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Goldstein SC, Spillane NS, Nalven T, Weiss NH. Harm reduction acceptability and feasibility in a North American indigenous reserve community. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:3607-3624. [PMID: 35420216 PMCID: PMC9464673 DOI: 10.1002/jcop.22859] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/23/2022] [Accepted: 03/26/2022] [Indexed: 06/14/2023]
Abstract
AIMS The present study assessed community and culturally specific alcohol-related harm among North American Indigenous (NAI) individuals, as well as the acceptability and feasibility of harm reduction approaches in one reserve-based NAI community. METHODS Participants lived on or near a NAI reserve in Canada. Semi-structured focus groups were conducted with health care workers (N = 8, 75% NAI) and community members (N = 9, 100% NAI). Self-report questionnaires were administered that measured acceptability and feasibility of harm reduction strategies. RESULTS Conventional content analysis revealed loss of culture as culturally specific alcohol-related harm. Health care workers rated harm reduction approaches to be acceptable and feasible, while community participants were more mixed. Majority of participants felt that some harm reduction strategies could provide opportunities for individuals who use alcohol to connect to Indigenous culture and traditions. However, there were mixed findings on whether harm reduction strategies are consistent with Indigenous cultural traditions and values. CONCLUSION Future research is needed to evaluate potential utility of harm-reduction approaches for NAI communities.
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Affiliation(s)
- Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Nichea S Spillane
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Tessa Nalven
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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Toombs E, Lund J, Radford A, Drebit M, Bobinski T, Mushquash CJ. Adverse Childhood Experiences (ACEs) and Health Histories Among Clients in a First Nations-Led Treatment for Substance Use. Int J Ment Health Addict 2022:1-21. [PMID: 35937611 PMCID: PMC9341413 DOI: 10.1007/s11469-022-00883-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 11/11/2022] Open
Abstract
First Nations adults continue to experience significant health disparities compared to non-First Nations adults in Canada. Ongoing difficulties associated with intergenerational trauma among First Nations peoples may be examined using the adverse childhood experiences (ACEs) model, which measures various forms of abuse, neglect, and household dysfunction. We examined prevalence rates of ACEs and physical and mental health outcomes within a predominately First Nation sample of clients seeking substance use treatment from a First Nations-led treatment facility. The prevalence of ACEs was higher than national averages and previous data collected with broader Indigenous samples in Canada. Descriptive analyses of ACEs and health outcomes for those seeking First Nations-led substance use treatment showed these participants had more chronic health difficulties co-morbid with clinical levels of problematic substance use. To improve ongoing best-treatment options for those seeking substance use treatment, continued assessment and promotion of broader aspects of health and wellbeing are required, including the balance of physical, emotional, spiritual, and mental health and wellbeing across a lifespan.
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Affiliation(s)
- Elaine Toombs
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
| | - Jessie Lund
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
| | - Abbey Radford
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
| | - Meagan Drebit
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
| | - Tina Bobinski
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
| | - Christopher J. Mushquash
- Department of Psychology, Lakehead University, 955 Oliver Road, Thunder Bay, ON P7B 5E1 Canada
- Dilico Anishinabek Family Care, Fort William First Nation, ON Canada
- Northern Ontario School of Medicine (NOSM), Lakehead University, Thunder Bay, ON Canada
- Thunder Bay Regional Health Sciences Centre, Thunder Bay, ON Canada
- Thunder Bay Regional Health Research Institute, Thunder Bay, ON Canada
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53
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Culturally Responsive Practices in Treatment of Substance Use Disorders. J Addict Nurs 2022; 33:131-136. [DOI: 10.1097/jan.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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54
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Zeledon I, Telles V, Dickerson D, Johnson C, Schweigman K, West A, Soto C. Exploring Culturally Based Treatment Options for Opioid Use Disorders Among American Indian and Alaska Native Adults in California. J Stud Alcohol Drugs 2022; 83:613-620. [PMID: 35838440 PMCID: PMC9318704 DOI: 10.15288/jsad.2022.83.613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/26/2022] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVE American Indian and Alaska Native (AIAN) communities have been severely affected by the opioid epidemic, resulting in high opioid overdose death rates and disrupted community life. An added complexity is the diversity of AIAN communities throughout California, with regional differences, resources, infrastructure, and economic opportunities. This study examined the perspective of 163 AIANs in California to assess culturally based or traditional healing treatment modalities to treat opioid/substance use disorder. METHOD A total of 21 adult focus groups were conducted throughout 10 counties in California reaching 20 urban and tribal communities. Eight of these focus groups were conducted in recovery centers and 13 focus groups were conducted in tribal and urban organizations. Interviews were transcribed and coded using NVivo software utilizing an iterative coding approach with a priori domains. RESULTS Participants emphasized building a sense of belonging, connecting with their culture, and having awareness of substance use disorder and treatment as protective factors. CONCLUSIONS Findings indicate that medications for opioid use disorder programs serving AIAN communities should include cultural components that resonate with urban and tribal communities.
