title: Effects of the "Circle of Life" HIV-prevention program on marijuana use among American Indian middle school youths: a group randomized trial in a Northern Plains tribe.
abstract: Early substance use threatens many American Indian/Alaska Native (AI/AN) communities, as it is a risk factor for maladaptive use and adverse health outcomes. Marijuana is among the first substances used by AI/AN youth, and its use becomes widespread during adolescence. Interventions that delay or reduce marijuana use hold the promise of curbing substance disorders and other health risk disparities in AI/AN populations.
  
  
  
  We evaluated the effectiveness of the Circle of Life (COL) program in reducing marijuana use among young AI adolescents. COL is a culturally tailored, theory-based human immunodeficiency virus (HIV) and sexually transmitted disease (STD) intervention shown to delay sexual initiation among AI youths.
  
  
  
  We conducted secondary analyses of data from a school-based group randomized trial conducted between 2006 and 2007 in all 13 middle schools on a rural, Northern Plains reservation (N = 635, 47% female). We used discrete-time survival analysis (DTSA) to assess COL effectiveness on risk of marijuana initiation among AI youths and latent growth curve modeling (LGCM) to evaluate effects on frequency of marijuana use over time.
  
  
  
  DTSA models showed that the overall risk of marijuana initiation was 17.3% lower in the COL group compared to the control group. No intervention effect on frequency of marijuana use emerged in LGCM analyses.
  
  
  
  COL is a multifaceted, culturally tailored, skills-based program effective in preventing marijuana uptake among AI youth.
authors.affiliation: a Department of Community and Behavioral Health, Colorado School of Public Health, Centers for American Indian and Alaska Native Health , University of Colorado Anschutz Medical Campus , Aurora , CO , USA.
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Asdigian
authors.affiliation: a Department of Community and Behavioral Health, Colorado School of Public Health, Centers for American Indian and Alaska Native Health , University of Colorado Anschutz Medical Campus , Aurora , CO , USA.
authors.forename: Nancy Rumbaugh
authors.initials: NR
authors.lastname: Whitesell
authors.affiliation: a Department of Community and Behavioral Health, Colorado School of Public Health, Centers for American Indian and Alaska Native Health , University of Colorado Anschutz Medical Campus , Aurora , CO , USA.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Keane
authors.affiliation: a Department of Community and Behavioral Health, Colorado School of Public Health, Centers for American Indian and Alaska Native Health , University of Colorado Anschutz Medical Campus , Aurora , CO , USA.
authors.forename: Alicia C
authors.initials: AC
authors.lastname: Mousseau
authors.affiliation: a Department of Community and Behavioral Health, Colorado School of Public Health, Centers for American Indian and Alaska Native Health , University of Colorado Anschutz Medical Campus , Aurora , CO , USA.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Kaufman
mesh_terms: D000293:Adolescent; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D007198:Indians, North American / Q000523:psychology*; D008297:Male; D000074609:Marijuana Use / Q000453:epidemiology*; D017063:Outcome Assessment, Health Care; D011322:Primary Prevention / Q000379:methods*; D012574:Schools; D012749:Sexually Transmitted Diseases / Q000517:prevention & control; D013334:Students / Q000523:psychology*; D014481:United States / Q000453:epidemiology
keywords: American Indian; intervention; marijuana use; prevention; youth