Culturally Grounded Early Substance Use Prevention for American Indian Families

Study Overview
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Brief Summary
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This study involves adaptation, implementation, and rigorous evaluation of a family-based program designed to prevent early initiation of substance use on a Northern Plains Indian reservation. The program, Thiwáhe Gluwáš'akapi, is a cultural adaptation of the Iowa Strengthening Families Program for Parents and Youth 10-14. Youth and their parents/caregivers will participate in weekly group sessions for 7 weeks and complete pre- and post-intervention surveys assessing a variety of risk and protective factors and youth outcomes. The evaluation design will allow the assessment of the effectiveness of different components within the program.

Detailed Description
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Feasibility Pilot A feasibility pilot for the Thiwáhe Gluwáš'akapi (TG) program will be conducted in the Spring of 2015. In the pilot, the intervention will be delivered to two groups of youth and families and the implementation process will be carefully evaluated to determine what works well and where further adaptation of the intervention or the study procedures may be necessary. Particular attention will be paid to retention of families and, if possible, any who drop out will be interviewed to understand barriers to participation. As with the intervention evaluation itself (see below) youth aged 10-14 will be recruited to participate, along with their parents and/or other adults (up to 3 adults per child) who are actively involved in raising them (e.g., grandparents, aunts, uncles). Pilot groups will be conducted in each of two different communities on the reservation. Once the feasibility pilot is complete, the intervention will be finalized for efficacy evaluation. Tasks for this phase will include refining the manual for the intervention and further developing training materials for interventionists. Implementation/Component Evaluation The formal evaluation of TG will begin in the fall of 2015 and will utilize the principles of Multiphase Optimization Strategy (MOST; Collins et al., 2009) for intervention development and a fractional factorial design to evaluate the relative effectiveness of different components within the intervention. Three components will be evaluated: (1) A Lakota language enhancement (Lakota), (2) a Facebook social media enhancement (FB), and (3) substance use resistance skill content (SU). A total of 24 intervention groups will be randomly assigned to one of 4 MOST design conditions, with the content of each condition determined using SAS PROC FACTEX, as recommended by Collins, et al, 2009. All 4 conditions will consist of the basic TG program, each supplemented by one or more of 3 components designated above: Condition A will include the substance use resistance content (SU; no Lakota or FB); Condition B will include the FB social media supplement (FB; no Lakota or SU); Condition C will include the Lakota language enhancement (Lakota; no FB or SU); and Condition D will include all three components (Lakota + FB + SU). A cumulative evidence design will be utilized, with the intervention implemented in 5 cohorts across 3 years. The intervention will be delivered to 4 groups (8 families each) in Cohort 1 in the fall of 2015. Additional cohorts will receive the intervention each fall and spring through 2017 as follows: Cohort 2, Spring 2016, 4 groups; Cohort 3, Fall 2016, 6 groups; Cohort 4, Spring 2017, 6 groups; and Cohort 5, Fall 2017, 4 groups. Thus, by the end of 2017, 24 intervention groups (each 8 families, total of 192 families) will have participated in the TG program. Cohorts will be randomly assigned to the 4 MOST design conditions in order to control for potential order of implementation effects. Power analysis Power analyses suggest that this design will result in adequate power (>.80) to detect a small effect (d=.15) with 48 families per condition; for the 4 conditions in the design, this will require a total of 192 families (not including 16 pilot families). TG, following Iowa Strengthening Families Program (ISFP) recommendations, will be delivered in family groups of 8 families each; thus, in order to involve 192 families, we plan a total of 24 intervention groups, with 6 in each the 4 experimental conditions. Each component targeted for evaluation will be implemented in 2 of the 4 conditions (see conditions A-B above), and estimates of each effect will thus be based on marginal Ns of 96 families. As is standard with MOST designs, there will not be a no-intervention control group nor will there be a group that receives every component. While this is a different approach than an randomized controlled trial (RCT) design, it is a rigorous and optimal approach for identifying the most effective components to include in an intervention. The intervention created using this process will be ready for a standard RCT evaluation, and more likely to be proven effective there. Implementation evaluation Fidelity across implementations will be ensured by using a detailed manual of procedures, providing extensive training for interventionists, and using fidelity logs to asses delivery of key session components. The intervention director, a clinical psychologist, will observe sessions periodically and verify the extent to which implementation is occurring with fidelity to the TG program manual. Efficacy evaluation The primary impetus for the development and implementation of the TG program is the desire to reduce risk for substance abuse problems among American Indian adolescents by preventing early initiation of substance use. Assessment of the success of the TG program components will hinge on observed impacts on substance use initiation and on the putative mediators of parental self-efficacy, strengthened family relationships, and cultural knowledge and values. Given the short timeline of the outcome evaluations (limited to 6 months post-intervention), effects on mediators are anticipated to stronger than distal effects on behavioral outcomes. Measures Measures used to assess study outcomes draw heavily from the investigators' previous research with young American Indian adolescents and their parents, and from previous evaluations of the Iowa Strengthening Families Program for Parents and Youth 10-14. Two instruments will be used to assess an array of outcomes expected to be affected by the TG intervention, along with demographic data: a Parent Survey (for parents and other caregivers participating in the TG program with youth), and a Youth Survey. Both the Parent Survey and Youth Survey will be administered electronically, using tablet computers connected to the Internet, with data uploaded directly. In addition, a Social Network Survey will be administered (either on an electronic tablet or on paper) to participating parents/caregivers; this survey is designed to assess the strength of the connections among participants in the program, both before and after participation in the program. A small number of participants (3-4) in each group assigned to the FaceBook condition will be asked to participate