Evaluating the Impact of a Tribal Naloxone Program Through Pre and Post Surveys from First Responders.

The Choctaw Nation Health Care Center established a first responder naloxone program in 2015. Limited data is available on community naloxone programs specific to tribal communities and the opinions of first responders who may utilize naloxone in the field. The purpose of this article is to highlight the model of a tribal first responder naloxone program in Talihina, Oklahoma and present analysis of the impact of program trainings on first responders' understanding and willingness to administer intranasal naloxone through pre- and post-surveys (n = 758) collected from May 2018 to November 2019. Descriptive analyses were conducted to compare first responders' rating of their support, willingness, and confidence in using naloxone. Overall, 95.1% of first responders reported learning something new from the training. However, the most significant changes in pre- to post-test results were among first responders that had never been at the scene of an overdose. Almost 77% of trainees who reported they never were at a scene of an overdose and responded "not very willing" in administering naloxone at pre-test, responded that they were "very willing" to administer naloxone at post-test.

Community readiness in the Syrian refugee community in Jordan: A rapid ecological assessment tool to build psychosocial service capacity.

The knowledge of Syrian psychosocial activists in displaced communities is an invaluable resource for developing an ecological understanding of community needs and attitudes. This may elucidate the structural challenges of displacement to be addressed in psychosocial interventions. During Phase 1 of the study, we employed the community readiness model-a tool to assess community climate, needs, and resources-to determine community capacity-building needs. Eight Syrian key informants were interviewed in Amman, Jordan (December 2013 to January 2014). Community readiness scores were calculated. Thematic analysis explored community identified needs. During Phase 2, a focus group was conducted with 11 local psychosocial workers in Amman (September 2016) employing Phase 1 findings to develop a local capacity-building intervention. For the Phase 1 results, community attitudes toward mental health were reported to be rapidly changing. However, continued stigma, lack of knowledge of service availability, and insufficient number of services were noted as barriers to care. Sense of civic engagement and cultural knowledge of local psychosocial actors were noted as significant strengths. However, lack of access to work rights and technical supervision were identified as contributing to burnout, undermining the sustainability of local, grassroots initiatives. A need for training in clinical interventions, along with ongoing supervision, was identified. For the Phase 2 results, local psychologists elected to receive training in culturally adapted cognitive behavior therapy and operational capacity building. The cultural and contextual knowledge of Syrian community members are invaluable. Unfortunately, failure to provide these professionals with basic work rights and technical support have undermined the sustainability of their endeavors. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Community readiness: an effective model for tribal engagement in prevention of cardiovascular disease.

Significant health disparities exist among culturally diverse minority populations in the United States. The ways in which healthcare providers recognize and respond to this issue is critical. Methods must be effective, culturally appropriate, and engage the community if they are to be utilized, and they also need to be sustainable to make a significant impact. American Indians and Alaska Natives face many unique health disparities and challenges and they confront many barriers when seeking care and treatment. These obstacles make it essential for healthcare professionals to engage the community in the development of culturally appropriate strategies with which to address health issues. This article describes a community-based participatory approach that was executed successfully by the Choctaw Nation of Oklahoma. By utilizing the Community Readiness Model, it effectively built on the culture and resiliency that exists in each of 10 communities to more successfully implement community-responsive health prevention and treatment. This article discusses the experience of the Choctaw Nation in its assessment and engagement of the community in addressing cardiovascular disease. Data are presented that reflect the successful use of the Community Readiness Model and discussion is provided. This article emphasizes the use of an effective community-based participatory method, Community Readiness, that enabled the Choctaw Nation to make strong "inroads" into its respective service area through successful community engagement.

Prevalence of American Indian adolescent tobacco use: 1993-2004.

Tobacco use rates for American Indian adolescents are examined and compared to rates for non-Indian youth. The data are taken from an ongoing surveillance project of substance use among Indian youth and the Monitoring the Future Project for the years 1993 to 2004. Sample sizes are in the range of 14,000 to 17,000 for non-Indian youth and 600 to 2400 for Indian youth. Tobacco use is considerably higher for Indian youth; however, these rates are following the national trends of significant reductions over the past three years. Indian youth manifested a lower perception of harm from regular tobacco use, which may, in part, account for their higher levels of use. Indian females have had slightly higher rates of lifetime and daily smoking rates than males in the past but recent trends indicate a narrowing of this gap.

Disparities in young adolescent inhalant use by rurality, gender, and ethnicity.

