摘要：Objectives. To evaluate combined individual- and community-level interventions to reduce underage drinking by American Indian/Alaska Native (AI/AN) youths on rural California Indian reservations. Methods. Individual-level interventions included brief motivational interviewing and psychoeducation for Tribal youths. Community-level interventions included community mobilization and awareness activities, as well as restricting alcohol sales to minors. To test effects, we compared 7 waves of California Healthy Kids Survey data (2002–2015) for 9th- and 11th-grade AI/AN and non-AI/AN students in intervention area schools with California AI/AN students outside the intervention area (n = 617, n = 33 469, and n = 976, respectively). Results. Pre- to postintervention mean past 30-day drinking frequency declined among current drinkers in the intervention group (8.4–6.3 days) relative to comparison groups. Similarly, heavy episodic drinking frequency among current drinkers declined in the intervention group (7.0–4.8 days) versus the comparison groups. Conclusions. This study documented significant, sustained past 30-day drinking or heavy episodic drinking frequency reductions among AI/AN 9th- and 11th-grade current drinkers in rural California Indian reservation communities exposed to multilevel interventions. Public Health Implications. Multilevel community-partnered interventions can effectively reduce underage alcohol use in this population. Underage drinking is a public health concern for US youths, including American Indians and Alaska Natives (AI/ANs), 1,2 and has acute and long-term consequences. 3–5 Early initiation of alcohol use and heavy drinking increase risks for lifetime alcohol use disorders, 6,7 especially among AI/ANs who have reported younger onsets than other groups. 8,9 Because adolescents from rural areas may be at increased risk for underage drinking, 10 AI/AN adolescents on rural Indian reservations may be at greater risk than are other adolescents. 2,11–14 However, reviews of interventions among AI/AN adolescents have found few studies with sufficient research rigor to establish program acceptability or effectiveness in Tribal communities. 15 Interventions to prevent underage drinking tend to be either: (1) community-level approaches to reduce alcohol availability or (2) individual-level approaches to discourage alcohol use via clinical or educational efforts with children or parents. Combining these approaches is rare, 16,17 especially for AI/AN youths. 18 However, multilevel interventions have the potential to work synergistically to reduce both supply of and demand for alcohol. The present study reports on a long-term collaborative effort (2006–2015) between clinicians, prevention scientists, and Tribal leaders to prevent underage drinking in 9 contiguous rural California Indian reservations. We initiated the project at the request of leaders of these sovereign Tribal nations. We developed the partnerships and interventions during a capacity-building and pilot phase. During the intervention phase (2008–2011), the project staff implemented both community- and individual-level prevention strategies. Following the intervention phase, program staff continued to hold outreach events at community gatherings and Tribal after school programs. The individual-level strategy consisted of a randomized trial of brief motivational interviewing (MI) compared with psychoeducation (PE) for reducing and preventing underage drinking. MI has been found to be effective for youths, 19,20 including AI/ANs, 21 is acceptable to California Indians, 22 and is culturally adaptable for use with AI youths. 23,24 The community-level strategies targeted the sale of alcohol to minors, together with outreach efforts to raise awareness of alcohol problems and mobilize support for project goals. Previous prevention studies have shown significant reductions in drinking and drinking problems as a result of modifying the alcohol environment. 25–27 Despite some evidence that modifying the alcohol environment can have beneficial effects for AI/ANs, 28,29 effects of environmental prevention programs for Tribal populations have been rarely tested. We hypothesized that combined individual- and community-level interventions to reduce alcohol consumption by Tribal youths in reservation settings would be associated with lower prevalence and frequency of alcohol consumption than among Tribal youths in reservations outside the intervention catchment area. Because the Tribal communities did not wish to implement a randomized control study, we assessed the overall impacts of the combined interventions by analyzing alcohol use data from the California Healthy Kids Survey (CHKS), which was collected anonymously in the school districts serving the 9 participating reservations and the 9 comparison reservations.
