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Article ; Online: School Racial Composition as a Moderator of the Effect of Discrimination on Mental Health and Substance use Among American Indian Adolescents.

Barry, Caroline M / Livingston, Melvin D / Livingston, Bethany J / Kominsky, Terrence K / Komro, Kelli A

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

2023 Volume 74, Issue 1, Page(s) 44–50

Abstract: Purpose: To examine the relationships between individual-level perceived racial/ethnic discrimination and mental health and substance use outcomes by school-level racial composition among American Indian (AI) adolescents.: Method: Self-reported ... ...

Abstract	Purpose: To examine the relationships between individual-level perceived racial/ethnic discrimination and mental health and substance use outcomes by school-level racial composition among American Indian (AI) adolescents. Method: Self-reported survey data on individual-level variables come from a sample of AI adolescents (n = 510) living in or near the Cherokee Nation during the fall of 2021. School-level data come from publicly available databases. Multilevel linear and logistic regression analyses were performed to test for and examine the interaction between perceived racial/ethnic discrimination and school racial composition in relation to symptoms of anxiety and depression, past 30-day use of alcohol and marijuana, and misuse of prescription opioids. Results: Adjusted analyses showed a significant interaction effect between discrimination and racial composition on anxiety symptoms, such that the effect of discrimination was more pronounced at lower % AI (10th percentile) than at more equivalently mixed (50th percentile) or higher % AI (90th percentile) school settings. No significant interactions were observed with depressive symptoms or substance use outcomes. Discussion: School racial compositions of higher percentage AI may buffer the adverse effect of racial/ethnic discrimination on anxiety symptoms among AI adolescents.
MeSH term(s)	Humans ; Adolescent ; Mental Health ; American Indian or Alaska Native ; Racism/psychology ; Substance-Related Disorders/psychology
Language	English
Publishing date	2023-09-20
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	1063374-1
ISSN	1879-1972 ; 1054-139X
ISSN (online)	1879-1972
ISSN	1054-139X
DOI	10.1016/j.jadohealth.2023.07.014
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Article ; Online: Adolescent Advertising Exposure to Cannabis Products in Rural Oklahoma via Medical Dispensaries.

Livingston, Melvin / Barry, Caroline / Walker, Andrew / Livingston, Bethany / Talavera-Brown, Sierra L / Harmon, Megan / Wagenaar, Alexander / Kominsky, Terrence / Komro, Kelli A

Journal of studies on alcohol and drugs

2023 Volume 84, Issue 5, Page(s) 693–699

Abstract: Objective: We assess cannabis advertising exposure among adolescents in rural Oklahoma from medical dispensaries.: Method: Our mixed-methods study identified medical dispensaries within a 15-minute drive time of rural Oklahoma high schools. Study ... ...

Abstract	Objective: We assess cannabis advertising exposure among adolescents in rural Oklahoma from medical dispensaries. Method: Our mixed-methods study identified medical dispensaries within a 15-minute drive time of rural Oklahoma high schools. Study staff completed observational data collection forms and took photographs of each dispensary. Quantitative data from the forms and qualitative coding of photographs were used to describe dispensary characteristics and likely advertising exposure for adolescents. Results: Ninety-two dispensaries were identified across 20 rural communities. The majority presented as retail spaces ( Conclusions: Sampled rural medical dispensaries present as retail spaces and are a likely source of adolescent cannabis advertising exposure.
MeSH term(s)	Humans ; Adolescent ; Cannabis ; Advertising/methods ; Oklahoma/epidemiology ; Rural Population ; Marketing ; Hallucinogens ; Commerce ; Medical Marijuana
Chemical Substances	Hallucinogens ; Medical Marijuana
Language	English
Publishing date	2023-05-18
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2266450-6
ISSN	1938-4114 ; 1934-2683 ; 1937-1888 ; 0096-882X
ISSN (online)	1938-4114 ; 1934-2683
ISSN	1937-1888 ; 0096-882X
DOI	10.15288/jsad.22-00292
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Article ; Online: Perceived Racial/Ethnic Discrimination and Depressive Symptoms among Adolescents Living in the Cherokee Nation.

