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The Zuni Life Skills Development Program: A School/Community-Based Suicide Prevention Intervention



The Zuni Life Skills Development Program, an effective community-initiated and high-school-based suicide prevention intervention, is featured. Development and evaluation of this intervention are followed by note of the specific challenges associated with stabilizing the program. A more tribally diverse, culturally-informed model entitled the American Indian Life Skills Development Curriculum is then presented to illustrate a hybrid approach to the cultural tailoring of interventions. This curriculum is broad enough to address concerns across diverse American Indian tribal groups yet respectful of distinctive and heterogeneous cultural beliefs and practices. Finally, we reflect upon issues in community-based research that emerged during this collaboration.
343Suicide and Life-Threatening Behavior 38(3) June 2008
2008 The American Association of Suicidology
The Zuni Life Skills Development Program:
A School/Community-Based Suicide
Prevention Intervention
Teresa D.LaFromboise,PhD,and Hayes A.Lewis,MEd
The Zuni Life Skills Development Program, an effective community-initiated
and high-school-based suicide prevention intervention, is featured. Development
and evaluation of this intervention are followed by note of the specific challenges
associated with stabilizing the program. A more tribally diverse, culturally-informed
model entitled the American Indian Life Skills Development Curriculum is then pre-
sented to illustrate a hybrid approach to the cultural tailoring of interventions.
This curriculum is broad enough to address concerns across diverse American
Indian tribal groups yet respectful of distinctive and heterogeneous cultural beliefs
and practices. Finally, we reflect upon issues in community-based research that
emerged during this collaboration.
Suicide and suicide-related behaviors are a lation until age 45, when the rate begins to
resemble that of the general U.S. populationmajor public health concern for American
Indian adolescents, yet their risk behavior (Goldsmith, Pellmar, Kleinman, & Bunney,
2002).pattern remains undefined. Suicide is the sec-
ond leading cause of death among American In studying adolescents from three
culturally distinct American Indian tribes,Indian adolescents and young adults in the
15- to 24-year-old age group and is the third Novins, Beals, Roberts, and Manson (1999)
noted that the correlates of suicidal ideationleading cause of death in the 10- to 14-year-
old age group (Centers for Disease Control, differed between tribes but were consistent
with the tribe’s social structure, individual2005). In addition, among American Indian
youth age 5 to 14 years, the rate of suicide is and gender expectations, support systems,
and conceptualization of death. These find-2.1 per 100,000 compared with .8 per
100,000 for U.S. youth in the same age ings underscore the need for caution when
generalizing across tribes about cultural in-group; the rate of suicide among American
Indian youth age 15 to 24 years is 37.4 per fluences on suicidal behavior. The variability
in rates and manifestation of symptoms may100,000 compared with 11.4 per 100,000 for
all U.S. youth in the same age group (Indian be a function of contagion within close-knit
and isolated communities rather than differ-Health Service, 2002). Suicidal behaviors
(i.e., suicidal ideation, suicide plans, and sui- ences in cultural mores or practices. Addi-
tional risk factors noted in the Novins et al.cide attempts) increase with age in this popu-
(1999) report, such as weak American Indian
identity and loss of cultural supports, have
Teresa D.LaFromboise is with Stanford not been found consistently in other related
University; and Hayes A.Lewis is with the Insti- research (LaFromboise, Medoff, Lee, &
tute of American Indian Arts. Harris, 2007). Recently, perceived discrimi-
Address correspondence to Teresa La- nation has joined the list of risk factors often
Fromboise, PhD, 485 Lasuen Mall, Stanford, Ca.
94305–3096; E-mail: mentioned in other studies; such as negative
344 Zuni Life Skills Development Program
life events, depression, and substance use tion, most HUD homes were cheaply made
and thus required added resources to heat(Yoder, Whitbeck, Hoyt, & LaFromboise,
2006). and cool. Moreover, the jewelry market, a
major source of income for many families,In 1987 tribal and community leaders
and parents residing on the Zuni Indian res- bottomed out during that time period caus-
ing further economic hardship.ervation became increasingly alarmed over
the rising rates of youth and young adult sui- Suicide is an especially distressing phe-
nomenon for the Zuni because it is forbiddencide. Over a 7-year period from 1980 to
1987, 13 school-aged youth and young adults in their traditional culture. Zunis believe that
to take one’s own life will cause the soul tohad fatal suicidal behavior in Zuni, a pueblo
located in northwestern New Mexico about remain in a state of distress. The soul of the
deceased will wander and may cause harm to150 miles west of Albuquerque. The youth
were between the ages of 14 and 18 and in- family members and close associates. The de-
ceased person’s soul will not go to “Zunicluded 12 males and 1 female. It is uncertain
if all of the individuals knew each other, but Heaven” until the time that death would have
naturally occurred. The soul of the one whoit is certainly possible within this small ho-
mogeneous community. The tribe and local has died by suicide may not be called upon
to spiritually help the living during times ofeducators had great difficulty obtaining in-
formation on the actual circumstances of the sacrifice and religious participation. In addi-
tion, death by this means is a source ofsuicides from the Zuni service unit of the In-
dian Health Service (IHS), which made the stigma to the family (A. Seowtewa, personal
communication, March 19, 1987).incidents difficult to evaluate.
