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In-home Prevention of Substance Abuse Risk in Native Teen Families: Focus on Fathers

In-home Prevention of Substance Abuse Risk in Native Teen Families: Focus on Fathers. Based on :“In-Home Prevention of Substance Abuse Risk in Navajo Teen Families” [NNR-05.174] Presenters: Trudy Billy & Lena Clitso Johns Hopkins Focus on Fathers Team:

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In-home Prevention of Substance Abuse Risk in Native Teen Families: Focus on Fathers

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  1. In-home Prevention of Substance Abuse Risk in Native Teen Families: Focus on Fathers Based on :“In-Home Prevention of Substance Abuse Risk in Navajo Teen Families” [NNR-05.174] Presenters: Trudy Billy & Lena Clitso Johns Hopkins Focus on Fathers Team: Kendall Tanner, Sean Parker, Timothy Johnson, Valerie Coho-Mescal, Allison Barlow, MA, MPH, Britta Mullany, PhD, Nicole Neault, MPH, Julia Powers, MHS, John Walkup, MD

  2. Presentation Overview • Johns Hopkins Center for American Indian Health • Focus on Fathers Project • Background • Methods • Results • Conclusions

  3. Johns Hopkins Center for American Indian Health • MISSION STATEMENT: • To work in partnership with American Indian and Alaska Native communities to raise AI/AN health status, self-sufficiency and health leadership of AI/AN people to the highest possible level.

  4. Three Core Activities

  5. Center Overview • 30 year relationship with Navajo Nation, White Mountain Apache, and San Carlos Apache • Public health technologies and interventions translated world wide • 80 Native American employees/research assistants (>300 over the past 3 decades) • Professional training program to advance AI paraprofessionals toward professional degrees and roles

  6. The Focus on Fathers Project

  7. Focus on Fathers: Background • Since 1995, Johns Hopkins Center for American Indian Health has implemented and evaluated a home-visiting parenting program (Family Spirit) specifically targeting young American Indian mothers and their children. (Barlow et al 2006, Walkup et al 2009, Novins 2009) • Fathers and other family members participated when invited by the mother. • Community members frequently asked about support specifically for fathers, especially targeting substance abuse and fatherhood absence from families.

  8. History of Family Spirit “Cradling our Future”:* teen moms* 28 weeks prenatal through baby’s 3rd birthday; * RCT evaluation moms/kids * “Focus on Fathers” supplement(322 moms/kids served; 87 dads enrolled) “Family Strengthening”:* parallel curriculum teen moms/dads* prenatal to baby’s 6 month birthday* RCT evaluation moms/dads(48 dads; 68 moms served) “SOS” Project* service * teen mothers, babies* prenatal to 6 mos pp(160 moms served) 1995 1999-2001 2005-present 1998-99 2002-05 2006-present “Family Spirit”:* teen moms/dads* prenatal to baby’s 1st bday* RCT evaluation (75 dads; 166 moms served) “Fathers Project”: curriculum to address needs of men expecting babies with AI teen moms. (55 dads; 62 moms served) “Family Spirit” Replication:* IHS Head Start* Chinle PHNs* Seattle Urban Indians * Santo Domingo Head Start

  9. Focus on Fathers: Background • Funding from NIDA in 2009 enabled the initiation of the Focus on Fathers project. • Project aims include: 1: Describe drug use patterns of young American Indian fathers.  2: Explore fathers’ and community stakeholders’ beliefs and motivations regarding fatherhood. 3: Examine relationships between fathers’ drug use patterns and their fatherhood roles. 4: Utilize data to design a culturally relevant intervention specifically for fathers.

  10. Focus on Fathers Project Sites Navajo Nation Nation San Carlos Apache White Mountain Apache Reservation Apache White Mountain Apache UTAH COLORADO ARIZONA Albuquerque Phoenix NEW MEXICO Tucson

  11. Focus on Fathers: Methods • Data were collected from 2010-2011. • Participants include: • 87 fathers/male partners of the teen mothers enrolled in an ongoing family strengthening study. • 39 community stakeholders.

  12. Focus on Fathers: Methods PHASE ONE: • Administer 87 computer-based surveys (ACASI) to describe fathers’ drug use patterns and fatherhood characteristics. • Conduct audio-recorded in-depth interviews with a random sub-sample of 28 fathers, representing different drug use categories.

  13. Focus on Fathers: Methods PHASE TWO: • Conduct 39 video-taped in-depth interviews with community stakeholders, including elders, “model fathers”, tribal leaders, and service providers. • Prepare a 10-20 minute film for each site featuring interview segments from community stakeholders.

  14. Focus on Fathers: Methods PHASE THREE: • Conduct 12 roundtable discussions (3 per site) to view the film, interpret ACASI and in-depth interview findings, and discuss potential fatherhood programs.

  15. Focus on Fathers: Data Analysis • All analysis and interpretation done in partnership with staff from each participating community. • Descriptive analysis conducted on quantitative data to summarize sample characteristics. • Correlates of lifetime and past-month drug use examined using chi-square tests and t-tests for associations with sociodemographic characteristics, fatherhood roles, and background family factors. • Qualitative data examined for evidence of causality for associations seen in quantitative correlate analysis.

