PhD Dissertation Defense - PowerPoint Presentation

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PhD Dissertation DefenseBeverly Patchell, RN, MS, CNSSeptember 27, 2011

NEW MEXICO STATE UNIVERSITY

SCHOOL OF NURSING

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Dr. Mary HokeDr. Leslie RobbinsDr. John LoweDr. Iris MullinsDr. Kathleen Chinn

DISSERTATION COMMITTEE

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NATIVE AMERICAN INDIAN ADOLESCENTS

:

RESPONSE TO A CULTURALLY TAILORED, SCHOOL-BASED Substance Abuse INTERVENTION

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SignificanceAimsMethodResultsDiscussion Next Steps

OVERVIEW OF THE PRESENTATION

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Substance abuse with Native American Indian tribes in the U.S.number one health concern for Native American Indians (NAI) Substance abuse among NAI adolescents correlates with higher incidence of associated problems (Substance Abuse Mental Health Services Administration, 2008)

Background

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2008 state statistics show the economic cost at $6 B/year personal cost is greater 85% of all homicides80% of all prison incarcerations65% of all child abuse cases55% of all domestic assaultsNAI are 9% of the general population, but >25% of the OK prison population. (Oklahoma Department of Mental Health and Substance Abuse Services, 2008)

Oklahoma Problem

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Beauvais et al. (2004) looked at patterns over the past 25 years and found substance abuse to be the primary contributor to health issues among NAIClarke (2002) looked at the emotional issues related to the incidence of substance abuseSAHMSA and the Indian Health Service have written extensively about the health issues

Literature review

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Prevention efforts have previously focused on protective factors such as parent-teen communication, decision-making skills, use of role models, and individual coping styles (Beebee et al., 2008; Chiong, Bry, & Johnson, 2009)Use of Native American Indian rituals and traditions has primarily been used in inpatient or residential treatment (Novins et al., 1996; Jacobs, 2002)The Cherokee Self-Reliance Theory and Model has demonstrated success based on a culturally tailored approach used with Cherokee adolescents (Lowe, 2006)

Literature REVIEW

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Gaps in

the Research

substance abuse treatment for NAI adolescents focuses on the inpatient and residential components of treatment

education and early prevention focused on school-based education efforts, with poor to mixed results

(Segal, 2003)

there is a need for culturally adapted models and documentation of that adaptation

(

Domencech

Rodriguiz

, Baumann & Schwartz, 2011)

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Developed through research into Cherokee culturally-protective factors as described by Cherokee people (Lowe, 2002)Utilized theoretical concepts to determine if strengthening the cultural components of a substance abuse prevention model would influence decisions about substance use and abuse (Lowe, 2006)

CHEROKEE SELF-RELIANCE THEORY

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Cherokee Talking Circle Intervention

BEING RESPONSIBLE

Substance

Abuse

Education

Recognition and Acknowledgement

of Personal

Substance Use

Problems

Identification of High-Risk

Situations

Relationship

Building

Family Conflict

Resolution

Social

Support

BEING DISCIPLINED

Self-Monitoring

Commitment Generation

Alternatives to Substance Use

BEING CONFIDENT

Acceptance of Personal Strengths

Practicing Resistance/Refusal

Coping with Stress

Abstinence Violation Effect

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Based on the general world view of Native American Indian peopleThe natural world is inherently circular and spiral, with ordered flow and movementHealth requires order and ill health is a result of interrupted flow and dis-orderFibonacci sequence is recognized by Western science as the mathematical foundation of life and creation

Circular Model for Cultural Tailoring

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The tribes of the Great Plains Area encompasses many tribes and sweeps across the United States in the region between the Mississippi River and the western coastal statesThe tribes were historically rovers and hunters, nomadic and loosely organizedTheir prowess was in hunting, raiding, and war

Population

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Original Inhabitants of Oklahoma Land Area