There was community speculation that At the time of this project, the epide-
miological reality of Zuni suicidal behaviorone of the possible reasons for this increase
in suicidal death was the fact that Zuni fami- was limited to a set of selected statistics from
1965–1988 which had been compiled by alies were becoming more fragmented. Family
and traditional support systems within the community member employed at the local
IHS hospital (Ghachu, 1989). Inferences oncommunity had weakened with an increase in
dispersed housing subdivisions. Traditional any earlier incidents of death by suicide had
to be made from this document. The list ofextended family dwellings had been virtually
replaced by single family dwellings. This risk factors associated with suicidal ideation
among Zuni adolescents during baseline as-broke up families and adversely affected the
value of the extended family as a social, emo- sessment for the current intervention re-
vealed the following: psychological symp-tional, cultural, and economic resource. As
the population expanded and extended family tomatology, past suicidal ideation, drug use,
depression, hopelessness, stress, limited so-units were separated, single-family Housing
and Urban Development (HUD) homes be- cial support, dislike for school, and weak in-
terpersonal communication (Howard-Pitney,came commonplace. The new housing pat-
terns also caused a cultural and spiritual LaFromboise, Basil, September, & Johnson,
1992).hardship because many families living in
Blackrock (a settlement three miles from What follows is an account of the de-
velopment and evaluation of the Zuni LifeZuni) began to find it more difficult to partic-
ipate in cultural activities. Absence from tra- Skills Development Program, a community-
initiated high school suicide prevention pro-ditional cultural activities weakened the
transference of cultural knowledge and be- gram designed to provide intervention strate-
gies consistent with cultural and communityliefs to younger family members. There was
a corresponding change in economic condi- values and strengths. We define the specific
challenges associated with institutionalizingtions in Zuni as well. Many families living in
HUD subdivisions had to make much higher this new and ultimately effective program,
which has been substantiated through adown payments to purchase homes. In addi-
LaFromboise and Lewis 345
quasi-experimental posttest evaluation study. Zuni IHS service unit to refine protocols for
appropriate response and support.Its derivative, the American Indian Life Skills
Development Curriculum, is presented as a The members of our team were first
hosted in the homes of Zuni communityculturally-informed model of suicide preven-
tion that is broad enough to capture concerns members in the spring of 1987. One member
was invited to spend the summer at Zuni torelevant across diverse tribal groups, yet re-
spectful of distinctive and heterogeneous learn about the community and to review ex-
isting school-based suicide prevention train-tribal beliefs and practices. Finally, we reflect
on critical issues in community-based re- ing programs. After a summer of fieldwork in
Zuni and 1 year of intervention developmentsearch that emerged in this collaboration.
on campus, the team began interventionist
training for the pilot study. Initially, the
teachers selected to deliver the intervention
INITIATION INTO were resistant to becoming involved with the
THE COMMUNITY project. They were upset about an article that
appeared in a local newspaper (the Gallup In-
dependent) just days before the initial imple-When the first author was invited by
the second author, then superintendent of mentation of the curriculum in the field. This
article highlighted the irony of the tribethe Zuni Public School District, to help facil-
itate a community response to the latest sui- bringing in Stanford University researchers
to “save Zuni lives” during the winter Sha-cide crises among its adolescents, there al-
ready existed a Zuni-Stanford Committee to lako ceremonies and solstice fasting period
which, in fact, celebrates life. Despite nega-address areas of need on the Zuni reserva-
tion. This committee was initiated as a result tive reactions to this publicity within the
community, Zuni support was mobilized andof a formal agreement between Stanford
University, the Zuni Board of Education, and the teachers (all of whom were non-Indian)
were encouraged to continue. Two Zuni pro-the Zuni Tribal Council. It represented col-
laboration between an interdisciplinary fessionals, a cultural consultant and a mental
health technician, joined the interventiongroup of Stanford faculty and Zuni commu-
nity leaders for the purpose of sharing exper- team as cultural brokers between the stu-
dents’ school and home contexts.tise concerning pressing issues in Zuni re-
lated to communication, education, and Extensive input was solicited from
Zuni tribal members by members of the re-economic development. Once an institu-
tional review of our intervention project was search team in order to examine key aspects
of helping and problem solving in Zuni cul-conducted and approval granted by this com-
mittee, there began a 3-year process of con- ture and to establish community support for
a formative evaluation of the intervention.sulting with the Zuni community to develop
and evaluate a suicide prevention interven- Focus groups representing various house-
holds, medicine fraternities, or kiva societytion which would emphasize life skills devel-
opment and peer support. A life skills train- members were selected by the superinten-
dent and gave necessary guidance on imple-ing approach was selected because of its
preventive focus on offsetting the underlying mentation issues and further refinement of
the intervention. Their input led to a titlefactors of vulnerability that contribute to
high-risk behavior among adolescents. Help- change (from Zuni “suicide prevention” to
Zuni “life skills development”) and to a reor-ing youth build help-seeking behaviors and
teaching their peers to respond appropriately dering of the sequence of skills presented. In-
stead of directly addressing suicide preven-when they reach out became our focus. In
addition, our research team provided com- tion skills-training at the onset, the intervention
gradually phased in information about crisismunity and school gatekeeper training for
suicide prevention and collaborated with the intervention and suicide prevention after first
346 Zuni Life Skills Development Program
addressing skills-training in problem solving, youth appeared to confide in peers about
their concerns more often than they confidedovercoming depression, and stress and anger
management. in adults. It was believed that provision of
help by peers would be beneficial to both the
peer helpers and the students in need. Partic-Selecting a Skills-Training Approach
ipating in help-giving would be a way to en-
gage in pro-social behavior and support a val-A skills-training approach was selected
for use in this work because of its effective- ued community norm. Furthermore, increased
contact with caring adults while acquiring de-ness with American Indian adolescents in re-
ducing the risk factors of substance (Hawk- pression management techniques and stress
management, problem solving, crisis inter-ins, Cummins, & Marlatt, 2004) and tobacco
use (Schinke, Moncher, Holden, Botvin, & vention, and goal-setting skills would widen
their network of available helping resources.Orlandi, 1989). Skills-training has several
features that facilitate intervention with Youth skill-building programs have
been applied to diverse adolescent preventionAmerican Indian youth. In particular, it is a
flexible model with inherent potential to of- programs, especially in school-based settings.
