Suicide is at crisis levels in Native youth and young adults. A key goal of suicide prevention is building social connections with suicidal people. Caring Contacts is a suicide prevention program that supplements standard healthcare by promoting human connectedness. It involves sending messages that express care, concern, and interest to suicidal people. It is the only intervention shown to prevent suicide in any population. We adapted this approach to design Caring Texts, an intervention that uses text messages to prevent suicide in Native youth. We are conducting a randomized controlled trial of Caring Texts in 1,200 high-risk Native people aged 18-34 years. Study sites include communities in Alaska, the Rocky Mountain region, and the Great Plains.
Rhythm and Timing Project
American Indians have a high incidence of cerebrovascular disease, which affects cognition, attention, memory, and other aspects of brain function. Therefore, substantial numbers of Native elders can benefit from treatment to improve brain function. This intervention study uses Interactive Metronome (IM) therapy to treat Native elders with cerebrovascular disease. IM is a computer-based system that uses a steady beat to recondition the brain and improve cognitive and motor function. Our planned study sample consists of 180 American Indians aged 68 to 80 years. We will test the effects of IM on cognitive function and health-related quality of life in this group of Native elders.
Family Intervention in the Spirit of Motivational Interviewing (FITSMI)
The prevalence of stroke is higher in American Indians and Alaska Natives than in any other U.S. racial or ethnic group. Native people tend to be younger at stroke onset than non-Hispanic Whites, and they have poor post-stroke survival. In addition, Native people bear a disproportionate burden of stroke risk factors, including high blood pressure, smoking, obesity, and diabetes. However, no rigorous, population-based studies of stroke prevention have included Native participants. With our partners, we designed the Family Intervention in the Spirit of Motivational Interviewing (FITSMI), which is delivered at the household level. This intervention encourages lifestyle changes that will transform the home environment and reduce stroke risk for all household members. FITSMI uses a “talking circle” format in which facilitators guide participants to identify goals for change and then create a tailored plan to reach them. Goals typically address smoking, exercise, diet, and medication adherence. FITSMI requires just two household sessions scheduled one month apart. After the first session, text messages are sent to participants to boost their adherence to household goals. In a group-randomized trial design, we are recruiting 360 households. Half of them are randomly assigned to the FITSMI intervention, and the other half are assigned to the control condition, in which they simply receive educational brochures. All household residents aged 11 years and older are eligible for participation.
Rewarding Recovery Project
American Indians are disproportionately affected by alcohol and drug abuse. Contingency management (CM) is a treatment approach in which patients receive tangible rewards for abstaining from alcohol and drug abuse. Most previous evaluations have shown that the effect sizes of CM interventions are among the largest of all mental health and behavioral interventions. Our goal is to determine whether a culturally appropriate CM treatment program leads to reductions in alcohol and drug abuse on two American Indian reservations. Phases 1 and 2, which included focus groups with providers and patients, have been completed at both sites. Phase 3, which is a randomized controlled trial of CM for alcohol and drugs, is now in progress. As of June 2016, we have successfully consented 30 participants.
Biobanking in Native Communities
Biobanking refers to the process of storing human tissue for use in health research. These tissue samples are known as biospecimens. Rapid advances in the genetic analysis of biospecimens have the potential to improve treatments for chronic disease. However, many American Indian and Alaska Native communities have a well-documented legacy of mistrust for health research, especially research involving biospecimens and genetic analysis. Our study has two closely related aims. The first is to offer culturally relevant education to Native communities on biobanking and measure any changes in community knowledge, attitudes, or beliefs. The second is to hear community members’ opinions and concerns regarding the ownership and appropriate use of biospecimens, as well as the relation between individual rights and tribal regulation.