Living in 2 Worlds (L2W) is a substance use prevention program for urban American Indian (AI) middle school students. To create Living in 2 Worlds (L2W), the SIRC research team partnered with the local urban Indian Center and a large school district within metropolitan Phoenix to engage youth, families, elders, and Native community leaders in a community-driven participatory process that was designed to identify cultural sources of resilience that protect AI youth from substance use and other risk behaviors.  L2Wwas adapted specifically for Native adolescents living in urban areas using the core components of an existing SAMHSA model substance abuse prevention curriculum (keepin’ it REAL) while keeping the focus on the four drug resistance strategies (Refuse, Explain, Avoid, Leave [R-E-A-L]) used most often by youth across the US.  A Cultural Adaptation model (Castro, Barerra, & Martinez, 2004) guided the adaptation process through phases of initial curriculum adaptation, piloting, curriculum revision, and a randomized control trial involving 208 students in 5 metropolitan Phoenix middle schools.

Despite the diverse tribal backgrounds of urban AI families, ten inter-tribal cultural elements identified by the community were found to resonate widely, and these were infused into the prevention curriculum.  These included the imperative of knowing ancestry, embracing kinship, and emphasizing oral traditions (see Reeves, Dustman, Harthun, Kulis, & Brown, 2013).  These elements were aligned with core components of the original intervention components and became the foundation upon which this culturally-grounded curriculum adaptation was built.  L2W emerged with lesson goals, objectives, activities, and prevention messages solidly grounded in urban American Indian inter-tribal cultures.  Focused on strengthening resiliency, L2W teaches a wide range of drug resistance skills and strategies including risk assessment, decision making, and culturally specific prevention messages in ways designated by the Native community as culturally appropriate and reflecting the social and cultural context of urban AI youth. 

Two schools received the L2W curriculum delivered by a native facilitator, and three schools served as a comparison group delivering the schools’ existing programming for native youth.  All students completed a pretest questionnaire before the lessons and a post-test at its conclusion, about 7 months later.  Preliminary data show promising results of effectiveness in expanding Native youth’s repertoire of drug resistance skills (Kulis, Dustman, Harthun, Reeves, & Brown, 2013).  L2W students increased their reliance on more direct methods of resisting substance use opportunities (Refuse, Explain, Leave).  Students maintained, rather than replaced, use of relatively passive or indirect strategies (Avoid, Redirect, Humor).  L2W students also reported less use of alcohol and inhalants than those in the comparison schools. 

Castro, F. G., Barrera, M., & Martinez, C. R. (2004). The cultural adaptation of prevention interventions: Resolving tensions between fidelity and fit. Prevention Science, 5, 41-45.

Reeves, L. R., Dustman, P. A., Harthun, M. L., Kulis, S., & Brown, E. F. (2013). American Indians’ cultures: How CBPR illuminated inter-tribal cultural elements fundamental to an adaptation effort. Prevention Science. PMCID: PMC23412946.

Kulis, S., Dustman, P.A., Brown, E. F., & Martinez, M. (2013). Expanding urban American Indian youths’ repertoire of drug resistance skills: Pilot results from a culturally adapted prevention program. American Indian and Alaska Native Mental Health Research, 20, 35-54
doi: 10.5820/aian.2001.2013.35