Be Under Your Own Influence (BUYOI-AI)

A culturally modified, school-based substance use prevention program for reservation-dwelling Native youth.

BUYOI-AI is a culturally modified version of a previously validated school-based substance use prevention intervention. Local high school students served as role models and delivered the intervention. This consisted of distributing visual media (posters, banners, and business cards) in the middle schools, giving a presentation at a 7th grade assembly, and distributing promotional items with the logo and tagline in classrooms or in small groups during lunch period. Schools were allocated to treatment or control using a randomized cluster design. Data were collected at 4 time points.

Outcomes

Estimates of changes or differences in alcohol-related problems and the stability of those changes or differences.

Medium/Mixed Level of Change

Decreased risks of alcohol use and intoxication initiation were demonstrated among those receiving the intervention.

Intervention group participants had a 34% lower risk of initiating alcohol use and a 36% lower risk of initiating intoxication compared to controls by the end of the study. The intervention appeared to be more effective in reducing the risk of first-time intoxication among boys and did not appear to have a significant effect among girls.

Costs

Two domains estimating start-up and ongoing expenses.

Start-Up Cost Medium

Ongoing Cost Low

Medium start-up costs followed by lower maintenance costs.

Medium-level initial costs involve the development and production of locally appropriate materials and stipends for schools and supervising staff. Ongoing costs appear to be minimal.

Cultural Engagement

Two indicators of cultural and Tribal/community contributions.

Cultural Inclusion High

Tribal Inclusion High

Community participation informed the extensive cultural modification and implementation of the intervention.

There were extensive surface and deep structure modifications to the existing intervention. Materials and delivery were adapted to finding strength in Native culture and cultural identity. Community Advisory Committees, which were comprised of school staff and community members, were formed in each community. There was formative work using focus groups and Photovoice.

Participants

Demographic description of the people who participated in the research study.

Child, Adolescent; Native, Non-Native; Female, Male

Setting

Place(s) in which this intervention was conducted.

Reservation, School

Delivery

Method through which the intervention was delivered to participants in the study.

Small Group, Large Group, Face-to-Face

Native and non-Native middle-school youth attending reservation schools in the Northern Plains.

Middle school students (n = 269 intervention, 176 control; 50% female; 67% AI/AN) were recruited in 7th grade and followed through the end of 8th grade. The average age at baseline was 12.5 years.

Staffing Needs

Credentials and/or background of personnel who delivered the intervention.

Community Member, Educator

Junior-level students delivered the intervention under the supervision of a school staff member.

Community members participated in culturally modifying the intervention. Local juniors in high school, acting as role models, delivered the intervention. A school staff member supervised. Research staff provided detailed instructions for each activity.

Research Design

Methods employed to gather research data.

Randomized controlled experimental design

Developmental stage of research

Stage of development of the evidence supporting this intervention.

Mid Stage

Overall beneficial effects, despite gender inconsistencies, were demonstrated in a study with a strong design.

This cultural adaptation of an evidence-based intervention used a community-based participatory research approach to adapt the intervention for Native communities. The design of the present study was rigorous, including dropping a non-equivalent school and specified handling of missing or recanted data. Additional research may be necessary to determine why boys responded more than girls to the intervention.

Potential

Narrative offered by expert reviewers providing overall comments or evaluations about the intervention.

Promising culturally congruent, transportable, relatively low-cost program.

The culturally adapted version of BUYOI for American Indian youth attending reservation schools appears to be a promising substance use prevention intervention, particularly for younger students who have not yet initiated alcohol use or intoxication. The relatively moderate start-up and low ongoing costs of the intervention makes it especially promising for under-resourced or geographically remote schools. Role models drawn from the community and extensive local input into materials suggest strong transportability.

References

Primary

Crabtree MA, Stanley LR, Kelly KJ, Swaim RC. Be under your own influence: Effectiveness of a culturally-adapted drug prevention campaign targeting reservation-dwelling American Indian youth. J Community Psychol. 2021;49(7):2316-2329. https://pubmed.ncbi.nlm.nih.gov/34273115 . https://doi.org/10.1002/jcop.22672 .

Associated

Stanley LR, Kelly KJ, Swaim RC, Jackman D. Cultural adaptation of the Be Under Your Own Influence media campaign for middle-school American Indian youth. J Health Commun . 2018;23(12):1017-1025. https://pubmed.ncbi.nlm.nih.gov/30381014 .

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