Proven Prevention Program Aims To Adapt for Native Americans

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This research showed:

  • A survey that is a key tool in the Communities That Care prevention system is largely valid in Native American communities.
  • Adjusting the survey to incorporate culturally specific risk and protective factors can improve its usefulness.

The Communities That Care (CTC) prevention system has demonstrated effectiveness in reducing youth drug use and other problem behaviors in a variety of communities. A new study represents a step forward in adapting the system for use among Native Americans.

Dr. Katarina Guttmannova and colleagues from the University of Washington showed that a key CTC assessment tool is generally as valid among Native Americans as it is among the general population. Communities use the tool—the CTC Youth Survey (CTC-YS)—to identify which of 32 proven risk and protective factors for drug use and other unhealthy behaviors are elevated in their community. They use the survey results to select from a roster of science-based prevention interventions those that best match their youths' vulnerabilities and their community resources.

The researchers analyzed data from 284,000 CTC-YS respondents, including about 5,100 who identified as Native American. Their results indicated that 30 of the 32 risk and protective factors predicted the likelihood of alcohol, cigarette, and marijuana use similarly among the whole population of respondents and the subpopulation of Native Americans (see Table).

Dr. Guttmannova and colleagues conclude that by and large, the CTC-YS can function in Native American communities as it does in others. Nevertheless, the researchers say, adapting the survey to capture the influence of unique experiences and cultural features on Native American youths' risk and resilience will enhance its utility. They point to the two instances in their analysis where the impact of a risk factor differed between Native Americans versus all respondents as likely examples of the influence of factors specific to Native American cultures. They are now collaborating with tribal members to identify risk and protective factors that have special salience among Native Americans (see "Additional Factors That May Affect Risk Among Native Americans").

Dr. Kathleen Etz, of NIDA's Epidemiology Research Branch, comments, "Native American youth have the highest rates of substance use compared with other racial/ethnic groups, but few studies have focused on etiological models or the efficacy of interventions in this population. This study advances knowledge in this area and will help address these significant health disparities."

Dr. Guttmannova says, "While there is a tremendous amount of resilience in Native American communities, there is a lack of understanding of behavioral health concerns and protective factors for indigenous people. The CTC has the structure and tools to provide culturally competent prevention in Indian country."

This study was supported by NIH grants DA024411, DA015183, and DA015183-08S2.


Table. Risk and Protective Factors Assessed in the CTC-YS That Predicted Youth Alcohol, Cigarette, and Marijuana Use Similarly in Native Americans and the General Population
Domain Risk Factors Protective Factors
Community Domain
  • Community disorganization
  • Transitions and mobility
  • Laws and norms favorable to drug use and firearms
  • Perceived availability of drug use and firearms
  • Rewards for prosocial involvement
Family Domain
  • Poor family supervision
  • Poor family discipline
  • Family conflict
  • Family history of antisocial behavior
  • Parental attitudes favorable to alcohol, tobacco, and other drug (ATOD) use
  • Parental attitudes favorable to antisocial behavior
  • Family attachment
  • Opportunities for prosocial involvement
  • Rewards for prosocial involvement
Peer and Individual Domain
  • Low perceived risks for drug use
  • Early initiation of drug use and antisocial behavior
  • Sensation seeking
  • Gang involvement
  • Rebelliousness
  • Friends' delinquent behavior
  • Friends' use of drugs
  • Peer rewards for antisocial behavior
  • Favorable attitudes to antisocial behavior
  • Favorable attitudes to ATOD use
  • Social skills
  • Belief in a moral order
School Domain
  • Poor academic performance
  • Low school commitment
  • Opportunities for prosocial involvement
  • Rewards for prosocial involvement

Additional Factors That May Affect Risk Among Native Americans

Dr. Guttmannova and her colleagues speculate that various factors that are not currently included in the CTC-YS may predict Native Americans’ risk for substance use. All of the factors in the list below have been linked to risk in other populations.

Risk Factors

  • Poverty
  • Institutional racism and discrimination
  • High prevalence of chronic health problems
  • Limited access to health care
  • Exposure to trauma/historical trauma
  • Microaggressions
  • Loss of culture
  • Dissonance between cultural ideals and behavioral realities

Protective Factors

  • Engagement in traditional spiritual/cultural practices
  • Positive ethnic/cultural identity
  • Community involvement
  • Strong extended families
  • Social networks