title: Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation.
abstract: OBJECTIVE
  To evaluate the effectiveness of a multilevel intervention designed to prevent underage alcohol use among youths living in the Cherokee Nation.
  
  
  METHODS
  We randomly assigned 6 communities to a control, Communities Mobilizing for Change on Alcohol (CMCA; a community-organizing intervention targeting alcohol access) only, CONNECT (a school-based universal screening and brief intervention) only, or a combined condition. We collected quarterly surveys 2012-2015 from students starting in 9th and 10th grades and ending in 11th and 12th grades. Response rates ranged from 83% to 90%; 46% of students were American Indian (of which 80% were Cherokee) and 46% were White only.
  
  
  RESULTS
  Students exposed to CMCA, CONNECT, and both showed a significant reduction in the probability over time of 30-day alcohol use (25%, 22%, and 12% reduction, respectively) and heavy episodic drinking (24%, 19%, and 13% reduction) compared with students in the control condition, with variation in magnitude of effects over the 2.5-year intervention period.
  
  
  CONCLUSIONS
  CMCA and CONNECT are effective interventions for reducing alcohol use among American Indian and other youths living in rural communities. Challenges remain for sustaining intervention effects.
authors.affiliation: Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK.
authors.forename: Kelli A
authors.initials: KA
authors.lastname: Komro
authors.affiliation: Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK.
authors.forename: Melvin D
authors.initials: MD
authors.lastname: Livingston
authors.affiliation: Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK.
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Wagenaar
authors.affiliation: Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK.
authors.forename: Terrence K
authors.initials: TK
authors.lastname: Kominsky
authors.affiliation: Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK.
authors.forename: Dallas W
authors.initials: DW
authors.lastname: Pettigrew
authors.affiliation: Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK.
authors.forename: Brady A
authors.initials: BA
authors.lastname: Garrett
authors.affiliation: Kelli A. Komro and Alexander C. Wagenaar are with the Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA. Melvin D. Livingston is with the Department of Biostatistics and Epidemiology, Health Sciences Center, University of North Texas, Fort Worth. Terrence K. Kominsky, Dallas W. Pettigrew, and Brady A. Garrett are with Cherokee Nation Behavioral Health, Tahlequah, OK.
mesh_terms: D000293:Adolescent; D000428:Alcohol Drinking / Q000517:prevention & control*; D055812:Community-Based Participatory Research; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D012307:Risk Factors; D014481:United States; D044465:White People