  16. Focus on Fathers: Results DEMOGRAPHIC CHARACTERISTICS

  17. Focus on Fathers: Results FATHERHOOD ROLES AND EXPERIENCES

  18. Focus on Fathers: Results BACKGROUND FAMILY FACTORS

  19. Focus on Fathers: Results REPORTED ALCOHOL AND DRUG USE

  20. Focus on Fathers: Results CORRELATES OF LIFETIME SUBSTANCE USE • Age: • Older (≥25 yrs) more likely to report binge drinking episode than younger (18-24 yrs) (57% vs. 26%, p<0.01) • Employment status: • Unemployed more likely to report lifetime marijuana (86% vs. 65%, p<0.05) and meth use (44% vs. 12%, p<0.005) • Presence at birth: • 25% of those present at birth vs. 56% of those not present had ever used meth (p<0.01) • Involvement in child care duties: • 73% of highly involved vs. 90% of others had ever used alcohol (p<0.05) • Being role model for child: • 71% of those prioritizing role model vs. 88% of others had ever used alcohol (p<0.05) • No significant associations with biological father status

  21. Focus on Fathers: Results CORRELATES OF LIFETIME SUBSTANCE USE, cont. • Higher lifetime drug use associated with participant’s biological father having alcohol problem, but not biological mother. • Compared to men whose fathers did not have drinking problems, participants reporting biological fathers ever having drinking problem were: • More likely to report binge drinking episode (54% vs. 18%, p<0.001) • More likely to report ever using meth (49% vs. 24%, p<0.05)

  22. Focus on Fathers: Results CORRELATES OF CURRENT SUBSTANCE USE • Employment status: • Unemployed more likely to report past month marijuana use than employed (43% vs. 19%, p<0.05) • Presence at birth: • 28% of those present at birth vs. 52% of those not present had ever used meth (p<0.05) • Being role model for child: • 34% of those prioritizing role model vs. 58% of others had used alcohol in past month (p<0.05) • Parenting stress: • higher stress levels reported among men who used marijuana in past month vs. non-users (p<0.05) • No significant associations with biological father status, involvement in child care duties or child play

  23. Focus on Fathers: Results CORRELATES OF CURRENT SUBSTANCE USE, cont. • Higher marijuana use among those whose biological fathers were part of life vs. not as child (46% vs. 26%, p<0.05) • Higher marijuana use among those whose father figures showed little interest in them as child (65% vs. 29%, p<0.005) • Compared to men whose fathers did not have drinking problem, participants that reported biological fathers ever having drinking problem were: • More likely to report binge drinking episode in past 6 months (27% vs. 8%, p<0.05) • More likely to report ever using meth (49% vs. 26%, p<0.05)

  24. Focus on Fathers: Results QUOTES FROM IN-DEPTH INTERVIEWS WITH YOUNG FATHERS “Like I had everything pictured out man the way I wanted it… just a couple bad decisions just like brought me to this way… Wish I did a couple things different, but at the same time I really don’t… I would want to do things different as like financially and like…more responsible you know?” “I just know that my family doesn’t like the things that I do but they just expect me to find it out, figure it out myself so… I wanted to be an adult when I was younger and that how they’re treating me now man.”

  25. Focus on Fathers: Results QUOTES FROM IN-DEPTH INTERVIEWS WITH YOUNG FATHERS “I just use it [drugs] for a lot of reasons. Some days you just give up, some days you just want to get away from things and everybody else, yeah pretty much you just want to escape from everybody and everything. Even though they say it’s not worth it…they say oh you’re only going to be high for little short period of time; but to me it’s worth it being away for that amount time just for a little while.”

  26. Focus on Fathers: Results QUOTES FROM IN-DEPTH INTERVIEWS WITH YOUNG FATHERS “Well, I know how I grew up. I grew up without a dad…And, I just didn’t want my son to go through that.” “I think it is very important for a father to be part of their life… spend time with them and just be there for them support them.” “I try to do everything I can, like make sure they’re not hungry… feed them and try to the best I can.” “I could have tried finishing school when I never had any kids… now it’s more harder.”

  27. Focus on Fathers: Conclusions • Multi-generational drug and alcohol abuse is a significant challenge for young American Indian fathers. • Men in this sample believed that being a good father and a good role model was important; drug and alcohol abuse may hinder these goals. • Fatherhood programs should address life skills (e.g. substance use, employment, education, relationships), in addition to parenting skills.

  28. Focus on Fathers: Conclusions • Community meetings to interpret findings reinforced significant community support for programs for fathers and all men. • However, recommendations for programming differed by community in the Navajo sites: • Tohatchi: school-based programs for teen boys • Fort Defiance: activity-based and group-based programs (e.g. father/son camping trips) • Gallup: programming through UNM • Kayenta: back to traditional teachings and concepts, teaching family roles (e.g. sweats) • Kaibeto: Christian teachings, modern mainstream teachings • Tuba City: a mix of traditional teachings, more female perspective rather than male

  29. Thank You CONTACT: Trudy Billy tbilly@jhsph.edu Lena Clitso lclitso@jhsph.edu Phone: 928-338-5215

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