Motivational Interviewing and Culture for Urban Native American Youth (MICUNAY)

描述(由申请人提供)：美国印第安人/阿拉斯加原住民(AI/AN)青年报告的酒精和毒品(AOD)使用率更高，AOD使用的频率和强度更高，首次AOD使用的时间更早，与酒精相关的死亡率也比美国其他种族/民族高得多。关于城市AIS/ANS的数据有限；然而，一项研究发现，与洛杉矶县所有其他种族/种族群体相比，城市环境中的高危AIS/AN成年人报告更早开始使用酒精、大麻、甲基苯丙胺和其他药物。这项提案响应了PAR-11-346《美洲原住民健康促进和疾病预防干预措施》，其重点是在美洲原住民中开发、调整和测试健康促进预防干预措施的有效性。这两个联合绩效指标提供了独特的专业知识融合，从而为人工智能/AN青年制定了一项创新的初步方案：美国城市原住民青年的动机访谈和文化(MICUNAY)，它将传统的治疗方法与动机访谈(MI)相结合。Dickerson是阿拉斯加原住民(Inupiaq)的新研究员，他与AI/AN社区合作，获得了关于减少AOD使用和心理健康问题的社区观点。达米科因其专注于针对不同环境中不同文化背景的青少年使用AOD的MI干预措施的开发和测试而受到国际认可。Dickerson和他的同事已经证明了对AI/AN年轻人进行文化上适当的干预的必要性。他的两个社区项目发现，缺乏将基于传统的治疗与循证治疗(EBTS)相结合的计划，这被认为是在城市AI/AN人群中寻求护理的一个重大障碍。因此，MICUNAY将把基于传统的治疗与MI结合起来。它包括6个每周1小时的会议(3个MI AOD会议和3个传统活动会议)。我们的建议还包括一种多系统干预方法。在个人层面，我们将为城市AI/AN青年提供MICUNAY。在社区层面，我们将在现有的社区健康聚会(CWG)上讨论AI/AN青少年使用AOD和预防AOD的问题。拟议的为期5年的研究将包括两个主要部分：1)开发阶段，在此阶段，我们与社区一起在洛杉矶和奥克兰的两个临床地点进行重点小组，以确定交付的可行性和可持续性；2)随机对照试验 将仅参加CWG的青年(n=100)与参加CWG并接受MICUNAY的青年(n=100)进行比较。我们将比较3个月和6个月随访的结果，以确定(A)AOD预期、同伴AOD使用的感知流行率、酒精消费、大麻和其他药物使用以及相关后果是否发生临床显著变化；(B)身体、社会、情感和功能健康是否发生临床显著变化 以及(C)如果发生减少，则估计CWG组和CWG+MICUNAY组的有效人数。我们的研究通过在社区和个人层面进行干预，并开发和测试针对城市AI/AN青少年的基于传统的综合AOD MI小组干预，大大扩展了对AI/AN青少年的工作。

DESCRIPTION (provided by applicant): American Indian/Alaska Native (AI/AN) youth report higher rates of alcohol and drug (AOD) use, greater frequency and intensity of AOD use, earlier first AOD use, and much higher alcohol-related mortality than other racial/ethnic groups in the U.S. Data regarding urban AIs/ANs are limited; however, one study found that at-risk AIs/AN adults in an urban setting report an earlier onset of alcohol, marijuana, methamphetamine, and other drug use compared to all other ethnic/racial groups within LA County. This proposal responds to PAR-11-346, Interventions for Health Promotion and Disease Prevention in Native American Populations, which is focused on developing, adapting, and testing the effectiveness of health promotion prevention interventions in Native American populations. The two Co-PIs provide a unique blend of expertise that has resulted in the development of an innovative preliminary protocol for AI/AN youth: Motivational Interviewing and Culture for Urban Native American Youth (MICUNAY), which integrates traditional healing approaches with motivational interviewing (MI). Dickerson is an Alaska Native (Inupiaq) new investigator who worked with the AI/AN community to obtain community-based perspectives on decreasing AOD use and mental health problems. D'Amico is internationally recognized for her work focused on the development and testing of MI interventions targeting AOD use for culturally diverse adolescents across different settings. Dickerson and colleagues have demonstrated the need for culturally-appropriate interventions for AI/AN youth. His two community-based projects found that there is a lack of programs integrating tradition-based healing with evidenced based treatments (EBTs), and this was cited as a significant barrier to seeking care within urban AI/AN populations. Therefore, MICUNAY will integrate tradition-based healing with MI. It consists of 6 weekly 1-hour sessions (3 MI AOD sessions and 3 tradition activity sessions). Our proposal also incorporates a multi-system intervention approach. At the individual level, we will provide MICUNAY to urban AI/AN youth. At the community level, we will discuss AOD use and AOD prevention among AI/AN youth at existing Community Wellness Gatherings (CWG). The proposed 5-year study will consist of two main components: 1) A Developmental Phase in which we conduct focus groups across two clinical sites in Los Angeles and Oakland with the community to establish feasibility and sustainability of delivery, 2) A randomized controlled trial comparing youth who only attend a CWG (n=100) to youth who attend a CWG plus receive MICUNAY (n=100). We will compare outcomes at 3- and 6-month follow-up to determine (a) whether clinically significant changes in AOD expectancies, perceived prevalence of peer AOD use, alcohol consumption, marijuana and other drug use, and related consequences occur; (b) whether clinically significant changes in physical, social, emotional, and functional well-being as well as spirituality and cultural identification occur, and (c) if reductions occur, estimate effec sizes for the CWG group and the CWG plus MICUNAY group. Our study substantially extends work with AI/AN youth by intervening at both the community and individual level, and developing and testing an integrated tradition-based AOD MI group intervention for urban AI/AN youth.