in Exit Interviews (by phone) to ascertain their use of and response to the social media messages provided between TG sessions. Data will also be captured from Facebook, including page visits, posts, and responses to online quizzes. Finally, participants will be asked to complete a Program Evaluation Form (Parent or Youth versions, on paper) at their last TG session, to provide feedback on the program and facilitators. Data Collection Schedule Time 1 - One week prior to the first TG session: Parent and Youth surveys (all participants). Time 2 - First TG session: Social Network Surveys (adults). Time 3 - One week after last TG session: Parent and Youth Surveys (all participants); Social Network Survey (adults) Time 4 - Within two weeks after final TG session: FaceBook Exit Interviews (3-4 adult participants in each condition including the FaceBook supplement) Time 5 - Approximately 6 months after the last TG session: Parent and Youth Surveys (all participants in the first two intervention cohorts) Analyses The simplest analyses for the evaluation of the TG program, using the MOST design, will involve analysis of variance (ANOVA), using the fractional factorial design described above, comparing post-intervention values (Time 3 and Time 5) on both mediators and outcomes across conditions (assuming that randomization across conditions will result in roughly equivalent pre-intervention values). Repeated measures ANOVA will also be performed, including both pre- and post-intervention measures, looking for interactions between time and condition. Finally, multivariate ANOVAs will be estimated for groups of outcome variables, to examine patterns of effects across outcomes. For all analyses, the focus will be on effect sizes (rather than significance tests and p values) to compare effect sizes across components to guide decisions about what should be retained in the optimized TG intervention. As noted above, standard errors will be adjusted to account for intraclass correlations and clustering of families within intervention groups. Analyses of the Social Network Measure will focus on assessing density and cohesion at the network level, to address two primary questions: First, do network characteristics at the beginning of the program (pre-existing relationships within intervention groups) modify the effect of the TG intervention within those groups and, second, do network characteristics change over the course of the TG intervention as new relationships are formed and existing relationships changed. Analyses will be conducted using UCINET or similar social network analysis software. Analyses of the Facebook data will be primarily descriptive, examining the frequency with which participants engage with the Facebook page for their TG group by posting comments, or responding to polls or quizzes. Exploratory analyses may be used to examine correlations between group rates of Facebook use and group-level outcomes, such as increased cohesion as measured by the Social Network Analysis. Analyses of Facebook Exit Interviews will be primarily notes-based content analysis and will involve three major stages of analysis: open coding, axial coding, and selective coding.

Official Title
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Culturally Grounded Early Substance Use Prevention for American Indian Families

Conditions
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Substance Use

Intervention / Treatment
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* Behavioral: Lakota Language enhancement
* Behavioral: Facebook Supplement
* Behavioral: Substance Use Resistance Skills


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Youth aged 10-14 years and their families, with connection to the South Dakota Indian Reservation where the study is being conducted. Families may include parents, extended family, guardians, and others living in the household. Exclusion Criteria: Individuals without a child in the family aged 10-14 will not be allowed to participate. Youth who are not between 10 and 14 years of age will not be allowed to participate.

Ages Eligible for Study
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Minimum Age: 10 Years
Maximum Age: 85 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Condition A<br>Substance use resistance skills; no Lakota language enhancement, no FaceBook supplement | Behavioral: Substance Use Resistance Skills<br>* This intervention component consists of the original substance use resistance skills training from the Iowa Strengthening Families Program for Parents and Youth 10-14; arms without this component will include a session on healthy eating and exercise (attention control).<br>|
| Experimental: Condition B<br>FaceBook supplement; no Lakota language enhancement; no Substance Use resistance skills | Behavioral: Facebook Supplement<br>* This intervention component includes a social media supplement to engage families outside of weekly intervention sessions and will include postings and polls for participating parents/other caregivers to complete between sessions.<br>|
| Experimental: Condition C<br>Lakota language enhancement; no FaceBook supplement; no Substance Use resistance skills | Behavioral: Lakota Language enhancement<br>* This intervention component includes more extensive adaptation for Lakota families, focusing on use of Lakota language specifically around relationship/kinship terms. Study arms without this component will include the same adapted intervention but with use of English language rather than Lakota.<br>|
| Experimental: Condition D<br>Lakota language enhancement; FaceBook supplement; Substance Use resistance skills | Behavioral: Lakota Language enhancement<br>* This intervention component includes more extensive adaptation for Lakota families, focusing on use of Lakota language specifically around relationship/kinship terms. Study arms without this component will include the same adapted intervention but with use of English language rather than Lakota.<br>Behavioral: Facebook Supplement<br>* This intervention component includes a social media supplement to engage families outside of weekly intervention sessions and will include postings and polls for participating parents/other caregivers to complete between sessions.<br>Behavioral: Substance Use Resistance Skills<br>* This intervention component consists of the original substance use resistance skills training from the Iowa Strengthening Families Program for Parents and Youth 10-14; arms without this component will include a session on healthy eating and exercise (attention control).<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Youth lifetime alcohol use | Lifetime prevalence of alcohol use | Baseline (1 week before program start) | 
| Youth lifetime alcohol use | Lifetime prevalence of alcohol use | Post-intervention (1 week after program conclusion) | 
| Youth lifetime alcohol use | Lifetime prevalence of alcohol use | Follow-up (6 months after program conclusion) | 
| Youth past-month alcohol use | Mean frequency of past month alcohol use | Baseline (1 week before program start) | 
| Youth past-month alcohol use | Mean frequency of past month alcohol use | Post-intervention (1 week after program conclusion) | 
