LAUSR

Abstract Purpose This study reports the impact of an entrepreneurship education intervention designed and evaluated specifically for its impact on substance use, suicide and violence-related outcomes among Native American adolescents. Methods This randomized controlled trial included N = 394 Native Americans ages 13–16. Participants were randomly assigned 2:1 (n = 267:127) to the Arrowhead Business Group intervention versus a control condition. Logistic mixed effects regression models examined within group and between group differences in trajectory from baseline to 24 months follow-up. Results Fewer intervention vs. control participants used marijuana at 6-, 12- and 24-months post-intervention (19.6% vs. 28.0%, p = 0.032; 20.4% vs. 31.8%, p = 0.01; and 24.1% vs. 31.4%, p = 0.047). All violence-related measures (suicide attempts, carrying a weapon, missing school because felt unsafe, fighting, and fighting at school) statistically significantly declined between baseline and 24 months for both groups. Positive between group differences favoring intervention participants were observed at 6-months for missing school because felt unsafe, and at 24-months for fighting at school. While alcohol use increased for both groups over time, control participants experienced a two-fold higher increase in binge alcohol use than intervention participants (control: 7.1–16.7% vs. intervention: 8.1–13.0%). Conclusions This is the first report in the US literature of a youth entrepreneurship intervention designed and evaluated to promote behavioral and mental health outcomes. It shows promise for reducing substance abuse and violence toward self and others, the largest health disparities for Native American youth.