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CONNECT
CONNECT consists of individual screening and brief intervention sessions with students as well as media messages about risk and protection factors.
The CONNECT intervention had two components: at least one individual meeting between the CONNECT coach and students each semester, and a media campaign about alcohol use risk and protective factors for youth. During school hours, a trained staff member delivered the 15-minute one-on-one sessions, a manualized screening and brief intervention protocol utilizing motivational interviewing (MI), feedback on normative behavior, and goal setting. Outcomes were assessed using student self-report surveys four times per year over 3 years. CONNECT was one of two prevention interventions included in a randomized controlled trial design. Communities were assigned to receive CONNECT, Communities Mobilizing for Change on Alcohol (CMCA), both interventions, or delayed intervention control.
Outcomes
CONNECT reduced current use of alcohol, episodes of heavy drinking, and alcohol-related consequences among American Indian and non-Native youth.
The CONNECT intervention was associated with reductions of 19% to 23% in current alcohol use, heavy episodic drinking, and alcohol-related consequences, compared to the control group. The effect peaked at year 2 and lessened in year 3. Statistical tests of the effectiveness of the interventions by race found the interventions were effective overall for both American Indian and non-Native participants.
Costs
Medium level of costs to hire, train, and supervise social worker(s) to deliver a time-intensive intervention and a media campaign.
Moderate start-up costs would be incurred to hire, train, and supervise social workers as CONNECT coaches, as well as to develop and implement a regionally specific media campaign (e.g., mailing postcards, posters). Intervention delivery is time-intensive, requiring at least a half-time staff dedicated to providing screening and brief intervention and follow-up. The amount of staff time would likely increase if delivered to all eligible students in a given school.
Cultural Engagment
No cultural adaptation was described, but the research included Cherokee Nation Behavioral Health as an equal partner.
No specific cultural adaptations are described but CONNECT was designed to be “culturally adaptive.” It is unclear how involved the AI community was in data collection, analyses, or interpretation of the data. The research was an equal partnership between university-based and Cherokee Nation Behavioral Health staffs; the Tribal institutional review board approved consents, presentations, and manuscripts.
Participants
Adolescent; Native, Non-Native; Female, Male
Setting
Rural, School
Delivery
Individual, 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.
The interventions were delivered in high schools in two rural Cherokee Nation communities (not a reservation setting). Participants included male and female high school students: CONNECT only (n = 224), combined CONNECT and CMCA (n = 603), and control (n = 558). The youth were approximately 15 years old, and nearly half were Native.
Staffing Needs
Advanced Degree (post BA) Professional
A social worker, a doctoral-level supervisor, and trained participants
A school-based social worker served half-time as the CONNECT coach in each school. A doctoral-level supervisor trained coaches in MI and monitored intervention fidelity.
Research Design
Randomized controlled experimental design
Developmental stage of research
The results are based on a rigorous research design, which would benefit from a larger sample of Native Americans and longer follow‑up.
The evidence supporting use of the CONNECT program as a universal prevention intervention to reduce alcohol use and related harm is promising. The present study makes use of a control group, multiple surveys over several years, with limited attrition, and fidelity monitoring throughout the intervention. However, it requires implementation in a larger sample, with more Native American representation, and follow-ups after the conclusion of the intervention to evaluate effectiveness and stability of effects over time.
Potential
This universal screening and brief intervention may be effective for Native youth, but might be costly to initiate and maintain.
CONNECT may be a universal alcohol prevention intervention that requires little cultural adaptation yet has relevance and efficacy for Native youth. One reason for this may be the incorporation of MI, which involves tailoring based on the goals of the individual. Some communities may find the cost and resources required to initiate and maintain the intervention prohibitive.
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.
Garrett BA, Komro KA, Merlo LJ, et al. CONNECT: Implementation of a school-based alcohol screening and brief intervention for youth in the Cherokee Nation. J Sch Health. 2019;89(11):874-882. https://pubmed.ncbi.nlm.nih.gov/31478206. https://doi.org/10.1111/josh.12830.
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. Combined CONNECT and CMCA. October 2024.
National Institute on Alcohol Abuse and Alcoholism. Communities Mobilizing for Change on Alcohol (CMCA). October 2024.
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