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Combined CONNECT and Communities Mobilizing for Change on Alcohol (CMCA)
Two prevention interventions were studied at the same time; one involved screening and brief intervention with students, and the other bolstered community action to reduce underage access to alcohol.
CONNECT and Communities Mobilizing for Change on Alcohol (CMCA) are two concurrently implemented interventions to prevent alcohol misuse among American Indian and non-Native high school students. CONNECT is a prevention strategy consisting of screening and brief intervention, and referral to treatment sessions delivered in schools by social workers; these sessions incorporate motivational interviewing, feedback on normative behavior, goal setting, and referrals as needed. CMCA is a community organizing intervention that supports local grassroots action teams in implementing evidence-based activities to target sales to and acquisition of alcohol by underage youth. The interventions were tested in six communities using a randomized trial design: CONNECT (n = 224), CMCA (n = 208), both CONNECT and CMCA (n = 603), and delayed intervention control (n = 588). Outcomes were assessed using student self-report surveys four times a year over 3 years.
Outcomes
Both CMCA and CONNECT reduced upward trend of alcohol involvement, but the combination of the two did not increase the benefit.
On average CMCA and CONNECT were associated with reductions in upward trend of current use, heavy episodic drinking, and alcohol-related consequences over time compared to control (22% to 25% reduction; 19% to 23% reduction, respectively). The combination of both interventions did not increase benefit (12% to 15 % reduction relative to control). There were no differences in effects for American Indian vs. non-Native students.
Costs
Initial and ongoing costs of these labor-intensive interventions would be substantial due to staff, training, and materials.
Start-up costs would be relatively high to implement both interventions at the same time (refer to webpages for CONNECT and CMCA). CMCA involves hiring and equipping a full-time community organizer, and CONNECT requires a trained social worker working at least half-time. The staff time to implement CONNECT universally in a larger school setting could be expensive. Ongoing costs may remain moderately high due to ongoing community activities, booster trainings for the social worker and community organizer, use of space in schools and community settings, printing and dissemination costs, and "connector" training for school and community members involved with youth.
Cultural Engagment
Although no cultural elements were described, the research included Cherokee Nation Behavioral Health as an equal partner.
No specific cultural adaptations to either intervention were described. The principles and methods of community-based participatory research were used, and Tribal involvement was described. Community members were involved, particularly in the CMCA intervention. The research was an equal partnership between university-based and the Cherokee Nation Behavioral Health, with approval by the Tribal institutional review board of informed consents, presentations, and manuscripts.
Participants
Adolescent; Native, Non-Native; Female, Male
Setting
Community Wide, Rural, School
Delivery
Multi-level, Face-to-Face
Participants were American Indian and non-Native students attending high school on the Cherokee Nation, a rural but not reservation setting.
Participants were American Indian and non-Native high school students; average age at baseline was 15 years, 48% to 51% of participants in each condition were female. The interventions were tested in six Cherokee Nation rural (non-reservation) communities. CMCA was delivered community-wide, and the CONNECT intervention took place in each community’s high schools.
Staffing Needs
Advanced Degree (post BA) Professional, Community Leader, Community Member
CONNECT was delivered by school-based social workers; CMCA interventions were delivered by community members.
The CMCA intervention was delivered by community members. CONNECT was delivered by school-based social workers who were trained to deliver screening and brief intervention.
Research Design
Randomized controlled experimental design
Developmental stage of research
The results are based on a rigorous research design but would benefit from a larger sample with longer follow-up in Native communities.
The evidence supporting use of the combined CMCA/CONNECT intervention in reducing alcohol use and related harm is promising. The present study is strengthened by use of a control group, randomization by school, and multiple surveys throughout the intervention. However, it requires implementation in a larger sample and follow-ups after the conclusion of the intervention to continue to evaluate effectiveness and stability of effects over time.
Potential
Although it is feasible to deliver both interventions simultaneously, the combination may not yield better outcomes.
Implementation within Native communities of the combined CMCA/CONNECT program appears feasible, as it was implemented successfully in two rural communities within Cherokee Nation. However, some communities may find the cost and resources required prohibitive. Further, the change in outcome with the combined intervention was not greater than the change with CONNECT or CMCA alone, suggesting that it may be more cost-effective to implement only one program.
References
Komro KA, Livingston MD, Wagenaar AC, et al. Multilevel prevention trial of alcohol use among American Indian and White high school students in the Cherokee Nation. Am J Public Health. 2017;107(3):453-459. https://pubmed.ncbi.nlm.nih.gov/28103073. https://doi.org/10.2105/ajph.2016.303603.
Komro KA, Wagenaar AC, Boyd M, et al. Prevention trial in the Cherokee Nation: Design of a randomized community trial. Prev Sci. 2015;16(2):291-300. https://pubmed.ncbi.nlm.nih.gov/24615546. https://doi.org/10.1007/s11121-014-0478-y.
Related Intervention Webpages
National Institute on Alcohol Abuse and Alcoholism (NIAAA). CONNECT. October 2024.
National Institute on Alcohol Abuse and Alcoholism (NIAAA). Communities Mobilizing for Change on Alcohol (CMCA). October 2024.
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