These programs have focused primarily onfer interventions that are culturally appro-
priate. Specific aspects of skills-training with the enhancement of competence in youth de-
velopment work (e.g., self-regulation), as wellAmerican Indian youth include the extensive
use of (a) small group work, which is compat- as the reduction of at-risk behaviors and the
prevention of mental health problems (Cata-ible with traditional and communal modes of
helping; (b) role modeling by adult guest lano, Berglund, Ryan, Lonczak, & Hawkins,
2002). Outcome data from these preventionspeakers on effective coping despite adver-
sity, which replicates knowledge transmission interventions have been promising, especially
when coupled with parent and family train-through apprenticeship opportunities with
designated family members—an essential ing and support (Weisz, Sandler, Durlak, &
Anton, 2005).source of childhood socialization in Zuni cul-
ture; and (c) community gatekeeping by School-based adolescent suicide pre-
vention is one area in which the skills-train-tribal members knowledgeable about the
tribal structure and worldviews (LaFrom- ing approach is insufficiently used. Increas-
ingly, school-based suicide prevention programsboise & Rowe, 1983). Skills-training lends it-
self to collaboration between community focus on early screening for suicidal risk, on
teaching information about suicide, on de-members and interventionists to determine
socially appropriate goals for the interven- tecting risk factors, on referring at-risk stu-
dents to mental health services, and on devel-tion, which could include the maintenance of
certain indigenous beliefs and skills as well as oping crisis intervention techniques. Few
explicitly strive to use skills enhancement tothe acquisition of new skills. This approach
allows the community to define the target modify suicide risk factors such as inadequate
problem solving or coping skills. The successproblems (e.g., substance use, violence) and
the types of behaviors deemed appropriate of the skills-training approach in ameliorat-
ing other adolescent risk behaviors suggestsfor each situation (e.g., refusal skills, coping
skills, anger management skills). It also facili- that it may be an effective approach for sui-
cide prevention with youth. This evidence oftates prevention efforts because it can be used
to develop skills and competencies prior to effectiveness coupled with the compatibility
of skills-training with Native American waysthe manifestation of behavioral problems or
deficiencies. of knowing made this approach appealing for
the universal intervention.The research team anticipated that a
universal intervention might raise the overall The Zuni Life Skills Development
Curriculum (ZLS; LaFromboise, 1991) wassupportiveness and responsiveness of the
school environment for at-risk youth. Zuni endorsed by the tribe to address essential risk
LaFromboise and Lewis 347
factors associated with adolescent suicide dents to remember that the life they were
given was the most important possession they(e.g., hopelessness, depression, anger). The
seven major units of the curriculum were as had. The beginning lessons focused on the
desire for community cohesion and knowl-follows: (1) build self-esteem; (2) identify
emotions and stress; (3) increase communica- edge of one’s family background. Core Zuni
values were underscored, such as resistancetion and problem-solving skills; (4) recognize
and eliminate self-destructive behavior; (5) and fortitude—qualities found necessary at
numerous times in their history, such as thelearn about current knowledge on the vari-
able rates of suicide across tribes, on risk fac- Pueblo Revolt of 1680 and subsequent
threats by outsiders over the years. Studentstors for American Indian adolescent suicidal
behavior, on the warning signs of suicide, and then began to review the ways in which other
tribal people had coped with stress, especiallyon facts and myths about suicide; (6) receive
suicide crisis intervention training; and (7) when struggling against the demeaning as-
pects of colonization. They also studied cul-engage in individual and collectivistic goal-
setting. Each lesson contained the standard ture-specific manifestations of psychological
symptoms associated with suicide from schol-skills-training techniques of providing infor-
mation about the helpful or harmful effects arly writings available at the time.
Each skill-building activity was se-of certain behaviors, modeling of target
skills, experiential activities and behavior re- lected by the first author from research sup-
porting best practices for social emotionalhearsal for skills acquisition, and feedback for
skill refinement. These four fundamental regulation and skills acquisition. The re-
search team made a thorough study of thecomponents tap a variety of different learn-
ing channels and actively engage students most efficacious components of group cogni-
tive and behavioral treatment strategies (seeearly in the training process.
review by Weisz et al., 2005). Once a treat-
ment procedure was identified, communityCultural Tailoring of the Intervention
input was sought concerning socially-valued
components of the procedure and necessaryA unique feature and strength of the
intervention was that it was specifically tai- modifications of the protocol. For example,
in the lessons on dealing with mild depres-lored to be compatible with Zuni cultural
teachings and world views, values, norms, sion, the Pleasant Events Schedule (Lewin-
sohn, Munoz, Youngren, & Ziess, 1986) wascommunication styles, and rewards and
forms of recognition. A key feature in the in- adapted for the adolescent developmental
level and for greater relevance to the reserva-tervention delivery process was team-teach-
ing: pairing a Zuni person with each non- tion context, and was used as a class activity
and homework assignment. Items such asZuni teacher to deliver the curriculum. Issues
of a highly personal nature brought up by “talking on the telephone” or “playing a mu-
sical instrument” were retained. However,students were often spoken in the Zuni lan-
guage to other students and the Zuni mem- new items were added: “doing heavy outdoor
work (cutting or chopping wood, clearingber of the team. It should be emphasized that
the deep structural aspects of Zuni culture land, etc.)” or “being at weddings and other
ceremonies.” In the lessons on stress man-were shared sparingly with the research team
during intervention development and only as agement, the eight coping categories ad-
vanced by Folkman and Lazarus were pre-they related to the goals of the intervention.
All involved acknowledged that it was impor- sented to community members and discussed
to better determine community preferencestant not to reveal tribal mores in spheres out-
side of the Zuni family, clan, and religious for each of the ways of coping (Folkman,
Lazarus, Dunkel-Schetter, DeLongis, &structures.
The curriculum began with an open- Gruen, 1986). The most highly ranked ways
of coping were featured in the lessons oning invocation from a Zuni leader, asking stu-
348 Zuni Life Skills Development Program
coping within the curriculum. Goal-setting, miliarity with community dynamics and fear
that the topic was a liability in local politicswhich is usually an individual endeavor, was
expanded to include both personal and com- among partner agencies were the chief rea-
sons for the end of the program (personalmunity goal-setting.
communication with J. West, November 20,
1994). Unfortunately, his views found accep-Stabilization of the Intervention
tance within the school site leadership,
among teachers, and with the school board.The ZLS was offered 3 days a week
in language arts classes during the first year It appears that the new leadership at
the administrative and board levels believedof the intervention, followed by booster ses-
sions on suicide prevention during the third that the Zuni-Stanford suicide prevention
goals were accomplished, since the numberyear. Using a multi-method evaluation ap-
proach including self-report, behavioral ob- of school-aged suicides had been drastically
reduced. The cumulative impact of changesservation, and peer rating, the intervention
was found to reduce suicidal thoughts and in district leadership and the sharp drop-off
in deaths by suicide resulted in a shift in pri-behaviors and feelings of hopelessness among
Zuni youth. It was also found to increase orities away from continuation of the suicide
prevention and intervention.problem-solving skills and suicide interven-
tion skills (LaFromboise & Howard-Pitney, In small, homogeneous tribal commu-
nities, many Native American service provid-1995).
