An RCT of a Family-Centered Ojibwe Substance Abuse Prevention

The goal of this project is to implement a multisite randomized controlled trial (RCT) of a family-centered, fourth-generation prevention program for Anishinabe (Ojibwe) pre-adolescents aged 8-10 years that can be replicated cross-culturally by other American Indian/Alaska Native cultures to decrease substance use among early adolescents and improve mental health outcomes. This program, Bii-Zin-Da-De-Dah (BZDDD) (Listening to One Another), has been developed and adapted in partnership with multiple Anishinabe communities over a span of 13 years. The program was the first American Indian (AI) adaptation of the Iowa Strengthening Families Program (now called the Strengthening Families Program: For Parents and Youth 10-14) 1, 2, 3, 4, 5. Now in its third generation, BZDDD has been enormously popular. It has been adapted for Dakota (AA015414), Lakota (NARCH,U261HS300288), Pueblo, and Navajo cultures and is currently the center piece of a Canadian national mental health promotion funded by the Public Health Agency of Canada (PHAC 6785-15-2009/9010952) where it is being culturally adapted for use by four Anishinabe First Nations (Ontario and Manitoba), eight Swampy Cree First Nations (Manitoba), Splatsin First Nation (British Columbia), and the two First Nations of Quebec and Labrador, one of which is French-speaking. 

This goal will be implemented through four Specific Aims:

(1) Complete a final adaptation of the 14-week BZDDD prevention program for U.S. Anishinabe reservations before implementing the RCT. The research team will work with focus groups including adults, adolescents, elders, and services providers and gain reservation and tribal council approvals of the program content and procedures.

(2) Implement an RCT of the finalized BZDDD to assess its efficacy for delaying and/or preventing adolescent onset of alcohol and drug use to obtain rigorous empirical information regarding its effectiveness, in addition to its extensive grassroots anecdotal support and positive qualitative feedback from families and facilitators.

(3) Empirically address cultural challenges for RCTs involving AI cultures by evaluating contamination and informal diffusion in AI communities and extended families. AI values of sharing and community benefits clash with Western RCT methods of withholding benefits from control groups vs. treatment groups. This research will address these challenges by attempting to measure and control for them by using specifically designed questions routing to identify content sharing among treatment and control adolescents and their treatment and control group parents, as well as investigate potential contamination via extended family members who have contact with both the treatment and control families.

(4) Work with our Anishinabe research partners to develop a plan to sustain the prevention program. We already have community readiness for sustainability on all of the reservations due to familiarity and the popularity of BZDDD. We will work through our advisory boards to place the program within schools, health services, and social services agencies. We will be leaving behind extremely comprehensive facilitator manuals in addition to a videotaped training program to facilitate ongoing training.