Barry, Caroline M / Garrett, Brady A / Livingston, Melvin D / Kominsky, Terrence K / Livingston, Bethany J / Komro, Kelli A

American Indian and Alaska native mental health research (Online)

2022 Volume 29, Issue 1, Page(s) 22–36

Abstract: The objective of this study was to examine the longitudinal relationship between perceived racial/ethnic discrimination and depressive symptoms among adolescents living in the Cherokee Nation, as well as the potential moderating roles of race and social ... ...

Abstract	The objective of this study was to examine the longitudinal relationship between perceived racial/ethnic discrimination and depressive symptoms among adolescents living in the Cherokee Nation, as well as the potential moderating roles of race and social support. Self-reported survey data were analyzed from a sample of high school students (n = 1,622) who identified as American Indian only, American Indian and White, and White only. Compared to students who reported no discrimination on the basis of race, those who reported ever having experienced discrimination scored, on average, 1.62 units higher on the depressive symptoms scale six months later (p = .0001, 95% CI: 0.90, 2.33), while adjusting for age, race, gender, baseline depressive symptoms, enrollment in a free/reduced-price lunch program, and social support. Discrimination intensity did not significantly predict depressive symptoms among those reporting some frequency of discrimination. Race and social support did not modify either effect. These findings may inform development of interventions to promote mental health among American Indian adolescents.
MeSH term(s)	Adolescent ; Depression/diagnosis ; Ethnicity ; Humans ; Indians, North American ; Mental Health ; Racism/psychology
Language	English
Publishing date	2022-03-07
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	2079045-4
ISSN	1533-7731 ; 1533-7731
ISSN (online)	1533-7731
ISSN	1533-7731
DOI	10.5820/aian.2901.2022.22
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Article: The Effects of Perceived Racial/Ethnic Discrimination on Substance Use Among Youths Living in the Cherokee Nation.

Garrett, Brady A / Livingston, Bethany J / Livingston, Melvin D / Komro, Kelli A

Journal of child & adolescent substance abuse

2017 Volume 26, Issue 3, Page(s) 242–249

Abstract: We examined frequency and intensity of racial/ethnic discrimination and the longitudinal relationship to substance use. The sample included ( ...

Abstract	We examined frequency and intensity of racial/ethnic discrimination and the longitudinal relationship to substance use. The sample included (
Language	English
Publishing date	2017-03-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	1317703-5
ISSN	1067-828X
ISSN	1067-828X
DOI	10.1080/1067828X.2017.1299656
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Article ; Online: Economic Evaluation Design within the HEAL Prevention Cooperative.

Dunlap, Laura J / Kuklinski, Margaret R / Cowell, Alexander / McCollister, Kathryn E / Bowser, Diana M / Campbell, Mark / Fernandes, Claudia-Santi F / Kemburu, Pranav / Livingston, Bethany J / Prosser, Lisa A / Rao, Vinod / Smart, Rosanna / Yilmazer, Tansel

Prevention science : the official journal of the Society for Prevention Research

2022 Volume 24, Issue Suppl 1, Page(s) 50–60

Abstract: The rapid rise in opioid misuse, disorder, and opioid-involved deaths among older adolescents and young adults is an urgent public health problem. Prevention is a vital part of the nation's response to the opioid crisis, yet preventive interventions for ... ...