Unfortunately, the ZLS was discon- ers and teachers believe that they know ev-
eryone else’s most private affairs. Whentinued 2 years following its promising evalua-
tion for several interrelated reasons. Suicide, blame for a suicide is assigned, particularly
when family dysfunction is assumed to be aas it occurs within the tribal community con-
text, has the potential to become not only major contributor, the process of intervening
with new systemic support systems from thecontroversial but adversarial at several levels.
Suicide prevention and intervention requires community and school becomes problematic
and controversial. A number of parents toldconstant vigilance and appropriate, timely ac-
tion. This takes energy, careful orientation, the second author that tribal and school-
based service providers were implying thattraining, community awareness, school and
community collaboration strategies, and the their inability to be “good parents” contrib-
uted to the suicide of their children. Feelingscreation of effective policies and protocols.
The second author, a Zuni tribal member, ex- of personal guilt and responsibility interfered
with their ability to effectively cope with theperienced first-hand initial resistance and
lack of support for the program by some IHS many complicated and emotion-laden issues.
This left many parents and relatives withpersonnel. Changes in the Zuni School Dis-
trict leadership occurred at the superinten- very few effective or appropriate ways to ex-
press their grief, frustrations, and fears.dent level the year following the final evalua-
tion. This involved reassignments of key
Zuni and other personnel who were familiar
with the school-community suicide issues. AMERICAN INDIAN LIFE SKILLS
Key staff replacements were primarily non-
Indian personnel who had little familiarity or
knowledge of community priorities or dy- While the ZLS was struggling with
stabilization issues, the first author turned tonamics. The new superintendent was unwill-
ing to press for the necessary community ad- other American Indian school settings to re-
fine the intervention and address the prob-vocacy to insure long-term implementation
and institutionalization (personal communi- lems of youth from other tribal nations. Un-
derlying this work was the assumption thatcation with W. Eriacho, G. Keene, and M.
Eriacho, November 13, 2005). His lack of fa- many tribes, especially more traditional ones,
LaFromboise and Lewis 349
would be reluctant to share valued deep- tective factors specific to American Indian
youth to inform the development of preven-structure cultural information. However, it
was believed by the first author and sup- tion strategies in their review of suicide pre-
vention programs in American Indian/Alaskaported by the diverse tribal community con-
sultants who worked on the project that Native communities. Greenberg, Domitrov-
ich, and Bumbarger (2001) also deemed it amany of the cultural nuances in the Zuni pro-
gram could be adapted to create intervention promising program in their review of preven-
tion interventions for mental disorders inprograms for other tribes. The more tribally
heterogeneous version for this process was school-aged children.
Clearly, further effectiveness studies ofpublished as the American Indian Life Skills
Development Curriculum (AILS; LaFrom- the AILS for suicide prevention are needed
in order to meet current standards of evi-boise, 1995). This curriculum encourages in-
terventionists to incorporate traditional and dence against which preventive interventions
are evaluated. If more evaluations of thecontemporary worldviews of their tribes and
communities into the cultural content of the AILS support continuation of this interven-
tion, applications in urban settings must becurriculum without altering the skills-train-
ing form of program delivery or compromis- studied. Then this intervention could be used
in tandem with evidence-based substanceing the core psychological components of the
intervention. Castro, Barrera, and Martinez abuse programs already implemented with
American Indian adolescents (Moran & Rea-(2004) have labeled the heuristic for this type
of cultural tailoring a “hybrid-like frame- man, 2002).
With the AILS we also attempted to
address the needs of both traditional and CONTROVERSY OVER
pan-tribal adolescents. The AILS contains
certain universal Native American values and
behaviors such as respect, kindness, and gen- Within the community of American
Indian mental health scholars there is in-erosity, but also allows for the local tailoring
of intervention content and training pro- creasing advocacy for an emic (within the
culture or “insider”) approach in which inter-cesses. Since its inception in 1995 it has been
used by representatives of traditional healing ventions are highly specific to the traditional
wisdom and healing practices of a particularsocieties with youth on reservations as well as
by teachers in after-school programs, and tribe (Gone, 2004). The ZLS is an example
of such an approach. This work not only in-with American Indian students in both public
and tribal schools. volved ongoing collaboration between the re-
search team and the Zuni-Stanford Commit-The AILS has been featured as an ef-
fective suicide prevention program for rural tee, it required ongoing reports about the
intervention, its related evaluation activities,American Indian communities in the Insti-
tute of Medicine of the National Academies’ and its results to the tribal council and to the
school board. There were also formativereport, Reducing Suicide: A National Imperative
(Goldsmith et al., 2002). Its inclusion in this evaluations of the ZLS conducted by tribal
educators and students (LaFromboise &report was based on a program evaluation at
the Cherokee Nation in Tahlequah, Okla- Howard-Pitney, 1994).
However, the field of prevention is di-homa, where there was a reversal of the Se-
quoyah High School’s 20-year suicide rate, vided about whether culturally-adapted in-
terventions are more effective than genericwith zero deaths by suicide recorded since the
AILS was implemented in the late 1980s. interventions when applied to ethnic minor-
ity populations. A number of researchersMiddlebrook, LeMaster, Beals, Novins, and
Manson (2001) noted that the AILS was have noted relatively limited success when
trying to involve ethnic minorities in generic,unique as a program that used risk and pro-
350 Zuni Life Skills Development Program
but evidence-based, prevention programs These authors have subsequently advocated
for phased intervention procedures that allow(Bernal & Scharron-Del-Rio, 2001; Dent,
Sussman, Ellickson, Brown, & Richardson, for post-intervention modifications of ge-
neric programs. They suggest that further1996; Turner, 2000). They suggest that ge-
neric interventions appear irrelevant or inac- evaluation of the generic intervention for
cultural appropriateness should be conductedcessible to individuals from communities that
strongly identify with their cultural heritage. by expert members of the target cultural
group (Kumpfer, Alvarado, Smith, & Bel-The movement to put generic, tested inter-
ventions into practice, including a mandate lamy, 2002).
