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

项目摘要/摘要 大量且迅速增长的美国印第安人/阿拉斯加原住民(AI)家庭现在居住在城市地区。 尽管他们经历了与滥用药物、危险的性行为有关的严重健康差距， 在抑郁症和自杀方面，很少有循证预防干预措施解决他们的独特需求。家庭 破坏、移徙和贫穷造成的压力以及文化和社会损失往往牵涉到不利的 城市人工智能家庭的健康结果。通过提高有效的育儿技能和整体家庭功能， 基于文化的育儿干预使父母能够示范和促进他们的孩子的幸福 并减少他们的孩子对危险行为的脆弱性。拟议的研究扩展了项目团队之前的 基于文化的城市人工智能育儿干预研究--两个世界的育儿方式 是与印度城市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 证明是有效的。研究小组加入了两名人工智能和两名非人工智能调查人员，他们总共 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知识。首先，这项研究将测试P2W 在更广泛和更多样化的环境中，在亚利桑那州以外的地区改善育儿和家庭功能方面的有效性 位于城市的城市人工智能社区群分布在四个地区：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)。通过赞助 与城市印度中心合作伙伴合作，该试验将招募720个12-17岁的人工智能青年家庭(每个城市180个) 并单独随机让他们接受P2W或信息性家庭健康课程。第二， 研究将测试P2W有效性的调节因素，预期结果是否会因 社会经济脆弱性，历史损失的经历，或父母参与者的人工智能文化认同。 第三，这项研究将在最初的亚利桑那州试验的基础上扩展，以检查青少年关于家庭的报告 功能和更大范围的青少年健康行为可能受到P2W干预的影响， 包括精神健康(抑郁症状、自杀)以及药物使用和危险性行为 行为。第四，这项研究将测试调解--是否在育儿和家庭方面有积极的变化 P2W导致的功能改变导致青少年健康行为的改变。这将是第一个十字架- 专门为城市人工智能设计的以文化为基础的育儿干预的现场多地区试验。会的 为受严重影响的服务不足的群体提供社区预防干预方面的关键知识 通过健康差距，并确定印度城市中心及其社区是否可以随时 P2W强化城市AI家庭，促进青年行为健康它还将提供一个 促进城市人工智能社区有效预防干预知识的基金会 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.