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1890’s Map of Oklahoma

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Current Map of Oklahoma

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Elder’s Transform the Model

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BEING RESPONSIBLESubstance Abuse EducationRecognition and Acknowledgement of Personal Substance Use ProblemIdentification of High-Risk SituationsRelationship BuildingFamily Conflict ResolutionSocial SupportBEING DISCIPLINEDSelf-Monitoring Commitment Generation Alternatives to Substance UseBEING CONFIDENTAcceptance of Personal StrengthsPracticing Resistance/Refusal Coping with StressAbstinence Violation Effect (Adapted with permission from the Cherokee Talking Circle, Lowe, 2006) 

Native Talking Circle Intervention

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adapt an existing culturally competent Cherokee theoretical model and school-based intervention targeting substance abuse prevention and intervention for use with Native American Indian adolescents in southwestern Oklahomaexamine the impact of the adapted Native American Indian Self-Reliance Substance Abuse Intervention tool on cultural protective factors associated with substance abuse involvement by Native American Indian youth from Native American Indian Plains tribes.

Study AIMS

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Following implementation of the adapted Native American Self-Reliance Intervention: there will be a significant increase in self-reliance (α ≤ .05) there will be a significant decrease in reported substance abuse (α ≤ .05) there will be significant decrease in perceived stress (α ≤ .05)Design: Pre-test/post-test quantitative study

Research

Hypotheses/DESIGN

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Institutional Review Boards at New Mexico State University and the University of Oklahoma. Support letter from the Comanche NationCertificate of Confidentiality from the National Institute on Drug Abuse.Permission of superintendents and principal's of the high schools.Parental permission and student assent

Human Subjects Protection

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Convenience sample obtained using two rural high schools in SW Oklahoma with high populations of Plains tribal adolescents; i.e., Comanche, Kiowa, Apache, Wichita, Lenape, CaddoSample size N = 44PowerInclusion Criteria:Self-identified member of one of the Plains tribes of SW Oklahoma.Attending one of the designated schools, in grades 9-12.Between the ages of 16-19Referred by a counselor due to being at risk for substance use or abuse

Sample

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Demographic Questionnaire Adapted Cherokee Self-Reliance QuestionnaireGlobal Appraisal of Individual Needs-Quick (GAIN-Q)Written Stories of Stress using the Linguistic Inquiry Word Count (LIWC)

instruments

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3 GROUPS8.5 WEEKS10 HOURS OF INSTRUCTIONGROUP RULESADAPTED TOPIC CONTENT

NATIVE TALKING CIRCLE INTERVENTION

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Obtained informed consent/assentPre-intervention data collectionoccurred at first sessionDemographic questionnaireNative Self-RelianceGAIN-QWritten Stories of StressPost-intervention data collectiondemographic questionnaire was omitted

Data Collection

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Descriptive statisticsPaired t-testCronbach alphaSPSS LIWC

DATA ANALYSIS

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Demographics:

Results

Table 2

Participant Demographics

 

Gender

Age

Grade

Tribe

Living Situation

Siblings

Drug Use

Team/School Activities

 

N

(%)

N

(%)

N

( %)

N

(%)

N

(%)

N

(%)

N

(%)

N

(%)

Group 1

M=4 (25)

F=12 (75)

16= 12 (75)

17= 4 (25)

10

th

=15 (94)

11

th

=1 (6)

Comanche = 12 (75)

Kiowa = 3 (19)

Apache =1 (6)

Parent(s) =16 (100)

Extended = 6 (38)

Yes = 15 (94)

No = 1 (6)

Alcohol =3 (19)

Marijuana = 1 (6)

None = 12 (75)

Yes = 7 (44)

No = 9 (56)

Group 2

M=7 (44)

F=9 (56)

16 =13 (82)

17 =3 (18)

10

th

=14 (88)

11

th

=2 (12)

Comanche = 13 (81)

Kiowa = 2 (13)

Apache = 1 (6)

Parent(s) =12 (75)

Extended = 8 (50)

Yes = 15 (94)

No = 1 (6)

Alcohol = 2 (13)

Marijuana = 1 (6)

None = 13 (81)

Yes = 12 (75)

No =4 (25)

Group 3

M=9 (75)

F=3 (25)

16 = 1 (8)

17 = 5 (42)

