Secondary Analyses of Clinical Trial Data to Understand Factors Associated with Alcohol Use Among Alaska Native Populations

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Project Summary/Abstract This project proposal reflects a collaborative and coordinated training and research plan that will facilitate the applicant’s transition towards becoming an independent alcohol researcher within Alaska Native (AN) communities. Namely, four training goals are proposed: 1) Develop expertise in alcohol treatment and clinical trials research within the AN population; 2) Obtain proficiency in traumatic stress research and the impact of trauma on alcohol use among AN people; 3) Acquire methodological and advanced quantitative skills for designing and analyzing clinical trials; and 4) Further develop scientific writing skills, strengthen publication record, and grow professionally as an AN alcohol researcher and future leader in the field. These skills will be applied to carrying out the proposed project of examining two randomized control trial datasets related to alcohol use disorder (AUD), problematic drinking, smoking, trauma, culture, and quality of life (QOL). Clinical trials data will be from (1) the Naltrexone Study39, a clinical trial of naltrexone and sertraline for the treatment of AUD among an AN and non-Native sample; and (2) the HEALTHH Study42, a clinical trial for people who smoke tobacco that includes two interventions to promote heart health (a) tobacco cessation and physical activity and (b) medication adherence and a heart healthy AN diet. Research examining AN representation in clinical trials for major mental disorders between 1986 and 2005 found that not one of the 10,000 participants were from American Indian (AI) or AN heritage5. Moreover, an exhaustive literature search in 2014 of AI/AN mental health treatment intervention resulted in only two clinical trials. This is more than troublesome given the fact that AN people experience disproportionately high rates of AUD, problematic drinking, alcohol-related injury and death, smoking, health disparities, high rates of PTSD and traumatic stress, and systemic racism and oppression2,5,12,16,25,48. These factors impact the very fabric of AN culture, wellbeing, and alcohol treatment access, utilization, and outcomes8,13,23. Thus, this project will explore the extent to which trauma, smoking, and culture impacts drinking and QOL outcomes. Aim 1 is to examine predictors of alcohol use and moderators of naltrexone treatment effects among AN people using data from the Naltrexone Study and Aim 2 is to examine the impact of drinking on the efficacy of two culturally tailored interventions targeting modifiable risks for cardiovascular health and the effects of these intervention on drinking among AN people using data from The HEALTHH Study. Resultant data from these aims have the potential to identify the nature and impacts of factors associated with alcohol use, treatment, and outcomes among AN people, which is of great public health importance. Additionally, the results have implications for developing trauma-informed, culturally derived, multilevel alcohol treatment interventions for AN people.