| Youth past-month alcohol use | Mean frequency of past month alcohol use | Follow-up (6 months after program conclusion) | 
| Youth maximum alcohol use in past month | Mean maximum quantity of past month alcohol consumption | Baseline (1 week before program start) | 
| Youth maximum alcohol use in past month | Mean maximum quantity of past month alcohol consumption | Post-intervention (1 week after program conclusion) | 
| Youth maximum alcohol use in past month | Mean maximum quantity of past month alcohol consumption | Follow-up (6 months after program conclusion) | 
| Youth age of first alcohol use | Mean age of first alcohol use | Baseline (1 week before program start) | 
| Youth age of first alcohol use | Mean age of first alcohol use | Post-intervention (1 week after program conclusion) | 
| Youth age of first alcohol use | Mean age of first alcohol use | Follow-up (6 months after program conclusion) | 
| Youth lifetime cigarette use | Lifetime prevalence of cigarette use | Baseline (1 week before program start) | 
| Youth lifetime cigarette use | Lifetime prevalence of cigarette use | Post-intervention (1 week after program conclusion) | 
| Youth lifetime cigarette use | Lifetime prevalence of cigarette use | Follow-up (6 months after program conclusion) | 
| Youth past-month cigarette use | Mean frequency of past month cigarette use | Baseline (1 week before program start) | 
| Youth past-month cigarette use | Mean frequency of past month cigarette use | Post-intervention (1 week after program conclusion) | 
| Youth past-month cigarette use | Mean frequency of past month cigarette use | Follow-up (6 months after program conclusion) | 
| Youth age of first cigarette use | Mean age of first cigarette use | Baseline (1 week before program start) | 
| Youth age of first cigarette use | Mean age of first cigarette use | Post-intervention (1 week after program conclusion) | 
| Youth age of first cigarette use | Mean frequency of past month cigarette use | Follow-up (6 months after program conclusion) | 
| Youth prevalence of smokeless tobacco use | Lifetime prevalence of smokeless tobacco use | Baseline (1 week before program start) | 
| Youth prevalence of smokeless tobacco use | Lifetime prevalence of smokeless tobacco use | Post-intervention (1 week after program conclusion) | 
| Youth prevalence of smokeless tobacco use | Lifetime prevalence of smokeless tobacco use | Follow-up (6 months after program conclusion) | 
| Youth frequency of past-month smokeless tobacco use | Mean frequency of past month smokeless tobacco use | Baseline (1 week before program start) | 
| Youth frequency of past-month smokeless tobacco use | Mean frequency of past month smokeless tobacco use | Post-intervention (1 week after program conclusion) | 
| Youth frequency of past-month smokeless tobacco use | Mean frequency of past month smokeless tobacco use | Follow-up (6 months after program conclusion) | 
| Youth age of first smokeless tobacco use | Mean age of first smokeless tobacco use | Baseline (1 week before program start) | 
| Youth age of first smokeless tobacco use | Mean age of first smokeless tobacco use | Post-intervention (1 week after program conclusion) | 
| Youth age of first smokeless tobacco use | Mean age of first smokeless tobacco use | Follow-up (6 months after program conclusion) | 
| Youth lifetime prevalence of e-cigarette use | Lifetime prevalence of e-cigarette use | Baseline (1 week before program start) | 
| Youth lifetime prevalence of e-cigarette use | Lifetime prevalence of e-cigarette use | Post-intervention (1 week after program conclusion) | 
| Youth lifetime prevalence of e-cigarette use | Lifetime prevalence of e-cigarette use | Follow-up (6 months after program conclusion) | 
| Youth past-month e-cigarette use | Mean frequency of past month e-cigarette use | Baseline (1 week before program start) | 
| Youth past-month e-cigarette use | Mean frequency of past month e-cigarette use | Post-intervention (1 week after program conclusion) | 
| Youth past-month e-cigarette use | Mean frequency of past month e-cigarette use | Follow-up (6 months after program conclusion) | 
| Youth lifetime marijuana use | Lifetime prevalence of marijuana use | Baseline (1 week before program start) | 
| Youth lifetime marijuana use | Lifetime prevalence of marijuana use | Post-intervention (1 week after program conclusion) | 
| Youth lifetime marijuana use | Lifetime prevalence of marijuana use | Follow-up (6 months after program conclusion) | 
| Youth past-month marijuana use | Mean frequency of past month marijuana use | Baseline (1 week before program start) | 
| Youth past-month marijuana use | Mean frequency of past month marijuana use | Post-intervention (1 week after program conclusion) | 
| Youth past-month marijuana use | Mean frequency of past month marijuana us | Follow-up (6 months after program conclusion) | 
| Youth age of first marijuana use | Mean age of first marijuana use | Baseline (1 week before program start) | 
| Youth age of first marijuana use | Mean age of first marijuana use | Post-intervention (1 week after program conclusion) | 
| Youth age of first marijuana use | Mean age of first marijuana use | Follow-up (6 months after program conclusion) | 
| Youth lifetime prevalence of huffing glue/gas | Lifetime prevalence of huffing | Baseline (1 week before program start) | 
| Youth lifetime prevalence of huffing glue/gas | Lifetime prevalence of huffing | Post-intervention (1 week after program conclusion) | 
| Youth lifetime prevalence of huffing glue/gas | Lifetime prevalence of huffing | Follow-up (6 months after program conclusion) | 
| Youth past-month huffing | Mean frequency of past month huffing | Baseline (1 week before program start) | 
| Youth past-month huffing | Mean frequency of past month huffing | Post-intervention (1 week after program conclusion) | 
| Youth past-month huffing | Mean frequency of past month huffing | Follow-up (6 months after program conclusion) | 
| Youth age of first huffing | Mean age of first huffing | Baseline (1 week before program start) | 
| Youth age of first huffing | Mean age of first huffing | Post-intervention (1 week after program conclusion) | 
| Youth age of first huffing | Mean age of first huffing | Follow-up (6 months after program conclusion) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Youth perceived consistency of parental discipline practices | Mean perceived consistency of parental discipline practices score | baseline (1 week before program start) | 
| Youth perceived consistency of parental discipline practices | Mean perceived consistency of parental discipline practices score | post-intervention (1 week after program conclusion) | 
| Youth perceived consistency of parental discipline practices | Mean perceived consistency of parental discipline practices score | follow-up (6 months after program conclusion) | 
| Youth perceived parental standard setting | Mean perceived parental standard setting score | baseline (1 week before program start) | 
| Youth perceived parental standard setting | Mean perceived parental standard setting score | post-intervention (1 week after program conclusion) | 
| Youth perceived parental standard setting | Mean perceived parental standard setting score | follow-up (6 months after program conclusion) | 