Inhalant use is of increasing concern as rates appear to be rising among young adolescents and gender differences narrowing. Data from 20,684 Mexican American and White non-Hispanic seventh- and eighth-grade males and females from the Western United States and 15,659 African American and White non-Hispanic seventh- and eighth-grade males and females from states in the southeastern United States collected via in-school surveys from 1996 to 2000 were analyzed using a variety of statistical techniques including multilevel modeling. Questions addressed in the study included: Does inhalant use vary by level of rurality? What effect does the ethnic composition of the community have on inhalant use and does this effect differ by an individual's ethnicity? Do males use more inhalants than females and does the level of use by males and females differ by individual ethnicity, ethnicity of the community, or level of rurality? Do males and females of different ethnicities initiate inhalant use at different ages? Limitations of the study and implications of findings for prevention are discussed and areas of future research are suggested. This study was funded by the National Institute on Drug Abuse.

Disparities in Community Readiness for HIV/AIDS prevention.

HIV and AIDS as a community(1) issue have not been dealt with extensively in the literature. One model that offers promise for development of effective prevention and intervention efforts is the Community Readiness Model, a nine-stage model that assesses the level of readiness of a community to develop and implement prevention programming. Data are presented from a Community Readiness assessment of 30 rural U.S. communities: 10 African American, 10 Mexican American, and 10 White non-Mexican American. Four to five key respondent interviews were conducted via telephone in each community using the Community Readiness Assessment protocol during 1999-2000. Limitations of the study and implications for prevention are discussed. This study was funded by the National Institute on Drug Abuse.

Advancing HIV/AIDS prevention among American Indians through capacity building and the community readiness model.

Although HIV/AIDS prevention has presented challenges over the past 25 years, prevention does work! To be most effective, however, prevention must be specific to the culture and the nature of the community. Building the capacity of a community for prevention efforts is not an easy process. If capacity is to be sustained, it must be practical and utilize the resources that already exist in the community. Attitudes vary across communities; resources vary, political climates are constantly varied and changing. Communities are fluid-always changing, adapting, growing. They are "ready" for different things at different times. Readiness is a key issue! This article presents a model that has experienced a high level of success in building community capacity for effective prevention/intervention for HIV/AIDS and offers case studies for review. The Community Readiness Model provides both quantitative and qualitative information in a user-friendly structure that guides a community through the process of understanding the importance of the measure of readiness. The model identifies readiness- appropriate strategies, provides readiness scores for evaluation, and most important, involves community stakeholders in the process. The article will demonstrate the importance of developing strategies consistent with readiness levels for more cost-effective and successful prevention efforts.

Combining in-school and community-based media efforts: reducing marijuana and alcohol uptake among younger adolescents.

This study tests the impact of an in-school mediated communication campaign based on social marketing principles, in combination with a participatory, community-based media effort, on marijuana, alcohol and tobacco uptake among middle-school students. Eight media treatment and eight control communities throughout the US were randomly assigned to condition. Within both media treatment and media control communities, one school received a research-based prevention curriculum and one school did not, resulting in a crossed, split-plot design. Four waves of longitudinal data were collected over 2 years in each school and were analyzed using generalized linear mixed models to account for clustering effects. Youth in intervention communities (N = 4,216) showed fewer users at final post-test for marijuana [odds ratio (OR) = 0.50, P = 0.019], alcohol (OR = 0.40, P = 0.009) and cigarettes (OR = 0.49, P = 0.039), one-tailed. Growth trajectory results were significant for marijuana (P = 0.040), marginal for alcohol (P = 0.051) and non-significant for cigarettes (P = 0.114). Results suggest that an appropriately designed in-school and community-based media effort can reduce youth substance uptake. Effectiveness does not depend on the presence of an in-school prevention curriculum.

Using community readiness key informant assessments in a randomized group prevention trial: impact of a participatory community-media intervention.

This study examines the role of key informant community readiness assessments in a randomized group trial testing the impact of a participatory community-media intervention (which was also complemented by in-school efforts). These assessments were used to help match communities in random assignment, as a source of formative data about the community, as the basis for a coalition-building workshop, and as an evaluation tool, with a follow-up set of surveys approximately 2 years after the baseline survey. Results of the nested, random effects analysis indicated that the intervention influenced community knowledge of efforts and (at marginally significant levels) improved prevention leadership quality and community climate supportive of prevention efforts. There was evidence that the professional affiliation of informants in some cases had an effect on their assessments, which could be controlled in the analysis. The authors conclude that key informant community readiness assessments can usefully serve to supplement aggregated measures of individual attitudes and behavior (reported elsewhere for this study) in evaluating community-based interventions.

