School- and Family-based Intervention Reduced Substance Use Among Rural and Tribal Youth
Rural and American Indian/Alaska Native (AI/AN) communities continue to experience some of the most severe impacts of the overdose crisis. During the fourth wave of the U.S. overdose crisis beginning in 2022, AI/AN youth and young adults—particularly those aged 15 to 34—experienced the highest overdose death rates of any racial or ethnic group. These disparities underscore the urgent need for prevention strategies that are both effective and responsive to community context.
A recent NIH-funded study offers promising evidence that low-cost, community-based approaches can reduce adolescent substance use before it escalates into more serious harm. Published in the American Journal of Public Health, the study evaluated the Connect intervention, a school- and family-based program developed through a collaboration between Cherokee Nation Behavioral Health and researchers at Emory University.
Methods
The study followed 919 students across 20 rural high schools in northeastern Oklahoma—primarily serving White and American Indian youth—over a three-year period from 2021 to 2024. The intervention targeted students during a critical developmental window, from 10th through 12th grade, when substance use typically begins to increase.
Using a cluster randomized controlled trial design, schools were assigned either to receive the Connect intervention or to a delayed-intervention control group that received the program after the study was complete. Students in intervention schools participated in a brief, digital session once per semester for four semesters. These sessions were grounded in motivational interviewing and supported by trained coaches from Cherokee Nation Behavioral Health.
Each session was tailored to the student’s level of risk. Low-risk students received reinforcement for healthy choices and goal setting, while moderate- to high-risk students were encouraged to avoid risky situations and participated in follow-up coaching sessions to support behavior change.
At the same time, parents and caregivers received Connect Kits for Family Action, with nine kits mailed over three years. These kits provided practical, developmentally appropriate guidance to strengthen family communication, reduce youth exposure to alcohol and drugs, and support healthy development. Together, these components created a low-cost, scalable model designed specifically for rural, low-resource settings.
Key Takeaways
Findings demonstrate that the Connect intervention significantly reduced substance use among adolescents and prevented the typical escalation seen during high school years.
Compared to students in control schools, those in the intervention group reported: 18% less alcohol use; 26% less binge drinking; 11% less cannabis use; and 40% less prescription opioid misuse.
These reductions were observed consistently across six-month survey waves over three years.
While students in the control group followed expected developmental patterns of increasing substance use, those in the intervention group demonstrated flat or declining trajectories.
These findings provide strong evidence that effective, low-cost prevention is feasible in rural and Tribal communities. By combining tailored student interventions with sustained family engagement, the Connect model highlights the impact of culturally grounded, community-driven approaches in reducing substance use during a critical developmental window.
The Article
Komro, K. A., Livingston, M. D., Skinner, J. R., Livingston, B. J., Kominsky, T. K., Jagtiani, A., Barry, C. M., Wagenaar, A. C., Cooper, H. L. F., Harmon, M., Ivanich, E., LaBounty, H., Gassaway, A. N., & Talavera-Brown, S. L. (2025). Primary Prevention of Drug Overdoses in Rural Low-Resource and Tribal Communities: A Cluster Randomized Trial. American journal of public health, 115(9), 1508–1517. https://doi.org/10.2105/AJPH.2025.308205
