Qungasvik (Toolbox): Prevention of Alcohol/Suicide Risk in Alaska Native Youth

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 DESCRIPTION (provided by applicant): For the past 10 years we have focused on addressing two interrelated public health issues, alcohol use disorder (AUD) and suicide in 12-18 year old Yup'ik Alaska Natives (AN). AUD and suicide are among the leading causes of mortality among AN people and a significant health disparity in contrast to the U.S. general population (1). AN mortality rates from all alcohol-induced disorders between 2001 2005 were 53.8/100,000 in contrast to 6.3/100,000 for other ethnic groups in Alaska (2), while the age-adjusted rate for suicide is twice the national average (3). Overall, between 1960-95 AN suicide rates increased approximately 500% (4). More recent data indicate continuation of these trends and also identify cluster suicide behavior as a feature of AN youth suicide (5). Yup'ik community leaders have made addressing AUD and suicide among their highest priorities. In response, working with several communities, a community-based and led intervention (Qungasvik - toolbox) was designed. The intervention is designed to develop protective factors that will ultimately reduce the incidence of AUD and suicide. Our research leading up to the currently proposed study has shown that it is possible to: (1) deliver the intervention in remote rural communities; (2) obtain valid and reliable measures of two ultimate outcomes (i.e., Reflective Processes regarding alcohol consequences and Reasons for Life) and intermediate protective factors variables that underlie them; (3) show a dose-response effect: the more intervention sessions a person attends (dose) the stronger the measured protective factors (response); and (4) obtain a maximum protective effect from the intervention by lengthening the duration of the intervention from one to two years. The proposed study is an assessment of a modified version of the intervention and focuses on three specific aims (SA): (SA1) test Qungasvik intervention efficacy through impact on the two protective factors and to link those measures to direct measures of alcohol use and suicidal ideation; (SA2) examine the mechanisms of change in response to the intervention through growth in: (a) intermediate outcome measures of protective factors at the individual, family, peer, and community level; (b) social network characteristics of supportive relationships with elders, immediate and extended kinship relations, and community adults and describe social network change; and (c) using qualitative interviewing and grounded theory analysis techniques, describe process and impact of the intervention from community elder and parent perspectives; and (SA3) examine the fidelity of implementing the intervention.