In essence, the iterative process of in-that programs funded by the Substance
Abuse and Mental Health Services Adminis- tervention modification with both generic
and culturally-tailored interventions alreadytration (SAMHSA) select interventions from
lists of evidence-based practices in its registry occurs in the field. Once an evidence-based
intervention is adopted by a school or com-of effective programs, is seen by many Amer-
ican Indians as yet another stringent imposi- munity, it is often modified to respond to
pressing issues and preferred modes of inter-tion placed on them by the federal govern-
ment. acting within the local context. The extent
of local cultural tailoring depends upon theBotvin and his colleagues attempted to
address this issue in their studies of the effec- interest, energy, and degree of traditional
involvement of members of the field curricu-tiveness of both culturally-focused and ge-
neric skills-training approaches to alcohol lum team. Adaptations range from surface
level modifications to versions based on care-and drug abuse prevention among ethnic mi-
nority adolescents. They compared the two ful analysis of the deeper structural cultural
tenets underlying each phase of the interven-prevention approaches and found that both
programs influenced mediating variables as- tion. Unfortunately, these locally modified
forms of intervention are rarely subjected tosociated with non-drug use more than the
information-only control group (Botvin, the rigor of the evaluation standards on
which the empirically validated version wasSchinke, Epstein, & Diaz, 1994). In a 2-year
follow-up study, they found that adolescents endorsed.
in both a culturally-focused and a generic in-
tervention approach had less current alcohol
use and lower intentions to engage in future FURTHER CONSIDERATIONS
alcohol use relative to adolescents in the con-
trol group. Adapting the program for a specific The opportunity for the authors to re-
flect on this community-initiated suicide pre-ethnic group led to lower levels of risk-taking
among students in the culturally-focused in- vention effort has been helpful in several im-
portant ways. The emotional distance createdtervention group compared to students in the
generic skills intervention group (Botvin, by time and space allowed us to think
through some of our original assumptions re-Schinke, Epstein, Diaz, & Botvin, 1995).
This finding points to the potential effective- garding the long-term implementation of the
ZLS. We learned that tribal and commu-ness of tailoring interventions to specific
populations. nity leaders assumed that prevention strate-
gies and intervention activities would con-Kumpfer and her colleagues posited
that culturally-adapted prevention programs tinue to be effective without monitoring sup-
port, after apparent successes, but programswould substantially improve engagement and
acceptance, leading to better involvement of were adversely affected by changes in leader-
ship. We discovered that advocacy for pro-ethnic communities in the intervention.
However, participants in culturally-adapted gram development, application, and institu-
tionalization should not depend upon a fewprograms only slightly improved on out-
comes (Aktan, Kumpfer, & Turner, 1996). individuals or agencies, especially when the
LaFromboise and Lewis 351
prevention of suicide is a vital concern the intervention unless parents were mem-
bers of the school board, school staff, or thethroughout the tribal community. We as-
sumed that the tribal community and school tribal council. Parental involvement was also
necessary to ensure cultural compatibilityleadership would initiate appropriate public
policy and procedures to continuously moni- and longevity of the prevention effort given
the importance of the family in Zuni culture.tor, support, and enhance the program as
well as strengthen the community’s capacity Perhaps if more Zuni parents had had the
opportunity to discuss positive parentingto address suicide needs and concerns. How-
ever, given the widely-held misperception by practices and become familiar with the con-
tent of the ZLS, they would have felt lesstribal/community and school leadership that
the suicide problem had been solved, neces- threatened by the insinuations that students’
family situations were to blame for their be-sary policy recommendations for commu-
nity-wide coordination and resource sharing havior. The research team should have re-
ported the evaluation findings to parentdid not occur. In addition, the tribal council
and community leadership did little to create groups who were not able to attend Zuni
School Board meetings. We can only specu-systemic approaches to maintain vigilance or
create second-level strategies to address the late about what might have happened if par-
ents had advocated for the continuation ofrelated causes of family and community vio-
lence. the program after the disruption in school
leadership.Interventions within tribal communi-
ties must include important protocols associ- The intervention was found to have a
positive impact on hopelessness (as measuredated with cultural resources, indigenous val-
ues, and healing practices. The reliance on by the Beck Hopelessness Scale; Beck, Weiss-
man, Lester, & Trexler, 1974), suicidal ide-evidence-based practices to address tribal
youth suicide needs may narrow family and ation (as measured by the Suicide Probability
Scale; Cull & Gill, 1988), and students’ abil-community options and neglect valuable cul-
tural resources found within tribal communi- ity to intervene in a peer suicidal crisis situa-
tion (as determined by the behavioral studyties, particularly in those that still maintain a
strong cultural and traditional base. The reported in LaFromboise & Howard-Pitney,
1995). These results only partially confirmedidentification and inclusion of traditional
healers has often been marginalized among the original cultural hypothesis: that Zuni
youth were engaged in fatal suicidal behaviorresearchers and interventionists who come to
tribal communities to work on issues of sui- due to rising levels of hopelessness and de-
creased involvement in cultural traditions,cide. The absence of this important cultural
resource sends mixed messages to commu- which in turn was associated with increased
family fragmentation and economic hardship.nity members who depend on traditional
healers for ongoing healing services, and di- This cultural hypothesis was tested in an
analysis of risk factors for suicidal ideationminishes the value of such a critical resource.
Although tribal cultural resources were an in- using data collected during the baseline as-
sessment. Traditionality (as defined by thetegral aspect of the ZLS, traditional heal-
ers should have been asked to participate fur- Zuni tribal council on a 10-item scale avail-
able from the first author) was not found tother, to support the appropriate community
infrastructure, and to help develop the capac- be a risk factor for suicidal ideation (Howard-
Pitney et al., 1992). More intensive efforts atity of the community for responsibility and
self-reliance in suicide prevention. improving this measure for the final evalua-
tion should have occurred, given the salienceAlthough the parents of Zuni High
School students were updated about the pro- of traditionality in Zuni culture. The con-
structs of enculturation and family cohesiongram on a regular basis and were invited to
celebrate their child’s completion of the pro- were not assessed in this evaluation. How-
ever, measures of enculturation have beengram, family members were not included in
352 Zuni Life Skills Development Program
subsequently developed for studies with and advocacy for capacity development.
