Adolescent Substance Use
Conditions
Brief summary
The goal of this project is to test the effectiveness of a successful anti-drug communications campaign (Be Under your Own Influence) to lower substance use among AI 7th graders. The campaign uses messages that support youths' personal autonomy and future aspirations, and these messages are delivered to 7th graders using high school students. Our goal is to develop a turnkey package for the broader population of AI youth and schools and to develop components that can incorporate flexibility and creativity in their delivery.
Detailed description
Substance use is a particularly dangerous risk to middle-school youth, and American Indian (AI) youth are at increased risk. We have found over the course of more than three decades that substance use among AI youth is consistently higher than that of other ethnic/racial groups. Schools are often the site for adolescent drug prevention efforts, but results from these efforts are often modest or even disappointing. This intervention adapts an existing campaign (Be Under Your Own Influence; BUYOI) that has been found to be effective in reducing substance use and that uses campaign messages that are congruent with AI culture. The intervention will be adapted using significant contributions from tribal members, including youth, teachers, parents, elders, and other community members. This proposal includes active involvement of local advisory boards, hiring of a local AI liaison, focus groups, a youth photo voice component, and use of AI staff from our Center and from the Native American Cultural Center at our university. The adapted anti-drug and alcohol use communications campaign will be delivered by selected high school students to 7th grade students. A distinguishing feature of the BUYOI campaign is a message that targets outcome expectations related to aspirations, autonomy, and physical harms. The campaign will use multiple channels of communication including print (e.g., posters and fliers), video and audio spots, presentations, and social media to deliver messages that are designed to alter outcome expectancies, intentions, and ultimately substance use among targeted youth. The campaign will be delivered to two cohorts of 7th graders, with 4 longitudinal measurement occasions for each cohort. Five middle schools (and their corresponding high schools) have been recruited for the study, where three of these will be randomly assigned to the intervention condition and two to the control condition. Multilevel data analysis will test for effects of campaign exposure on autonomy, aspirations, perceived harm, and intentions to use. Because of the heavy involvement of the school and community in the development and delivery of the intervention, we will be able to incorporate sustainability into the design of all integrated components. Ultimately, our goal is to develop a turnkey package for the broader population of reservation-based AI youth and schools and to develop components that can incorporate flexibility and creativity in their delivery. For example, a school or local group may implement the campaign in its original form or they may modify aspects to make them more pertinent to their community.
Interventions
BEHAVIORALBe Under Your Own Influence
School based anti-drug use communications campaign
Sponsors
Colorado State University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
11 Years to 14 Years
Healthy volunteers
Yes
Inclusion criteria
* Attend 7th grade in targeted schools that are on or near American Indian reservation and have received parental consent
Exclusion criteria
* No parental consent
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Alcohol Initiation | 18 months | The number of students who self-reported initiated alcohol for the first time during the study period |
| Alcohol Intoxication Initiation | 18 months | Number of participants self-reporting first-time alcohol intoxication initiation during the study period. |
| Marijuana Initiation | 18 months | Number of participants who self-reported first-time marijuana use initiation during the study period |
Participant flow
Participants by arm
| Arm | Count |
|---|---|
| Be Under Your Own Influence Intervention School-based anti-substance use communications campaign
Be Under Your Own Influence: School based anti-drug use communications campaign | 342 |
| Control Assessment only | 186 |
| Total | 528 |
Baseline characteristics
| Characteristic | Be Under Your Own Influence Intervention | Control | Total |
|---|---|---|---|
| Age, Categorical <=18 years | 342 Participants | 186 Participants | 528 Participants |
| Age, Categorical >=65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Categorical Between 18 and 65 years | 0 Participants | 0 Participants | 0 Participants |
| Age, Continuous | 12.5 Years STANDARD_DEVIATION 0.57 | 12.5 Years STANDARD_DEVIATION 0.65 | 12.5 Years STANDARD_DEVIATION 0.59 |
| Ethnicity (NIH/OMB) Hispanic or Latino | 18 Participants | 47 Participants | 65 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 324 Participants | 139 Participants | 463 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized American Indian | 321 Participants | 176 Participants | 497 Participants |
| Sex: Female, Male Female | 188 Participants | 91 Participants | 279 Participants |
| Sex: Female, Male Male | 151 Participants | 95 Participants | 246 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk |
|---|---|---|
| deaths Total, all-cause mortality | 0 / 342 | 0 / 186 |
| other Total, other adverse events | 0 / 342 | 0 / 186 |
| serious Total, serious adverse events | 0 / 342 | 0 / 186 |
Outcome results
Primary
Alcohol Initiation
The number of students who self-reported initiated alcohol for the first time during the study period
Time frame: 18 months
Population: BUYOI efficacy was tested in a five-year study with two cohorts of middle school students, and five middle schools recruited from the Northern Plains and Southwest regions of the United States, representing a recent sample of American Indian adolescents (grades 7th-8th, age at first assessment = 12.5 years).
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Be Under Your Own Influence Intervention | Alcohol Initiation | 160 Participants |
| Control | Alcohol Initiation | 109 Participants |
Comparison: Discrete time hazard represents the conditional probability that a student will experience first time alcohol use during a given measurement period, given that students did not use alchohol in a previous measurement period. Thus for each model, we tested the following hypothesis: Controlling for age at first-assessment, students attending BUYOI-assigned schools will have a lower risk of substance use uptake by the end of their eighth-grade year, relative to students attending control schools.p-value: 0.00495% CI: [-0.714, -0.126]Regression, Logistic
Primary
Alcohol Intoxication Initiation
Number of participants self-reporting first-time alcohol intoxication initiation during the study period.
Time frame: 18 months
Population: BUYOI efficacy was tested in a five-year study with two cohorts of middle school students, and five middle schools recruited from the Northern Plains and Southwest regions of the United States, representing a recent sample of American Indian adolescents (grades 7th-8th, age at first assessment = 12.5 years).
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Be Under Your Own Influence Intervention | Alcohol Intoxication Initiation | 90 Participants |
| Control | Alcohol Intoxication Initiation | 62 Participants |
Comparison: Discrete time hazard represents the conditional probability that a student will experience first time alcohol initiation during a given measurement period, given that students did not become intoxicated in a previous measurement period. Thus, for each model, we tested the following hypothesis: controlling for age at first assessment, students attending BUYOI-assigned schools will have a lower risk of substance use uptake at the end of their eight grade yearp-value: 0.03795% CI: [-0.762, -0.018]Regression, Logistic
Primary
Marijuana Initiation
Number of participants who self-reported first-time marijuana use initiation during the study period
Time frame: 18 months
Population: BUYOI efficacy was tested in a five-year study with two cohorts of middle school students, and five middle schools recruited from the Northern Plains and Southwest regions of the United States, representing a recent sample of American Indian adolescents (grades 7th-8th, age at first assessment = 12.5 years).
| Arm | Measure | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|
| Be Under Your Own Influence Intervention | Marijuana Initiation | 183 Participants |
| Control | Marijuana Initiation | 97 Participants |
Comparison: Discrete time hazard represents the conditional probability that a student will experience first time marijuana use during a given measurement period, given that students did not use marijuana in a previous measurement period. Thus for each model, we tested the following hypothesis: Controlling for age at first-assessment, students attending BUYOI-assigned schools will have a lower risk of marijuana use uptake by the end of their eighth-grade year, relative to students attending control schools.p-value: 0.22895% CI: [-0.104, 0.444]Regression, Logistic