Project Summary Alcohol and other drug (AOD) abuse and family violence are secondary health effects of COVID-19 and risk factors for the Native American (NA) health disparities that drive mortality rates. Given the gap in culturally- grounded programs to address these secondary effects of COVID-19—AOD abuse and violence in families— there is a critical need to test the efficacy of digitally enhanced and sustainable community-based interventions. The long-term goal of the parent research is to promote health and wellness, while preventing and reducing AOD abuse and violence in NA families. The supplement will extend this to address the secondary health effects of COVID-19 promoting access, sustainability, and engagement with a digitally assisted intervention. Using community-based participatory research methods (CBPR), the overall objectives of the proposed parent award are to use a stepped-wedge trial design (SWTD) to test the efficacy of the community-based, “Weaving Healthy Families program (WHF)”, which will prevent, reduce, and postpone the secondary health effects of COVID-19, namely AOD use and violence in families while promoting resilience and wellness (including mental health) among NA adults and youth. Objective 1 of the Supplement is to examine the secondary health effects of COVID-19, namely AOD abuse, IPV, as well as family functioning, and mental/physical health. Our working hypothesis is that the greater stress imposed by COVID-19 will worsen AOD abuse, IPV, and family conflict, but the WHF program will ameliorate these secondary health effects. We continue to use the parent grant's SWTD where groups (i.e. 175 MBCI families) are randomly assigned the order in which they receive the intervention. We examine the sex differences for COVID-19, using sex as a moderator to understand whether and how sex moderates the secondary health effects of COVID-19 and the differential effect of the WHF program by sex. We also integrate the explanatory sequential mixed- methods design to evaluate socio-behavioral impacts of COVID-19 through 30-50 qualitative interviews with female heads of household. Objective 2 of the Supplement is to evaluate the sustainability and feasibility of the WHF program with the inclusion of the mHealth component through the use of SMS text messaging to enhance the reach, access, engagement, efficiency, quality, and sustainability of the adapted evidence-based intervention. Our working hypothesis is that the inclusion of SMS text messages for survey and session reminders, engagement, and psychoeducation during and after the WHF program will improve the reach, access, engagement, efficiency, quality, and sustainability of the program. We use the parent grant's CFIR and the explanatory sequential mixed-methods design to evaluate the impact of qualitative and quantitative engagement methods enhanced with SMS text messaging. This research is well-matched to the supplement as the digitally enhanced WHF program directly addresses the secondary health effects of COVID-19, in particular AOD abuse, violence and family conflict, as well as health and mental health.

Alcohol and other drug (AOD) abuse and family violence are secondary health effects of COVID-19 and risk factors for the Native American (NA) health disparities that drive mortality rates. The long-term goal of the parent research is to promote health and wellness, while preventing and reducing AOD abuse and violence in NA families, and the supplement will extend this to address the secondary health effects of COVID-19 promoting access, sustainability, and engagement with a digitally assisted intervention. This digitally enhanced “Weaving Healthy Family” program directly addresses the secondary health effects of COVID- 19, in particular AOD abuse, violence and family conflict, as well as health and mental health.