Connect Kits for Family Action: Intervention Development and Exploratory Data Analysis of Proximal Outcomes.

We designed a home-based family intervention to address risk of substance use among adolescents in rural and Native American communities. Through a Tribal-University partnership, study aims were to develop, implement and explore effects on proximal risk and protective factors. The study was conducted in or near the Cherokee Nation Reservation in northeastern Oklahoma and was a cluster-randomized trial with 10 high schools randomly assigned to intervention and 10 to delayed intervention group. The study involved a cohort of 919 tenth-grade students, surveyed approximately every six months over three years. Self-reported measures assessed the intervention's impact on proximal outcomes linked to receipt of specific intervention components. Results indicate successful altering of norms, increased risk perceptions and parental disapproval of substance use. No improvements were found for parent/caregiver support and monitoring, friend support, or anxiety and depressive symptoms. The intervention's cultural relevance and community involvement were key strengths, particularly in addressing health disparities in rural and Native populations. Despite some limitations, such as unchanged perceptions of social support, the findings suggest that culturally tailored, family-centered interventions can effectively reduce risk factors and increase protective factors. The study contributes to the limited literature on family-focused prevention for Indigenous youth and underscores the importance of community partnerships and culturally inclusive approaches in public health practice.