Native Communities—Alcohol Intervention Review (NativeAIR) is a user-friendly website to help American Indian/Alaska Native (AI/AN) and other Indigenous communities identify and select evidence-based interventions that prevent and address alcohol-related problems.

Developed by the National Institute on Alcohol Abuse and Alcoholism (NIAAA)—in partnership with scientific experts having extensive experience conducting alcohol research with Native communities—NativeAIR evaluates nearly 40 evidence-based alcohol-related interventions involving Native populations from published, peer-reviewed research on the prevention of fetal alcohol spectrum disorders, the prevention of alcohol misuse, and the treatment of alcohol use disorder.

Each Tribe and community has a unique constellation of cultural strengths and experiences, and community members understand how to leverage these to address health issues effectively. The interventions in NativeAIR are rated on a variety of variables that can inform decisions on which interventions may be better suited to help promote wellness and to reduce the adverse impact of alcohol on Native individuals and communities.

• What is NativeAIR
• How to use NativeAIR
• Why NativeAIR was developed
• How the interventions in NativeAIR were selected
• Culture as a key aspect of many interventions in NativeAIR
• Who contributed to NativeAIR

What is NativeAIR

NativeAIR provides information about evidence-based alcohol prevention and treatment interventions from published, peer-reviewed studies. Although focused primarily on AI/AN communities in the continental United States, NativeAIR also includes research conducted with other Indigenous populations, including Canadian First Nation communities on the Canada border and Native Hawaiian/Pacific Islander populations. Scientific experts evaluated each intervention in NativeAIR using a rigorous set of criteria. Many of the interventions include important aspects of cultural relevance and Tribal inclusion (defined in the Description of the Intervention Variables section).

NativeAIR was developed to provide research-based information that Tribal and community leaders, educators, health professionals, and others can use in their efforts to reduce the adverse impact of alcohol misuse in their communities. Although the primary goal of NativeAIR is to inform communities, researchers also may find the resource useful.

How to use NativeAIR

NativeAIR provides easy access to research-based information organized into three sections:

• Prevention of fetal alcohol spectrum disorders
• Prevention of alcohol misuse
• Treatment of alcohol use disorder

Within each section, you can filter and sort interventions to help find the ones that may be most appropriate for your community’s needs. Each intervention was assessed on nine variables: setting, delivery, participants, staffing, research design, outcomes, cultural engagement, costs, and developmental stage of the research. See the Description of the Intervention Variables section for more information.

You can filter interventions by:

• Setting: Place(s) in which this intervention was conducted (e.g., school, reservation, hospital, clinic, community center, community-wide setting)
• Delivery: Method through which the intervention was delivered to the participants in the study (e.g., individual, group, face-to-face)
• Participants: Demographic description of the people who participated in the research study
• Costs: Best estimate of costs required to implement and maintain the intervention

You can sort interventions by:

• Outcomes: Estimates of changes in alcohol-related problems and the stability of those changes
• Cultural engagement: Degree of cultural and Tribal inclusion
• Costs: Best estimate of costs required to implement and maintain the intervention

Each individual intervention page provides additional background, including a summary of the intervention, more details about the intervention variables evaluated, a brief statement about the potential of the intervention, a reference list of cited articles, and, where available, additional resources such as intervention manuals, websites, and other materials. This information will help you decide if and how you can implement the interventions in your community.

Why NativeAIR was developed

Alcohol misuse poses a significant public health burden in the United States. Native populations share this burden of alcohol-related consequences. Their efforts to address alcohol-related challenges through culturally appropriate approaches offer hope and promise in improving the health and well-being of Native communities.

Research suggests that psychosocial stressors associated with being a marginalized racial group, the transgenerational impact of historical trauma, and limited health, economic, social, and educational resources contribute to alcohol problems in Native communities. While some epidemiological studies have found high rates of alcohol use disorder among AI/AN populations, it is important to note that studies also have found high rates of abstinence or drinking in moderation with large variations by age, gender, Tribe, cultural group, and residential pattern.

There is a growing interest in addressing alcohol-related problems through strength-based, community-oriented interventions that leverage cultural and protective factors. Despite this interest, there are a limited number of studies in this area, and they are often not referenced in popular search engines, making it difficult to find them. NativeAIR helps to overcome this barrier by compiling many of these interventions and providing key information in a user-friendly format.

Although many robust, evidence-based interventions for alcohol problems have been developed for the general U.S. population, it is difficult to determine the acceptability, feasibility, and efficacy of these interventions among Native populations. One reason is that the historical mistreatment of Indigenous populations has led to an understandable mistrust and an unwillingness to engage in research. Native people’s mistrust of westernized research has presented barriers to collaborations with outside researchers, contributing to a lack of data on the efficacy of interventions in Indigenous populations.