Describing community needs: examples from the Circles of Care initiative.

The assessment of community needs was one of the key foundations of the Circles of Care planning effort. Grantees identified a range of needs at the child, adolescent, family, programmatic, and community levels. This information, along with an emphasis on the importance of each community's history and culture, served as an important guide for each program as they developed their model systems of care.

Surveillance of drug use among American Indian adolescents: patterns over 25 years.

PURPOSE: To examine the trends in drug use among American Indian adolescents attending schools on, or near, Indian reservations in the United States, to provide comparisons with non-Indian youth, and to discuss implications for prevention. METHODS: Reliable and valid school administered drug use surveys have been given every year for 25 years (1975-2000) to representative samples of Indian youth living on reservations, yielding a continuous record of trends in drug use. Comparisons are made with non-Indian youth with data from the Monitoring the Future project. Data were analyzed to obtain measures of lifetime prevalence ("ever tried a drug"), use in the last 30 days, and proportions at high risk and at moderate risk from their drug use. Comparisons utilized difference in proportion tests. RESULTS: From 1975 to 2000, reservation Indian youth show elevated levels of drug use for most illicit drugs compared with non-Indian youth. Despite higher levels of use, the trends showing increases and decreases in use over time mirror those shown by non-Indian youth. Indian youth who use drugs can be divided into moderate and high levels of use. The number of youth in the moderate category varies over time whereas the number in the high category remains relatively constant. CONCLUSIONS: There is a clear need for intensive efforts to reduce the levels of drug use among Indian youth. Although interventions must be tailored to the social and cultural milieu of Indian reservations, the rates of use vary over time in the same pattern as seen for non-Indian youth. Further, interventions must address the differing characteristics of high and moderate risk users of drugs.

Community readiness: the journey to community healing.

Community readiness is a research-based theory that provides a basic understanding of the intervention process in communities. This theory allows us to accurately describe the developmental level of a community relative to a specific issue or problem. In order to move the community toward implementing and maintaining efforts that are effective and sustainable, community mobilization must be based on involvement of multiple systems and utilization of within-community resources and strengths. Successful local prevention and intervention efforts must be conceived from models that are community-specific, culturally relevant, and consistent with the level of readiness of the community to implement an intervention. The community readiness model is an innovative method for assessing the level of readiness of a community to develop and implement prevention programming. It can be used as both a research tool to assess distribution of levels of readiness across a group of communities or as a tool to guide prevention efforts at the individual level. This tool has proven useful in addressing a gamut of problems ranging from health and nutritional issues to environmental and social issues. The model identifies specific characteristics related to different levels of problem awareness and readiness for change.

A survey of attitudes among drug user treatment providers toward the treatment of inhalant users.

This study assessed the attitudes of drug user treatment program directors towards the problem of inhalant "abuse." In 2000, surveys were mailed to directors asking about treatment success and prognosis for inhalant users, level of neurological damage incurred by users, availability of treatment resources, their program's policies toward admission of users, and staff training needs for inhalant use. Two open-ended questions queried their assessment of barriers to treatment and subjective feelings about the topic of inhalant use. Five hundred and fifty responses were received. Findings show that program directors perceive a great deal of neurological damage incurred through inhalant use and have a general pessimism about treatment effectiveness and recovery. The respondents also felt that there were insufficient resources for inhalant user treatment and that special staff training in the area was needed. The majority of the directors indicated that they have or would treat inhalant users. Implications for future research and policy change are discussed.

Inhalant abuse among American Indian, Mexican American, and non-Latino white adolescents.

The abuse of volatile solvents, or inhalants, is an enduring problem among adolescents although a number of factors obscure the nature and extent of this drug using behavior. The data presented here indicate that a number of social and perceptual correlates of inhalant use operate similarly across Mexican American, American Indian and non-Latino white adolescents. Peer factors appear to dominate, although they are somewhat less important for Mexican American and Indian youth. Increased perception of harm reduces inhalant use for all groups. Of particular significance in the findings here are the continued increase of inhalant use among females compared to males and the strong pattern of decreases in inhalant use among American Indian adolescents over the last decade. A number of implications for increased effectiveness of prevention are discussed.