| Youth perceived parental monitoring | Mean perceived parental monitoring score | baseline (1 week before program start) | 
| Youth perceived parental monitoring | Mean perceived parental monitoring score | post-intervention (1 week after program conclusion) | 
| Youth perceived parental monitoring | Mean perceived parental monitoring score | follow-up (6 months after program conclusion) | 
| Youth perceived parental positive affect | Mean perceived parental positive affect score | baseline (1 week before program start) | 
| Youth perceived parental positive affect | Mean perceived parental positive affect score | post-intervention (1 week after program conclusion) | 
| Youth perceived parental positive affect | Mean perceived parental positive affect score | follow-up (6 months after program conclusion) | 
| Youth perceived parental approval | Mean perceived parental approval score | baseline (1 week before program start) | 
| Youth perceived parental approval | Mean perceived parental approval score | post-intervention (1 week after program conclusion) | 
| Youth perceived parental approval | Mean perceived parental approval score | follow-up (6 months after program conclusion) | 
| Youth perceived parental negative affect | Mean perceived parental negative affect score | baseline (1 week before program start) | 
| Youth perceived parental negative affect | Mean perceived parental negative affect score | post-intervention (1 week after program conclusion) | 
| Youth perceived parental negative affect | Mean perceived parental negative affect score | follow-up (6 months after program conclusion) | 
| Youth perceived parent-child communication | Mean perceived parent-child communication score | baseline (1 week before program start) | 
| Youth perceived parent-child communication | Mean perceived parent-child communication score | post-intervention (1 week after program conclusion) | 
| Youth perceived parent-child communication | Mean perceived parent-child communication score | follow-up (6 months after program conclusion) | 
| Youth perceived parent-child communication about alcohol and drugs | Mean perceived parent-child communication about alcohol and drugs score | baseline (1 week before program start) | 
| Youth perceived parent-child communication about alcohol and drugs | Mean perceived parent-child communication about alcohol and drugs score | post-intervention (1 week after program conclusion) | 
| Youth perceived parent-child communication about alcohol and drugs | Mean perceived parent-child communication about alcohol and drugs score | follow-up (6 months after program conclusion) | 
| Youth perceived enforcement of family rules | Mean perceived enforcement of family rules score | baseline (1 week before program start) | 
| Youth perceived enforcement of family rules | Mean perceived enforcement of family rules score | post-intervention (1 week after program conclusion); follow-up (6 months after program conclusion) | 
| Youth perceived enforcement of family rules | Mean perceived enforcement of family rules score | follow-up (6 months after program conclusion) | 
| Youth perceived parental autonomy support | Mean perceived parental autonomy support score | baseline (1 week before program start) | 
| Youth perceived parental autonomy support | Mean perceived parental autonomy support score | post-intervention (1 week after program conclusion); follow-up (6 months after program conclusion) | 
| Youth perceived parental autonomy support | Mean perceived parental autonomy support score | follow-up (6 months after program conclusion) | 
| Parent-child shared activities - youth report | Count of parent-child shared activities | baseline (1 week before program start) | 
| Parent-child shared activities - youth report | Count of parent-child shared activities | post-intervention (1 week after program conclusion) | 
| Parent-child shared activities - youth report | Count of parent-child shared activities | follow-up (6 months after program conclusion) | 
| Family cohesion - youth report | Mean family cohesion score | baseline (1 week before program start) | 
| Family cohesion - youth report | Mean family cohesion score | post-intervention (1 week after program conclusion) | 
| Family cohesion - youth report | Mean family cohesion score | follow-up (6 months after program conclusion) | 
| Family conflict resolution - youth report | Mean family conflict resolution score | baseline (1 week before program start) | 
| Family conflict resolution - youth report | Mean family conflict resolution score | post-intervention (1 week after program conclusion) | 
| Family conflict resolution - youth report | Mean family conflict resolution score | follow-up (6 months after program conclusion) | 
| Family expressiveness - youth report | Mean family expressiveness score | baseline (1 week before program start) | 
| Family expressiveness - youth report | Mean family expressiveness score | post-intervention (1 week after program conclusion) | 
| Family expressiveness - youth report | Mean family expressiveness score | follow-up (6 months after program conclusion) | 
| Lakota cultural socialization - youth report | Mean Lakota cultural socialization score | baseline (1 week before program start) | 
| Lakota cultural socialization - youth report | Mean Lakota cultural socialization score | post-intervention (1 week after program conclusion) | 
| Lakota cultural socialization - youth report | Mean Lakota cultural socialization score | follow-up (6 months after program conclusion) | 
| Youth perceived parental disapproval of alcohol, tobacco, and marijuana | Mean disapproval of alcohol, tobacco, and marijuana score | baseline (1 week before program start) | 
| Youth perceived parental disapproval of alcohol, tobacco, and marijuana | Mean disapproval of alcohol, tobacco, and marijuana score | post-intervention (1 week after program conclusion) | 
| Youth perceived parental disapproval of alcohol, tobacco, and marijuana | Mean disapproval of alcohol, tobacco, and marijuana score | follow-up (6 months after program conclusion) | 
| Descriptive norms for alcohol, tobacco, and marijuana - youth report | Mean descriptive norms for alcohol, tobacco, and marijuana score | baseline (1 week before program start) | 
| Descriptive norms for alcohol, tobacco, and marijuana - youth report | Mean descriptive norms for alcohol, tobacco, and marijuana score | post-intervention (1 week after program conclusion) | 
| Descriptive norms for alcohol, tobacco, and marijuana - youth report | Mean descriptive norms for alcohol, tobacco, and marijuana score | follow-up (6 months after program conclusion) | 
| Youth antisocial behavior | Mean antisocial behavior score | baseline (1 week before program start) | 
| Youth antisocial behavior | Mean antisocial behavior score | post-intervention (1 week after program conclusion) | 
| Youth antisocial behavior | Mean antisocial behavior score | follow-up (6 months after program conclusion) | 
| Youth prosocial behavior | Mean prosocial behavior score | baseline (1 week before program start) | 
| Youth prosocial behavior | Mean prosocial behavior score | post-intervention (1 week after program conclusion) | 
