Parenting in 2 Worlds: A Randomized Controlled Trial of a Culturally Adapted Parenting Program for Urban American Indians

Purpose: Culturally appropriate evidence-based prevention programs outside reservations often are neither available nor accessible to the rapidly growing majority of American Indians (AIs) (70%) who now live in cities. Urban AI adolescents have higher rates, earlier onset, and more severe consequences of substance abuse than their non-native counterparts, as well as a higher likelihood of pre-teenage sexual intercourse and multiple sex partners. The goal of this study was to strengthen protective family factors against substance use and risky sexual behaviors among urban AI youth through a culturally grounded parenting intervention, Parenting in 2 Worlds (P2W). P2W was developed specifically to reflect a special constellation of social influences on urban AI families: high residential instability and mobility, socioeconomic stressors, poor educational attainment, cultural disruption, unstable home environments, and  fluid, dispersed, transient,and  resource strained social networks in the city.  By systematically employing community-based participatory research in three urban AI communities with diverse tribal backgrounds, a multi-stage cultural program adaptation process uncovered common teachings, cultural values and communication customs relating to parenting, and systematically incorporated them in the P2W curriculum. This presentation reports the results of a test of the efficacy of the intervention.

Methods: Data come from 585 parents of AI children (ages 10-17) in a randomized controlled trial of P2W in three Arizona cities.  Parents were recruited through the auspices of urban Indan centers in their city, and were randomly assigned to P2W or to an informational family health curriculum, Healthy Families in 2 Worlds (HF2W).  Both the P2W and HF2W curricula consisted of 10 workshops delivered weekly by AI community facilitators. All recruited parents received incentives for participating in each workshop ($15), and 98% of them consented to complete self-administered questionnaires. Pretests were administered at the first workshop and a post-test at the last workshop, measuring parenting skills, family functioning, youth risk behaviors, and cultural engagement. Tests of the efficacy of P2W versus HF2W were analyzed through baseline adjusted regression models, adjusting for random effects at the site and facilitator levels, using full information maximum likelihood estimation in Mplus, and controlling for program dosage (# workshops attended). Intervention effect sizes were estimated with Cohen’s d.

Results: Most parents (77%) were female, either single (36%) or living with an unmarried partner (28%), and had annual incomes under $10,000 (56%). On average parents were 38 years old, had lived for 14 years on a reservation, and now resided in an urban area for 18 years. The parents were affiliated with 31 different AI tribes. Parents in P2W reported significantly larger pretest to post-test increases than parents in HF2W on measures of parental self-agency, positive parenting practices, communication with their children about safe sex, child’s prosocial behavior, and strength of parental AI ethnic identity. P2W parents reported significantly larger decreases in their child’s discipline problems and substance use. Most of these desired program effects for P2W achieved medium size.

Conclusions: Culturally adapted parenting interventions like P2W can effectively strengthen parenting practices, family functioning and cultural identity among urban AI families.