Research Project 1

项目总结 这项名为《孕育我们未来的长期(16年)跟踪调查》的研究将确定一项根据文化定制的证据 以儿童早期家访为基础的干预措施，称为“家庭精神®”，可减少长期的物质使用， 土著母亲及其子女在离开16年后的自杀及其相关后果 该计划(产后3年)。吸毒和自杀构成了最大和最具破坏性的 美国印第安人的健康不平等现象，是几代人种族创伤和压迫的结果。家庭 SPIRIT是在8年的时间里专门为美国印第安人社区设计的，并由他们通过 以社区为基础的密集参与性进程，以促进两个国家的行为和心理健康 几代人。最初的“孕育我们的未来”研究(NIDA R01 DA019042-01A1)是1：1随机进行的 一项对照试验，纳入了N=322名怀孕32周的十几岁准妈妈，并对她们和她们的 孩子到产后3岁。被随机分配到干预组的母亲得到了文化定制的家庭 当地美国印第安人准专业人员提供的访问课程侧重于积极的育儿和内容 解决母亲的压力、物质使用和抑郁问题。控制条件是转运到产前。 以及对健康儿童的访问和促进与社区资源的联系，这两种干预都是母亲 收到控制武器。试验结果表明，家庭精神显著提高了父母的养育效能， 减少了母亲的大麻和非法药物使用以及抑郁症状，并改善了社会、情感、 和儿童在产后3年前的行为发育，以预测较少的物质使用 并降低青少年母亲和青少年发展过程中的自杀风险和相关问题。基座 根据这一证据，家访人员和监督员在150多个部落接受了贯彻家庭精神的培训 以及美国各地更多的非部落社区，但这种和其他家访的长期影响 关于有问题的物质使用、过量服药和自杀的项目研究严重不足。这项工作的目的是： UP研究旨在确定家庭精神对母亲(30-39岁)及其子女的长期影响 (18-19岁)物质使用和自杀想法和行为，同时探索主持人(即， 歧视压力、文化参与)和影响的中介者(即持续的积极育儿)。我们会 还使用定性叙事调查方法来探索个人和代际药物使用途径 (例如，首次使用、滥用、多药使用、成瘾前、戒酒、康复)，以及参与者的次级样本。如果 发现了有利的长期影响，这些发现可以利用联邦政府对循证家访的支持 在部落社区中仍未得到充分利用的执行。部落人口应该得到更多的证据 有效的基于文化优势的解决方案，以纠正殖民对行为和心理健康的持久影响 和种族主义。

PROJECT SUMMARY This study, “Cradling Our Future Long-Term (16-year) Follow-Up,” will determine if a culturally tailored, evidence based early childhood home visiting intervention, called “Family Spirit®,” reduces long-term substance use, suicide, and related consequences among Indigenous mothers and their children16 years after they exited the program (at 3 years postpartum). Substance use and suicide comprise the largest and most devastating health inequities for American Indians and are the result of generations of racial trauma and oppression. Family Spirit was designed over an 8-year period specifically for and by American Indian communities through an intensive community based participatory process to promote behavioral and mental health across two generations. The original “Cradling Our Future” study (NIDA R01 DA019042-01A1) was a 1:1 randomized controlled trial that enrolled N = 322 expectant teen mothers by 32 weeks gestation and followed them and their children to 3 years postpartum. Mothers randomized to the intervention group received culturally tailored home visiting lessons delivered by local American Indian paraprofessionals focused on positive parenting and content addressing maternal stress, substance use, and depression. The control condition was transportation to prenatal and well-child visits and facilitated connections to community resources, which mothers in both the intervention and control arms received. Trial results demonstrated Family Spirit significantly improved parenting efficacy, reduced marijuana and illicit drug use and depressive symptoms in mothers, and improved social, emotional, and behavioral development for children until 3 years postpartum in ways that would predict less substance use and lower suicide risk and related problems across teen mothers' and youth's developmental life course. Based on this evidence, home visitors and supervisors have been trained to implement Family Spirit in over 150 tribal and additional non-tribal communities across the US, but long-term impacts of this and other home visiting programs on problematic substance use, overdose, and suicide are vastly understudied. The aims of this follow- up study are to identify long-term impacts of Family Spirit on mothers' (at 30-39 years old) and their children's (at 18-19 years old) substance use and suicidal thoughts and behaviors, while exploring moderators (i.e., discriminatory stress, cultural engagement) and mediators (i.e., continued positive parenting) of effects. We will also use qualitative narrative inquiry methodology to explore individual and intergenerational drug use pathways (e.g., first use, misuse, polydrug use, pre-addiction, abstinence, recovery) with a sub-sample of participants. If favorable long-term impacts are found, findings could leverage federal support for evidence-based home visiting implementation that is still under-utilized in tribal communities. Tribal populations deserve greater evidence for effective cultural strengths-based solutions to redress lasting behavioral and mental health effects of colonization and racism.