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Affiliation(s)
- Ingrid Zeledon
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Victoria Telles
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Daniel Dickerson
- UCLA Integrated Substance Abuse Programs, Los Angeles, California
| | - Carrie Johnson
- United American Indian Involvement, Inc., Los Angeles, California
| | | | - Amy West
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Claradina Soto
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
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Zeledon I, Telles V, Dickerson D, Johnson C, Schweigman K, West A, Soto C. Exploring Culturally Based Treatment Options for Opioid Use Disorders Among American Indian and Alaska Native Adults in California. J Stud Alcohol Drugs 2022; 83:613-620. [PMID: 35838440 PMCID: PMC9318704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 01/26/2022] [Indexed: 07/04/2023] Open
Abstract
OBJECTIVE American Indian and Alaska Native (AIAN) communities have been severely affected by the opioid epidemic, resulting in high opioid overdose death rates and disrupted community life. An added complexity is the diversity of AIAN communities throughout California, with regional differences, resources, infrastructure, and economic opportunities. This study examined the perspective of 163 AIANs in California to assess culturally based or traditional healing treatment modalities to treat opioid/substance use disorder. METHOD A total of 21 adult focus groups were conducted throughout 10 counties in California reaching 20 urban and tribal communities. Eight of these focus groups were conducted in recovery centers and 13 focus groups were conducted in tribal and urban organizations. Interviews were transcribed and coded using NVivo software utilizing an iterative coding approach with a priori domains. RESULTS Participants emphasized building a sense of belonging, connecting with their culture, and having awareness of substance use disorder and treatment as protective factors. CONCLUSIONS Findings indicate that medications for opioid use disorder programs serving AIAN communities should include cultural components that resonate with urban and tribal communities.
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Affiliation(s)
- Ingrid Zeledon
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Victoria Telles
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Daniel Dickerson
- UCLA Integrated Substance Abuse Programs, Los Angeles, California
| | - Carrie Johnson
- United American Indian Involvement, Inc., Los Angeles, California
| | | | - Amy West
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
| | - Claradina Soto
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, California
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Racial-Based Bullying and Substance Use: a Brazilian National Cross-Sectional Survey Among Students. J Racial Ethn Health Disparities 2022; 10:1441-1454. [PMID: 35578154 PMCID: PMC9109669 DOI: 10.1007/s40615-022-01330-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/04/2022] [Accepted: 05/08/2022] [Indexed: 11/30/2022]
Abstract
Racial discrimination has been associated with worse health status and risky health behavior. Understanding the relationship between racial-based bullying (RBB) — an overlap of bullying and interpersonal racial discrimination — and substance use can guide school-based actions to prevent bullying and substance use, but investigations rarely involve Brazilian students. We used data from the National Survey of School Health (PeNSE) 2015, which included 102,072 ninth-grade students from the capital and inland cities in the five regions of Brazil. Students self-reported their race/skin color according to the Brazilian official census. We explored racial and recent RBB differences in recent use of alcohol, tobacco, and other substances [marijuana, cocaine, crack, sniffed glue, loló/lança-perfume (ether and chloroform blend)] by comparing prevalence ratios (estimated with quasi-Poisson, crude, and adjusted models by demographic and socioeconomic characteristics) obtained from analyses of imputed data and complete case. We found that RBB prevalence increased according to racial categories associated with darker skin tones; racial differences in the prevalence of RBB were greater among girls than boys. Girls from all racial groups consistently had a higher prevalence of alcohol use than boys. RBB partially explained the recent use of alcohol and tobacco for the minority racial groups and was not associated with the use of other substances. School-based actions should explicitly incorporate anti-racist goals as strategies for substance use prevention, giving particular attention to gender issues in racial discrimination and alcohol use.
