Chukka Auchaffi’ Natana: The Weaving Healthy Families Program to Promote Wellness and Resilience and Prevent Alcohol and Other Drug Abuse and Violence

项目摘要 酒精和其他药物（AOD）滥用和家庭暴力是美国原住民（NA）共同发生的风险因素 健康差距，并与这一人口中的主要死亡原因有关，如 心血管疾病（CVD）和糖尿病。然而，现有的干预措施往往未能全面促进 恢复力，健康和健康，而不是孤立地解决问题。据我们所知， 少数以文化为基础和以家庭为重点的干预措施，以增强家庭的复原力， 减少家庭中的虐待和暴力。鉴于社区和文化基础项目之间的差距， 为了防止家庭中的滥用和暴力，迫切需要测试这种可持续的 基于社区的干预。这项研究的长期目标是促进健康和保健， 通过测试一种与文化相关的家庭暴力，预防和减少新来港定居人士家庭中的虐待和暴力行为， 以跨国传播为中心的干预。使用基于社区的参与性研究方法 （CBPR），拟议研究的总体目标是使用阶梯楔形试验设计（SWTD）， 测试由基于部落的社区卫生促进的经文化修改的干预措施的效力 并利用执行情况研究综合框架， 干预措施可持续性和执行的障碍和促进因素。我们的中心假设是， 以社区为基础的"编织健康家庭计划"--一个缩短、精简和适应文化的计划， 庆祝家庭的版本!计划-将减少和推迟AOD的使用，减少和防止 家庭暴力，促进NA成年人的复原力和健康（包括心理健康）， 青年这种干预旨在通过针对关键行为（AOD滥用）、精神/情感 （情绪调节/愤怒管理，认知和弹性），社会和家庭（健康和非健康） 暴力关系，家庭环境和养育），文化（价值观和传统），和身体 （营养和AOD滥用）因素。我们通过这些目标来实现既定目标：目标1：测试 改良干预对减少AOD滥用和暴力以及恢复力的有效性 增强使用开放队列、多基线SWTD和多水平纵向模型，我们 将测试我们的工作假设，即干预将减少父母的虐待和暴力，推迟 青少年使用AOD，并提高家庭成员的适应力和健康。目标2：评估可持续性 干预措施实施的可行性。我们将使用CFIR和收敛的混合方法 设计评估干预实施的障碍和促进因素，测试我们的工作假设， 修改后的干预措施将提供一个文化相关的和可行的模式，以促进健康， 可持续的方式。拟议研究的预期成果是一个有效的，文化相关的， 以社区为基础可持续方案，以促进跨国部落的健康和福祉。

Project Summary Alcohol and other drug (AOD) abuse and family violence are co-occurring risk factors for Native American (NA) health disparities and are associated with the leading causes of death within this population, such as cardiovascular disease (CVD) and diabetes. However, extant interventions often fail to holistically promote resilience, health, and wellness, instead addressing problems in isolation. To our knowledge, there have been few NA culturally-based and family-focused interventions that enhance family resilience and prevent and reduce AOD abuse and violence in families. Given the gap in community and culturally-grounded programs to prevent AOD abuse and violence in families, there is a critical need to test the efficacy of such sustainable community-based interventions. The long-term goal of this research is to promote health and wellness, while preventing and reducing AOD abuse and violence in NA families by testing a culturally-relevant and family- centered intervention for cross-national dissemination. Using community-based participatory research methods (CBPR), the overall objectives of the proposed research are to use a stepped-wedge trial design (SWTD) to test the efficacy of a culturally modified intervention that is facilitated by Tribally-based community health representatives (CHRs) and to use the consolidated framework for implementation research (CFIR) to examine the barriers and facilitators for intervention sustainability and implementation. Our central hypothesis is that the community-based, “Weaving Healthy Families program”—a shortened, streamlined, and culturally adapted version of the Celebrating Families! Program—will reduce and postpone AOD use, decrease and prevent violence in families, and promote resilience and wellness (including mental health) among NA adults and youth. This intervention seeks to promote wellness by targeting key behavioral (AOD abuse), mental/emotional (emotional regulation/anger management, cognitions, and resilience), social and familial (healthy and non- violent relationships, the family environment, and parenting), cultural (values and traditions), and physical (nutrition and AOD abuse) factors. We accomplish the stated objectives through these aims: Aim 1: Test the efficacy of the modified intervention on AOD abuse and violence reduction and resilience enhancement. Using an open cohort, multiple baseline SWTD and multilevel and longitudinal modeling, we will test our working hypothesis that the intervention will reduce parental AOD abuse and violence, postpone youth AOD use, and enhance family members' resilience and wellness. Aim 2: Evaluate the sustainability and feasibility of the intervention's implementation. We will use the CFIR and a convergent mixed-method design to evaluate barriers and facilitators to intervention implementation, testing our working hypothesis that the modified intervention will provide a culturally relevant and feasible model to promote wellness in a sustainable way. The expected outcomes of the proposed research are an efficacious, culturally relevant, and sustainable community-based program to promote health and wellness for tribes cross-nationally.