in-home prevention of substance abuse risk in native teen families: focus on fathers based on...
TRANSCRIPT
In-home Prevention of Substance Abuse Risk in Native
Teen Families: Focus on Fathers
Based on :“In-Home Prevention of Substance Abuse Risk in Navajo Teen Families” [NNR-05.174]
Presenters: Trudy Billy & Lena Clitso
Johns Hopkins Focus on Fathers Team: Kendall Tanner, Sean Parker, Timothy Johnson, Valerie Coho-Mescal,
Allison Barlow, MA, MPH, Britta Mullany, PhD, Nicole Neault, MPH, Julia Powers, MHS, John Walkup, MD
Presentation Overview Johns Hopkins Center for American Indian
Health Focus on Fathers Project
Background Methods Results Conclusions
Johns Hopkins Center for American Indian Health
MISSION STATEMENT: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.
Training
Behavioral Health Programs/Research
Infectious Disease Research
Three Core Activities
Center Overview
30 year relationship with Navajo Nation, White Mountain Apache, and San Carlos Apache
Public health technologies and interventions translated world wide
80 Native American employees/research assistants (>300 over the past 3 decades)
Professional training program to advance AI paraprofessionals toward professional degrees and roles
The Focus on Fathers Project
Focus on Fathers: Background Since 1995, Johns Hopkins Center for American Indian
Health has implemented and evaluated a home-visiting parenting program (Family Spirit) specifically targeting young American Indian mothers and their children. (Barlow et al 2006, Walkup et al 2009, Novins 2009)
Fathers and other family members participated when invited by the mother.
Community members frequently asked about support specifically for fathers, especially targeting substance abuse and fatherhood absence from families.
History of Family SpiritHistory of Family Spirit
1995
“SOS” Project* service * teen mothers, babies* prenatal to 6 mos pp(160 moms served)
1998-99
“Fathers Project”: curriculum to address needs of men expecting babies with AI teen moms.
(55 dads; 62 moms served)
1999-2001
“Family Strengthening”: * parallel curriculum teen moms/dads* prenatal to baby’s 6 month birthday* RCT evaluation moms/dads (48 dads; 68 moms served)
2002-05
“Family Spirit”: * teen moms/dads* prenatal to baby’s 1st bday* RCT evaluation (75 dads; 166 moms served)
2005-present
“Cradling our Future”: * teen moms* 28 weeks prenatal through baby’s 3rd birthday; * RCT evaluation moms/kids * “Focus on Fathers” supplement(322 moms/kids served; 87 dads enrolled)
“Family Spirit” Replication: * IHS Head Start* Chinle PHNs* Seattle Urban Indians* Santo Domingo Head Start
2006-present
Focus on Fathers: Background Funding from NIDA in 2009 enabled the initiation of the
Focus on Fathers project.
Project aims include:1: Describe drug use patterns of young American Indian fathers. 2: Explore fathers’ and community stakeholders’ beliefs and motivations regarding fatherhood.3: Examine relationships between fathers’ drug use patterns and their fatherhood roles.4: Utilize data to design a culturally relevant intervention specifically for fathers.
Focus on Fathers Project SitesNavajo Nation Nation
White Mountain Apache
UTAH COLORADO
NEW MEXICO
ARIZONAAlbuquerque
Tucson
Phoenix
White Mountain Apache Reservation Apache
San Carlos Apache
Focus on Fathers: Methods Data were collected from 2010-2011. Participants include:
87 fathers/male partners of the teen mothers enrolled in an ongoing family strengthening study.
39 community stakeholders.
Focus on Fathers: Methods
PHASE ONE:
Administer 87 computer-based surveys (ACASI) to describe fathers’ drug use patterns and fatherhood characteristics.
Conduct audio-recorded in-depth interviews with a random sub-sample of 28 fathers, representing different drug use categories.
Focus on Fathers: MethodsPHASE TWO:
Conduct 39 video-taped in-depth interviews with community stakeholders, including elders, “model fathers”, tribal leaders, and service providers.
Prepare a 10-20 minute film for each site featuring interview segments from community stakeholders.
Focus on Fathers: MethodsPHASE THREE:
Conduct 12 roundtable discussions (3 per site) to view the film, interpret ACASI and in-depth interview findings, and discuss potential fatherhood programs.
Focus on Fathers: Data Analysis All analysis and interpretation done in partnership with staff from
each participating community.
Descriptive analysis conducted on quantitative data to summarize sample characteristics.
Correlates of lifetime and past-month drug use examined using chi-square tests and t-tests for associations with sociodemographic characteristics, fatherhood roles, and background family factors.
Qualitative data examined for evidence of causality for associations seen in quantitative correlate analysis.