While there is a strong sense of urgency toother tribes (Whitbeck, McMorris, Hoyt,
Stubben, & LaFromboise; 2002), and could address the critical needs and issues of suicide
within the American Indian community con-serve as a useful model in this regard. The
measurement of family cohesion, deemed too text, there are many community and tribal
relationships and protocols that must be con-personal for inclusion within this study, may
have further informed the cultural hypothesis sidered in any mobilization effort to address
suicide. Often it takes quite a bit of time totesting. Thus the process of confirming, dis-
confirming, and reconfirming cultural hypoth- bring people, agencies, and resources to-
gether, which may leave researchers with theeses was limited in this research and may
have left important community stakeholders impression that there is little active concern
on the part of tribal leaders and communitywanting more.
members. In terms of tribal capacity for de-
velopment and effective intervention, tribal
leadership must take the initiative and re-
CONCLUSION sponsibility for promoting public policy that
will enhance community-wide responsibility
for the elimination of suicide within Ameri-One of the tenets in community-based
research is to intervene, yet to wait for can Indian communities. In terms of inter-
vention development and outcome researchchange in order not to interfere. This sug-
gests that the researcher must seek guidance to support intervention effectiveness and va-
lidity, researchers must intervene in the mostfor the development and application of inter-
ventions from tribal/community leaders and professional and culturally competent man-
ner possible. To do less on either part is aother resource people. Local people are often
best positioned to know the community dy- serious disservice to tribes and to the field of
mental health.namics and needs, and can provide leadership
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... For instance, individual-level impacts for gatekeeper trainings included improved attitudes toward suicide, increases in participants' knowledge and confidence in how to identify individuals at-risk of suicide, increases in intended and actual assisting behaviours, and significant improvements in understanding the links between cultural strengths, social and emotional wellbeing and suicide prevention [47,48,51,52]. Moreover, participants in culturally-grounded suicide education and awareness initiatives were shown to have less suicidal ideation and "negative thinking", expressed fewer feelings of hopelessness, could come to terms with the 'cycle of grief, ' demonstrated reduced stigma towards suicide and increased willingness to seek help, and had an increase in psychological service utilization [49,[56][57][58]. Participants in community suicide prevention programs which integrated culture had significant increases in positive mood, feelings of belongingness, perceived coping, reasons for living, and overall resiliency [36,38,41]. ...
... Cultural adaptations of conventional suicide prevention strategies may be more susceptible to reliance on the underlying Western/colonial assumptions of the original intervention and typically involve modifying "non-active" treatment components of the intervention for cultural acceptability such as language or style of the intervention, who delivers it, or the treatment setting [50]. Many adaptations also place importance on finding a balance between meeting community/cultural needs and preserving fidelity/standardization [54,56,71,80]. ...
... Use of pan-Indigenous approaches was cautioned in the literature and authors advised against application of Indigenous-driven suicide prevention in contexts that they were not designed for [56,67,71,90]. This is because pan-Indigenous strategies may not be reflective of diverse cultural practices, values, sociohistorical context, and geographic considerations unique to each group. ...
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Background Indigenous peoples of Canada, United States, Australia, and New Zealand experience disproportionately high rates of suicide as a result of the collective and shared trauma experienced with colonization and ongoing marginalization. Dominant, Western approaches to suicide prevention—typically involving individual-level efforts for behavioural change via mental health professional intervention—by themselves have largely failed at addressing suicide in Indigenous populations, possibly due to cultural misalignment with Indigenous paradigms. Consequently, many Indigenous communities, organizations and governments have been undertaking more cultural and community-based approaches to suicide prevention. To provide a foundation for future research and inform prevention efforts in this context, this critical scoping review summarizes how Indigenous approaches have been integrated in suicide prevention initiatives targeting Indigenous populations. Methods A systematic search guided by a community-based participatory research (CBPR) approach was conducted in twelve electronic bibliographic databases for academic literature and six databases for grey literature to identify relevant articles. the reference lists of articles that were selected via the search strategy were hand-searched in order to include any further articles that may have been missed. Articles were screened and assessed for eligibility. From eligible articles, data including authors, year of publication, type of publication, objectives of the study, country, target population, type of suicide prevention strategy, description of suicide prevention strategy, and main outcomes of the study were extracted. A thematic analysis approach guided by Métis knowledge and practices was also applied to synthesize and summarize the findings. Results Fifty-six academic articles and 16 articles from the grey literature were examined. Four overarching and intersecting thematic areas emerged out of analysis of the academic and grey literature: (1) engaging culture and strengthening connectedness; (2) integrating Indigenous knowledge; (3) Indigenous self-determination; and (4) employing decolonial approaches. Conclusions Findings demonstrate how centering Indigenous knowledge and approaches within suicide prevention positively contribute to suicide-related outcomes. Initiatives built upon comprehensive community engagement processes and which incorporate Indigenous culture, knowledge, and decolonizing methods have been shown to have substantial impact on suicide-related outcomes at the individual- and community-level. Indigenous approaches to suicide prevention are diverse, drawing on local culture, knowledge, need and priorities.
... The program primarily utilizes scenarios that convey Indigenous knowledge to develop their curriculum, and in the selection of their activities. The curriculum emphasizes social-cognitive skills training and includes seven main themes: (1) building self-esteem, (2) identifying emotions and stress, (3) increasing communication and problem-solving skills, (4) recognizing and eliminating self-destructive behavior, (5) information on suicide, (6) suicide intervention training, and (7) setting personal and community goals (LaFromboise and Lewis, 2008). She explained that even though this intervention has a heavy skills component, it is saturated with constant, positive health messages that aim to increase the cognitive flexibility needed for executive function, instill optimism, reinforce cultural pride, increase a sense of school belonging, and increase perceived competence. ...
... She explained that even though this intervention has a heavy skills component, it is saturated with constant, positive health messages that aim to increase the cognitive flexibility needed for executive function, instill optimism, reinforce cultural pride, increase a sense of school belonging, and increase perceived competence. LaFromboise said that, after the program was evaluated over a three-year period, the Zuni gave permission to broaden the program to include American Indian Life Skills (LaFromboise and Lewis, 2008). ...
