Review of Community-Level Interventions for Suicide and Substance Use Prevention Among North American Indigenous Youth: 2012-2023 Open Access

Abstract

The purpose of this review is to assess the field of research from January 2012 to February 2023 on community-level suicide and substance use interventions among AI/AN youth to answer the research question: what is the current landscape in the field of indigenous-focused, community-based interventions for suicide and substance-use prevention in indigenous youth in North America? It will do this by focusing on three aspects of the literature, including evaluation measures, effectiveness, and strategies addressing cultural, familial, community, and individual needs of AI/AN youth.

A search of five electronic databases for articles related to the research questions (CINAHL, Web of Science, PubMed, Cochrane, and EmBase) was conducted, and published reference lists of other reviews were manually searched to identify articles published between 2012 and 2023 that related to the research questions for this review. A manual search of websites of organizations involved in indigenous health research was also utilized. Abstracts were manually assessed for inclusion and exclusion criteria.

Twenty-three interventions related to suicide and/or substance use prevention for AI/AN youth in the US and Canada with published material between 2012 and 2023 were identified. Outcomes varied in significance and generalizability, with two interventions producing significant results and nine producing mixed effectiveness. Interventions showed a high attention to cultural appropriateness and engagement with community members.

Progress in this field of research is ongoing; short-term recommendations for the field include further evaluation of promising interventions for effectiveness, adaptation of effective interventions to other communities, and piloting of culturally based interventions for urban-dwelling AI/AN youth.

Table of Contents

TABLE OF CONTENTS

1. Introduction 1

1.1 Rationale 1

Table 1.0 CDC YRBS Data for Alcohol, Suicidal Ideation, and Illicit Drug Use 3

Table 1.2 CDC ABES (2021) data for Alcohol, Suicidal Ideation, and Illicit drug use 4

1. 2 Background 5

1.2.1 Health inequities 6

1.2.2 Adverse Childhood Experiences 8

Table 1.3 Comparison of AI/AN ACE Prevalence to other races in the U.S., 2009‒2017 (N=3,894) from Giano et al., 2021 9

1.2.3 Colonization and Historical Trauma Theory 10

1.2.4 Historical Trauma and Adverse Childhood Experiences 11

1.2.5 Link between Historical Trauma, ACEs, and Mental Health 12

1.2.6 Implications for interventions 13

1.2.7 Related Systematic Reviews 14

1.3 Problem Statement 15

1.4 Purpose Statement 15

1.5 Significance 16

2.    Methods 17

2.1 Data Sources 17

Table 2.0 Search Strategies 17

2.2 Study selection 18

Table 2.1 Inclusion and exclusion criteria 19

Figure 1: PRISMA flow diagram 21

2.3 Data coding and analysis 22

Table 2.2 Variables and Codes 22

3.    Results 23

3.1 Evaluation of Interventions 23

Table 3.1 Results 24

3.2 Location and Population 35

3.2.1 Location 35

3.2.2 Population 35

3.3 Sampling and recruitment strategies 36

3.4 Delivery Mechanisms 38

3.4.1 Summary 38

3.4.2 Community-delivered interventions 39

3.4.3 School-delivered 40

3.4.4 Community Mental Health Workers and Paraprofessionals 41

3.5 Intervention focus 42

3.5.1 Summary 42

3.5.2 Community Involvement 43

3.5.3 Approaches 44

3.5.5 Cultural Appropriateness 46

3.6 Study Designs 47

3.7 Limitations and challenges 48

4. Discussion 49

4.1 Summary of results 49

4.1.1 Addressing ACEs 49

4.2 Evaluation and Evidence of Intervention Effectiveness 50

4.3 Intervention Delivery and Indigenous CMHWs 51

4.4 Family, Culture, and Community connection 51

4.4.1 Urban-dwelling AI/AN Youth 53

4.5 Limitations 53

5. Recommendations and Conclusions 54

References 57

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Psychology, Behavioral Health Sciences, Public Health Native American Studies
Keyword	Substance Use Prevention Community-based interventions Mental Health Substance Use Native American Health Suicide Prevention
Committee Chair / Thesis Advisor	Kate Winskell, Emory University Gaëlle Sabben, Emory University

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