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Using multi-level approach to reduce underage drinking among youths on rural reservations

Using multi-level approach to reduce underage drinking among youths on rural reservations

Underage drinking is a concern all over the country. Among American Indian and Alaska Native populations, there are especially serious issues: alcohol use and heavy drinking at an early age increase risks for lifetime alcohol problems, and American Indians and Native Alaskans have reported younger onsets than other groups.

A recent study by the Prevention Research Center of the Pacific Institute for Research and Evaluation, the Scripps Research Institute, and the Southern California Tribal Health Center, evaluated the effects of combined individual- and community-level interventions to reduce underage drinking by American Indian/Alaska Native youths on rural California Indian reservations. The study was funded by the National Institute on Alcohol Abuse and Alcoholism.

Eligible youths between 13 and 20 were randomly assigned to receive brief motivational interviewing or psychoeducation. Motivational interviewing is a widely researched technique that uses a non-confrontational approach to encourage individuals to change unhealthy behaviors, in this case drinking alcohol.

The clinic therapists who delivered this part of the program used a culturally-tailored approach tested with diverse American Indian groups. The psychoeducation program consisted of watching 2 DVDs on the consequences of drinking and dangers of binge drinking, assisted by the therapist. Both conditions lasted 1.5 hours and took place either individually or in groups.

The community-level program focused on reducing underage access to alcohol and reinforcing community norms against providing alcohol to youths. The researchers implemented a “recognition and reminder” program to reduce sales to minors. In recognition and reminder programs, apparent minors (i.e., volunteers 21 years or older, but judged to look younger) visited stores and tried to buy alcoholic beverages. Project staff rewarded clerks who asked for age identification (with gift cards and congratulatory letters) or reminded clerks who did not request identification of underage sales laws.

These programs have been found to reduce alcohol sales to minors.

The researchers also implemented an outreach program to raise community awareness about the risks of underage substance use and to mobilize support for the interventions.

Project staff developed informational materials on underage alcohol use for distribution to youths, parents, Tribal leaders, and health clinic professionals. Outreach staff from local communities presented these materials and discussed alcohol-related risks and alcohol-free strategies with youths and parents at health fairs, pow-wows, and cultural gatherings. Staff also gave age-appropriate presentations at the after-school programs of each Tribe, a reservation charter school, Tribal councils, and other meetings.

To test the effects of these strategies, the researchers compared 7 waves of California Healthy Kids Survey data (2002-2015) for 9th and 11th-grade American Indian and non-Indian students in intervention area schools with California American Indian students outside the intervention area.

Reports of drinking frequency declined among students who were current drinkers in the intervention group relative to comparison groups. Heavy drinking frequency among current drinkers also declined in the intervention group relative to the comparison groups.

Follow-up with the students who received both the motivational interviews and the psychoeducation showed significant reductions in drinking and problem behaviors over time, although there were no significant differences between the two approaches.

Study authors concluded that this type of multi-level approach – including both individual interventions and community participation – can reduce the frequency of underage drinking and reduce the frequency of heavy drinking among young American Indians.

Lead study author Roland Moore stated, “American Indian Tribes place a high value on the current and future well-being of their children. Their well-being is threatened by early alcohol involvement. We are pleased to be able to suggest this combination of approaches to help protect American Indian and Alaska Native youth.”​

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