Technical Report
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The Forum on Mental Health and Substance Use Disorders and the Forum for Children's Well-Being of the National Academies of Sciences, Engineering, and Medicine hosted a three-part virtual public workshop on April 26, 2022, May 13, 2022, and June 10, 2022. The workshop featured subject matter experts who examined suicide risk and protective factors in Indigenous populations, discussed culturally appropriate and effective suicide prevention policies and programs, explored existing data systems and how data can be used for tracking suicide rates, and considered gaps and challenges in providing the continuum of services needed for substance use and mental health disorders in multiple health care settings across Indigenous communities.
... LaFromboise and Howard-Pitney (1995b) developed and piloted the Zuni Life Skills curriculum which was designed in collaboration with the Zuni Pueblo to prevent suicide by promoting social cognitive development (e.g., recognizing and eliminating self-destructive behavior such as pessimistic thoughts or anger reactivity). This curriculum was effective and has since been expanded into the American Indian Life Skills curriculum, which addresses concerns across a diverse range of Tribal groups (Lafromboise & Lewis, 2008). More recently, Rasmus and colleagues (2014) developed programs for Alaska Native youth with the Qungasvik ("Toolbox"; see Allen et al., 2009), a Yup'ik intervention that promotes reasons for living and sobriety. ...
Objective We conducted a systematic review to answer the following research question: “What logics or rationales have structured interventions aimed at preventing suicidal behaviors among AI/AN populations?” Method Our screening and searching process yielded 32 publications that overlapped considerably in terms of suicide prevention strategies, logics, and rationales. Results Regarding suicide prevention strategies, most studies featured interventions that sought to pro connectedness, create protective environments, identify and support people at risk, and teach coping and problem-solving skills, while others strengthened access and delivery of suicide care, lessened harms and prevented future risk, and strengthened economic support. The rationales justifying these suicide prevention strategies varied from strategy to strategy. Discussion While most program developers related their choice of suicide prevention strategy to distress at the individual level, each and every developer foregrounded their efforts in collectivist-attitudes, social relations, non-professional services, and community-driven projects rooted in decolonization efforts. This focus may reflect a need to honor Indigenous assumptions about suicide in community-based prevention programs. Conclusion Altogether, our analysis points to a multi-level ecosystem of interventions that incorporates individual-centered rationales and interventions so long as they also consider systems, contexts, and a collectivist mentality.
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As part of the National Action Alliance for Suicide Prevention’s American Indian and Alaska Native (AI/AN) Task Force, a multidisciplinary group of AI/AN suicide research experts convened to outline pressing issues related to this subfield of suicidology. Suicide disproportionately affects Indigenous peoples, and remote Indigenous communities can offer vital and unique insights with relevance to other rural and marginalized groups. Outcomes from this meeting include identifying the central challenges impeding progress in this subfield and a description of promising research directions to yield practical results. These proposed directions expand the alliance’s prioritized research agenda and offer pathways to advance the field of suicide research in Indigenous communities and beyond.
Introduction: Suicide is caused by the interaction of many factors; however, most suicides are preventable. If suicide does not lead to death, there is concern that the behavior may be repeated. Teaching life skills based on participatory and practical learning is very effective in increasing health and early prevention of problems, as well as helping adolescents to learn positive behaviors and maintain their mental health. This study aimed to compare the effectiveness of life skill training in ego power, temperament, and suicidal thoughts among the girls and boys who attempted to commit suicide in Ilam province, Iran. Material & Methods: This semi-experimental study was conducted based on a pretest-posttest design with control and follow-up groups. The statistical population of the research included all boys and girls aged 18 to 24 (n=212) in Ilam province who for the first time over the past six months in 2018-2019 committed suicide and were referred to the medical centers of this province. In total, 80 cases were purposefully selected as an accessible sample and were matched and assigned into (based on education status) the experimental (20 girls and 20 boys) and control groups (20 girls and 20 boys). The data were collected using the temperament scale, ego scale, and suicidal thought scale. The data were analyzed through variance analysis with frequent measurements. (Ethic code:10120705972003) Findings: The results of analysis of variance showed a significant difference in pre-post life skill training test among girls and boys who attempted to commit suicide in Ilam province in the experimental, control, and follow-up groups in terms of the level of temperament, ego power, and suicidal thoughts. Similarly, multivariate analysis of variance showed that life skill training in group type and test status had an effect on temperament and its dimensions, ego power, and suicidal thoughts of boys and girls who attempted to commit suicide in Ilam province. Discussion & Conclusion: According to the findings it can be concluded that life skills training has been effective in ego power, temperament, and suicidal thoughts of girls and boys who attempted suicide both in the post-test and follow-up stages.
Written against the backdrop of the 2020 twin pandemics of a global health crisis and greater national awareness of structural racism, this article issues a call for psychology to invest in training all psychologists to respond to the social ills of racial and other forms of oppression. We introduce a public psychology for liberation (PPL) training model. Essentially, the model reflects a science, a pedagogical commitment, and practice of, by, and with the people who have been most marginalized in society. The PPL consists of five foundational domains or cross-cutting areas of expertise (e.g., facilitate human relationships; generate reciprocal knowledge and translation) and 10 interrelated lifelong practices (e.g., cultural humility; care and compassion) that foster healing and equity. The model centers the perspectives of the Global Majority, focuses on radical healing and equity, and emphasizes a developmental, culturally grounded, strengths-based approach to training. Various training initiatives consistent with a public psychology for liberation approach are presented. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Suicide is the second leading cause of death in the 15–29 age group worldwide, and is a severe public health problem worldwide. Adolescent and young adult individuals primarily attend educational institutions which can play an essential role in detecting and preventing suicide. For this reason, the purpose of this research is to examine the role that educational institutions play in suicide prevention. A systematic review was conducted to determine what educational institutions and agents are identified in the literature when addressing suicide. The systematic review yielded 58 articles published over the last 30 years. The results show that a wide variety of educational stakeholders are required to intervene for suicide prevention between primary education and college. Overall, educational suicide initiatives report positive effects on participants’ understanding, attitudes, and beliefs regarding suicide and suicide prevention, although some studies have expressed some caution. The different types of programs and recommendations are discussed.