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Sun J, Goforth AN, Nichols LM, Violante A, Christopher K, Howlett R, Hogenson D, Graham N. Building a space to dream: Supporting indigenous children's survivance through community-engaged social and emotional learning. Child Dev 2022; 93:699-716. [PMID: 35560219 PMCID: PMC9324777 DOI: 10.1111/cdev.13786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Indigenous communities practice survivance and challenge social and political systems to support their children's identity and well-being. Grounded in transformative social-emotional learning (SEL) and tribal critical race theory, this 3-year community-based participatory research study (2019-2021) examined how a SEL program co-created with an Indigenous community in Flathead Nation in Montana supports anti-racism and anti-colonialism among Indigenous children. Critical reflexivity and thematic analyses of Community Advisory Board meetings and journals written by 60 students (Mage = 10.3, SD = 1.45; 47% girls; 60% Native American) during the SEL program revealed themes on Indigenous identity, belonging, wellness, and colonialism. These results shed light on challenging the racist and colonial roots of education to support Indigenous children's survivance and social-emotional well-being.
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Affiliation(s)
| | | | | | | | | | | | | | - Niki Graham
- University of Montana, Missoula, Montana, USA
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58
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Qeadan F, Madden EF, Mensah NA, Tingey B, Herron J, Hernandez-Vallant A, Venner KL, English K, Dixit A. Epidemiological trends in opioid-only and opioid/polysubstance-related death rates among American Indian/Alaska Native populations from 1999 to 2019: a retrospective longitudinal ecological study. BMJ Open 2022; 12:e053686. [PMID: 35501103 PMCID: PMC9109082 DOI: 10.1136/bmjopen-2021-053686] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 03/04/2022] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES The rate of drug overdose deaths in the USA has more than tripled since the turn of the century, and rates are disproportionately high among the American Indian/Alaska Native (AI/AN) population. Little is known about the overall historical trends in AI/AN opioid-only and opioid/polysubstance-related mortality. This study will address this gap. DESIGN This is a retrospective longitudinal ecological study. SETTING US death records from 1999 to 2019 using the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. PARTICIPANTS US non-Hispanic AI/AN people age 12 years and older. MEASURES The primary outcomes, identified via the 10th revision of the International Statistical Classification of Diseases and Related Health Problems codes, included overdose deaths due to (1) opioids only, opioids in combination with any other substance, all-opioid related overdoses; (2) combinations of opioids and alcohol, opioids and methamphetamine, opioids and cocaine, opioids and benzodiazepines; and (3) specific types of opioids. RESULTS From 1999 to 2019, opioid-only mortality rates increased from 2.8 to 15.8 per 100 000 (p<0.001) for AI/AN women and 4.6 to 25.6 per 100 000 (p<0.001) for AI/AN men. All opioid-related mortality rates increased significantly (p<0.001) from 5.2 to 33.9 per 100 000 AI/AN persons, 3.9 to 26.1 for women and 6.5 to 42.1 for men. AI/AN also exhibited significant increases in mortality rates due to opioids and alcohol, opioids and benzodiazepines, opioids and methamphetamine, and AI/AN men experienced substantial increases in mortality due to opioids and cocaine. Mortality rates by individual opioid types increased significantly over time for heroin, natural and semi-synthetic (prescription), and synthetic opioids (fentanyl/fentanyl analogues) other than methadone. CONCLUSIONS These findings highlight magnification over time in opioid-related deaths and may point to broader systemic factors that may disproportionately affect members of AI/AN communities and drive inequities.
