Connect for Prevention
On This Page
Overview
About Our Program
Preventing alcohol and other drug use is key to protecting young people from harm. Students who avoid using substances will perform better academically, have better mental health, and lower risk of injuries and accidents.
To address this issue, Cherokee Nation Behavioral Health collaborated with Emory University to develop the Connect Brief Intervention (CBI) to implement in high schools and Connect Kits for Family Action to use with families with children in grades 10 through graduation. This innovative program aims to curb the initiation and progression of alcohol and other drug use among teenagers.
To see how well these programs worked, the 20 Oklahoma schools were randomly assigned to the intervention group or the control group (the control group received the programs after the testing period). All students in the class of 2024 had the opportunity to participate by completing surveys each semester. The surveys asked about alcohol use, drug use, mental health, and other important outcomes that the programs aimed to improve. After graduation, we compared outcomes between the two groups.
Fire: symbolizes the sacred fire and, in Cherokee tradition, how Cherokee people communicate with the Creator
Middle circle: represents a young person and the protection of the sacred fire
Outer circles: symbolize the layers of support surrounding the young person, including family, school, and community
By high school graduation, the intervention group had...
lower alcohol use compared to the control group
lower cannabis use compared to the control group
lower prescription opioid use compared to the control group
Program Materials
Connect Brief Intervention
The CBI is to given to every student in a given school. This approach provides the best opportunity for every student to receive a dose of prevention, reinforcing students who are not using substances and minimizing the risk of any student feeling singled out or stigmatized.
Students engage in brief sessions using a tablet or computer. The program assesses life goals and risk for substance use, encourages reflection, reinforces positive choices, and assists with setting goals. When resources allow, students identified as being at a higher risk for substance use through the CBI have the option to meet privately and confidentially with a Connect Coach. These coaches are trained to assist students in setting healthy goals and, if necessary, link them to appropriate resources.
Download the CBI Implementation Guide
Connect Kits for Family Action
From 10th grade until graduation, families receive Connect Kits for Family Action several times per year. Kits aim to strengthen relationships and promote wellness via three key themes:
- Connection matters to teens
- Safe places matter to teens
- Communities matter to teens
Each kit includes tools, resources, and activities to help families foster stronger bonds, safe decision-making, and supportive environments.
Download the implementation guide
Communities Mobilizing for Change on Alcohol (CMCA)
CMCA is a previous intervention in the Cherokee Nation that utilized a community organizing approach to engage local citizens in working together to prevent or reduce alcohol use among teenagers.
Tribal and Community Partnership
Tribal Partnership
Connect for Prevention was developed in partnership with Cherokee Nation Behavioral Health. The intervention was co-designed with Tribal health leadership, practitioners, academic prevention scientists, and community partners, who were involved across all phases of the project, including intervention development, implementation, and evaluation.
The project builds on longstanding partnerships with Cherokee Nation Behavioral Health and community organizations, including Neighbors Building Neighborhoods. These collaborations facilitated implementation through existing systems of care, education, and community networks, enabling the intervention to reach youth and families in trusted and familiar settings.
Partnership with Cherokee Nation Behavioral Health was central to ensuring that the intervention reflected community priorities and addressed issues most relevant to Cherokee youth and families. Cherokee Nation Behavioral Health partners informed both the content and strategies of the intervention to ensure its responsiveness to the lived experiences of rural and tribal communities.
This work is rooted in prior prevention research conducted in partnership with Cherokee Nation and the Oklahoma Department of Human Services, including Communities Mobilizing for Change on Alcohol. Lessons learned from these earlier projects laid the foundation for Connect for Prevention and informed the collaborative, community-engaged approach that was fundamental to its success.
Cherokee Nation Behavioral Health Leadership and Implementation
Connect for Prevention was implemented through Cherokee Nation Behavioral Health and delivered within communities located on or near the Cherokee Nation Reservation. Cherokee Nation Behavioral Health social workers supervised Connect coaches (social workers in training), who led youth engagement in schools.
Weekly meetings between Cherokee Nation Behavioral Health leadership and Rollins-based researchers supported day-to-day implementation and shared decision-making. Together, partners reviewed intervention materials, evaluated program implementation and emerging findings, addressed barriers, and guided culturally responsive approaches and adaptations throughout the project.
The expertise of Cherokee Nation Behavioral Health practice, prevention, and the cultural and community contexts that shape youth well-being was essential to the intervention’s success in prevention of substance use among adolescents.
Neighbors Building Neighborhoods also supported the project by providing team members and logistical support for the Connect Kits for Family Action.
Blanket gifting from Cherokee Nation Behavioral Health. Left to right: Ashley N. Gassaway, Kelli A. Komro, Juli R. Skinner
Grounded in Community Context
This intervention was designed with culturally responsive practices and an Indigenous relational perspective, emphasizing the role of relationships across family, school, and community contexts in supporting youth well-being. Prevention efforts engaged multiple levels of influence rather than focusing solely on youth behavior.
This intervention served rural communities, where geographic distance and lack of access to services constrain how prevention can be delivered. These conditions, along with broader historical and structural inequities, were central considerations in designing and delivering the intervention.