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A dynamic tension has developed in prevention science regarding two imperatives: (a) fidelity of implementation—the delivery of a manualized prevention intervention program as prescribed by the program developer, and (b) program adaptation—the modification of program content to accommodate the needs of a specific consumer group. This paper examines this complex programmatic issue from a community-based participatory research approach for program adaptation that emphasizes motivating community participation to enhance program outcomes. Several issues, key concepts, and implementation strategies are presented under a strategic approach to address issues of fidelity and adaptation. Despite the noted tension between fidelity and adaptation, both are essential elements of prevention intervention program design and they are best addressed by a planned, organized, and systematic approach. Towards this aim, an innovative program design strategy is to develop hybrid prevention programs that “build in” adaptation to enhance program fit while also maximizing fidelity of implementation and program effectiveness.
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Although research has increased concerning the psychological and social correlates of American Indian adolescent suicidal ideation, little is known about the precursors to suicidal ideation with the early adolescent age group. In this study, we examined a number of cognitive, behavioral, and emotional correlates of suicidal ideation among 122 American Indian middle school youth who lived on a reservation in the Northern Plains area of the United States in February 2006. The participants were on average 12.4 years old, and about 20% reported that they had made a nonfatal suicide attempt at some time in their lives. When using a multivariate model (adjusted R of .70), depression and substance use were the only significant predictors of suicidal ideation as measured by the Suicidal Ideation-JR scale (Reynolds, 1988). We suggest potential ways in which variables such as gender, friend and family member suicidal behavior, and engagement in traditional activities may affect suicidal ideation through their effects on depression and substance use. We recommend that suicide prevention programs with American Indian early adolescents draw on cognitive-behavioral interventions emphasizing the strengths of select cultural tenets in tandem with substance abuse prevention strategies that appear promising.
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Two-year follow-up data (from inner-city, minority adolescents) were collected to test the effectiveness of 2 skills-based substance abuse prevention programs and were compared both with a control condition and with each other. Students were originally recruited from 6 New York City public schools while in 7th grade. Schools were matched and assigned to receive a generic skills training prevention approach, a culturally focused prevention approach, or an information-only control. Students in both prevention approaches had less current alcohol use and had lower intentions to engage in future alcohol use relative to students in the control group. Students in the culturally focused group also engaged less in current alcohol behavior and had lower intentions to drink beer or wine than those in the generic skills group. Both prevention programs influenced several mediating variables in a direction consistent with nondrug use, and these variables also mediated alcohol use. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Tested the effectiveness of 2 alcohol and drug abuse prevention programs among 639 inner-city minority 7th-grade students in New York City. Ss were randomly assigned to receive (1) a generic skills training prevention approach, (2) a culturally focused prevention approach, or (3) an information-only control. Results indicate that Ss in both prevention approaches had lower intentions to drink beer or wine in the future relative to Ss in the control group. The generic skills training approach also showed promise in terms of intention to drink hard liquor and use illicit drugs. Both prevention programs influenced several mediating variables in a direction consistent with nondrug use. Results provide preliminary support for the 2 approaches with respect to alcohol and drug use prevention among minority youths in New York City. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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As the population of American Indians and Alaska Natives continues to expand in the 21st century United States, an increasing number of professional psychologists will be called upon to provide culturally appropriate mental health services for Native American people and their communities. This article provides a general overview of contemporary tribal America before describing the legal, political, and institutional contexts for mental health service delivery administered through the federally sponsored Indian Health Service. Recommendations for mental health professionals who desire to avoid a subtle but profound Western cultural proselytization in their therapeutic service to Native clients and their communities are presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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In collaboration with the Zuni pueblo, a culturally tailored intervention program was designed using a model of social cognitive development to remediate the behavioral and cognitive correlates of suicide. The Zuni Life Skills Development curriculum was introduced in the tribal high school and evaluated using a multimethod approach including self-report, behavioral observation, and peer rating. Students exposed to the curriculum scored better than the no-intervention group at posttest on suicide probability and hopelessness. In addition, the intervention group showed greater ability to perform problem-solving and suicide intervention skills in a behavioral assessment. The effectiveness of the program and recommendations for similar prevention programs are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This article summarizes a much lengthier one that appeared in Prevention and Treatment. The earlier article grew out of a project initiated by the Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation. The Positive Youth Development Evaluation project described why policy makers, practitioners, and prevention scientists advocated a shift in approach for how youth issues are addressed in this country. The Positive Youth Development Evaluation project sought to define how youth development programs have been defined in the literature and then to locate, through a structured search, strong evaluations of these programs and summarize the outcomes of these evaluations. In the current article, we explain why prevention has shifted from a single problem focus to a focus on factors that affect both positive and problem youth development, describe what is meant by positive youth development, and summarize what we know about the effectiveness of positive youth develop...
This paper examines prevention programs targeting alcohol and other drug use among American Indian youth. We start with a review of what is known about substance use by this population. We provide consideration of specific prevention programs for Indian youth within these frameworks: Cognitive/Information Dissemination, Affective Education, Social Influence, and Personal and Social Skills Training. A particular focus is on the manner in which issues of culture are incorporated into prevention programs. A detailed overview of the diversity of the American Indian population is presented and its implications for prevention work with Indian youth are discussed. A major conclusion is that there is not one type of prevention program that is likely to work with American Indian youth since there is no such thing as a typical American Indian.
Abstract After reviewing the special problems of smoked and smokeless tobacco use among American Indian people, this paper notesthe risks of early and regular substance use by Indian youth. Theoretical and empirical explanations for tobacco and substance use among Indian youth are then recounted. Based on those explanations, the authors outline the wisdom of interventions to prevent tobacco and other substance use among American Indian young people. Briefly, the authors describe their own original efforts to design such preventive interventions. The paper concludes by calling for additional research on the measurement and prevention of smoked and smokeless tobacco, alcohol and drug abuse among Indian children and adolescents.
Considerable progress has been made over the past two decades in identifying effective drug abuse prevention strategies. In particular, much support has been obtained for the effectiveness of a comprehensive social influences approach to drug abuse prevention. Given the inclusion of fundamental social psychological principles in comprehensive programs, it is possible that currently developed drug abuse prevention programming is generalizable to different ethnic groups. However, the empirical and theoretical evidence is equivocal regarding the extent to which this is true. In this article, the authors present arguments for and against the need to develop drug abuse prevention programs specifically for minority ethnic groups.