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Affiliation(s)
- Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, Illinois, USA
| | - Erin F Madden
- Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, Michigan, USA
| | - Nana A Mensah
- Department of Family and Preventive Medicine, University of Utah Health, Salt Lake City, Utah, USA
| | - Benjamin Tingey
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Chicago, Illinois, USA
| | - Jalene Herron
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | | | - Kamilla L Venner
- Department of Psychology, University of New Mexico, Albuquerque, New Mexico, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC), Albuquerque Area Indian Health Service, Albuquerque, New Mexico, USA
| | - Amruta Dixit
- Albuquerque Area Southwest Tribal Epidemiology Center (AASTEC), Albuquerque Area Indian Health Service, Albuquerque, New Mexico, USA
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Spillane NS, Nalven T, Goldstein SC, Schick MR, Kirk-Provencher KT, Jamil A, Weiss NH. Assaultive trauma, alcohol use, and alcohol-related consequences among American Indian adolescents. Alcohol Clin Exp Res 2022; 46:815-824. [PMID: 35342962 PMCID: PMC9117488 DOI: 10.1111/acer.14819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/16/2022] [Accepted: 03/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND American Indian (AI) adolescents report disproportionate higher rates of alcohol use and alcohol-related consequences than adolescents from other racial/ethnic groups. Trauma exposure is also reported at high rates among AI individuals and likely confers risk for alcohol use. The purpose of the present study was to examine the effects of assaultive trauma experiences (e.g., physical assault, sexual assault) on alcohol use and alcohol-related consequences in AI adolescents. METHODS We conducted a secondary analysis of self-reported data on trauma exposure, alcohol consumption, and lifetime alcohol-related consequences provided by AI 7th to 12th graders residing on or near a reservation (n = 3498, Mage = 14.8; 49.5% female). Institutional Review Boards, tribal authorities, and school boards approved the study protocols prior to beginning data collection. RESULTS Nearly half (49.3%, n = 1498) of AI adolescents reported having experienced at least one assaultive trauma in their lifetime. Those who had experienced assaultive trauma were more likely to report lifetime alcohol use (χ2 = 111.84, p < 0.001) and experienced greater alcohol-related consequences (t(1746) = 12.21, p < 0.001) than those with no assaultive trauma exposure. Multilevel regression analyses indicated that a greater number of assaultive traumatic events was significantly associated with greater odds of lifetime alcohol use (p < 0.001, OR = 1.81, 95% CI [1.65, 2.00]) and having experienced a greater number of alcohol-related consequences (b = 0.36, SE = 0.04, t = 16.95, p < 0.001, 95% CI [0.31, 0.46]). CONCLUSIONS Findings of the present study highlight the relevance of exposure to assaultive trauma to AI adolescents' use of alcohol and experiences of alcohol-related consequences. These findings support the need for trauma-informed interventions in addressing alcohol use among AI adolescents.
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Affiliation(s)
- Nichea S Spillane
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Tessa Nalven
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Silvi C Goldstein
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Melissa R Schick
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | | | - Aayma Jamil
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
| | - Nicole H Weiss
- Department of Psychology, University of Rhode Island, Kingston, Rhode Island, USA
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Agyemang DO, Madden EF, English K, Venner KL, Handy R, Singh TP, Qeadan F. The mediation and moderation effect of social support on the relationship between opioid misuse and suicide attempts among native American youth in New Mexico: 2009-2019 Youth Risk Resiliency Survey (NM-YRRS). BMC Psychiatry 2022; 22:243. [PMID: 35382787 PMCID: PMC8985366 DOI: 10.1186/s12888-022-03900-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 03/30/2022] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Suicide attempt and opioid misuse continue to be major behavioral health challenges among American Indians and Alaska Natives (AI/AN). The aim of the study is to evaluate the mediating and moderating role that social support (SS) plays in their association among AI/AN high-school students in New Mexico (NM). METHODS An aggregated NM Youth Resiliency and Risk Survey (NM-YRRS, 2009-2019: odd years) dataset was used. Multivariable logistic regression modeling and mediation analysis were conducted while adjusting for confounding variables. RESULTS Overall, 12.0 and 14.0% of AI/AN students reported opioid misuse and suicide attempt, respectively. The adjusted odds ratio of suicide attempt in students with high SS relative to low SS who misused opioids was 0.43 (p-value = 0.007). The effect of high SS relative to low SS among males who misused opioids was more pronounced (AOR = 0.24, p-value < 0.0001) compared to females (AOR = 0.43, p-value = 0.007). Relative to low SS, high SS was protective for suicide attempt among AI/AN students who misused opioids and attended school in off-reservation (AOR = 0.42, p-value = 0.012) communities, rural communities (AOR = 0.44, p = 0.040), and in communities that are both rural and off-reservation (AOR = 0.39, p = 0.035). Overall, 23.64, and 41.05% of the association between opioid misuse, and suicide attempt was mediated and moderated by SS, respectively. The mediation effect of SS was lowest for rural, on-reservation schools. CONCLUSION More resources need to be allocated to rural on-reservation schools to enhance social support. The study highlights key insights into the significant role SS plays in promoting health and mitigating the association between opioid misuse and suicide attempt.
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Affiliation(s)
- Daniel Opoku Agyemang
- grid.223827.e0000 0001 2193 0096Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Erin Fanning Madden
- grid.254444.70000 0001 1456 7807Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, USA
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, Santa Fe, NM USA
| | - Kamilla L. Venner
- grid.266832.b0000 0001 2188 8502Department of Psychology, Center on Alcohol, Substance use, And Addiction (CASAA), University of New Mexico, Albuquerque, USA
| | - Rod Handy
- grid.223827.e0000 0001 2193 0096Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Tejinder Pal Singh
- grid.223827.e0000 0001 2193 0096Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Fares Qeadan
- Parkinson School of Health Sciences and Public Health, Loyola University Chicago, Maywood, IL, US, United States.
