Brief Intervention for Substance Using Native Youth

描述（由申请人提供）：“对吸毒的土著青年的简短干预”是一个为期5年的研究项目，旨在开发和测试一个基于学校的，对吸毒的美国土著高中生的简短动机干预。动机访谈（MI）是一种针对物质使用问题的行为治疗方法，已经在一些人群中显示出疗效。临床试验支持心肌梗死治疗有药物使用问题的成人和大龄青少年的有效性。然而，迄今为止，心肌梗死临床试验受到以下因素的限制：(a)样本的种族/种族多样性不足（即，迄今发表的几乎所有心肌梗死随机对照试验都主要关注非西班牙裔白人样本），(b)缺乏对非寻求治疗人群的关注，(c)没有对假定的变化机制的直接检查，以及(d)没有对文化相关变量如何影响治疗反应的直接检查。心肌梗死对少数民族人群的有效性，特别是对美洲原住民的有效性，很少得到研究的关注，并且仍然是未知的。此外，与其他种族/族裔背景的青年相比，美洲土著青年吸毒和酗酒的风险特别高，这使他们特别容易出现药物使用问题。本研究的主要目的是进行一项临床试验，评估一种文化一致的、以学校为基础的针对美国土著高中生药物使用的动机性访谈干预。项目的发展阶段（6个月）将侧重于(a)调整我们的评估和干预材料，以确保与目标人群的文化和发展相一致；(b)培训工作人员进行具有发展和文化敏感性的MI评估和干预；(c)与学校和部落代表合作，规划和实施项目的临床试验阶段。临床试验的参与者将从位于俄克拉何马州的三所以印第安人为主的公立高中招募。一份全校范围的纸笔物质使用筛选问卷将用于选择“高风险物质使用者”样本（n = 480），他们将被随机分配到三种治疗条件之一：(1)简单建议和单独的个性化反馈报告（BA+PFR; n = 160）；(2)简单建议，个性化反馈报告和动机访谈(BA+PFR+MI；n =160)，或(3)简短的建议、个性化的反馈报告、动机性访谈和6个月的干预后促进会议（BA+PFR+MI+BOOST; n =160）。参与者将在研究开始时，以及3个月、6个月、9个月和12个月的随访时进行评估。我们假设接受动机性访谈的美国原住民高中生在干预后的物质使用和物质相关的负面后果方面比没有接受MI的高中生（即BA+PFR参与者）显著减少。我们还假设接受强化治疗的青少年会比没有接受强化治疗的青少年表现出更大、更持久的物质使用减少。第二个目的是研究与心肌梗死反应相关的变化机制（即介质）。我们假设干预前和干预后感知改变的准备程度、感知改变的重要性和自我效能感的变化将预测参与者对干预的反应。我们的第三个目标是探索性别和美洲原住民特有的文化变量（切诺基人的自力更生和美洲原住民的种族认同）作为MI差异有效性的调节因子；这一目标是专门设计的，作为我们基于学校的MI干预的性别和文化不变性的初步评估。我们相信我们提出的研究是有意义的和创新的，并且代表了跨文化有效的、简短的、以学校为基础的青少年吸毒和饮酒干预发展的重要下一步。

DESCRIPTION (provided by applicant): "Brief Intervention for Substance Using Native Youth" is a 5-year research project designed to develop and test a school-based, brief motivational intervention for substance using, Native American high school students. Motivational Interviewing (MI) is a behavioral treatment for substance use problems that has already shown efficacy in some populations. Clinical trials support the effectiveness of MI with adults and older adolescents with substance use problems. However, MI clinical trials to date have been limited by (a) insufficient ethnic/racial diversity of samples (i.e., almost every MI RCT published to date has focused on predominantly non-Hispanic white samples), (b) lack of attention to non-treatment seeking populations, (c) no direct examination of putative mechanisms of change, and (d) no direct examination of how culture-related variables may influence treatment response. MI's effectiveness for minority populations, and especially Native American populations, has received scant research attention, and remains unknown. Moreover, Native American youth, compared to youth from other racial/ethnic backgrounds, are at especially high risk for drug use and drinking, which makes them particularly susceptible to the development of substance use problems. The primary goal of the proposed study is to conduct a clinical trial evaluating a culturally congruent, school-based motivational interviewing intervention targeting substance use among Native American high school students. The development phase of the project (6 months) will focus on (a) adapting our assessment and intervention materials in order to ensure cultural and developmental congruency with our target population, (b) training staff in conducting MI assessment and intervention with developmental and cultural sensitivity, and (c) collaborating with school and tribal representatives in the planning and implementation the clinical trial phase of the project. Clinical trial participants will be recruited from three predominantly Native American public high schools located in Oklahoma. A school-wide paper-and-pencil substance use screening questionnaire will be used to select a sample of "high risk substance users" (n = 480), who will be randomly assigned to one of three treatment conditions: (1) brief advice and a personalized feedback report alone (BA+PFR; n = 160), (2) brief advice, a personalized feedback report, and motivational interviewing (BA+PFR+MI; n =160), or (3) brief advice, a personalized feedback report, motivational interviewing, and a 6-months post- intervention booster session (BA+PFR+MI+BOOST; n =160). Participants will be evaluated at study entry, and at 3-, 6-, 9-, and 12-month follow-ups. We hypothesize Native American high school students who receive motivational interviewing will demonstrate significantly greater post-intervention reductions in substance use and substance- related negative consequences than their counterparts who do not receive MI (i.e., BA+PFR participants). We also hypothesize adolescents who receive the booster session will demonstrate significantly greater and longer-lived substance use reductions than adolescents who do not receive the booster. A secondary aim is to examine mechanisms of change (i.e., mediators) associated with MI response. We hypothesize pre-to post-intervention changes in perceived readiness to change, perceived importance of change, and self-efficacy will predict participants' response to intervention. Our third aim is to explore gender and Native American-specific cultural variables (Cherokee self- reliance & Native American ethnic identity) as moderators of the differential effectiveness of MI; this aim is specifically designed as a preliminary evaluation of the gender and cultural invariance of our school-based MI intervention. We believe our proposed study is significant and innovative, and represents an important next step in the development of cross-culturally effective, brief, and school- based interventions for drug use and drinking among teenagers.