Motivational Interviewing and Culture for Urban Native American Youth (MICUNAY)

描述（由申请人提供）：美国印第安人/阿拉斯加原住民（AI/AN）青年报告酒精和药物（AOD）使用率更高，使用频率和强度更高，首次使用AOD的时间更早，与美国其他种族/族裔群体相比，酒精相关死亡率更高。然而，一项研究发现，与洛杉矶县所有其他民族/种族群体相比，城市环境中有风险的AIs/AN成年人报告说，他们更早开始使用酒精、大麻、甲基苯丙胺和其他药物。该提案响应PAR-11-346，美洲原住民健康促进和疾病预防干预措施，其重点是开发，适应和测试美洲原住民健康促进预防干预措施的有效性。这两家合作项目提供了独特的专业知识，为AI/ an青年制定了一项创新的初步协议：美国城市土著青年的动机性访谈和文化（MICUNAY），该协议将传统的治疗方法与动机性访谈（MI）相结合。Dickerson是阿拉斯加原住民（Inupiaq）的新调查员，他与AI/ an社区合作，以获得以社区为基础的关于减少AOD使用和心理健康问题的观点。D'Amico因其专注于开发和测试针对不同文化背景下不同青少年使用AOD的MI干预措施而获得国际认可。Dickerson及其同事已经证明，需要为人工智能/人工智能青年提供文化上适当的干预措施。他的两个基于社区的项目发现，缺乏将基于传统的治疗与基于证据的治疗（ebt）结合起来的项目，这被认为是在城市人工智能/人工智能人群中寻求治疗的一个重大障碍。因此，MICUNAY将传统治疗与MI结合起来。它包括每周6次1小时的课程（3次MI AOD课程和3次传统活动课程）。我们的建议还结合了多系统干预方法。在个人层面，我们将为城市AI/AN青年提供MICUNAY。在社区层面，我们将在现有的社区健康聚会（CWG）上讨论AI/AN青年中AOD的使用和预防。这项为期5年的研究将包括两个主要部分：1)发展阶段，我们在洛杉矶和奥克兰的两个临床站点与社区进行焦点小组讨论，以确定交付的可行性和可持续性；2)随机对照试验

DESCRIPTION (provided by applicant): American Indian/Alaska Native (AI/AN) youth report higher rates of alcohol and drug (AOD) use, greater frequency and intensity of AOD use, earlier first AOD use, and much higher alcohol-related mortality than other racial/ethnic groups in the U.S. Data regarding urban AIs/ANs are limited; however, one study found that at-risk AIs/AN adults in an urban setting report an earlier onset of alcohol, marijuana, methamphetamine, and other drug use compared to all other ethnic/racial groups within LA County. This proposal responds to PAR-11-346, Interventions for Health Promotion and Disease Prevention in Native American Populations, which is focused on developing, adapting, and testing the effectiveness of health promotion prevention interventions in Native American populations. The two Co-PIs provide a unique blend of expertise that has resulted in the development of an innovative preliminary protocol for AI/AN youth: Motivational Interviewing and Culture for Urban Native American Youth (MICUNAY), which integrates traditional healing approaches with motivational interviewing (MI). Dickerson is an Alaska Native (Inupiaq) new investigator who worked with the AI/AN community to obtain community-based perspectives on decreasing AOD use and mental health problems. D'Amico is internationally recognized for her work focused on the development and testing of MI interventions targeting AOD use for culturally diverse adolescents across different settings. Dickerson and colleagues have demonstrated the need for culturally-appropriate interventions for AI/AN youth. His two community-based projects found that there is a lack of programs integrating tradition-based healing with evidenced based treatments (EBTs), and this was cited as a significant barrier to seeking care within urban AI/AN populations. Therefore, MICUNAY will integrate tradition-based healing with MI. It consists of 6 weekly 1-hour sessions (3 MI AOD sessions and 3 tradition activity sessions). Our proposal also incorporates a multi-system intervention approach. At the individual level, we will provide MICUNAY to urban AI/AN youth. At the community level, we will discuss AOD use and AOD prevention among AI/AN youth at existing Community Wellness Gatherings (CWG). The proposed 5-year study will consist of two main components: 1) A Developmental Phase in which we conduct focus groups across two clinical sites in Los Angeles and Oakland with the community to establish feasibility and sustainability of delivery, 2) A randomized controlled trial comparing youth who only attend a CWG (n=100) to youth who attend a CWG plus receive MICUNAY (n=100). We will compare outcomes at 3- and 6-month follow-up to determine (a) whether clinically significant changes in AOD expectancies, perceived prevalence of peer AOD use, alcohol consumption, marijuana and other drug use, and related consequences occur; (b) whether clinically significant changes in physical, social, emotional, and functional well-being as well as spirituality and cultural identification occur, and (c) if reductions occur, estimate effec sizes for the CWG group and the CWG plus MICUNAY group. Our study substantially extends work with AI/AN youth by intervening at both the community and individual level, and developing and testing an integrated tradition-based AOD MI group intervention for urban AI/AN youth.