The Weaving Healthy Families Program Preventing Alcohol Misuse Among U.S. Indigenous Adults and Youth

Objectives To evaluate the effectiveness of the Weaving Healthy Families (WHF) program in reducing alcohol and substance use among U.S. Indigenous adults and youth, addressing health disparities and premature mortality driven by alcohol misuse. Design setting A longitudinal dynamic, open cohort stepped-wedge trial conducted in U.S. Indigenous communities, grounded in over a decade of community-based participatory research (CBPR) and Indigenous knowledge (McKinley et al., Citation2023). Participants A total of 218 adults and 354 youth participated in the study. Intervention WHF is a psychoeducational and experiential family-centered intervention consisting of 2.5-hr sessions. Each session began with a shared family meal and included components on nutrition, health, communication, and promotive family rituals. Main outcome measures Multilevel longitudinal modeling assessed outcomes across five points (i.e., pretest; posttest; and 6-, 9-, and 12-month follow-ups). Measures included the Alcohol Use Disorders Identification Test (AUDIT) and individual indicators of alcohol and substance use. Results Among adults, significant reductions were observed postintervention, including declines in alcohol use disorder (AUD; B = −0.67, p < 0.001), overall alcohol use as measured by the AUDIT (B = −0.32, p = 0.0002), and number of drinks in the last month (B = −0.09, p = 0.0001). There were also significant decreases in past 30-d alcohol use (B = −0.53, p < 0.0001) and marijuana use (B = −0.27, p = 0.03). Sex differences were found in AUD use and feelings of guilt, with variations by gender. Among youth, postintervention reductions were seen in AUD use (B = −0.09, p < 0.03), with sex differences approaching significance (B = −0.09, p < 0.057), where female respondents showed greater declines than male respondents. Conclusions Significant postintervention reductions in alcohol misuse and hazardous drinking indicate strong support for the WHF program in preventing alcohol misuse among U.S. Indigenous families. These findings replicate pilot results and provide a robust foundation for culturally grounded, efficacious alcohol misuse prevention efforts in Indigenous communities. Clinical Trial NCT03924167