Abstract	The rapid rise in opioid misuse, disorder, and opioid-involved deaths among older adolescents and young adults is an urgent public health problem. Prevention is a vital part of the nation's response to the opioid crisis, yet preventive interventions for those at risk for opioid misuse and opioid use disorder are scarce. In 2019, the National Institutes of Health (NIH) launched the Preventing Opioid Use Disorder in Older Adolescents and Young Adults cooperative as part of its broader Helping to End Addiction Long-term (HEAL) Initiative ( https://heal.nih.gov/ ). The HEAL Prevention Cooperative (HPC) includes ten research projects funded with the goal of developing effective prevention interventions across various settings (e.g., community, health care, juvenile justice, school) for older adolescent and young adults at risk for opioid misuse and opioid use disorder (OUD). An important component of the HPC is the inclusion of an economic evaluation by nine of these research projects that will provide information on the costs, cost-effectiveness, and sustainability of these interventions. The HPC economic evaluation is integrated into each research project's overall design with start-up costs and ongoing delivery costs collected prospectively using an activity-based costing approach. The primary objectives of the economic evaluation are to estimate the intervention implementation costs to providers, estimate the cost-effectiveness of each intervention for reducing opioid misuse initiation and escalation among youth, and use simulation modeling to estimate the budget impact of broader implementation of the interventions within the various settings over multiple years. The HPC offers an extraordinary opportunity to generate economic evidence for substance use prevention programming, providing policy makers and providers with critical information on the investments needed to start-up prevention interventions, as well as the cost-effectiveness of these interventions relative to alternatives. These data will help demonstrate the valuable role that prevention can play in combating the opioid crisis.
MeSH term(s)	Adolescent ; Young Adult ; Humans ; Cost-Benefit Analysis ; Opioid-Related Disorders/prevention & control ; Opioid-Related Disorders/drug therapy ; Analgesics, Opioid ; Behavior, Addictive
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2022-08-10
Publishing country	United States
Document type	Journal Article
ZDB-ID	2251270-6
ISSN	1573-6695 ; 1389-4986
ISSN (online)	1573-6695
ISSN	1389-4986
DOI	10.1007/s11121-022-01400-5
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Article ; Online: Study protocol for a cluster randomized trial of a school, family, and community intervention for preventing drug misuse among older adolescents in the Cherokee Nation.

Komro, Kelli A / Kominsky, Terrence K / Skinner, Juli R / Livingston, Melvin D / Livingston, Bethany J / Avance, Kristin / Lincoln, Ashley N / Barry, Caroline M / Walker, Andrew L / Pettigrew, Dallas W / Merlo, Lisa J / Cooper, Hannah L F / Wagenaar, Alexander C

Trials

2022 Volume 23, Issue 1, Page(s) 175

Abstract: Background: The national opioid crisis has disproportionately burdened rural White populations and American Indian/Alaska Native (AI/AN) populations. Therefore, Cherokee Nation and Emory University public health scientists have designed an opioid ... ...

Abstract	Background: The national opioid crisis has disproportionately burdened rural White populations and American Indian/Alaska Native (AI/AN) populations. Therefore, Cherokee Nation and Emory University public health scientists have designed an opioid prevention trial to be conducted in rural communities in the Cherokee Nation (northeast Oklahoma) with AI and other (mostly White) adolescents and young adults. Our goal is to implement and evaluate a theory-based, integrated multi-level community intervention designed to prevent the onset and escalation of opioid and other drug misuse. Two distinct intervention approaches-community organizing, as implemented in our established Communities Mobilizing for Change and Action (CMCA) intervention protocol, and universal school-based brief intervention and referral, as implemented in our established Connect intervention protocol-will be integrated with skill-based training for adults to strengthen social support for youth and also with strategic media. Furthermore, we will test systems for sustained implementation within existing organizational structures of the Cherokee Nation and local schools and communities. This study protocol describes the cluster randomized trial, designed to measure implementation and evaluate the effectiveness on primary and secondary outcomes. Methods: Using a cluster randomized controlled design and constrained randomization, this trial will allocate 20 high schools and surrounding communities to either an intervention or delayed-intervention comparison condition. With a proposed sample of 20 high schools, all enrolled 10th grade students in fall 2021 (ages 15 to 17) will be eligible for participation. During the trial, we will (1) implement interventions through the Cherokee Nation and measure implementation processes and fidelity, (2) measure opioid and other drug use and secondary outcomes every 6 months among a cohort of high school students followed over 3 years through their transition out of high school, (3) test via a cluster randomized trial the effect of the integrated CMCA-Connect intervention, and (4) analyze implementation costs. Primary outcomes include the number of days during the past 30 days of (1) any alcohol use, (2) heavy alcohol use (defined as having at least four, among young women, or five, among young men, standard alcoholic drinks within a couple of hours), (3) any marijuana use, and (4) prescription opioid misuse (defined as "without a doctor's prescription or differently than how a doctor or medical provider told you to use it"). Discussion: This trial will expand upon previous research advancing the scientific evidence regarding prevention of opioid and other drug misuse during the critical developmental period of late adolescent transition to young adulthood among a sample of American Indian and other youth living within the Cherokee Nation reservation. Trial registration: ClinicalTrials.gov NCT04839978 . Registered on April 9, 2021. Version 4, January 26, 2022.
MeSH term(s)	Adolescent ; Adult ; Alcohol Drinking/prevention & control ; Drug Misuse ; Female ; Humans ; Male ; Opioid-Related Disorders/diagnosis ; Opioid-Related Disorders/epidemiology ; Opioid-Related Disorders/prevention & control ; Randomized Controlled Trials as Topic ; Schools ; Students ; Young Adult
Language	English
Publishing date	2022-02-23
Publishing country	England
Document type	Clinical Trial Protocol ; Journal Article
ZDB-ID	2040523-6
ISSN	1745-6215 ; 1468-6694 ; 1745-6215
ISSN (online)	1745-6215
ISSN	1468-6694 ; 1745-6215
DOI	10.1186/s13063-022-06096-0
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Article ; Online: CONNECT: Implementation of a School-Based Alcohol Screening and Brief Intervention for Youth in the Cherokee Nation.

