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Native American Prevention Project Against AIDS and Substance Abuse

Ages 12-18

Rating: Level 3


The Native American Prevention Project Against AIDS and Substance Abuse (NAPPASA) school curriculum consisted of a 24-session curricula that addressed multiple issues facing Native American communities. Classroom sessions were designed to build knowledge, acquire and practice prevention skills with peers, and foster new positive peer group norms for preventive communications and behaviors in the context of Native American values. The curriculum covered facts and issues about alcohol and other drug (AOD) abuse; basic reproductive biology; HIV/AIDS; linking AOD to HIV; sexually transmitted diseases (STDs) and how they are transmitted; how assertive communication skills can prevent unwanted sex, pregnancy, and STDs; decision-making skills; healthy options; social skills; coping with pressures; and reinforced practice and role-plays. Further booster sessions involved activities, community meetings, and showing NAPPASA–produced videos and print media.


The evaluation used a pretest–posttest quasi-experimental design with nonequivalent control groups. Data was collected on 2,704 (2,038 treatment and 666 control) high school students. The NAPPASA curriculum was administered to 790 students in eighth grade, 1,021 students in ninth grade, and 227 students in both grades. All groups were administered pretests, immediate posttests, and a follow-up test. Each student completed a standard AOD–use questionnaire (the American Drug and Alcohol Survey) at baseline, with selected items repeated at posttest and follow-up. A second questionnaire (NAPPASA’s Health Behavior Survey) was also administered. The follow-ups intervals differed by grade. There was a 3-month (eighth grade) or a 6-month (ninth grade) follow-up and an 8-month (eighth grade) or 1-year (ninth grade) follow-up. Seventy-seven percent of the subjects were identified as “American Indian” or “American Indian plus other,” while 12 percent were Anglo, 7 percent Hispanic, and 4 percent African-American. The male–female ratio was roughly 1:1.


Compared with nonintervention groups, a significantly higher percentage of NAPPASA intervention participants remained in or moved to the lower risk AOD use category at both 9th and 10th grade follow-up. Among the baseline nonusers, the “normal developmental trend toward increased AOD use” was slowed. Preventive interventions targeting sexual behavior often raise concerns that teaching about this may lead to an increase in sexual activity. However, intervention youths showed greater maintenance of virginity and lower rates of some types of risky sexual behavior in nonvirgins. Among the older nonvirgin youths, NAPPASA participants were less likely to have had sex while drunk or high, a particularly risky behavior for transmission of STDs including HIV. The NAPPASA students consistently showed a marked increase in their use of family, rules, laws, religion, traditional ways, and community protective influences to help them avoid health-risking behaviors.

Risk Factors


  • Early sexual involvement
  • Favorable attitudes toward drug use/Early onset of AOD use/Alcohol and/or drug use
  • Poor refusal skills


  • Family history of the problem behavior/Parent criminality
  • Family management problems/Poor parental supervision and/or monitoring
  • Poor family attachment/Bonding


  • Availability of alcohol and other drugs
  • Community instability
  • Economic deprivation/Poverty/Residence in a disadvantaged neighborhood


  • Peer alcohol, tobacco, and/or other drug use

Protective Factors


  • Healthy / Conventional beliefs and clear standards
  • Religiosity / Involvement in organized religious activities
  • Social competencies and problem-solving skills


  • Effective parenting


  • Clear social norms / Policies with sanctions for violations and rewards for compliance
  • Presence and involvement of caring, supportive adults


  • Good relationships with peers
  • Involvement with positive peer group activities


Baldwin, Julie A., Jon E. Rolf, Jeannette L. Johnson, Jeremy Bowers, Christine J. Benally, and Robert T. Trotter. 1996. “Developing Culturally Sensitive HIV/AIDS and Substance Abuse Prevention Curricula for Native American Youth.”Journal of School Health 66(9):322–27.

Johnson, Jeannette L., and Mark C. Cameron. 2001. “Barriers to Providing Effective Mental Health Services to American Indians.” Mental Health Services Research3(4):215–23.

Rolf, Jon E., Tonja R. Nansel, Julie A. Baldwin, Jeannette L. Johnson, and Christine J. Benally. 2002. “HIV/AIDS and Alcohol and Other Drug Abuse Prevention in American Indian Communities: Behavioral and Community Effects.” In Patricia D. Mail, Suzanne Heurtin–Roberts, Susan E. Martin, and Jan Howard (eds.). Alcohol Use Among American Indians and Alaska Natives: Multiple Perspectives on a Complex Problem. National Institute on Alcohol Abuse and Alcoholism Research Monograph No. 37. Bethesda, Md.: National Institute on Alcohol Abuse and Alcoholism.


Jeannette Johnson, Active Guide, LLC
National Institute of Child Health and Human Development
11521 Shell Flower Lane
Columbia, MD 21044
Phone: (443) 621-4859