Using CBPR to Adapt a Culturally-grounded Prevention Curriculum for Urban America

描述（由申请人提供）：现在生活在城市地区的美洲印第安人家庭经历着与药物滥用和危险性行为相关的不成比例的健康差异，但很少有基于证据的预防方法来预防、减少和消除这一迅速增长的人口中的健康差异。家庭破裂、与贫困和农村向城市迁移有关的压力以及文化和社会联系的丧失，往往是导致人工智能家庭出现不良健康结果的途径。通过加强家庭功能（父母参与、家庭支持、父母监督和亲子沟通），父母干预可以帮助父母加强与文化相关的养育技能，这些技能与促进孩子的健康和福祉是一致的，并帮助他们在减少孩子使用药物和危险性行为的风险方面发挥直接的影响力。拟议的研究借鉴了项目团队在NCMHD卓越中心进行的研究，内容涉及人工智能家庭行为健康的社会决定因素、其突出的风险和弹性因素、抵制风险行为的文化适当策略以及适应文化的预防方案的系统方法。该研究的目的是通过修改现有的预防计划，为城市人工智能家庭创建和测试一种基于文化的育儿干预措施，家庭为下一代做好准备（FPNG）。适应将采用文化适应模型，以增加文化契合度的方式适应新的目标人群，同时保持对原计划核心组成部分的忠诚。干预措施将进行调整、试点、评估、文化验证、相应修订，并在一项随机对照试验（RCT）中进行测试，该试验与亚利桑那州三个最大的城市印第安人中心合作，涉及600个家庭（300个干预家庭，300个对照家庭）。生态发展理论为识别父母、家庭、同伴、社区和文化对青少年物质使用和危险性行为的影响提供了框架。CBPR方法将用于调整干预措施，利用来自城市人工智能父母、人工智能专业人员和预防专家的焦点小组的反馈，并通过原始干预措施的设计者与印度城市中心的工作人员之间的密切合作，从而提高这些中心提供未来育儿干预措施的能力。除了测试干预的有效性外，我们还将评估参与者与本土文化和身份的联系是否以及如何影响干预的效果，以及整体家庭功能的变化是否会导致旨在减少孩子危险行为的特定育儿实践。这些模型和理论可以为设计和实施更有效的、与文化相关的干预措施提供信息。由此产生的预防干预将解决受健康差异严重影响的服务不足群体的需求，加强家庭并帮助他们避免家庭和个人功能障碍，并推进有效转化研究策略的知识，以便为不同种族的家庭调整预防干预措施。

DESCRIPTION (provided by applicant): American Indian (AI) families now living in urban areas experience disproportional health disparities associated with substance abuse and risky sexual behavior but few evidence-based prevention approaches exist to prevent, reduce and eliminate health disparities among this rapidly growing population. Family disruption, stresses related to poverty and rural-to-urban migration, and loss of cultural and social connections frequently operate as pathways to adverse health outcomes among AI families. By strengthening family functioning (parental involvement, family support, parental monitoring, and parent-child communication), a parenting intervention can help parents strengthen culturally relevant parenting skills that are consistent with promoting their children's health and well-being, and help them serve as direct sources of influence in reducing their children's risk of substance use and risky sexual behavior. The proposed study draws upon the project team's research, conducted at an NCMHD Center of Excellence, on the social determinants of AI families' behavioral health, their salient risk and resiliency factors, culturally appropriate strategies for resisting risk behaviors, and systematic methods for culturally adapting prevention programs. The aims of the study are to create and test a culturally grounded parenting intervention for urban AI families through a modification of an existing prevention program, Families Preparing the Next Generation (FPNG). The adaptation will employ a Cultural Adaptation Model for adapting programs for new target populations in ways that increase cultural fit while maintaining fidelity to core components of the original program. The intervention will be adapted, piloted, evaluated, culturally validated, revised accordingly, and tested in a randomized control trial (RCT) involving 600 families (300 intervention, 300 control) in partnership with the three largest urban Indian centers in Arizona. Ecodevelopmental Theory provides the framework for identifying parental, family, peer, community and cultural influences on youths' substance use and risky sexual behavior. CBPR methods will be used to adapt the intervention, using feedback from focus groups of urban AI parents, AI professionals and prevention experts, and through close collaboration between the designers of the original intervention and staff of the urban Indian centers, thus increasing the capacity of those centers to provide future parenting interventions. In addition to testing the intervention's efficacy, we will assess whether and how the participants' connection to native culture and identity influences the interventions effects, and whether changes in overall family functioning lead to specific parenting practices directed at reducing their children's risk behaviors. These models and theory can inform the design and implementation of more effective, culturally relevant interventions. The resulting prevention intervention will address the needs of an under-served group severely affected by health disparities, strengthen families and help them to avoid familial and individual dysfunction, and advance knowledge on effective translational research strategies for adapting prevention interventions for ethnically diverse families. PUBLIC HEALTH RELEVANCE: The proposed study responds to a need, identified by urban Indian coalitions in Arizona and across the nation, for innovative culturally grounded prevention program adaptation for urban American Indian (AI) families. Public health efforts to address unacceptably high levels of substance use and risky sexual behavior among urban AI youth can be advanced through the creation of an intervention that focuses on effective parenting strategies tailored to the cultural and social forces that urban AI families face. The CBPR methodology of the study not only integrally involves community partners and community members in the design and testing of the intervention, it builds institutional capacity for sustaining the development and delivery of this and similarly designed culturally grounded prevention interventions.