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Allwood M, Ghafoori B, Salgado C, Slobodin O, Kreither J, Waelde LC, Larrondo P, Ramos N. Identity-based hate and violence as trauma: Current research, clinical implications, and advocacy in a globally connected world. J Trauma Stress 2022; 35:349-361. [PMID: 34708457 DOI: 10.1002/jts.22748] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/08/2021] [Accepted: 07/21/2021] [Indexed: 11/08/2022]
Abstract
Hate-based violence is increasingly recognized as an urgent social justice and human rights issue that is pervasive across geographical and socioeconomic boundaries. There is a growing body of research that demonstrates the traumatic impact of hate-based violence on the victim's mental and physical health. This review focuses on examining scientific knowledge and prevalence data on identity-based hate and violence exposure. A framework for conceptualizing hate-based violence as a traumatic event or series of traumatic events is offered as a means to understand research findings and intervention approaches. The importance of research, advocacy, and human rights training is highlighted in the efforts to address the traumatic impact of identity-based hate and violence.
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Affiliation(s)
- Maureen Allwood
- Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York, New York, USA
| | - Bita Ghafoori
- Long Beach Trauma Recovery Center, Department of Advanced Studies in Education and Counseling, California State University, Long Beach, Long Beach, California, USA
| | - Carolina Salgado
- Department of Psychiatry, Universidad Catolica del Maule, Talca, Chile
| | - Ortal Slobodin
- Department of Education, Ben-Gurion University of the Negev, Beersheba, Israel
| | | | - Lynn C Waelde
- Pacific Graduate School of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Paulina Larrondo
- Centre for Reproductive Medicine and Adolescent Integral Development, School of Medicine, University of Chile, Santiago, Chile
| | - Nadia Ramos
- Department of Psychiatry, Universidad de Talca, Talca, Chile
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Mason M, Soliman R, Kim HS, Post LA. Disparities by Sex and Race and Ethnicity in Death Rates Due to Opioid Overdose Among Adults 55 Years or Older, 1999 to 2019. JAMA Netw Open 2022; 5:e2142982. [PMID: 35015062 PMCID: PMC8753495 DOI: 10.1001/jamanetworkopen.2021.42982] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Rates of opioid overdose deaths are increasing for older adults. Less is known about these deaths compared with those of younger adults. OBJECTIVE To analyze rate variation among opioid overdose deaths in older adults by sex and by race and ethnicity over time. DESIGN, SETTING, AND PARTICIPANTS This 21-year longitudinal cross-sectional study of adults who died due to opioid overdose at 55 years or older stratified by sex and by race and ethnicity used data from the Multiple Cause of Death database from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research. The data include all opioid overdose deaths among this age group that occurred between January 1, 1999, and December 31, 2019 (N = 79 893). EXPOSURES Sex and racial and ethnic groups. MAIN OUTCOMES AND MEASURES Rates of opioid overdose deaths per 100 000 population by sex and by race and ethnicity for persons 55 years or older. RESULTS During the period 1999 to 2019, 79 893 US residents 55 years or older died due to an opioid overdose. Among these individuals, 79.97% were aged 55 to 64 years, and 58.98% were men. Annual numbers of deaths increased over time from 518 in 1999 to 10 292 in 2019. Annual rates of opioid overdose deaths per 100 000 persons 55 years or older increased over time and ranged from 0.90 in 1999 to 10.70 in 2019. Substantial variation by sex and by race and ethnicity was found. In 2013, rates among non-Hispanic Black men began to diverge from those of other demographic subgroups. By 2019, the opioid overdose fatality rate among non-Hispanic Black men 55 years or older was 40.03 per 100 000 population, 4 times greater than the overall opioid overdose fatality rate of 10.70 per 100 000 for persons of the same age. CONCLUSIONS AND RELEVANCE In this longitudinal cross-sectional study of US adults who died due to opioid overdose, the burden of opioid overdose deaths among older adults since 2013 was most concentrated among non-Hispanic Black men. Deaths among non-Hispanic Black men were disproportionality represented in the overall increase in the rate of opioid overdose deaths among older adults. Further research is needed to inform policy and practice.
