Research Project 2

项目摘要 有问题的物质使用（SU）是美国印第安人和阿拉斯加原住民（AIAN）的持续流行病 社区，与AIAN人经历的SU相关的发病率和死亡率最高的任何 种族/民族团体。然而，AIAN年轻人在很大程度上被SU预防科学所忽视。有 缺乏科学支持的预防战略，特别是在关键时期为AIAN男子设计的预防战略， 从青少年到成年的过渡期。此外，目前没有任何预防方案， 被设计为利用上下文（例如，历史创伤和殖民化）和文化优势 有效性和可持续性。丰富的文化和传统习俗对人工智能男性尤为重要，但这些 实践和世界观迄今基本上尚未得到利用。我们的团队在过去的两年里一直在适应， 试行共同要素治疗方法（CETA），这是一种基于证据的跨诊断干预措施 可以根据参与者的独特需求量身定制。拟议的研究建立在以下方面的记录之上： 适应CETA为土著预防科学，35年以上的研究合作之间的约翰 霍普金斯土著健康中心（CIH;前美国印第安人健康中心）和纳瓦霍民族， CIH数十年来传播和扩展循证干预措施的经验， 覆盖了150多个AIAN社区。由一组土著研究人员和联合调查人员领导， 在与社区研究理事会的合作中，我们的团队将与两个农村纳瓦霍社区合作 为了改编CETA并在一项随机对照试验中测试改编后的版本Hastóí Bidziil（强壮的男人）， 目标1：调整CETA和相关的实施战略，以适应年轻的AI男性，年龄 18-26岁，导致Hastóí Bidziil（强人）干预。假设：标准交付 CETA将需要根据CETA在文化和性别方面的具体交付情况进行修改，以最大限度地提高社区 冲击目的2：确定Hastóí Bidziil在N=160名AI男性（年龄）中降低SU的有效性 18-26）使用随机对照试验设计。假设：Hastóí Bidziil将减少年轻人中的SU 成年男性参与随机对照试验的干预组。目标3：探索介质和 Hastóí Bidziil的主持人，在土著生态系统模型的指导下， 执行的方法。假设：计划的有效性将由几个调节和 调解因素，这将有助于通知如何最好地规模，实施和定制的计划，如果证明是有效的。 该项目与CIRCLE的目标协同作用，促进土著和盟军的领导，理解 SU的异质模式，以进一步精确的公共卫生方法来预防SU，并建立在 本土力量的源泉。我们的重点也与最近的NIDA资助优先事项一致，特别是侧重于 减少药物使用的不平等。

PROJECT SUMMARY Problematic substance use (SU) is an ongoing epidemic across American Indian and Alaska Native (AIAN) communities, with AIAN people experiencing the highest rates of SU-related morbidity and mortality of any racial/ethnic group. However, AIAN young men have been largely neglected by SU prevention science. There is a lack of prevention strategies supported by science, and specifically designed for AIAN men during the critical time as they transition from adolescents to adulthood. Moreover, no current prevention programming has been designed to leverage contextual (e.g., historical trauma and colonization) and cultural strengths to optimize effectiveness and sustainability. Rich cultural and traditional practices are particularly vital for AI men, yet these practices and worldviews are largely untapped to date. Our team has spent the past two years adapting and piloting the Common Elements Treatment Approach (CETA), an evidence-based, transdiagnostic intervention that can be tailored to meet the unique needs of participants. The proposed study builds on this track record of adapting CETA for Indigenous prevention science, 35+ years of research collaboration between the Johns Hopkins Center for Indigenous Health (CIH; formerly Center for American Indian Health) and the Navajo Nation, and CIH's decades of experience disseminating and scaling evidence-based interventions that have now reached over 150+ AIAN communities. Led by a team of Indigenous researchers and allied co-investigators, and in collaboration with a Community Research Council, our team will collaborate with two rural Navajo communities to adapt CETA and test this adapted version, Hastóí Bidziil (Strong Men), in a randomized controlled trial through the following Aims: Aim 1: Adapt CETA and associated implementation strategies for young AI men, age 18-26 years, resulting in the Hastóí Bidziil (Strong Men) intervention. Hypothesis: Standard delivery of CETA will require modifications for cultural and gendered specific delivery of CETA for maximum community impact. Aim 2: Determine the effectiveness of Hastóí Bidziil for reducing SU among N=160 AI men (ages 18-26) using a randomized controlled trial design. Hypothesis: Hastóí Bidziil will reduce SU among young adult males enrolled in the intervention arm of the randomized controlled trial. Aim 3: Explore mediators and moderators of Hastóí Bidziil, guided by the Indigenist Ecological Systems Model, to inform a precision approach to implementation. Hypothesis: Program effectiveness will be driven by several moderating and mediating factors which will help inform how best to scale, implement, and tailor the program if proven effective. This project synergizes with CIRCLE's aims of advancing Indigenous and allied leadership, understanding heterogeneous patterns of SU to further a precision public health approach to SU prevention, and building on Indigenous sources of strength. Our focus also aligns with recent NIDA funding priorities particularly focused on reducing drug use inequities.