18 = 6 (50)

10

th

=1 (8)

11

th

=5 (42)

12

th

=6 (50)

Comanche = 7 (58)

Kiowa = 3 (25)

Apache = 2 (17)

Parent(s) =12 (100)

Extended = 9 (75)

Yes = 12 (75)

No = 0 (25)

Alcohol = 6 (50)

Marijuana = 2 (17)

None = 4 (33)

Yes = 9 (75)

No = 3 (25)

Totals

M= 20 (45)

F=24 (55)

16 = 26 (59)

17 = 12 (27)

18 = 6 (14)

10

th

= 30 (68)

11

th

= 9 (20)

12

th

= 5 (11)

Comanche = 32 (73)

Kiowa = 8 (18)

Apache = 4 (9)

Parent(s) = 40 (91)

Extended = 23 (52)

Yes = 42 (95)

No =2 (5)

Alcohol = 11 (25)

Marijuana = 4 (9)

None = 29 (66)

Yes = 28 (64)

No = 16 (36)

Note. N

= 44. Participants were assigned to one of three intervention groups based on their attended high school and class schedule. M= male. F=female. Age is in years. Living situation is living with parents and presence of extended family members in the home. Siblings are if participant has siblings or not. Drug use refers to self-reported drug of choice. Team/school activities refers to participant involvement in sports and/or group sponsored school activities.

 

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Age16 = 26 (59)17 = 12 (27)18 = 6 (14)GenderM= 20 (45)F=24 (55)Grade10th = 30 (68)11th = 9 (20)12th = 5 (11) TribeComanche = 32 (73)Kiowa = 8 (18)Apache = 4 (9)

Living SituationParent(s) = 40 (91) Extended = 23 (52)SiblingsYes = 42 (95) No =2 (5)Drug UseAlcohol = 11 (25)Marijuana = 4 (9)None = 29 (66) Team/School ActivitiesYes = 28 (64)No = 16 (36)

Participant Demographics

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Pre-test baseline mean of 86.23 (SD=23.40) increased to a post-intervention mean of 92.20 (SD=18.46), SE = .369, medium effect sizeSupporting the hypothesis that self-reliance would increase post-intervention

Native

Self-Reliance questionnaire

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 Baseline Post Intervention Paired Differences  Indices MSDMSDMSDtdfp valueGeneral Life Problems (N=41)9.5367.5047.4155.7232.1225.8872.30840.013Internal Behaviors(N=44)  3.6364.0982.0232.9371.6143.4523.10143.002External Behaviors Internal Behaviors(N=42)  4.3574.4773.3103.4531.0484.8841.39041.086Substance Problems Internal Behaviors(N=34) 2.2654.2661.2652.9681.0003.1621.84433.037

GAIN-Q Indices at Baseline, Post-Intervention and Paired T-Test Results

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Baseline Post Intervention  Paired DifferencesDimensions of Words MSDMSDMSDtdfpPositive Emotion 4.4312.6533.6002.075.83112.9552.30825.082Negative Emotion  5.1201.9296.0372.430-.91653.3193.10125.086Social 9.4113.32910.8604.024-1.4484.5051.39025.057

LIWC word use results at Baseline, post-Intervention, and paired

T-Test (

n

=26)

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Groups were facilitated by a Native American Indian woman with extensive adolescent group experienceThe intervention was flexible enough to allow the participants to express themselves in multiple waysConvenience sampleSelf-identified tribal membersSelf-reporting of substance use could be biased

Strengths and Limitations

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This study: addresses a significant problem for Native American Indian adolescents and the specific tailoring of a successful intervention to meet the needs of the participantsdemonstrates the effectiveness of specific tailoring using traditional and contemporary life experiencesprovides a template/model for use in future studies

DISCUSSION

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Native Talking Circle Intervention requires replication of the study with larger sample sizes and longitudinal studies to address long term effectiveness Validation of the effectiveness of the CMCT as a timely cultural tailoring model across subsets of Indigenous cultural groups

Recommendations for further research

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Questions?

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Thank YouWado!

TO THE AUDIENCE