| Youth prosocial behavior | Mean prosocial behavior score | follow-up (6 months after program conclusion) | 
| Youth deviant peer influences | Mean deviant peer influences score | baseline (1 week before program start) | 
| Youth deviant peer influences | Mean deviant peer influences score | post-intervention (1 week after program conclusion) | 
| Youth deviant peer influences | Mean deviant peer influences score | follow-up (6 months after program conclusion) | 
| Youth prosocial peer influences | Mean prosocial peer influences score | baseline (1 week before program start) | 
| Youth prosocial peer influences | Mean prosocial peer influences score | post-intervention (1 week after program conclusion) | 
| Youth prosocial peer influences | Mean prosocial peer influences score | follow-up (6 months after program conclusion) | 
| Youth peer resistance skills | Mean peer resistance skills score | baseline (1 week before program start) | 
| Youth peer resistance skills | Mean peer resistance skills score | post-intervention (1 week after program conclusion) | 
| Youth peer resistance skills | Mean peer resistance skills score | follow-up (6 months after program conclusion) | 
| Youth lifetime history of stressful life events | Count of stressful events | baseline (1 week before program start) | 
| Youth lifetime history of stressful life events | Count of stressful events | post-intervention (1 week after program conclusion) | 
| Youth lifetime history of stressful life events | Count of stressful events | follow-up (6 months after program conclusion) | 
| Youth stress management skills | Mean stress management skills score | baseline (1 week before program start) | 
| Youth stress management skills | Mean stress management skills score | post-intervention (1 week after program conclusion) | 
| Youth stress management skills | Mean stress management skills score | follow-up (6 months after program conclusion) | 
| Youth psychological well-being | Mean psychological well-being score | baseline (1 week before program start) | 
| Youth psychological well-being | Mean psychological well-being score | post-intervention (1 week after program conclusion) | 
| Youth psychological well-being | Mean psychological well-being score | follow-up (6 months after program conclusion) | 
| Youth knowledge of Lakota kinship terminology | Count of correct Lakota kinship terms | baseline (1 week before program start) | 
| Youth knowledge of Lakota kinship terminology | Count of correct Lakota kinship terms | post-intervention (1 week after program conclusion) | 
| Youth knowledge of Lakota kinship terminology | Count of correct Lakota kinship terms | follow-up (6 months after program conclusion) | 
| Youth self-esteem | Mean self-esteem score | baseline (1 week before program start) | 
| Youth self-esteem | Mean self-esteem score | post-intervention (1 week after program conclusion) | 
| Youth self-esteem | Mean self-esteem score | follow-up (6 months after program conclusion) | 
| General parent-child communication - parent/guardian report | Mean general parent-child communication score | baseline (1 week before program start) | 
| General parent-child communication - parent/guardian report | Mean general parent-child communication score | post-intervention (1 week after program conclusion) | 
| General parent-child communication - parent/guardian report | Mean general parent-child communication score | follow-up (6 months after program conclusion) | 
| Parent-child communication about family issues - parent/guardian report | Mean general parent-child communication about family issues score | baseline (1 week before program start) | 
| Parent-child communication about family issues - parent/guardian report | Mean general parent-child communication about family issues score | post-intervention (1 week after program conclusion) | 
| Parent-child communication about family issues - parent/guardian report | Mean general parent-child communication about family issues score | follow-up (6 months after program conclusion) | 
| Parent-child communication about alcohol and drugs - parent/guardian report | Mean parent-child communication about alcohol and drugs score | baseline (1 week before program start) | 
| Parent-child communication about alcohol and drugs - parent/guardian report | Mean parent-child communication about alcohol and drugs score | post-intervention (1 week after program conclusion) | 
| Parent-child communication about alcohol and drugs - parent/guardian report | Mean parent-child communication about alcohol and drugs score | follow-up (6 months after program conclusion) | 
| Parent/guardian report of youth behavior | Mean youth behavior score | baseline (1 week before program start) | 
| Parent/guardian report of youth behavior | Mean youth behavior score | post-intervention (1 week after program conclusion) | 
| Parent/guardian report of youth behavior | Mean youth behavior score | follow-up (6 months after program conclusion) | 
| Parent/guardian report parent-child shared activities | Count of shared activities | baseline (1 week before program start) | 
| Parent/guardian report parent-child shared activities | Count of shared activities | post-intervention (1 week after program conclusion) | 
| Parent/guardian report parent-child shared activities | Count of shared activities | follow-up (6 months after program conclusion) | 
| Parental monitoring - parent/guardian report | Mean parental monitoring score | baseline (1 week before program start) | 
| Parental monitoring - parent/guardian report | Mean parental monitoring score | post-intervention (1 week after program conclusion) | 
| Parental monitoring - parent/guardian report | Mean parental monitoring score | follow-up (6 months after program conclusion) | 
| General family rules - parent/guardian report | Mean family rules score | baseline (1 week before program start) | 
| General family rules - parent/guardian report | Mean family rules score | post-intervention (1 week after program conclusion) | 
| General family rules - parent/guardian report | Mean family rules score | follow-up (6 months after program conclusion) | 
| Family rules about substance use - parent/guardian report | Mean substance use rules score | baseline (1 week before program start) | 
| Family rules about substance use - parent/guardian report | Mean substance use rules score | post-intervention (1 week after program conclusion) | 
| Family rules about substance use - parent/guardian report | Mean substance use rules score | follow-up (6 months after program conclusion) | 
| Parent discipline practices | Mean parent discipline practices score | baseline (1 week before program start) | 
| Parent discipline practices | Mean parent discipline practices score | post-intervention (1 week after program conclusion) | 
| Parent discipline practices | Mean parent discipline practices score | follow-up (6 months after program conclusion) | 
| Other household member discipline practices | Mean other household member discipline practices score | baseline (1 week before program start) | 
| Other household member discipline practices | Mean other household member discipline practices score | post-intervention (1 week after program conclusion) | 
