JOHNS HOPKINS UNIVERSITY

Protective factors associated with

psychosocial and behavioral health

outcomes among Native American youth

participating in an entrepreneurship

education intervention

Francene Larzlere, BA, MPC, PhD (in process)

DISCLOSURE SLIDE

• I, Francene Larzelere, have no relevant financial

relationships with the manufacturer(s) of commercial

services discussed in this CME activity

OUTLINE

• Background on Johns Hopkins Center for American Indian Health

• Arrowhead Business Group Youth Entrepreneurship Education program

• Protective factors associated with targeted program impacts at baseline

• Conclusions & Next Steps

Background on

Johns Hopkins Center for American Indian Health

Johns Hopkins Center for American Indian

Founded in 1991 by Dr. Mathu

Santosham, based on 10+ years

work with Southwest tribes

Mission: To work in partnership

with American Indian and Alaska

Native communities to raise AI/AN

health status, self-sufficiency and

health leadership of AI/AN people

to the highest possible level

NINE OFFICES SERVING RESERVATION

COMMUNITIES

White Mountain Apache

Navajo Nation

Hopi

UTAH COLORADO

NEW MEXICO

ARIZONAAlbuquerque

Tucson

Phoenix

Arizona

• Chinle

• Fort Defiance

• Tuba City

• Whiteriver

• Fort Apache

New Mexico

• Albuquerque

• Gallup

• Santo Domingo

• Shiprock

Santo Domingo Pueblo

FACTS ABOUT OUR CENTER

The Center’s

work now

serves

tribal

communities

across

states.

120+

17

Our Center’s Core Programs

Training & Scholarships

Behavioral and Mental

Health Promotion

InfectiousDisease

Prevention

Arrowhead Business Group Youth

Entrepreneurship Education

SOCIAL RELATIONSHIPS• Peers• Caring Adults• Elders• Community

LIFE OPPORTUNITIES• Education• Employment• Service

SELF-CARE• Behavioral• Mental• Spiritual

IDENTITY• Values• Cultural Identity• Self-Esteem• Communal

Mastery

Values identification with Apache role models

Coping and problem-solving skill-building

Self-care skill-building

Didactic financial literacy & entrepreneurship education

Culture-based job training

Mentored, internships,apprenticeships

Prosocial peer activities

Goal-setting

Elder teachings

College guidance andfield trips

Learning Apache language & history of entrepreneurship

Elder, adult & peer mentoring

Communityevents

Healthy recreationalactivities Less alcohol

& drug use

Decreased suicidal

thoughts & behaviors

Less violent behaviors

Decreased sexual risk

taking

Improved connectednes

s to caring adults

Improved connectedness to

school & peers

Hopefulness about the

futureDecreased depressive symptoms

Greater life skills self-efficacy

Communal mastery

Increased locus of control

Increased school

attendance

Improved school

performance

Increased college &

occupational interest

Economic advancement & empowerment

Increased entrepreneurial activity

& small business knowledge

Building a web of support

Communication & decision-making skill-building

Theoretical Model

Intervention Development

• Promote school connectedness– Increase college matriculation and aspiration

• Teach life skills: communication, coping, problem solving

• Cultivate relationships with positive peers, caring adults,

business mentors and Apache Elders

• Foster employment readiness, job skills training, and

small business development

• Reinforce Apache identity and cultural connectedness

Intervention Structure & Delivery

• 16-sessions:

– 10 during summer

residential camp

– 6 post-camp workshops

• Delivery by 2 Apache

facilitators to mixed-gender

groups of youth

• Participation and mentorship

from Apache entrepreneurs,

community leaders and key

stakeholders

• Opportunity for business

incubation and start-up

Intervention Evaluation

• Randomized controlled

trial (2:1)

• Youth ages 13-16 (N=393)