Focus on Fathers: ResultsDEMOGRAPHIC CHARACTERISTICS
Age Mean (SD) Range
Mean age of participants 22.9 years (2.8) 18-30 years
Mean age of children 33.2 months (6.3) 18-45 months
Characteristics Percent
Biological father of child 76%
Currently living with child 93%
Married 13%
Completed HS/GED 48%
Unemployed 70%
Focus on Fathers: ResultsFATHERHOOD ROLES AND EXPERIENCES
Experiences Percent
Present at birth of child 69%
High involvement in child care duties 52%
High involvement in child play 34%
Participants ranked highest priorities in raising child
Percent
Being a good role model for child 41%
Educating child 21%
Being able to buy what child wants 8%
Protecting child 8%
Spending time with the child 6%
Focus on Fathers: ResultsBACKGROUND FAMILY FACTORS
Family factors Percent
Biological father was part of life as child 53%
Had at least weekly contact with biological father as a child
45%
Identified no father figure growing up 21%
Father/father figure showed interest in what he did as child
71%
Biological father ever had serious drinking problem 43%
Biological mother ever had serious drinking problem 26%
Focus on Fathers: Results
Lifetime n (%)
Current (past mon)n (%)
Alcohol, any 70 (80%) 38 (44%)
Alcohol, binge episode 29 (33%) 14 (16%)*
Cigarettes 61 (70%) 45 (52%)
Marijuana 68 (78%) 31 (36%)
Methamphetamines 30 (34%) 1 (1%)
Crack/cocaine 27 (31%) 4 (5%)
Never used any alcohol or drugs
7 (8%) 38 (44%)
* Time frame was past 6 months for binge drinking episode
REPORTED ALCOHOL AND DRUG USE
Focus on Fathers: ResultsCORRELATES OF LIFETIME SUBSTANCE USE Age:
Older (≥25 yrs) more likely to report binge drinking episode than younger (18-24 yrs) (57% vs. 26%, p<0.01)
Employment status: Unemployed more likely to report lifetime marijuana (86% vs. 65%, p<0.05) and
meth use (44% vs. 12%, p<0.005)
Presence at birth: 25% of those present at birth vs. 56% of those not present had ever used meth
(p<0.01)
Involvement in child care duties: 73% of highly involved vs. 90% of others had ever used alcohol (p<0.05)
Being role model for child: 71% of those prioritizing role model vs. 88% of others had ever used alcohol
(p<0.05)
No significant associations with biological father status
Focus on Fathers: ResultsCORRELATES OF LIFETIME SUBSTANCE USE, cont.
Higher lifetime drug use associated with participant’s biological father having alcohol problem, but not biological mother.
Compared to men whose fathers did not have drinking problems, participants reporting biological fathers ever having drinking problem were: More likely to report binge drinking episode (54% vs. 18%,
p<0.001) More likely to report ever using meth (49% vs. 24%, p<0.05)
Focus on Fathers: ResultsCORRELATES OF CURRENT SUBSTANCE USE
Employment status: Unemployed more likely to report past month marijuana use than
employed (43% vs. 19%, p<0.05)
Presence at birth: 28% of those present at birth vs. 52% of those not present had ever used
meth (p<0.05)
Being role model for child: 34% of those prioritizing role model vs. 58% of others had used alcohol in
past month (p<0.05)
Parenting stress: higher stress levels reported among men who used marijuana in past
month vs. non-users (p<0.05)
No significant associations with biological father status, involvement in child care duties or child play
Focus on Fathers: ResultsCORRELATES OF CURRENT SUBSTANCE USE, cont.
Higher marijuana use among those whose biological fathers were part of life vs. not as child (46% vs. 26%, p<0.05)
Higher marijuana use among those whose father figures showed little interest in them as child (65% vs. 29%, p<0.005)
Compared to men whose fathers did not have drinking problem, participants that reported biological fathers ever having drinking problem were: More likely to report binge drinking episode in past 6 months
(27% vs. 8%, p<0.05) More likely to report ever using meth (49% vs. 26%, p<0.05)
Focus on Fathers: ResultsQUOTES FROM IN-DEPTH INTERVIEWS WITH YOUNG FATHERS
“Like I had everything pictured out man the way I wanted it… just a couple bad decisions just like brought me to this way… Wish I did a couple things different, but at the same time I really don’t… I would want to do things different as like financially and like…more responsible you know?”
“I just know that my family doesn’t like the things that I do but they just expect me to find it out, figure it out myself so… I wanted to be an adult when I was younger and that how they’re treating me now man.”
Focus on Fathers: ResultsQUOTES FROM IN-DEPTH INTERVIEWS WITH YOUNG FATHERS
“I just use it [drugs] for a lot of reasons. Some days you just give up, some days you just want to get away from things and everybody else, yeah pretty much you just want to escape from everybody and everything. Even though they say it’s not worth it…they say oh you’re only going to be high for little short period of time; but to me it’s worth it being away for that amount time just for a little while.”
Focus on Fathers: ResultsQUOTES FROM IN-DEPTH INTERVIEWS WITH YOUNG FATHERS
“Well, I know how I grew up. I grew up without a dad… And, I just didn’t want my son to go through that.”
“I think it is very important for a father to be part of their life… spend time with them and just be there for them support them.”
“I try to do everything I can, like make sure they’re not hungry… feed them and try to the best I can.”
“I could have tried finishing school when I never had any kids… now it’s more harder.”
Focus on Fathers: Conclusions
Multi-generational drug and alcohol abuse is a significant challenge for young American Indian fathers.
Men in this sample believed that being a good father and a good role model was important; drug and alcohol abuse may hinder these goals.
Fatherhood programs should address life skills (e.g. substance use, employment, education, relationships),in addition to parenting skills.
Focus on Fathers: Conclusions Community meetings to interpret findings reinforced
significant community support for programs for fathers and all men.
However, recommendations for programming differed by community in the Navajo sites:
Tohatchi: school-based programs for teen boys Fort Defiance: activity-based and group-based programs (e.g. father/son
camping trips) Gallup: programming through UNM Kayenta: back to traditional teachings and concepts, teaching family
roles (e.g. sweats) Kaibeto: Christian teachings, modern mainstream teachings Tuba City: a mix of traditional teachings, more female perspective rather
than male