| Other household member discipline practices | Mean other household member discipline practices score | follow-up (6 months after program conclusion) | 
| Standard setting | Mean standard setting score | baseline (1 week before program start) | 
| Standard setting | Mean standard setting score | post-intervention (1 week after program conclusion) | 
| Standard setting | Mean standard setting score | follow-up (6 months after program conclusion) | 
| Parent-child conflict, parent/guardian report | Mean parent-child conflict score | baseline (1 week before program start) | 
| Parent-child conflict, parent/guardian report | Mean parent-child conflict score | post-intervention (1 week after program conclusion) | 
| Parent-child conflict, parent/guardian report | Mean parent-child conflict score | follow-up (6 months after program conclusion) | 
| Parent support, parent/guardian report | Mean parent support score | baseline (1 week before program start) | 
| Parent support, parent/guardian report | Mean parent support score | post-intervention (1 week after program conclusion) | 
| Parent support, parent/guardian report | Mean parent support score | follow-up (6 months after program conclusion) | 
| Parental positive affect, parent/guardian report | Mean parental positive affect score | baseline (1 week before program start) | 
| Parental positive affect, parent/guardian report | Mean parental positive affect score | post-intervention (1 week after program conclusion) | 
| Parental positive affect, parent/guardian report | Mean parental positive affect score | follow-up (6 months after program conclusion) | 
| Parental negative affect, parent/guardian report | Mean parental negative affect score | baseline (1 week before program start) | 
| Parental negative affect, parent/guardian report | Mean parental negative affect score | post-intervention (1 week after program conclusion) | 
| Parental negative affect, parent/guardian report | Mean parental negative affect score | follow-up (6 months after program conclusion) | 
| Parental anger management, parent/guardian report | Mean parental anger management score | baseline (1 week before program start) | 
| Parental anger management, parent/guardian report | Mean parental anger management score | post-intervention (1 week after program conclusion) | 
| Parental anger management, parent/guardian report | Mean parental anger management score | follow-up (6 months after program conclusion) | 
| Parental self-efficacy | Mean parental self-efficacy | baseline (1 week before program start) | 
| Parental self-efficacy | Mean parental self-efficacy | post-intervention (1 week after program conclusion) | 
| Parental self-efficacy | Mean parental self-efficacy | follow-up (6 months after program conclusion) | 
| Family meetings, parent/guardian report | Mean family meetings score | baseline (1 week before program start) | 
| Family meetings, parent/guardian report | Mean family meetings score | post-intervention (1 week after program conclusion) | 
| Family meetings, parent/guardian report | Mean family meetings score | follow-up (6 months after program conclusion) | 
| Family cohesion, parent/guardian report | Mean family cohesion score | baseline (1 week before program start) | 
| Family cohesion, parent/guardian report | Mean family cohesion score | post-intervention (1 week after program conclusion | 
| Family cohesion, parent/guardian report | Mean family cohesion score | follow-up (6 months after program conclusion) | 
| Family conflict resolution, parent/guardian report | Mean family conflict resolution score | baseline (1 week before program start) | 
| Family conflict resolution, parent/guardian report | Mean family conflict resolution score | post-intervention (1 week after program conclusion) | 
| Family conflict resolution, parent/guardian report | Mean family conflict resolution score | follow-up (6 months after program conclusion) | 
| Family expressiveness, parent/guardian report | Mean family expressiveness score | baseline (1 week before program start) | 
| Family expressiveness, parent/guardian report | Mean family expressiveness score | post-intervention (1 week after program conclusion) | 
| Family expressiveness, parent/guardian report | Mean family expressiveness score | follow-up (6 months after program conclusion) | 
| Lakota cultural socialization, parent/guardian report | Mean Lakota cultural socialization score | baseline (1 week before program start) | 
| Lakota cultural socialization, parent/guardian report | Mean Lakota cultural socialization score | post-intervention (1 week after program conclusion) | 
| Lakota cultural socialization, parent/guardian report | Mean Lakota cultural socialization score | follow-up (6 months after program conclusion) | 
| Lakota parenting practices | Mean Lakota parenting practices score | baseline (1 week before program start) | 
| Lakota parenting practices | Mean Lakota parenting practices score | post-intervention (1 week after program conclusion) | 
| Lakota parenting practices | Mean Lakota parenting practices score | follow-up (6 months after program conclusion) | 
| Knowledge of Lakota kinship terminology | Count of correct Lakota kinship terms | baseline (1 week before program start) | 
| Knowledge of Lakota kinship terminology | Count of correct Lakota kinship terms | post-intervention (1 week after program conclusion) | 
| Knowledge of Lakota kinship terminology | Count of correct Lakota kinship terms | follow-up (6 months after program conclusion) | 
| Parent lifetime alcohol use | Lifetime prevalence of alcohol use | baseline (1 week before program start) | 
| Parent lifetime alcohol use | Lifetime prevalence of alcohol use | post-intervention (1 week after program conclusion) | 
| Parent lifetime alcohol use | Lifetime prevalence of alcohol use | follow-up (6 months after program conclusion) | 
| Parent past month alcohol use | Mean frequency of past month alcohol use | baseline (1 week before program start) | 
| Parent past month alcohol use | Mean frequency of past month alcohol use | post-intervention (1 week after program conclusion) | 
| Parent past month alcohol use | Mean frequency of past month alcohol use | follow-up (6 months after program conclusion) | 
| Parent past month alcohol use quantity | Mean usual quantity of past month alcohol consumption | baseline (1 week before program start) | 
| Parent past month alcohol use quantity | Mean usual quantity of past month alcohol consumption | post-intervention (1 week after program conclusion) | 
| Parent past month alcohol use quantity | Mean usual quantity of past month alcohol consumption | follow-up (6 months after program conclusion) | 
| Parent past month alcohol use maximum quantity | Mean maximum quantity of past month alcohol consumption | baseline (1 week before program start) | 
| Parent past month alcohol use maximum quantity | Mean maximum quantity of past month alcohol consumption | post-intervention (1 week after program conclusion) | 
| Parent past month alcohol use maximum quantity | Mean maximum quantity of past month alcohol consumption | follow-up (6 months after program conclusion) | 
