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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
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
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 Engagment
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
Child, Adolescent; Native, Non-Native; Female, Male
Setting
Reservation, School
Delivery
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
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
Randomized controlled experimental design
Developmental stage of research
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
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
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.
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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