Fortunately, Tribal/community-based participatory research is shifting this narrative. Research that values and incorporates community expertise and feedback builds trust, encourages participation in research, and yields culturally appropriate interventions. Many of the interventions highlighted in NativeAIR use community-based participatory research methods.

How the interventions in NativeAIR were selected

NativeAIR is based on a comprehensive review of the existing peer-reviewed alcohol intervention literature involving Native populations from 1968 to 2022. Most of these interventions involved AI/AN populations; however, some studies included non-Indigenous populations as well. A coding scheme was developed and used that consisted of (1) categorization and ratings of variables thought to be relevant to evaluating the literature, and (2) brief narrative descriptions of the interventions. Notably, this evaluation provides scores in cultural or Tribal inclusion.

Specifically, publications were selected for inclusion in NativeAIR based on the following criteria:

• They include at least 50% Native participation, or they report results of analysis for Native participants.
• They provide a description of the intervention in sufficient detail to allow for implementation in Native communities.
• They contain evidence of a program evaluation or use a quasi-experimental or randomized controlled research design.
• They report data regarding alcohol use.
• They are published in a peer-reviewed journal.

These criteria excluded many publications, most notably studies that did not report specific alcohol-related outcomes. Some rigorously conducted studies, including those of widely used interventions, did not distinguish alcohol from other substance use outcomes due to factors such as measurement nuances, Tribal concerns about the inclusion of alcohol-specific questions being stigmatizing, or inadequate power in studies with small sample sizes.

NativeAIR includes studies with a wide range of research designs, including studies that utilize innovative variations on randomized controlled trials. Randomized controlled trials are highly regarded as the best approach to determine whether an intervention produced an observed change. Tribal leaders are eager to ensure that research provides opportunities to deliver effective interventions to all members of their communities. Many Tribal leaders may prefer innovative experimental designs that are both rigorous and equitable, without including placebo or “no treatment” comparison groups. For example, some studies may investigate an intervention in comparison to an intervention associated with improved outcomes, and demonstrate negligible differences in positive outcomes between the interventions. This finding could mean that both the investigational and comparison interventions have a positive impact on alcohol outcomes, potentially offering Tribal and community leaders a choice between more than one intervention that might meet their community’s needs.

Culture as a key aspect of many interventions in NativeAIR

Some interventions highlighted in NativeAIR utilize community-based participatory research methods, include Tribes in the research process, and incorporate cultural components into the interventions. In some cases, existing evidence-based treatments are adapted to be more culturally appropriate and inclusive. These interventions reflect the concepts of “Culture is prevention” and “Culture is treatment.”

For example, in the prevention of alcohol misuse section, several interventions promote traditional values and protective factors as active prevention elements. Prevention often involves behavioral change and lends itself to adopting positive practices honed over millennia and passed down through Indigenous Ways of Knowing. In the treatment section, traditional practices, such as sweat lodges, drumming, spirituality, and storytelling, can be added to established treatment regimens or can serve as the basis of treatment and recovery.

Culturally congruent interventions have been found to be more effective among Native populations than westernized interventions developed for the general population, spurring an interest in cultural modification and culturally grounded strategies. Cultural and Tribal inclusion are increasingly understood to be crucial to conducting intervention research with Indigenous communities and to creating meaningful interventions.

Indigenous Ways of Knowing also can inform the design of interventions “from the ground up” as well as the cultural adaption of existing interventions. Some intervention studies have included community members participating in research planning, delivery, and dissemination of results. This inclusion is important as each Tribe and community has a unique constellation of cultural strengths and experiences. Including community members in the design and conduct of research builds trust, ensures that the research reflects cultural and community attributes, encourages participation in research, and yields culturally appropriate interventions.

Who contributed to NativeAIR

NativeAIR was developed with input from scientific experts conducting alcohol research in Native populations. Many of these researchers are members of Native communities across the United States. The development of NativeAIR was led by an expert team that identified the variables to be evaluated from the peer-reviewed publications. A large team of volunteers read, reviewed, and coded the published research based on a set of rigorous criteria.

The National Institutes of Health Tribal Health Research Office and Tribal Advisory Committee were consulted to improve the quality, cultural relevance, and ease of use of NativeAIR. In addition, a panel of AI/AN end user experts tested and provided feedback on the design, appearance, and functionality of the NativeAIR website.

NIAAA thanks the many individuals who contributed to NativeAIR, including editorial, administrative, and programmatic development staff, as well as scientific review volunteers.