| Parent past month alcohol use usual quantity | Mean usual quantity of past month alcohol consumption | baseline (1 week before program start) | 
| Parent past month alcohol use usual quantity | Mean usual quantity of past month alcohol consumption | post-intervention (1 week after program conclusion) | 
| Parent past month alcohol use usual quantity | Mean usual quantity of past month alcohol consumption | follow-up (6 months after program conclusion) | 
| Parent past month alcohol intoxication frequency | Mean frequency of past month alcohol intoxication | baseline (1 week before program start) | 
| Parent past month alcohol intoxication frequency | Mean frequency of past month alcohol intoxication | post-intervention (1 week after program conclusion) | 
| Parent past month alcohol intoxication frequency | Mean frequency of past month alcohol intoxication | follow-up (6 months after program conclusion) | 
| Parent first age of alcohol use | Mean age of first alcohol use | baseline (1 week before program start) | 
| Parent first age of alcohol use | Mean age of first alcohol use | post-intervention (1 week after program conclusion) | 
| Parent first age of alcohol use | Mean age of first alcohol use | follow-up (6 months after program conclusion) | 
| Parent first age of alcohol intoxication | Mean age of first alcohol intoxication | baseline (1 week before program start) | 
| Parent first age of alcohol intoxication | Mean age of first alcohol intoxication | post-intervention (1 week after program conclusion) | 
| Parent first age of alcohol intoxication | Mean age of first alcohol intoxication | follow-up (6 months after program conclusion) | 
| Parent lifetime cigarette use | Lifetime prevalence of cigarette use | baseline (1 week before program start) | 
| Parent lifetime cigarette use | Lifetime prevalence of cigarette use | post-intervention (1 week after program conclusion) | 
| Parent lifetime cigarette use | Lifetime prevalence of cigarette use | follow-up (6 months after program conclusion) | 
| Parent past month cigarette use | Mean frequency and quantity of past month cigarette use | baseline (1 week before program start) | 
| Parent past month cigarette use | Mean frequency and quantity of past month cigarette use | post-intervention (1 week after program conclusion) | 
| Parent past month cigarette use | Mean frequency and quantity of past month cigarette use | follow-up (6 months after program conclusion) | 
| Parent age of first cigarette use | Mean age of first cigarette use | baseline (1 week before program start) | 
| Parent age of first cigarette use | Mean age of first cigarette use | post-intervention (1 week after program conclusion) | 
| Parent age of first cigarette use | Mean age of first cigarette use | follow-up (6 months after program conclusion) | 
| Parent lifetime smokeless tobacco use | Lifetime prevalence of smokeless tobacco use | baseline (1 week before program start) | 
| Parent lifetime smokeless tobacco use | Lifetime prevalence of smokeless tobacco use | post-intervention (1 week after program conclusion) | 
| Parent lifetime smokeless tobacco use | Lifetime prevalence of smokeless tobacco use | follow-up (6 months after program conclusion) | 
| Parent past month smokeless tobacco use | Mean frequency and quantity of past month smokeless tobacco use | baseline (1 week before program start) | 
| Parent past month smokeless tobacco use | Mean frequency and quantity of past month smokeless tobacco use | post-intervention (1 week after program conclusion) | 
| Parent past month smokeless tobacco use | Mean frequency and quantity of past month smokeless tobacco use | follow-up (6 months after program conclusion) | 
| Parent age of first smokeless tobacco use | Mean age of first smokeless tobacco use | baseline (1 week before program start) | 
| Parent age of first smokeless tobacco use | Mean age of first smokeless tobacco use | post-intervention (1 week after program conclusion) | 
| Parent age of first smokeless tobacco use | Mean age of first smokeless tobacco use | follow-up (6 months after program conclusion) | 
| Parent lifetime e-cigarette use | Lifetime prevalence of e-cigarette use | baseline (1 week before program start) | 
| Parent lifetime e-cigarette use | Lifetime prevalence of e-cigarette use | post-intervention (1 week after program conclusion) | 
| Parent lifetime e-cigarette use | Lifetime prevalence of e-cigarette use | follow-up (6 months after program conclusion) | 
| Parent frequency of past-month e-cigarette use | Mean frequency of past month e-cigarette use | baseline (1 week before program start) | 
| Parent frequency of past-month e-cigarette use | Mean frequency of past month e-cigarette use | post-intervention (1 week after program conclusion) | 
| Parent frequency of past-month e-cigarette use | Mean frequency of past month e-cigarette use | follow-up (6 months after program conclusion) | 
| Parent lifetime marijuana use | Lifetime prevalence of marijuana use | baseline (1 week before program start) | 
| Parent lifetime marijuana use | Lifetime prevalence of marijuana use | post-intervention (1 week after program conclusion) | 
| Parent lifetime marijuana use | Lifetime prevalence of marijuana use | follow-up (6 months after program conclusion) | 
| Parent past-month marijuana use | Mean frequency of past month marijuana use | baseline (1 week before program start) | 
| Parent past-month marijuana use | Mean frequency of past month marijuana use | post-intervention (1 week after program conclusion) | 
| Parent past-month marijuana use | Mean frequency of past month marijuana use | follow-up (6 months after program conclusion) | 
| Parent age of first marijuana use | Mean age of first marijuana use | baseline (1 week before program start) | 
| Parent age of first marijuana use | Mean age of first marijuana use | post-intervention (1 week after program conclusion) | 
| Parent age of first marijuana use | Mean age of first marijuana use | follow-up (6 months after program conclusion) | 
| Parent lifetime huffing | Lifetime prevalence of huffing/inhalant use | baseline (1 week before program start) | 
| Parent lifetime huffing | Lifetime prevalence of huffing/inhalant use | post-intervention (1 week after program conclusion) | 
| Parent lifetime huffing | Lifetime prevalence of huffing/inhalant use | follow-up (6 months after program conclusion) | 
| Parent past month huffing | Mean frequency of past month huffing/inhalant use | baseline (1 week before program start) | 
| Parent past month huffing | Mean frequency of past month huffing/inhalant use | post-intervention (1 week after program conclusion) | 
| Parent past month huffing | Mean frequency of past month huffing/inhalant use | follow-up (6 months after program conclusion) | 
| Parent age of first huffing | Mean age of first huffing/inhalant use | baseline (1 week before program start) | 
| Parent age of first huffing | Mean age of first huffing/inhalant use | post-intervention (1 week after program conclusion) | 
| Parent age of first huffing | Mean age of first huffing/inhalant use | follow-up (6 months after program conclusion) | 
| Parent lifetime use of non-prescription painkillers | Lifetime prevalence of non-prescription painkiller use | baseline (1 week before program start) | 