Garrett, Brady A / Komro, Kelli A / Merlo, Lisa J / Livingston, Bethany J / Rentmeester, Shelby / Tobler, Amy / Livingston, Melvin D / Kominsky, Terrence K

The Journal of school health

2019 Volume 89, Issue 11, Page(s) 874–882

Abstract: Background: There is growing optimism regarding the use of screening and brief intervention (SBI) to identify and reduce risk behaviors during adolescence. However, understanding successful SBI implementation remains unclear. We previously reported the ... ...

Abstract	Background: There is growing optimism regarding the use of screening and brief intervention (SBI) to identify and reduce risk behaviors during adolescence. However, understanding successful SBI implementation remains unclear. We previously reported the effects of CONNECT, a school-based SBI, on reducing the primary outcome, the rate of monthly alcohol use among primarily American Indian (AI) and White high school students in the Cherokee Nation. In this paper, we describe the design and implementation process for CONNECT. Method: CONNECT was designed to reduce alcohol use with 2 key strategies: (1) SBI with motivational interviewing (MI), implemented by a school-based CONNECT coach, and (2) a media campaign. Results: Implementation results indicate that during each semester of the 2-1/2 years, between 73% and 100% of eligible students had at least one 15-minute meeting with a CONNECT coach. Postcards and posters with positive communication tips for parents were displayed in CONNECT communities. No statistically significant differences occurred between the CONNECT and control groups on the hypothesized intermediate outcomes. Conclusions: We describe implementation of a universal, school-based, culturally adapted SBI that was effective in reducing alcohol use among youth living in the Cherokee Nation. Schools provide an important context for universal delivery of SBI interventions, such as CONNECT, for diverse adolescent populations, including AI youth.
MeSH term(s)	Adolescent ; Female ; Humans ; Indians, North American ; Male ; Mass Media ; Mass Screening/methods ; Motivational Interviewing ; School Health Services/organization & administration ; Underage Drinking/prevention & control ; United States
Language	English
Publishing date	2019-09-02
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	952835-0
ISSN	1746-1561 ; 0022-4391
ISSN (online)	1746-1561
ISSN	0022-4391
DOI	10.1111/josh.12830
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Article ; Online: Fifteen-minute comprehensive alcohol risk survey: reliability and validity across American Indian and White adolescents.

Komro, Kelli A / Livingston, Melvin D / Kominsky, Terrence K / Livingston, Bethany J / Garrett, Brady A / Molina, Mildred Maldonado / Boyd, Misty L

Journal of studies on alcohol and drugs

2014 Volume 76, Issue 1, Page(s) 133–142

Abstract: Objective: American Indians (AIs) suffer from significant alcohol-related health disparities, and increased risk begins early. This study examined the reliability and validity of measures to be used in a preventive intervention trial. Reliability and ... ...

