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.
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Notes
In Community 2, youth entered in two cohorts and the second cohort comparison term is dropped.
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Acknowledgements
The Qungasvik Team includes the Yupiucimta Asvairtuumallerkaa Council, the Ellangneq Council, the Yuuyaraq Council, the Yup’ik Regional Coordinating Council, the Ellangneq Advisory Group, and the Ellangneq, Yupiucimta Asvairtuumallerkaa, and Cuqyun Project Staff. The Yupiucimta Asvairtuumallerkaa Council included Sophie Agimuk, Harry Asuluk, Thomas Asuluk, T.J. Bentley, John Carl, Mary Carl, Emily Chagluk, James Charlie, Sr., Lizzie Chimiugak, Ruth Jimmie, Jolene John, Paul John, Simeon John, Aaron Moses, Phillip Moses, Harry Tulik, and Cecelia White. The Ellangneq Council included Catherine Agayar, Fred Augustine, Mary Augustine, Paula Ayunerak, Theresa Damian, Lawrence Edmund, Sr., Barbara Joe, Lucy Joseph, Joe Joseph, Placide Joseph, Zacheus Paul, Charlotte Phillip, Henry Phillip, Joe Phillip, Penny Alstrom, Fred Augustine, Mary Augustine, Paula Ayunerak, Theresa Damian, Shelby Edmund, Flora Patrick, Dennis Sheldon, Isidore Shelton, Catherine Agayar, Theresa Damian, Freddie Edmund, Shelby Edmund, Josie Edmund, and Flora Patrick. The Yuuyaraq Council included the elders Ben Tucker, Phillip Yupanik, Andrew Kelly, Matrona Yupanik, Mike Andrews, Sr., Maryann Andrews, Evan Hamilton, Jr., Nick Tucker, Paul Crane, Clara Andrews, Bernice Redfox, Margaret Charles, Cecilia Redfox, Ray Waska, Sr., Peter Moore, and Martin Moore, Sr., and community members Ronald Trader, Fredrick Joseph, Marvin Kelly, Stephen Levi, Leandra Andrews, Malora Hunt, Dominic Hunt, Patrick Tam, Yolanda Kelly, Emily Crane, Grace Charles, Roberta Murphy, Ray Waska, Jr., Doug Redfox, Evan Charles Mark Tucker, Greg Fratis, and Wilbur Hootch. The Yup’ik Regional Coordinating Council included Martha Simon, Moses Tulim, Ed Adams, Tammy Aguchak, Paula Ayunerak, Sebastian Cowboy, Lawrence Edmunds, Margaret Harpak, Charles Moses, and Raymond Oney. The Ellangneq Advisory Group included Walkie Charles, Richard Katz, Mary Sexton, Lisa Rey Thomas, Beti Thompson, and Edison Trickett. The Qungasvik Project Staff included Debbie Alstrom, Carl Blackhurst, Rebekah Burkett, Diana Campbell, Arthur Chikigak, Gunnar Ebbesson, Aaron Fortner, John Gonzalez, Scarlett Hopkins, Nick Hubalik, Joseph Klejka, Charles Moses, Dora Nicholai, Eliza Orr, Marvin Paul, Michelle Dondanville, Jonghan Kim, Rebecca Koskela, Johanna Herron, and currently includes Roy Bell, Jorene Joe, Sam Joe, Simeon John, Cyndi Nation, Jennifer Nu, Maria Russsel, and Dhara Shah.
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The authors, including the Qungasvik Team, our community research partners, and the estate of David Henry, declare that they have no conflicts of interest.
Funding
This study was funded by NIDA, NIAAA, NIMHD, and NIGMS (R21AA016098, RO1AA11446, R24MD001626, P20RR061430, R01AA023754).
Ethical Approval
The University of Alaska Fairbanks and University of Minnesota Institutional Review Board, the Yukon-Kuskokwim Health Corporation Human Studies Committee, and the tribal councils in each community approved this research.
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All parents gave informed consent before youth participation, and all youth participants gave assent following parent consent.
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Allen, J., Rasmus, S.M., Fok, C.C.T. et al. Multi-Level Cultural Intervention for the Prevention of Suicide and Alcohol Use Risk with Alaska Native Youth: a Nonrandomized Comparison of Treatment Intensity. Prev Sci 19, 174–185 (2018). https://doi.org/10.1007/s11121-017-0798-9
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DOI: https://doi.org/10.1007/s11121-017-0798-9