Developing and evaluating a culturally grounded Mother-Daughter intervention to promote protective factors and reduce early substance use among Apache girls

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Project Summary This study, Developing and evaluating a culturally grounded “Mother-Daughter” intervention to promote protective factors and reduce early substance use and associated sexual risk among Apache girls, addresses a dangerous upturn in early substance use initiation among American Indian (AI) females through a gender-specific, culturally driven approach. National and tribal data show: 1) girls’ substance use is catching up or exceeding boys’; 2) girls use substances for different reasons than boys; 3) health effects are more deleterious for girls; and 4) protective factor approaches appear more effective than risk reduction strategies in AI communities. The primary goal of this research is to test the feasibility of a novel, culturally grounded mother-daughter intervention that taps matrilineal cultural assets to enhance protective and reduce risks factors for early substance use and associated unsafe sexual behaviors among Apache girls as they transition through puberty. Targeted mediators of intervention change are based on a strong line of WMAT-JHU team research, and include: positive maternal (mother and other female caregiver) monitoring and involvement, mother-daughter communication and daughter’s positive cultural identity, emotional regulation, and positive peer group selection. This study’s three primary aims are: 1) To qualitatively gather community attitudes, beliefs and practices about protective and risk factors for early substance use and sexual risk behaviors among Apache females. Through 30 in-depth interviews and 10 focus groups, or until saturation is reached, we will obtain insights on: beliefs and practices related to girls’ development of positive cultural and community identity; cultural, familial and community strengths that promote girls’ positive transition through puberty; characteristics of protective relationships between girls and their mothers and other adult female caregivers; and other determinants of girls’ substance use and sexual risk-taking behaviors. 2) To design a culturally grounded “mother-daughter” intervention for pre-pubescent girls ages 8 to 11 and their mothers/ female caregivers. The intervention will be delivered by trained Apache behavioral health interventionists. 3) To assess the feasibility, acceptability, and preliminary effectiveness of the intervention with n=40 mother- daughter dyads and associated female caregivers (i.e., grandmothers, aunties). This proposal is highly significant given the threatening combination of early substance use and sexual risk behaviors among young AI girls on intergenerational cycles of unintended pregnancy and poor behavioral health outcomes. The study will apply strong evidence that parent-child strategies can prevent adolescent substance use to the development of a novel mother-daughter intervention. If study aims are achieved, we will produce a gender- specific intergenerational intervention built on Apache cultural and matrilineal protective factors to reduce early substance use and related sexual risk behaviors among Apache girls, with import to other indigenous communities.