Grounding evidence-based prevention within cultural context: promising effects of substance use prevention adapted for American Indian families

Background: Effective substance use prevention strategies are needed for American Indian (AI) youth, who face disproportionate risk for early substance use and consequently bear a disproportionate burden of health and developmental disparities related to early use. With few exceptions, significant advances in prevention science have largely excluded this population, leaving gaps in the evidence of effective practice. This paper builds on emerging efforts to address this gap, reporting first outcome findings from an evidence-based early substance use prevention program culturally adapted for young adolescents on a Northern Plains reservation. Methods: Using a community-based participatory approach, the Thiwáhe Gluwáš'akapi Program (TG, sacred home in which family is made strong) was developed by embedding cultural kinship teachings within the Strengthening Families Program for Parents and Youth 10-14 and aligning other elements of program content with local culture and context. Results: Results of pre and post comparisons of proximal program outcomes showed that youth reported significant improvements in parental communication about substance use, substance use resistance skills, stress management, family cohesion, and overall well-being. Adults reported improvements in a wide array of parenting behaviors and indicators of family dynamics. Conclusions: These findings provide an initial glimpse into the potential effects of the TG program and suggest that it holds promise for helping AI families address risks for youth substance use through positive impacts on modifiable risk and protective factors documented to influence early substance use.