Multi-Level Cultural Intervention for the Prevention of Suicide and Alcohol Use Risk with Alaska Native Youth: a Nonrandomized Comparison of Treatment Intensity

Abstract

Suicide and alcohol use disorders are primary determinants of health disparity among Alaska Native people in contrast to the US general population. Qungasvik, a Yup'ik word for toolbox, is a strengths-based, multi-level, community/cultural intervention for rural Yup'ik youth ages 12-18. The intervention uses "culture as intervention" to promote reasons for life and sobriety in young people using local expertise, high levels of community direction, and community based staff. The intervention is grounded in local practices and adaptive to local cultural differences distinctive to rural Yup'ik communities. The current study compares the effectiveness of high-intensity intervention in one community (treatment), operationalized as a high number of intervention activities, or modules, implemented and attended by youth, contrasted to a lower intensity intervention in a second community (comparison) that implemented fewer modules. A Yup'ik Indigenous theory of change developed through previous qualitative and quantitative work guides intervention. In the model, direct intervention effects on proximal or intermediate variables constituting protective factors at the individual, family, community, and peer influences levels lead to later change on the ultimate prevention outcome variables of Reasons for Life protective from suicide risk and Reflective Processes about alcohol use consequences protective from alcohol risk. Mixed effects regression models contrasted treatment and comparison arms, and identified significant intervention effects on Reasons for Life (d = 0.27, p < .05) but not Reflective Processes.

Keywords: Alcohol; American Indian/Alaska Native; Community intervention; Community-based participatory research; Suicide.

Figure 1

CONSORT Flow Diagram

Figure 2

Estimated Reasons for Life (RL) functions for treatment (Community 1) and comparison (Community 2). Cross markers indicate raw treatment RL scores, while circles indicate raw comparison RL scores. The solid curve represents the estimated function for treatment, while the dotted curve indicates comparison. Three data points that were outliers on time in intervention beyond 12.3 months were winsorised to 12.3 months. Drop in the treatment smoothed function curve at 11–12 months is a common functional data analysis artifact when data points are lacking; treatment had few data points available at 11–12 months.