| Parent lifetime use of non-prescription painkillers | Lifetime prevalence of non-prescription painkiller use | post-intervention (1 week after program conclusion | 
| Parent lifetime use of non-prescription painkillers | Lifetime prevalence of non-prescription painkiller use | follow-up (6 months after program conclusion) | 
| Parent past month non-prescription painkiller use | Mean frequency of past month non-prescription painkiller use | baseline (1 week before program start) | 
| Parent past month non-prescription painkiller use | Mean frequency of past month non-prescription painkiller use | post-intervention (1 week after program conclusion) | 
| Parent past month non-prescription painkiller use | Mean frequency of past month non-prescription painkiller use | follow-up (6 months after program conclusion) | 
| Parent lifetime stimulant use | Lifetime prevalence of stimulant use | baseline (1 week before program start) | 
| Parent lifetime stimulant use | Lifetime prevalence of stimulant use | post-intervention (1 week after program conclusion) | 
| Parent lifetime stimulant use | Lifetime prevalence of stimulant use | follow-up (6 months after program conclusion) | 
| Parent past month stimulant use | Mean frequency of past month huffing/inhalant use | baseline (1 week before program start) | 
| Parent past month stimulant use | Mean frequency of past month huffing/inhalant use | post-intervention (1 week after program conclusion) | 
| Parent past month stimulant use | Mean frequency of past month huffing/inhalant use | follow-up (6 months after program conclusion) | 
| Parent lifetime sedative use | Lifetime prevalence of sedative use | baseline (1 week before program start) | 
| Parent lifetime sedative use | Lifetime prevalence of sedative use | post-intervention (1 week after program conclusion) | 
| Parent lifetime sedative use | Lifetime prevalence of sedative use | follow-up (6 months after program conclusion) | 
| Parent past month sedative use | Mean frequency of past month sedative use | baseline (1 week before program start) | 
| Parent past month sedative use | Mean frequency of past month sedative use | post-intervention (1 week after program conclusion) | 
| Parent past month sedative use | Mean frequency of past month sedative use | follow-up (6 months after program conclusion) | 
| Parent lifetime heroin use | Lifetime prevalence of heroin use | baseline (1 week before program start) | 
| Parent lifetime heroin use | Lifetime prevalence of heroin use | post-intervention (1 week after program conclusion) | 
| Parent lifetime heroin use | Lifetime prevalence of heroin use | follow-up (6 months after program conclusion) | 
| Parent past month heroin use | Mean frequency of past month heroin use | baseline (1 week before program start) | 
| Parent past month heroin use | Mean frequency of past month heroin use | post-intervention (1 week after program conclusion) | 
| Parent past month heroin use | Mean frequency of past month heroin use | follow-up (6 months after program conclusion) | 
| Parent lifetime methamphetamine use | Lifetime prevalence of methamphetamine use | baseline (1 week before program start) | 
| Parent lifetime methamphetamine use | Lifetime prevalence of methamphetamine use | post-intervention (1 week after program conclusion) | 
| Parent lifetime methamphetamine use | Lifetime prevalence of methamphetamine use | follow-up (6 months after program conclusion) | 
| Parent past month methamphetamine use | Mean frequency of past month methamphetamine use | baseline (1 week before program start) | 
| Parent past month methamphetamine use | Mean frequency of past month methamphetamine use | post-intervention (1 week after program conclusion) | 
| Parent past month methamphetamine use | Mean frequency of past month methamphetamine use | follow-up (6 months after program conclusion) | 
| Parent lifetime hallucinogen use | Lifetime prevalence of hallucinogen use | baseline (1 week before program start) | 
| Parent lifetime hallucinogen use | Lifetime prevalence of hallucinogen use | post-intervention (1 week after program conclusion) | 
| Parent lifetime hallucinogen use | Lifetime prevalence of hallucinogen use | follow-up (6 months after program conclusion) | 
| Parent past month hallucinogen use | Mean frequency of past month hallucinogen use | baseline (1 week before program start) | 
| Parent past month hallucinogen use | Mean frequency of past month hallucinogen use | post-intervention (1 week after program conclusion) | 
| Parent past month hallucinogen use | Mean frequency of past month hallucinogen use | follow-up (6 months after program conclusion) | 
| Parent lifetime club drug use | Lifetime prevalence of club drug use | baseline (1 week before program start) | 
| Parent lifetime club drug use | Lifetime prevalence of club drug use | post-intervention (1 week after program conclusion) | 
| Parent lifetime club drug use | Lifetime prevalence of club drug use | follow-up (6 months after program conclusion) | 
| Parent past month club drug use | Mean frequency of past month club drug use | baseline (1 week before program start) | 
| Parent past month club drug use | Mean frequency of past month club drug use | post-intervention (1 week after program conclusion) | 
| Parent past month club drug use | Mean frequency of past month club drug use | follow-up (6 months after program conclusion) | 
| Parent lifetime cocaine/crack use | Lifetime prevalence of cocaine/crack use | baseline (1 week before program start) | 
| Parent lifetime cocaine/crack use | Lifetime prevalence of cocaine/crack use | post-intervention (1 week after program conclusion) | 
| Parent lifetime cocaine/crack use | Lifetime prevalence of cocaine/crack use | follow-up (6 months after program conclusion) | 
| Parent past month cocaine/crack use | Mean frequency of past month cocaine/crack use | baseline (1 week before program start) | 
| Parent past month cocaine/crack use | Mean frequency of past month cocaine/crack use | follow-up (6 months after program conclusion) | 
| Parent HIV risk behavior | Lifetime prevalence of HIV risk behavior | baseline (1 week before program start) | 
| Parent HIV risk behavior | Lifetime prevalence of HIV risk behavior | post-intervention (1 week after program conclusion) | 
| Parent HIV risk behavior | Lifetime prevalence of HIV risk behavior | follow-up (6 months after program conclusion) | 
| Parent psychological distress | Mean psychological distress score | baseline (1 week before program start) | 
| Parent psychological distress | Mean psychological distress score | post-intervention (1 week after program conclusion) | 
| Parent psychological distress | Mean psychological distress score | follow-up (6 months after program conclusion) | 
| Parent life satisfaction | Mean life satisfaction score | baseline (1 week before program start) | 
| Parent life satisfaction | Mean life satisfaction score | post-intervention (1 week after program conclusion) | 
| Parent life satisfaction | Mean life satisfaction score | follow-up (6 months after program conclusion) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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American Indian, Adolescent, Prevention