Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN, 55812-3301, USA.
Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA.
Prev Sci. 2018 Feb;19(2):174-185. doi: 10.1007/s11121-017-0798-9.
Suicide and alcohol use disorders are primary determinants of health disparity among Alaska Native people in contrast to the US general population. Qungasvik, a Yup'ik word for toolbox, is a strengths-based, multi-level, community/cultural intervention for rural Yup'ik youth ages 12-18. The intervention uses "culture as intervention" to promote reasons for life and sobriety in young people using local expertise, high levels of community direction, and community based staff. The intervention is grounded in local practices and adaptive to local cultural differences distinctive to rural Yup'ik communities. The current study compares the effectiveness of high-intensity intervention in one community (treatment), operationalized as a high number of intervention activities, or modules, implemented and attended by youth, contrasted to a lower intensity intervention in a second community (comparison) that implemented fewer modules. A Yup'ik Indigenous theory of change developed through previous qualitative and quantitative work guides intervention. In the model, direct intervention effects on proximal or intermediate variables constituting protective factors at the individual, family, community, and peer influences levels lead to later change on the ultimate prevention outcome variables of Reasons for Life protective from suicide risk and Reflective Processes about alcohol use consequences protective from alcohol risk. Mixed effects regression models contrasted treatment and comparison arms, and identified significant intervention effects on Reasons for Life (d = 0.27, p < .05) but not Reflective Processes.
自杀和酒精使用障碍是阿拉斯加原住民健康差异的主要决定因素，与美国一般人群形成对比。Qungasvik 是一个Yup'ik 语词汇，意思是工具箱，是一种基于优势、多层次的社区/文化干预措施，针对的是 12-18 岁的Yup'ik 农村青年。该干预措施利用“文化作为干预手段”，利用当地专业知识、高度的社区指导和社区工作人员，促进年轻人的生活和戒酒理由。该干预措施立足于当地实践，并适应农村 Yup'ik 社区特有的当地文化差异。目前的研究比较了一个社区（治疗组）高强度干预的效果，表现为大量的干预活动或模块，由青年实施和参与，与另一个社区（对照组）的低强度干预形成对比，后者实施的模块较少。通过以前的定性和定量工作制定的Yup'ik 土著变革理论指导干预措施。在该模型中，直接干预对个体、家庭、社区和同伴影响层面构成保护因素的近端或中间变量的影响，导致最终预防结果变量的变化，即保护自杀风险的生活理由和保护酒精风险的酒精使用后果的反思过程。混合效应回归模型对比了治疗组和对照组，并发现对生活理由有显著的干预效果（d=0.27，p<.05），但对反思过程没有影响。
