Project Summary Alcohol and other drug (AOD) abuse and family violence are co-occurring risk factors for Native American (NA) health disparities and are associated with the leading causes of death within this population, such as cardiovascular disease (CVD) and diabetes. However, extant interventions often fail to holistically promote resilience, health, and wellness, instead addressing problems in isolation. To our knowledge, there have been few NA culturally-based and family-focused interventions that enhance family resilience and prevent and reduce AOD abuse and violence in families. Given the gap in community and culturally-grounded programs to prevent AOD abuse and violence in families, there is a critical need to test the efficacy of such sustainable community-based interventions. The long-term goal of this research is to promote health and wellness, while preventing and reducing AOD abuse and violence in NA families by testing a culturally-relevant and family- centered intervention for cross-national dissemination. Using community-based participatory research methods (CBPR), the overall objectives of the proposed research are to use a stepped-wedge trial design (SWTD) to test the efficacy of a culturally modified intervention that is facilitated by Tribally-based community health representatives (CHRs) and to use the consolidated framework for implementation research (CFIR) to examine the barriers and facilitators for intervention sustainability and implementation. Our central hypothesis is that the community-based, “Weaving Healthy Families program”—a shortened, streamlined, and culturally adapted version of the Celebrating Families! Program—will reduce and postpone AOD use, decrease and prevent violence in families, and promote resilience and wellness (including mental health) among NA adults and youth. This intervention seeks to promote wellness by targeting key behavioral (AOD abuse), mental/emotional (emotional regulation/anger management, cognitions, and resilience), social and familial (healthy and non- violent relationships, the family environment, and parenting), cultural (values and traditions), and physical (nutrition and AOD abuse) factors. We accomplish the stated objectives through these aims: Aim 1: Test the efficacy of the modified intervention on AOD abuse and violence reduction and resilience enhancement. Using an open cohort, multiple baseline SWTD and multilevel and longitudinal modeling, we will test our working hypothesis that the intervention will reduce parental AOD abuse and violence, postpone youth AOD use, and enhance family members' resilience and wellness. Aim 2: Evaluate the sustainability and feasibility of the intervention's implementation. We will use the CFIR and a convergent mixed-method design to evaluate barriers and facilitators to intervention implementation, testing our working hypothesis that the modified intervention will provide a culturally relevant and feasible model to promote wellness in a sustainable way. The expected outcomes of the proposed research are an efficacious, culturally relevant, and sustainable community-based program to promote health and wellness for tribes cross-nationally.

Project Narrative Alcohol and other drug (AOD) abuse and violence in families are co-occurring risk factors that drive health disparities and mortality among Native Americans (NA), and thus, the long-term goal of this research is to promote health and wellness, while preventing and reducing AOD abuse and violence in NA families by testing an efficacious, sustainable, culturally-relevant and family-centered intervention for cross-national dissemination. Our central hypothesis is that the sustainable and community-based Weaving Healthy Families program will reduce and postpone AOD use, decrease and prevent violence in families, and promote resilience and wellness (including mental health) among NA adults and youth. The expected outcomes of the proposed research are an efficacious, culturally relevant, and sustainable community-based program to promote health and wellness among NA families that will address the factors that drive health disparities and promote individual, family, and community resilience.