Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation

Komro, Kelli A.; Livingston, Melvin D.; Wagenaar, Alexander C.; Kominsky, Terrence K.; Pettigrew, Dallas W.; Garrett, Brady A.

doi:10.2105/ajph.2016.303603

Cited by 45 publications

(62 citation statements)

References 23 publications

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“…Also, we did not find positive changes in the hypothesized intermediate outcomes of alcohol expectancies, social support, or parent communication. Despite the lack of change through these intermediate pathways, the CONNECT intervention was effective at reducing alcohol use and alcohol‐related consequences . Perhaps CONNECT worked through other key pathways or through mechanisms unique to the intervention (ie, MI).…”

Section: Discussionmentioning

confidence: 96%

“…The combination of the 2 interventions had a similar effect as each intervention alone. Details of the trial design and alcohol use outcomes are described elsewhere . This article will describe the specific characteristics and implementation of the CONNECT SBI intervention, the universally‐implemented, multiculturally‐appropriate school‐based prevention program.…”

mentioning

confidence: 99%

“…We previously reported the effectiveness of a community-based intervention (Communities Mobilizing for Change on Alcohol: CMCA) and an individual-level SBI and complementary media campaign (CONNECT), which were designed as part of a large-scale alcohol use prevention trial for high school students living in rural communities within the Oklahoma Cherokee Nation. 23 The participating high schools, which included nearly 50% AI students, were randomly assigned to receive CONNECT only (N = 1), CMCA only (N = 1), a combined treatment condition CONNECT+ CMCA (N = 2), or no intervention (N = 2). Compared to the control condition, CMCA reduced past month alcohol use among the high school students by 25% and CONNECT reduced past month alcohol use by 22%.…”

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confidence: 99%

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

Garrett¹,

Komro

Merlo

et al. 2019

Journal of School Health

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BACKGROUND There is growing optimism regarding the use of screening and brief intervention (SBI) to identify and reduce risk behaviors during adolescence. However, understanding successful SBI implementation remains unclear. We previously reported the effects of CONNECT, a school‐based SBI, on reducing the primary outcome, the rate of monthly alcohol use among primarily American Indian (AI) and White high school students in the Cherokee Nation. In this paper, we describe the design and implementation process for CONNECT. METHOD CONNECT was designed to reduce alcohol use with 2 key strategies: (1) SBI with motivational interviewing (MI), implemented by a school‐based CONNECT coach, and (2) a media campaign. RESULTS Implementation results indicate that during each semester of the 2–1/2 years, between 73% and 100% of eligible students had at least one 15‐minute meeting with a CONNECT coach. Postcards and posters with positive communication tips for parents were displayed in CONNECT communities. No statistically significant differences occurred between the CONNECT and control groups on the hypothesized intermediate outcomes. CONCLUSIONS We describe implementation of a universal, school‐based, culturally adapted SBI that was effective in reducing alcohol use among youth living in the Cherokee Nation. Schools provide an important context for universal delivery of SBI interventions, such as CONNECT, for diverse adolescent populations, including AI youth.

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Section: Discussionmentioning

confidence: 96%

mentioning

confidence: 99%

mentioning

confidence: 99%

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

Garrett¹,

Komro

Merlo

et al. 2019

Journal of School Health

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“…In the prevention trial in the Cherokee Nation, the theory of community change was explicitly tested and defined as a process of citizen-led and direct-action community organizing (Komro et al, 2015, 2017). The direct-action community organizing process was the standard intervention delivered across communities, yet specific intervention components and their dosage varied based on local contexts (Komro et al, 2017). We hired local citizens to serve as community organizers and provided ongoing training and support in community organizing processes and strategies.…”

Section: Intervention Designmentioning

confidence: 99%

“…We conducted a community-randomized trial testing two theoretically distinct alcohol preventive interventions in rural towns within the jurisdictional service boundaries of the Cherokee Nation (Komro et al, 2015, 2017). We implemented a community environmental change intervention using community organizing called Communities Mobilizing for Change on Alcohol (CMCA) and a universally implemented individual-level intervention implemented within schools combining brief intervention with motivational interviewing called CONNECT and found that both interventions, alone and in combination, were effective in reducing past month alcohol use, heavy use, and alcohol consequences (Komro et al, 2017). Results of these preventive intervention trials conducted over the past two decades shape the prevention landscape in the United States, advancing theory, practice, and methods.…”

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confidence: 99%

25 Years of Complex Intervention Trials

Komro

2017

Research on Social Work Practice

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For the past 25 years, I have led multiple group-randomized trials, each focused on a specific underserved population of youth and each one evaluated health effects of complex interventions designed to prevent high-risk behaviors. I share my reflections on issues of intervention and research design, as well as how research results fostered my evolution toward addressing fundamental social determinants of health and well-being. Reflections related to intervention design emphasize the importance of careful consideration of theory of causes and theory of change, theoretical comprehensiveness versus fundamental determinants of population health, how high to reach, and health in all policies. Flowing from these intervention design issues are reflections on implications for research design, including the importance of matching the unit of intervention to the unit of assignment, the emerging field of public health law research, and consideration of design options and design elements beyond and in combination with random assignment.

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Family-based prevention programmes for alcohol use in young people

Gilligan

Wolfenden²,

Foxcroft

et al. 2019

Cochrane Database of Systematic Reviews

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Background Alcohol use in young people is a risk factor for a range of short-and long-term harms and is a cause of concern for health services, policymakers, youth workers, teachers, and parents. Objectives To assess the e ectiveness of universal, selective, and indicated family-based prevention programmes in preventing alcohol use or problem drinking in school-aged children (up to 18 years of age). Specifically, on these outcomes, the review aimed: • to assess the e ectiveness of universal family-based prevention programmes for all children up to 18 years ('universal interventions'); • to assess the e ectiveness of selective family-based prevention programmes for children up to 18 years at elevated risk of alcohol use or problem drinking ('selective interventions'); and • to assess the e ectiveness of indicated family-based prevention programmes for children up to 18 years who are currently consuming alcohol, or who have initiated use or regular use ('indicated interventions').

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Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation

Abstract: CMCA and CONNECT are effective interventions for reducing alcohol use among American Indian and other youths living in rural communities. Challenges remain for sustaining intervention effects.

Cited by 45 publications

References 23 publications

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

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

25 Years of Complex Intervention Trials

Family-based prevention programmes for alcohol use in young people

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