title: Suicide prevention as a community development process: understanding circumpolar youth suicide prevention through community level outcomes.
abstract: OBJECTIVE
  Community-based models have become increasingly prominent in prevention, and have special relevance for suicide prevention in circumpolar Indigenous communities. It follows that outcomes from circumpolar suicide prevention programs might be more completely understood at the community level. We present here a methodology for analysis at this level. This paper seeks to understand a cultural prevention program for rural Yup'ik youth in Alaska targeting suicide and co-occurring alcohol abuse as a community development process through changes at the community level.
  
  
  METHODS
  Quasi-experimental design with assessment at pre- and post-intervention or at 4 time points. The community development process for this project began in October 2004. The first program baseline assessment began in November 2006, prior to prevention activities with youth and parents, and the post-intervention assessment concluded in March 2008.
  
  
  METHODS
  Five key informants pre- and post-intervention completed a community readiness assessment, which is a structured procedure assessing a community's awareness of suicide as an issue and its, organizational readiness for prevention programming. Forty-three adult caregivers or sponsors of youth in the prevention program completed an assessment of behaviours that contributed to community protective factors from youth suicide and alcohol abuse at 4 time points before, during and after the intervention. The 54 youth who participated in the prevention program completed an assessment of community protective factors, also at 4 time points before, during and after the intervention. The community protective factors from suicide that were assessed included safety, enforcement of alcohol prohibitions, role models, support and opportunities for youth.
  
  
  RESULTS
  Community readiness for the prevention efforts increased to new developmental stages of readiness post-intervention, and a trend in the data suggested community protective factors increased in the amount of protective behaviours performed by adults (slope estimate = 0.0162, 95% CI--0.0028-0.0351, d=.55) and in the perceptions of youth (slope estimate=0.0148, 95% CI--0.0004-0.0291, d=.45), in a dose response relationship to the number of prevention program sessions attended by adults and youth.
  
  
  CONCLUSIONS
  Using data from a feasibility study, this paper demonstrates the feasibility and potential utility of methodological approaches that use community-level variables beyond individual level outcomes in circumpolar suicide prevention research.
authors.affiliation: Department of Psychology and Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK 99775-6480, USA. Jim.Allen@uaf.edu
authors.forename: James
authors.initials: J
authors.lastname: Allen
authors.forename: Gerald
authors.initials: G
authors.lastname: Mohatt
authors.forename: Carlotta Ching Ting
authors.initials: CC
authors.lastname: Fok
authors.forename: David
authors.initials: D
authors.lastname: Henry
mesh_terms: D000293:Adolescent; D000328:Adult; D000413:Alaska; D001110:Arctic Regions; D002648:Child; D019058:Community Networks; D055812:Community-Based Participatory Research; D005260:Female; D006801:Humans; D004930:Inuit; D008297:Male; D008875:Middle Aged; D055815:Young Adult; D000092864:Suicide Prevention
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