A multiregional RCT of Parenting in 2 Worlds for Urban Indian Families

项目总结/摘要 美国印第安人/阿拉斯加原住民（AI）家庭中的大多数人现在居住在城市地区。 尽管他们经历了与药物滥用、危险的性行为、 抑郁症和自杀，很少有循证预防干预措施解决他们的特殊需要。家庭 破坏、移民和贫困造成的压力以及文化和社会损失往往与不利的环境有关。 城市AI家庭的健康状况。通过改善有效的育儿技能和整体家庭功能， 基于文化的育儿干预措施使父母能够树立榜样，促进子女的福祉 减少孩子对危险行为的脆弱性。拟议的研究扩展了项目小组先前的 对城市人工智能的基于文化的育儿干预研究，两个世界的育儿（P2 W）， 是与一个城市印度非营利组织联盟共同开发的，在亚利桑那州的三个城市进行了测试， 表现出有效性。该研究团队加入了两名AI和两名非AI研究人员，他们共同拥有 在城市和部落环境中与人工智能人群进行合作研究的丰富经验。这 拟议的多区域研究将在四个领域创造新的知识。首先，该研究将测试P2 W的 在亚利桑那州以外的地区，在更广泛、更多样化的 位于四个地区的城市AI社区：东北部（布法罗/尼亚加拉）， 中西部（圣保罗/明尼阿波利斯）、山区（丹佛）和西南部（凤凰城）。在…的主持下 与印度城市中心合作，该试验将招募720个12-17岁的AI青少年家庭（每个城市180个） 并将他们随机分组，接受P2 W或信息化家庭健康课程。二是 研究将测试P2 W有效性的调节剂，无论预期结果是否因 社会经济脆弱性，历史损失的经历，或父母参与者的AI文化身份。 第三，这项研究将扩大原来的亚利桑那州的试验，以检查青少年的家庭报告， 功能和扩大范围的青年健康行为可能受到P2 W干预的影响， 包括心理健康（抑郁症状，自杀倾向）以及物质使用和危险性行为 行为。第四，本研究将检验中介作用--父母教养和家庭的积极变化是否 由P2 W产生的功能导致青少年健康行为的变化。这将是第一个十字架- 现场多区域试验的文化接地亲职干预专为城市AI。它将 为受到严重影响的服务不足群体提供社区预防干预措施的关键知识 通过健康差距，并确定城市印度中心及其社区是否可以随时雇用 P2 W旨在加强城市AI家庭，促进其青少年的行为健康。它还将提供一个 在城市AI社区推进有效预防干预知识的基础， 不同的迁徙历史和部落组成。

Project Summary/Abstract A large and rapidly growing majority of American Indian/Alaska Native (AI) families now reside in urban areas. Although they experience severe health disparities associated with substance abuse, risky sexual behavior, depression and suicide, few evidence-based prevention interventions address their distinctive needs. Family disruption, stresses due to migration and poverty, and cultural and social losses are often implicated in adverse health outcomes for urban AI families. By improving effective parenting skills and overall family functioning, culturally grounded parenting interventions enable parents to model and promote their children's well-being and reduce their children’s vulnerability to risk behaviors. The proposed study extends the project team's prior research on a culturally grounded parenting intervention for urban AIs, Parenting in 2 Worlds (P2W), which was co-developed with a coalition of urban Indian non-profit organizations, tested in three Arizona cities, and demonstrated efficacious. The research team joins two AI and two non-AI investigators, who together have extensive experience conducting collaborative research with AI populations in urban and tribal settings. This proposed multi-regional study will create new knowledge in four areas. First, the study will test P2W’s effectiveness beyond Arizona in improving parenting and family functioning, among a wider and more diverse group of urban AI communities located in cities spread across four regions: Northeast (Buffalo/Niagara), Midwest (St. Paul/Minneapolis), Mountain (Denver), and Southwest (Phoenix). Through the auspices of collaborating urban Indian center partners, the trial will recruit 720 families of AI youth age 12-17 (180 per city) and individually randomize them to receive P2W or an informational family health curriculum. Second, the study will test for moderators of the effectiveness of P2W, whether desired outcomes vary by the level of socioeconomic vulnerability, experiences of historical loss, or AI cultural identity of the parent participants. Third, the study will expand on the original Arizona trial to examine the adolescent’s reports on family functioning and an enlarged range of youth health behaviors potentially impacted by the P2W intervention, including mental health (depressive symptoms, suicidality) as well as substance use and risky sexual behaviors. Fourth, the study will test for mediation—whether positive changes in parenting and family functioning that result from P2W lead to changes in the youth health behaviors. This would be the first cross- site multiregional trial of a culturally grounded parenting intervention designed specifically for urban AIs. It will advance critical knowledge on community prevention interventions for an under-served group severely affected by health disparities, and establish whether urban Indian centers and their communities can readily employ P2W to strengthen urban AI families and promote the behavioral health of their youth. It will also provide a foundation for advancing knowledge on effective prevention interventions in urban AI communities that have different migration histories and tribal compositions.