The Helping Our People End Suicide 2 SMS Study: A Culturally Grounded pJITAI to Prevent Cannabis Use Escalation and Suicidal Ideation Among Urban AIAN Youth

About This Grant

PROJECT SUMMARY/ABSTRACT Urban American Indian and Alaska Native (AIAN) youth experience the highest rates of cannabis use and suicide risk, yet few prevention interventions have been designed to address these cooccurring challenges simultaneously. Urban AIAN youth, also, experience persistent barriers to accessing behavioral healthcare, while being only minimally included in prevention research. Social connectedness, an AIAN cultural value, is a robust protective factor against both cannabis use and suicide risk. There is an urgent need for culturally grounded interventions (developed from the ground up) that integrate key protective factors with Artificial Intelligence methods to deliver personalized support. The Helping Our People End Suicide 2 SMS (HOPES2SMS) Study uses community-based participatory research with three Urban Indian Health Organizations in California to co-develop and evaluate a culturally grounded, reinforcement learning-powered personalized Just-in-Time Adaptive Intervention (pJITAI) delivered via SMS text message. This study will: (1) co-develop and pretest a culturally grounded pJITAI targeting co-occurring cannabis use and suicide risk in partnership with Urban AIAN youth, community members, and a Community Research Council; (2) evaluate the effects of the pJITAI on proximal outcomes of mood, social connectedness, and SMS engagement using a micro-randomized trial with 240 Urban AIAN youth; and (3) assess impact of the pJITAI on the distal outcomes of cannabis use escalation, suicidal ideation severity, and behavioral healthcare service engagement, as well as implementation processes using the RE-AIM framework. A contextual bandit reinforcement learning algorithm with a co-designed multi-objective reward function will personalize intervention delivery in real time while preserving community-defined priorities. The candidate’s career development plan complements this research with structured training in: (1) epidemiology of cannabis use and suicide co-occurrence; (2) adaptive clinical trials for AIAN-focused mobile health interventions; and (3) implementation science frameworks aligned with Indigenous Data Sovereignty. The Johns Hopkins Bloomberg School of Public Health, the Center for Indigenous Health, and partnering Urban Indian Health Organizations provide an exceptional environment for research and training. This K99/R00 award will prepare the candidate to transition to independence, secure a tenure-track faculty position, and establish a NIDA-funded research program focused on precision-prevention approaches that apply Artificial Intelligence to reduce co-occurring cannabis use and suicide risk among Urban AIAN youth. The candidate’s proposed research and career goals align with NIDA’s Strategic Priority to “develop and test novel strategies for preventing drug use, substance use disorders, and their consequences” and intersect with two cross-cutting themes: “leverage data science and analytics to understand realworld complexity” and “develop personalized interventions informed by people with lived experience.”