Living in 2 Worlds (L2W)

Cultural adaption of prevention program for urban-dwelling American Indian (AI) youth.

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Living in 2 Worlds (L2W) culturally adapted the keepin’ it REAL (kiR) substance use prevention curriculum for use with urban AI youth. The goal of both interventions is to delay or postpone typical adolescent developmental trends toward increased substance use by teaching youth a repertoire of skills to resist substance use. Schools were randomized to L2W vs. kiR without a no-treatment control group. The manualized L2W curriculum consists of 12 lessons (45 minutes each) delivered by AI teachers in enrichment classes over a 5-month period.

Outcomes

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

No Change

L2W better than kiR in slowing some substance use involvement. 

Youth in both interventions reported increased substance use involvement. L2W was better than kiR on four outcomes: less growth in cigarette use, less frequent use of the "leave" drug resistance strategy (physically removing oneself from a drug-related situation), and less loss of connections to American Indian spirituality and cultural traditions. L2W may have blunted the increase in frequency of alcohol use to a greater extent than kiR, but the difference was not significant.

Costs

Two domains estimating start-up and ongoing expenses. 

Start-up and ongoing costs would be low. 

Costs include a day-long interventionist training and curriculum materials. The costs are kept low by utilizing teachers and delivering the intervention during already scheduled classroom time.

Cultural Engagement

Two indicators of cultural and Tribal/community contributions. 

AI community participated in adaptation of intervention. 

A community-based participatory research approach was used to adapt the intervention to incorporate American Indian cultural heritage elements, including reference to reservation life, clans, Elders, ceremonial practices, and storytelling. Teachers and research assistants were AI.

Early adolescent students in urban Southwest schools. 

Participants were a gender-balanced sample of 107 urban AI students (ages 12–13 years) in 7th and 8th grades, who completed pre- and post-intervention questionnaires. The study was conducted in three urban middle schools in the southwest United States.

Staffing Needs

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

Educator

AI teachers trained to provide intervention. 

AI teachers of cultural and academic enrichment classes were trained to deliver the interventions.

Research Design

Methods employed to gather research data. 

Quasi experimental design

Developmental stage of research

Stage of development of the evidence supporting this intervention. 

Early Stage

Promising trends, but small sample and lack of control. 

Feasibility of delivering L2W was demonstrated, but efficacy in reducing alcohol use was not, indicating an early stage of development. The small sample size and lack of a no-treatment control group limited the ability to detect positive effects.

Potential

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

Culturally adapted version of an established prevention program is promising. 

Whereas previous research had found that kiR was not effective to prevent or slow increased substance use among urban AI youth, this study suggests that a culturally adapted version (L2W) may show more promise. The L2W intervention integrates cultural themes and elements that are shared across diverse AI cultures (e.g., storytelling), which enhances its potential to be transportable across different AI groups beyond the urban Southwest and specialized cultural enrichment classes.

References

Primary 

Kulis SS, Ayers SL, Harthun ML. Substance use prevention for urban American Indian youth: A efficacy trial of the culturally adapted Living in 2 Worlds program. J Prim Prev. 2017;38(1-2):137-158. https://pubmed.ncbi.nlm.nih.gov/27943031 . https://doi.org/10.1007/s10935-016-0461-4 .

Associated 

Kulis S, Dustman PA, Brown EF, Martinez M. Expanding urban American Indian youths' repertoire of drug resistance skills: Pilot results from a culturally adapted prevention program. Am Indian Alsk Native Mental Health Res. 2013;20(1):35-54. https://pubmed.ncbi.nlm.nih.gov/23529769 . https://doi.org/10.5820/aian.2001.2013.35 .

Recommended Reading 

Dixon AL, Yabiku ST, Okamoto SK, et al. The efficacy of a multicultural prevention intervention among urban American Indian youth in the southwest U.S. J Prim Prev. 2007;28(6):547-568. https://pubmed.ncbi.nlm.nih.gov/18058235 . https://doi.org/10.1007/s10935-007-0114-8 .

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