The Weaving Healthy Families Program to Prevent Substance Misuse and Mental Health Disparities While Promoting Parenting, Family Resilience, and Communal Mastery

Background and Purpose: Historical oppression (including discrimination), along with community and family resilience (including parenting), are well-documented factors driving the disproportionate health inequities experienced by U.S. Indigenous peoples. Inequities in health differ by sex and span from mental and behavioral factors (i.e., alcohol and other drug (AOD) use, anxiety, depression, and suicide), relational factors (i.e., parenting and family and community resilience), and structural factors (i.e., as discrimination and historical oppression). This purpose of this presentation is to examine pilot results from the culturally grounded Weaving Healthy Families (WHF) program (clinical trial NCT03924167) to prevent AOD abuse while improving wellness and family resilience. We longitudinally examine changes in outcomes across ecological levels before and after participation in the WHF intervention program. First, we examine changes in behavioral outcomes and relational outcomes before and after participation in the WHF program, as well as sex difference for each outcome. Next, we examine how differing levels of historical oppression moderate differences in key outcomes.

Methods: This nonexperimental and longitudinal design used repeated measures regression analysis and generalized estimating equations (GEE) with the adults and adolescents of 8 Indigenous families (n = 24) to examine pretest data, posttest data, and data at 6, 9, and 12 months after completion of the WHF program. First, we examined changes in mental and behavioral outcomes (i.e., AOD use, symptoms of anxiety, dysfunctional attitudes associated with depression, and suicide ideation) and relational outcomes (i.e., parental quality, family resilience, and communal mastery) before and after participation in the WHF program and noted sex differences. Next, we examined differences in the outcomes before and after the WHF program for participants reporting high and low levels of historical oppression: AOD use, symptoms of anxiety, parental quality, communal mastery, and discrimination.

Results: We observed a nearly threefold decline in alcohol use, and significant declines in drug use, dysfunctional attitudes, symptoms of anxiety, and suicidal ideation. Alcohol use and dysfunctional attitudes declined significantly more for men than women. We observed significant improvements over time in parenting quality, communal mastery and in family resilience after accounting for sex. Parenting improved significantly more for men than women. When examining historical oppression’s differential effects on outcomes, we observed significant effect modification by historical oppression in the changes in alcohol use, drug use, discrimination, communal mastery, symptoms of anxiety, positive parenting, and poor parental monitoring.

Conclusions and Implications: Preliminary results of the WHF program indicate it may be a promising culturally grounded prevention program to address AOD use, dysfunctional attitudes related to depression, suicidal ideation, and symptoms of anxiety as well as promote parenting, family resilience, and communal mastery. Results support the integration sex differences and of historical oppression as a primary factor to prevent substance abuse while promoting mental, familial, and community factors to redress health inequities and promote health and wellness.