A culturally tailored HIV prevention program also reduced marijuana use among American Indian middle schoolers | Research

The takeaway

The Circle of Life program, designed primarily for HIV/STD prevention in American Indian youth, reduced the overall risk of marijuana initiation by 17.3% compared to controls.

Read this if you work with American Indian youth or are interested in culturally grounded substance use prevention.

17.3% lower risk of marijuana initiation in the intervention group

What the researchers found

Researchers evaluated a secondary benefit of the Circle of Life (COL) program, a culturally tailored HIV and STD prevention intervention delivered in all 13 middle schools on a rural Northern Plains reservation. While the program was designed primarily to delay sexual initiation, the study examined whether it also affected marijuana use.

Across 635 American Indian middle school students, the overall risk of initiating marijuana use was 17.3% lower in the COL intervention group compared to the control group. This is notable because the program was not specifically designed to target marijuana use.

However, the intervention did not affect how frequently students used marijuana once they had started. Students who initiated marijuana use in both groups used it at similar rates. This suggests the program was effective at preventing uptake but not at reducing consumption among those who had already begun.

Why it matters

American Indian and Alaska Native communities face disproportionate substance use rates, and marijuana use often begins in early adolescence. Finding that a culturally tailored intervention not specifically targeting marijuana still reduced initiation by 17% suggests that comprehensive, culturally grounded prevention programs can have spillover benefits across multiple risk behaviors.

The numbers in context

635 American Indian middle school students across 13 schools. 47% female. Risk of marijuana initiation was 17.3% lower in the intervention group. No significant effect on frequency of marijuana use among those who initiated. Study conducted 2006-2007.

How the study worked

This was a secondary analysis of a school-based group randomized controlled trial conducted in 2006-2007 across all 13 middle schools on a rural Northern Plains reservation. The sample included 635 American Indian students (47% female). Discrete-time survival analysis assessed marijuana initiation risk, and latent growth curve modeling evaluated frequency of use over time.

What this study cannot tell us

This was a secondary analysis, meaning the study was not specifically designed to test marijuana prevention effects. The sample was from a single reservation, limiting generalizability to other AI/AN communities or populations. Data were collected in 2006-2007 and may not reflect current patterns. Self-reported marijuana use may be underreported.

How to read the evidence

This is a group randomized controlled trial, though the marijuana findings are from a secondary analysis rather than the primary study aim.

When this study was published

Published in 2018 with data from 2006-2007. The Circle of Life program has continued to be used in AI/AN communities.

The bigger picture

This study adds to evidence that comprehensive, culturally appropriate prevention programs can address multiple health behaviors simultaneously. Rather than needing separate programs for each risk behavior, integrated approaches that build on cultural values and skills-based learning may be more efficient and effective, particularly in underserved communities.

Questions still open

What specific components of the Circle of Life program drove the marijuana prevention effect? Would a version specifically targeting substance use produce even larger reductions? How do culturally tailored programs compare to generic prevention programs in AI/AN communities?

Common questions

Can HIV prevention programs also prevent marijuana use?

This study found that the Circle of Life program, designed for HIV/STD prevention, reduced marijuana initiation by 17.3% among American Indian middle schoolers. The program builds skills around decision-making and cultural identity that appear to transfer to substance use decisions.

Did the program stop kids from using marijuana entirely?

The program reduced the likelihood of starting marijuana use but did not affect how often students used it once they began. This suggests the program influenced the decision to initiate but not patterns of ongoing use.

Read the original research

Effects of the "Circle of Life" HIV-prevention program on marijuana use among American Indian middle school youths: a group randomized trial in a Northern Plains tribe.

The American journal of drug and alcohol abuse, 44(1), 120-128

View on PubMed ↗Publisher’s paper ↗

Citation

Asdigian, Nancy L; Whitesell, Nancy Rumbaugh; Keane, Ellen M; Mousseau, Alicia C; Kaufman, Carol E. (2018). Effects of the "Circle of Life" HIV-prevention program on marijuana use among American Indian middle school youths: a group randomized trial in a Northern Plains tribe.. The American journal of drug and alcohol abuse, 44(1), 120-128. https://doi.org/10.1080/00952990.2016.1265122