A Community Trial in Alaska to Prevent Youth's Use of Legal Products to Get High

描述(由申请人提供)：这是一项名为“在阿拉斯加预防吸入剂使用的社区试验”(1 R01 DA015966)的竞争性续期拨款的重新提交。最初的拨款是根据NIH审查员的要求设计的可行性研究，旨在为阿拉斯加5-7年级的青少年开发和试点测试综合社区预防模式(CPM)，以防止使用吸入剂和食用有害法律产品(HLP)来兴奋。这一模式包括针对零售店、家庭和学校的社区动员和环境战略，以及以学校为基础的预防课程。作为为期三年的可行性研究的结果，已经开发了干预材料和研究工具，并在阿拉斯加的四个社区进行了实地测试。六份出版物和三份手稿的结果在参与的阿拉斯加社区成功实施，尽管有人担心过于复杂；关键结果有足够的变化，足以保证进行全面的疗效试验。在这项应用中，我们建议测试由社区动员(CM)和环境策略(ES)组成的CPM干预的精简版本的有效性。社区管理战略旨在使社区领导人和团体能够采取行动。零售店、家庭和学校的教育服务涉及社区规范和青少年使用高价医疗保险的价值观、社区通过的政策、限制和执行这些政策和限制，以及零售、家庭和学校控制，以减少青少年获得高额医疗保险的机会。取消了以学校为基础的教育课程，以降低三组分CPM的复杂性，并集中注意环境战略在预防青年使用HLP方面的效力。阿拉斯加16个偏远农村(边境)社区的主要社区领导人作出了承诺，这些社区主要是高加索人或阿拉斯加土著人口的混合体。近期的结果是减少阿拉斯加边境社区使用的氟氯烃聚合物的供应。远端结果是减少吸食或摄取当地零售店、家庭和学校中发现的羟基苯丙胺的比例，增加社区准备实施环境战略以防止使用羟基苯丙烷的比例，这些青少年包括打算或确实经历吸入或摄入当地零售店、家庭和学校中的羟基苯丙胺的学龄前和早期儿童。研究设计为为期五年的随机对照试验(RCT)，将8对匹配的前沿群落随机分配到实验和对照条件下。这16个社区分布在该州的不同地区，人口规模从536到5937人不等。这项功效试验将把严格的量化方法与参与性研究原则结合起来，包括社区参与和合作，承认每个研究社区的独特文化和第七遗产。这项研究的意义在于，它可能会产生一种有效的干预措施，以防止美国偏远农村和可持续社区的青少年使用吸入剂和其他有害的法律产品。公共卫生相关性：在实验条件下对拟议的社区预防模式进行测试具有特别重要的意义，因为在阿拉斯加、得克萨斯州西部或明尼苏达州北部的边境社区中几乎没有循证预防模式。此外，针对吸入剂和其他有害合法产品的循证预防模式甚至更少。此外，将社区动员与注重零售店、家庭和学校的环境战略相结合是创新的，并邀请整个社区承担预防青少年药物滥用的责任，而不仅仅是学校系统的责任。

DESCRIPTION (provided by applicant): This is a resubmission of a competing renewal of the grant entitled "A Community Trial to Prevent Inhalant Use in Alaska" (1 R01 DA015966). The original grant was designed as a feasibility study per NIH reviewers' request to develop and pilot-test an integrated Community Prevention Model (CPM) for Alaskan youth in the 5th - 7th grades to prevent the use of inhalants and ingestible harmful legal products (HLPs) to get high. This model consisted of community mobilization and environmental strategies that targeted retail outlets, homes, and schools, and a school-based prevention curriculum. As a result of the three-year feasibility study, intervention materials and research instruments have been developed and field tested in four Alaskan communities. Results from six publications and three manuscripts successfully implemented in the participating Alaskan communities, although there were concerns about it being too complex; and, there were sufficient changes in the key outcomes to warrant a full efficacy trial. In this application, we propose to test the efficacy of a condensed version of the CPM intervention consisting of community mobilization (CM) and environmental strategies (ES). The CM strategy is designed to enable community leaders and groups to take action. The ES in retail outlets, homes, and schools address community norms and values regarding youth use of HLPs, community adopted policies, restrictions and enforcement of these policies and restrictions, and retail, family, and school controls to reduce youth access to HLPs. The school based education curriculum has been dropped to reduce the complexity of a three-component CPM and to focus attention on the efficacy of environmental strategies in preventing HLPs use among youth. Commitments have been obtained from key community leaders in 16 remote rural (frontier) communities in Alaska that contain primarily a mixture of Caucasian or Alaska Native populations. The proximal outcomes are to and to reduce the availability of HLPs used in Alaskan frontier communities. The distal outcomes are to reduce the proportion of increase community readiness to implement environmental strategies to prevent HLP use, pre and early adolescents (5th, 6th, graders) who intend to or do experience inhaling or ingesting HLPs found in local retail outlets, homes, and schools. The research design is a five-year randomized control trial (RCT) in which eight pairs of matched frontier communities will be randomly assigned to experimental and control conditions. The 16 communities are located in various regions of the state, with population sizes that range from 536 to 5,937. This efficacy trial will integrate rigorous quantitative methods with participatory research principles consisting of community participation and collaboration that recognizes the unique cultural and 7th heritage of each study community. The significance of this study is its potential to produce an effective intervention to prevent youth's use of inhalants and other harmful legal products in remote rural and sustainable communities across the U.S. PUBLIC HEALTH RELEVANCE: The testing of the proposed Community Prevention Model under experimental conditions is particularly significant because there are few evidence-based prevention models for frontier communities like those in Alaska, western Texas, or northern Minnesota. Further, there are even fewer evidence-based prevention models that target use of inhalants and other harmful legal products. In addition, the integration of community mobilization and environmental strategies focusing on retail outlets, homes, and schools is innovative and invites the entire community to assume responsibility for youth substance abuse prevention rather than assuming it is the responsibility of only the school system.