Commentary on Montag et al. (2017): The Importance of CBPR in FASD Prevention with American Indian Communities

PRENATAL ALCOHOL CONSUMPTION is a public health concern due to potential lifelong physical and cognitive effects in offspring, often presenting in the form of fetal alcohol syndrome (FAS) or other fetal alcohol spectrum disorders (FASD). FASD is the continuum of lifelong outcomes in those born prenatally exposed to alcohol and includes a diagnosis of FAS, which is diagnosed through facial abnormalities, growth retardation, and delayed brain growth (Hoyme et al., 2016), as well as secondary disabilities such as conduct disorders, mental illness, and psychosocial functioning. Although local, community-specific surveillance data are generally lacking, FASD is of particular concern for many American Indian/Alaska Native (AI/ AN) communities, and rates of FAS among Northern Plains AI/ANs range as high as 9 per 1,000 live births (May et al., 2002). Therefore, prevention of FASD and alcohol-exposed pregnancy among AI/AN communities is essential. Previous FASD prevention projects within AI/AN communities have focused almost exclusively on women prior to pregnancy (Hanson et al., 2017), pregnant women (May et al., 2008), or on broad community education (Williams and Gloster, 1999). Many of these FASD prevention efforts with AI/AN communities highlight the need for community-based participatory research, commonly referred to as CBPR. A recent article by Montag and colleagues (2017) features CBPR strategies used to engage AI/AN communities in FASD prevention. CBPR is a theoretical model that informs the scientific process of research (Israel et al., 2005; Minkler and Wallerstein, 2008). CBPR is built on teamwork and endeavors to include community members, representatives, and researchers in all aspects of the research project, from initiation to final project dissemination. The goal of CBPR is to utilize community strengths and resources to facilitate capacity building while benefiting all participants (Israel et al., 2005). This partnership-based approach aims to integrate research and action. CBPR is an important part of public health program development for any population, but particularly for AI/AN communities. AI/AN communities have a convoluted history with research. Historical trauma caused by broken treaties and the exploitation of culture has led to an overall distrust of non-Natives (Heart et al., 2011). In conjunction, negative experiences with research, including the Barrow Alcohol Study (Foulks, 1989), misuse of blood samples from the Havasupai Tribe (Mello and Wolf, 2010), and “helicopter research” practices, have reinforced a wariness of research and researchers. In relation to substance use, the Barrow Alcohol Study aimed to describe violence, accidental death, and suicide and their correlation with alcohol in rural Alaska. However, the research did not employ validated measures and failed to adequately include the community in the research process. Interpretations of the study were construed and immensely overgeneralized, and failed to recognize cultural, social, historical, and political context (Foulks, 1989). These traumatic events have highlighted the importance for active community input at all stages of research and have pointed researchers toward implementation of CBPR methods. It is difficult to argue that CBPR is an innovative approach with AI/AN tribes, as multiple research projects have been based on CBPR principles. More specifically, the CBPR model has been used fairly extensively with AI/AN communities regarding alcohol consumption. Several of these CBPR studies with AI/ANs have focused on reducing drinking among youth (Barlow et al., 2012) and AI/AN college students (Thomas et al., 2011). However, only a few CBPR-based studies have focused solely on substance use in AI/AN women of childbearing age (Hanson and Pourier, 2015). Therefore, the article on reducing risk for alcohol-exposed pregnancies in AI/AN women in Southern California is From the Sanford Research – Population Health Group (JDH, TLW), Sioux Falls, South Dakota. Received for publication September 11, 2017; accepted October 5, 2017. Reprint requests: Jessica D. Hanson, PhD, Sanford Research, Center for Health Outcomes and Population Research, 2301 E. 60th St North, Sioux Falls, SD 57104; Tel.: 605-312-6209; Fax: 605-312-6301; E-mail: Jessica.D.Hanson@sanfordhealth.org Copyright© 2017 by the Research Society on Alcoholism.