Abstract	Objective: American Indians (AIs) suffer from significant alcohol-related health disparities, and increased risk begins early. This study examined the reliability and validity of measures to be used in a preventive intervention trial. Reliability and validity across racial/ethnic subgroups are crucial to evaluate intervention effectiveness and promote culturally appropriate evidence-based practice. Method: To assess reliability and validity, we used three baseline surveys of high school students participating in a preventive intervention trial within the jurisdictional service area of the Cherokee Nation in northeastern Oklahoma. The 15-minute alcohol risk survey included 16 multi-item scales and one composite score measuring key proximal, primary, and moderating variables. Forty-four percent of the students indicated that they were AI (of whom 82% were Cherokee), including 23% who reported being AI only (n = 435) and 18% both AI and White (n = 352). Forty-seven percent reported being White only (n = 901). Results: Scales were adequately reliable for the full sample and across race/ethnicity defined by AI, AI/White, and White subgroups. Among the full sample, all scales had acceptable internal consistency, with minor variation across race/ethnicity. All scales had extensive to exemplary test-retest reliability and showed minimal variation across race/ethnicity. The eight proximal and two primary outcome scales were each significantly associated with the frequency of alcohol use during the past month in both the cross-sectional and the longitudinal models, providing support for both criterion validity and predictive validity. For most scales, interpretation of the strength of association and statistical significance did not differ between the racial/ethnic subgroups. Conclusions: The results support the reliability and validity of scales of a brief questionnaire measuring risk and protective factors for alcohol use among AI adolescents, primarily members of the Cherokee Nation.
MeSH term(s)	Adolescent ; Alcohol Drinking/epidemiology ; Alcohol Drinking/ethnology ; Cross-Sectional Studies ; Ethnicity/statistics & numerical data ; Female ; Humans ; Indians, North American/statistics & numerical data ; Male ; Reproducibility of Results ; Risk ; Students ; Surveys and Questionnaires ; White People/statistics & numerical data
Language	English
Publishing date	2014-12-08
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Validation Study
ZDB-ID	2266450-6
ISSN	1938-4114 ; 1934-2683 ; 1937-1888 ; 0096-882X
ISSN (online)	1938-4114 ; 1934-2683
ISSN	1937-1888 ; 0096-882X
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Article ; Online: Prevention trial in the Cherokee Nation: design of a randomized community trial.

Komro, Kelli A / Wagenaar, Alexander C / Boyd, Misty / Boyd, B J / Kominsky, Terrence / Pettigrew, Dallas / Tobler, Amy L / Lynne-Landsman, Sarah D / Livingston, Melvin D / Livingston, Bethany / Molina, Mildred M Maldonado

Prevention science : the official journal of the Society for Prevention Research

2014 Volume 16, Issue 2, Page(s) 291–300

Abstract: Despite advances in prevention science and practice in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youth, especially among vulnerable rural and Native American youth. The Prevention Trial ... ...

Abstract	Despite advances in prevention science and practice in recent decades, the U.S. continues to struggle with significant alcohol-related risks and consequences among youth, especially among vulnerable rural and Native American youth. The Prevention Trial in the Cherokee Nation is a partnership between prevention scientists and Cherokee Nation Behavioral Health to create, implement, and evaluate a new, integrated community-level intervention designed to prevent underage drinking and associated negative consequences among Native American and other youth living in rural high-risk underserved communities. The intervention builds directly on results of multiple previous trials of two conceptually distinct approaches. The first is an updated version of CMCA, an established community environmental change intervention, and the second is CONNECT, our newly developed population-wide intervention based on screening, brief intervention, and referral to treatment (SBIRT) research. CMCA direct-action community organizing is used to engage local citizens to address community norms and practices related to alcohol use and commercial and social access to alcohol among adolescents. The new CONNECT intervention expands traditional SBIRT to be implemented universally within schools. Six key research design elements optimize causal inference and experimental evaluation of intervention effects, including a controlled interrupted time-series design, purposive selection of towns, random assignment to study condition, nested cohorts as well as repeated cross-sectional observations, a factorial design crossing two conceptually distinct interventions, and multiple comparison groups. The purpose of this paper is to describe the strong partnership between prevention scientists and behavioral health leaders within the Cherokee Nation, and the intervention and research design of this new community trial.
MeSH term(s)	Adolescent ; Alcohol Drinking/prevention & control ; Community-Based Participatory Research ; Humans ; Indians, North American ; United States
Language	English
Publishing date	2014-03-10
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2251270-6
ISSN	1573-6695 ; 1389-4986
ISSN (online)	1573-6695
ISSN	1389-4986
DOI	10.1007/s11121-014-0478-y
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