with urban AI/AN adolescents highlighted that many experience stress related to identity in the form of both subtle (e.g., being asked whether one is a "real" Indian) and overt (e.g., being called a racist name like Squaw or Red Skin) discrimination. Programming that incorporates traditional practices, promotes community involvement, and encourages healthy notions of AI/AN identity may increase well-being and healthy behaviors by addressing sources of stress linked to cultural identity, stigma, and community connections. However, few evidence-based programs that integrate these cultural elements have been developed, implemented, and evaluated with urban AI/AN using a strong research design. The current study substantially extends work with AI/AN emerging adults by adapting and testing an integrated culturally appropriate MI and social network intervention to address opioid and other AOD (alcohol and other drug) misuse at both the individual and community level.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 18 Years 至 25 Years（Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •must self-identify as American Indian/Alaska Native (AI/AN)
- •be in the age range of 18-25
- •not be in need of substance treatment
排除标准
- •If substance treatment need is indicated
研究组 & 干预措施
TACUNA
Randomized participants will attend 3 virtual TACUNA workshops, focused on behavioral, physical, and spiritual domains, and designed to guide AI/AN youth to make healthy choices surrounding opioid and AOD use. They will also attend a Wellness Circle, focused on healthy social networks and engaging in traditional practices.
干预措施: TACUNA plus Wellness Circle (Behavioral)
Opioid education
Randomized participants will attend 1 virtual opioid education workshop, focused on behavioral and physical domains, and designed to guide AI/AN youth to make healthy choices surrounding opioid and AOD use.
干预措施: Opioid Education Workshop (Behavioral)
结局指标
主要结局
Frequency of alcohol and marijuana use
时间窗: change from baseline to 12 months
We will assess frequency of alcohol and marijuana use in the past three months from 1 = never to 6 = over 20 times.
Frequency of opioid use
时间窗: change from baseline to 12 months
We will assess frequency of opioid use in the past three months from 1 = never to 6 = over 20 times.
Alcohol Use Past 3 Months
时间窗: 3, 6, and 12 months post-baseline
Survey asks number of times had "At least one drink of alcohol." Response was on a scale with options 0=none, 1=1 time, 2=2 times, 3=3-5 times, 4=6-9 times, 5=10-19 times, 6=20-30 times, and 7=31+ times. Responses were translated to actual number of times by taking the midpoints of intervals, e.g. response 3 ("3-5 times") coded as 4 times. To be conservative values were rounded down when the midpoint was not an integer, e.g. response 4 ("6-9 times") coded as 7 times. Response 7 ("31+ times") was coded as 31 times.
Cannabis Use Past 3 Months
时间窗: 3, 6, and 12 months post-baseline
Survey asks how many times participant used "Marijuana (cannabis, pot, weed, hash)." Response was on a scale with options 0=none, 1=1 time, 2=2 times, 3=3-5 times, 4=6-9 times, 5=10-19 times, 6=20-30 times, and 7=31+ times. Responses were translated to actual number of times by taking the midpoints of intervals, e.g. response 3 ("3-5 times") coded as 4 times. To be conservative values were rounded down when the midpoint was not an integer, e.g. response 4 ("6-9 times") coded as 7 times. Response 7 ("31+ times") was coded as 31 times.
Most Drinks in One Day During the Past Month
时间窗: 3, 6, and 12 months post-baseline
If participant reports any drinks in past month, survey asks "What is the largest number of drinks you had on any day in the PAST MONTH (30 DAYS)?" Response options range from 1 (a few sips) to 17 (15 or more drinks)
Amount of Cannabis Used Per Day When Using
时间窗: 3, 6, and 12 months post-baseline
Participants reporting lifetime marijuana use were asked "On the days you use marijuana, about how much marijuana flower/bud do you personally consume?" with response options ranging from 1="less than 0.25g" to 10="more than 5g."
Opioid Use Past 3 Months
时间窗: 3, 6, and 12 months post-baseline
Measure Description: Survey asks number of times used "Prescription opioid." Response was on a scale with options 0=none, 1=1 time, 2=2 times, 3=3-5 times, 4=6-9 times, 5=10-19 times, 6=20-30 times, and 7=31+ times. Responses were translated to actual number of times by taking the midpoints of intervals, e.g. response 3 ("3-5 times") coded as 4 times. To be conservative values were rounded down when the midpoint was not an integer, e.g. response 4 ("6-9 times") coded as 7 times. Response 7 ("31+ times") was coded as 31 times.
次要结局
- Network Composition(change from baseline to 12 months)
- Network Structure(change from baseline to 12 months)
- Cultural connectedness(change from baseline to 12 months)
- Cultural Connectedness(3, 6, and 12 months post-baseline)