The project also responded to emerging community concerns. Growing rates of cannabis use and the rapid proliferation of cannabis dispensaries led to additional qualitative and community-based participatory research examining youth exposure to cannabis advertising. Findings from this work documented youth-appealing advertising strategies near schools and informed the development of tailored prevention materials on media literacy, advocacy, and cannabis use risks.
Research from the trial also highlighted the importance of Native culture and identity in adolescent health. Findings showed that a stronger sense of tribal belonging and connection supported healthy behaviors in youth. These findings support prevention approaches that build on cultural strengths and community connection.
Governance, Ethics, and Data
Connect for Prevention was conducted in partnership with the Cherokee Nation and guided by principles of tribal governance. Throughout the project, Cherokee Nation Behavioral Health and leadership played an active role in shaping how research was conducted, how findings were interpreted, and how knowledge generated through the project could support communities.
The study was reviewed and approved by the Cherokee Nation Institutional Review Board. Consistent with principles of data sovereignty, Cherokee Nation determines how data generated through the project are stored, managed, and shared.
Ongoing Impact
Findings from the project have been presented to Cherokee Nation Health leadership and all resources and materials made open access. Connect for Prevention continues to inform new research, dissemination, and prevention efforts within Cherokee Nation and beyond. In addition, intervention materials are informing new grant proposals focused on dissemination and the continued development of family-centered prevention strategies in rural and tribal communities.
Publications
Main Outcome Publications
- Primary Prevention of Drug Overdoses in Rural Low-Resource and Tribal Communities: A Cluster Randomized Trial, American Journal of Public Health
- Multilevel Prevention Trial of Alcohol Use Among American Indian and White High School Students in the Cherokee Nation, American Journal of Public Health
Previous Publications
- Adapting Opioid Misuse Prevention Programs During COVID-19: Implications for Increasing Access Post-Pandemic, RTI Press
- Adolescent Advertising Exposure to Cannabis Products in Rural Oklahoma via Medical Dispensaries, Journal of Studies on Alcohol and Drugs
- Anxiety and Depressive Symptoms as Predictors of Substance Use Initiation Among Adolescents Living on and Near a Tribal Reservation in the Great Plains Region of the U.S., Frontiers in Child and Adolescent Psychiatry
- Culturally Responsive Opioid and Other Drug Prevention for American Indian/Alaska Native People: A Comparison of Reservation- and Urban-Based Approaches, Prevention Science
- Economic Evaluation Design Within the HEAL Prevention Cooperative, Prevention Science
- Including Community Partners in the Development and Adaptation of Intervention Strategies to Prevent Initiation or Escalation of Opioid Misuse, Prevention Science
- Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder, Prevention Science
- Methodological Strategies for Prospective Harmonization of Studies: Application to 10 Distinct Outcomes Studies of Preventive Interventions Targeting Opioid Misuse, Prevention Science
- Perceived Racial/Ethnic Discrimination and Depressive Symptoms Among Adolescents Living in the Cherokee Nation, American Indian and Alaska Native Mental Health Research
- School Racial Composition as a Moderator of the Effect of Discrimination on Mental Health and Substance use Among American Indian Adolescents, Journal of Adolescent Health
- Study Protocol for a Cluster Randomized Trial of a School, Family, and Community Intervention for Preventing Drug Misuse Among Older Adolescents in the Cherokee Nation, Trials
- Theory, Measurement, and Psychometric Properties of Risk and Protective Factors for Drug Misuse Among Adolescents Living on or Near the Cherokee Nation Reservation, Adversity and Resilience Science
- Tribal Identity, Pain Interference, and Substance Use Among American Indian and Alaska Native Adolescents, JAMA Pediatrics
Connect for Prevention Team
Left to right: Ashna Jagtiani, Caroline M. Barry, Kelli A. Komro, Ashley N. Gassaway, Juli R. Skinner, Sierra L. Talavera-Brown, Melvin D. Livingston, and Brianna Reynolds.
Cherokee Nation Behavioral Health
- Juli R. Skinner, Senior Director (Trial Principal Investigator)
- Ashley N. Gassaway, Clinic Administrator
- Hannah LaBounty, Clinical Supervisor
- Gena Atkinson, LBHP Candidate/Supervisee
- Brianna Reynolds, Behavioral Health Technician
- Terrence K. Kominsky, PhD, Coordinator, Behavioral Health Research and Evaluation (Trial Principal Investigator, 2019-2023)
Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health of Emory University
- Kelli A. Komro, PhD, Professor (Trial Principal Investigator)
- Melvin D. Livingston, PhD, Professor (Trial Principal Investigator)
- Alexander C. Wagenaar, PhD, Professor
- Hannah Cooper, ScD, Professor
- Bethany J. Livingston, Project Director (2019-2023)
- Emily Ivanich, Project Coordinator
- Ashna Jagtiani, Epidemiologist
- Caroline M. Barry, PhD, Postdoctoral Fellow
- Sierra L. Talavera-Brown, Community Health Specialist, Graduate Research Assistant
Neighbors Building Neighborhoods
- Kim Lynch, Director
- Megan Harmon, Evaluation Coordinator
- Brittany Beasley, Community Organizer
- Patsy Upton, Evaluation Team Member
Contact
Questions about Connect for Prevention?
Kelli Komro, PhD, Principal Investigator