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

 描述(由申请人提供)：在过去的10年里，我们一直专注于解决两个相互关联的公共卫生问题，酒精使用障碍(AUD)和12-18岁阿拉斯加当地人(AN)的自杀。AUD和自杀是一个人死亡的主要原因之一，与美国普通人口形成鲜明对比的是显著的健康差距(1)。2001-2005年间，所有酒精所致精神障碍的死亡率为53.8/100,000，相比之下，阿拉斯加其他族裔的死亡率为6.3/100,000(2)，而年龄调整后的自杀率是全国平均水平的两倍(3)。总体而言，在1960-95年间，自杀率上升了约500%(4)。最近的数据表明，这些趋势仍在继续，并将群体性自杀行为确定为青少年自杀的一个特征(5)。是的，社区领导人已经把解决AUD和自杀问题作为他们的首要任务之一。为此，与几个社区合作，设计了一个以社区为基础、以社区为主导的干预措施(Qunasvik-工具箱)。这项干预旨在开发保护性因素，最终减少AUD和自杀的发生率。我们对当前拟议研究进行的研究表明，有可能：(1)在偏远农村社区进行干预；(2)对两个最终结果(即关于酒精后果和生活原因的反思过程)及其背后的中间保护因素获得有效和可靠的测量；(3)显示剂量-反应效应：一个人参加的干预会议越多(剂量)，所测量的保护因素(反应)就越强；以及(4)通过将干预时间从一年延长到两年，获得干预的最大保护效果。这项拟议的研究是对干预措施的修订版本的评估，并侧重于三个具体目标(SA)：(SA1)通过对两个保护因素的影响来测试昆加斯维克干预的有效性，并将这些措施与酒精使用和自杀意念的直接措施联系起来；(SA2)通过以下方面的增长来检验干预措施的变化机制：(A)个人、家庭、同伴和社区层面的保护因素的中间结果衡量；(B)与老年人、直接和扩大的亲属关系以及社区成年人的支持性关系的社会网络特征，并描述社会网络变化；(C)运用定性访谈和扎根的理论分析方法，从社区老年人和家长的角度描述干预的过程和影响；以及(SA3)检验实施干预的忠诚度。

 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.