An Examination of Novel Harm Reduction Interventions for Indigenous and Other Youth of Color
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Alcohol and other drug (AOD) use among youth populations remains a pressing social issue in the United States. Young people who experiment with or regularly use AODs are at heightened risk for experiencing AOD-related harms such as mental health issues, overconsumption, and death. Among American Indian/Alaska Native/Indigenous (hereafter, “Indigenous”) youth, contextual risk factors such as limited access to culturally relevant AOD prevention information can exacerbate their risk for AOD harms such as early onset for problematic AOD use, AOD-use disorders in adulthood, infection of the human immunodeficiency virus (HIV), unresolved issues of trauma, and related experiences of inter-personal violence. An effective approach to reduce AOD-related harm among youth is harm reduction. Youth-specific harm reduction studies have shown significant effects in reducing AOD use and related harms, as well as increasing knowledge and awareness. However, there is a dearth of empirical literature on the development, acceptability, and measurement of culturally relevant, theoretically grounded harm reduction interventions for Indigenous youth. This dissertation examines three sets of interrelated questions regarding novel interventions designed to prevent and reduce AOD harms for youth of color (YOC), with a focus on the needs of Indigenous youth who participate in an Indigenous-specific after-school program. The first study reports use, usability, and overall satisfaction outcomes for the MyPEEPS (Male Youth Pursing Empowerment, Education, and Prevention around Sexuality) mobile app, an evidence-based HIV prevention intervention. A pre-post pilot feasibility study was conducted with racially and ethnically diverse 40 young men living in Birmingham, Alabama; Chicago, Illinois; New York City, New York; and Seattle, Washington. Results indicated 62.5% (25/40) of all participants completed the intervention in an average of 28.85 (SD 21.69) days. Overall, participants reported the app was easy to use and useful and had the potential to improve their sexual health knowledge, behaviors, and awareness in risky situations. The second study focused exclusively on the AOD prevention needs of Indigenous youth towards the development of a culturally relevant and theoretically grounded harm reduction intervention. A community-based participatory research approach was used to understand the perceptions of AOD use, harm reduction and culture among Indigenous youth 13-17 years of age enrolled in an Indigenous-specific after-school program. Key themes were organized with the Indigenous framework of Relationality and included: a) youth understand the negative consequences of AOD use, b) youth appreciated balanced, non-abstinence based AOD education, c) youth described a need for safe opportunities to talk about the impacts of AOD use, and d) youth described a desire to lead and help prevent AOD harms for their future selves and for those in their circle. The third study examined perceptions of Indigenous adults (18+ years of age) affiliated with the same Indigenous after-school program regarding AOD use, harm reduction, and risk factors for youth participants. Findings were organized using a risk environment framework to identify risk factors for youth on micro and macro levels across physical, social, economic, and policy domains. Last, adult-identified risk factors were paired with the previously reported youth recommendations where similar, to establish core content for a community-based, culturally relevant, and theoretically grounded harm reduction intervention for Indigenous youth, inclusive of multigenerational Indigenous perspectives. Results of these studies strongly indicate that harm reduction interventions as an acceptable approach to prevent AOD use and harm among diverse YOC. In addition, findings support culturally relevant harm reduction education as a valuable way to prevent AOD use and harm among Indigenous youth participating in an after-school program. Future research should seek to explicitly test the hypothesis that interventions designed to enhance relationality among Indigenous youth can serve to buffer risk for AOD use and harm. Finally, meeting the needs of diverse YOC requires a community-based approach. Trust and respect must be established in order to develop a mutually beneficial research partnership with representatives from diverse populations and communities.