• 3 cohorts

• Surveys: Baseline through

24 months; assess 4

domains: 1) Psychosocial

2) Behavioral health

3) Educational

4) Economic

Figure 2: Trial Design

Screened for eligibility based on

inclusion/exclusion criteria Excluded -Not meeting inclusion criteria

Completion of assent and parental permission

Excluded -Participant declined participation

Baseline Assessment (All outcomes measured)

2:1 Randomization (by individual)

ABG Program 10 camp-based sessions

6 workshops 3 group-based sport and

recreational events (control)

Post-Intervention Assessment (All outcomes measured)

6-Month Post-Intervention Assessment (All outcomes measured)

Noncompliance with data collection -Reasons for non-completes

Control Program 3 group-based sport and

recreational events

12-Month Post-Intervention Assessment

(All outcomes measured)

24-Month Post-Intervention Assessment

(All outcomes measured)

Protective Factors Associated with Targeted

Psychosocial and Behavioral Outcomes at

Baseline

Analysis

• Explored protective

baseline associations

between youth’s

sociodemographic,

sociocultural & household

characteristics and ABG’s

primary outcomes:– Connectedness

– Depression/hopelessness

– Locus of control

– Life skills self-efficacy

– Substance use

– Sexual risk-taking

– Violence to self and others

Results: Connectedness

Friends Self Future Self Peers School Teachers

Aware of

Connection

Gender

Boys Ref

Girls 0.18*

Language Spoken At Home

Spanish 0.47* 0.45**

Youth lives a…

Hispanic/Mexican American way of life 0.34**

Follow Christian beliefs 0.33*** 0.41*** 0.31*** 0.39*** 0.50*** 6.81***

Importance of traditional Native values &

practices 0.19** 0.29* 0.39** 0.43** 4.58*

Results: Socioemotional

Depression

Locus of

Control

Life Skills Self

Efficacy Hopefulness Hopelessness

Follow traditional Native beliefs 1.36**

Follow Christian beliefs 0.33*** 1.29*** 0.31*** -1.16**

Importance of traditional Native values & practices 0.37** -1.91**

Results: Substance Use & Sexual Initiation

• NO factors protected against lifetime substance use and

lifetime sexual initiation except:– Following Christian beliefs protected against lifetime use of cigarettes

and illicit/prescription drugs

Results: Violence and Suicide

Carried

Weapon,

Last 30 days

Fight Last

Year

Fight School

Property,

Last Year

Suicide

Attempt,

Last Year

Gender

Boys Ref Ref

Girls 0.31*** 0.47**

Language Spoken At Home

English 0.39*

Follow Christian beliefs 0.43** 0.18***

Who cares for you in your home?

Both parents Ref Ref

One parent (mother or father) 0.51* 0.62

Grandparent(s) 0.67 0.33*

Conclusions

• Several factors operating at baseline to positively impact

the trial’s targeted outcomes– Importance of having traditional Native values and practices

– Following traditional Native beliefs

– Following Christian beliefs

• That ABG aims to reconnect youth to their values and

beliefs, plus that of their family and community--- shows it

is well fit to the needs of enrolled youth participants

Next Steps

• Variables with significant, positive associations with

targeted outcomes at baseline will be adjusted for in final

analyses

• Additional consideration of the strength of these factors in

combination with other factors (measured and not

measured in the trial) for impacting ABG efficacy

• Qualitative data collection to understand how values and

beliefs are impacting key outcomes

• Latent class analysis to distinguish subgroups

Acknowledgements

• Allison Barlow

• Feather Sprengeler

• Novalene Goklish

• Sean Parker

• Vanya Szabo

• Rebecca Larson

• Ryan Grass

• Allison Ingalls

• Summer Rosenstock

• Sarah Stern

• Lauren Tingey

National Institutes of

Health: NARCH

THANK YOU!

Francene Larzelere, BA, MPC,

PhD Candidate

Johns Hopkins Center for

American Indian Health

Phone: (928) 338-3032

flarzel1@jhu.edu