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Affiliation(s)
- Maryann Mason
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Buehler Center for Health Policy and Economics, Northwestern University, Chicago, Illinois
| | - Rebekah Soliman
- currently an undergraduate student at Northwestern University, Weinberg College of Arts and Sciences, Evanston, Illinois
| | - Howard S. Kim
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Center for Health Services and Outcomes Research, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Associate Editor, JAMA Network Open
| | - Lori Ann Post
- Department of Emergency Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Buehler Center for Health Policy and Economics, Northwestern University, Chicago, Illinois
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Salas-Wright CP. Risk, resilience, and thriving among racial/ethnic minorities and underserved populations at-risk for substance use disorders. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2022; 48:1-7. [PMID: 34932401 DOI: 10.1080/00952990.2021.1995403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 06/14/2023]
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Giacci E, Straits KJ, Gelman A, Miller-Walfish S, Iwuanyanwu R, Miller E. Intimate Partner and Sexual Violence, Reproductive Coercion, and Reproductive Health Among American Indian and Alaska Native Women: A Narrative Interview Study. J Womens Health (Larchmt) 2022; 31:13-22. [PMID: 34747659 PMCID: PMC8785763 DOI: 10.1089/jwh.2021.0056] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Background: The disproportionately high prevalence of poor reproductive and sexual health outcomes among American Indian and Alaska Native (AI/AN) women is related to histories of colonization, oppression, and structural racism. Intimate partner violence (IPV) and sexual violence (SV) contribute to these health outcomes. Materials and Methods: Narrative interviews were conducted with AI/AN women from four tribal reservation communities. Interviews explored connections among sexual and reproductive health, IPV, SV, reproductive coercion (RC), and pregnancy experiences as well as women's experiences of healing and recovery. Results: Among the 56 women interviewed (aged 17-55 years, 77% were aged 40 years and younger), all described multiple exposures to violence and highlighted lack of disclosure related to sexuality, childhood abuse, SV, and historical trauma. Access to confidential reproductive health services and contraceptive education was limited. Almost half (45%) reported experiencing RC in their lifetime. Use of substances occurred in both the context of SV and for surviving after exposure to violence. Women underscored the extent to which IPV, SV, and RC are embedded in histories of colonization, racism, and ongoing oppression. Interventions that incorporate AI/AN traditions, access to culturally responsive reproductive health and advocacy services, organizations, and services that have AI/AN personnel supporting survivors, public discussion about racism, abuse, sexuality, and more accountable community responses to violence (including law enforcement) are promising pathways to healing and recovery. Conclusions: Findings may advance understanding of AI/AN women's reproductive health in the context of historical trauma and oppression. Intervention strategies that enhance resiliency of AI/AN women may promote reproductive health.
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Affiliation(s)
- Elena Giacci
- Advocate and Training Specialist (Dine), Albuquerque, New Mexico, USA
| | - Kee J.E. Straits
- Tinkuy Life Community Transformations, LLC, Albuquerque, New Mexico, USA
| | - Amanda Gelman
- Chinle Comprehensive Health Care Facility, Chinle, Arizona, USA
| | - Summer Miller-Walfish
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Rosemary Iwuanyanwu
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Pittsburgh School of Medicine, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Henderson-Matthews B, Gordon M, Mason S, Rynda-Apple A, John-Henderson NA. Culture as Medicine for the Blackfeet Community: A pilot intervention. TRIBAL COLLEGE AND UNIVERSITY RESEARCH JOURNAL 2022; 6:20-31. [PMID: 36637375 PMCID: PMC9831844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
| | | | | | - Agnieszka Rynda-Apple
- Montana State University, Department of Microbiology and Immunology, Bozeman, Montana
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Barry CM, Garrett BA, Livingston MD, Kominsky TK, Livingston BJ, Komro KA. Perceived Racial/Ethnic Discrimination and Depressive Symptoms among Adolescents Living in the Cherokee Nation. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2022; 29:22-36. [PMID: 35255148 PMCID: PMC9511878 DOI: 10.5820/aian.2901.2022.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The objective of this study was to examine the longitudinal relationship between perceived racial/ethnic discrimination and depressive symptoms among adolescents living in the Cherokee Nation, as well as the potential moderating roles of race and social support. Self-reported survey data were analyzed from a sample of high school students (n = 1,622) who identified as American Indian only, American Indian and White, and White only. Compared to students who reported no discrimination on the basis of race, those who reported ever having experienced discrimination scored, on average, 1.62 units higher on the depressive symptoms scale six months later (p = .0001, 95% CI: 0.90, 2.33), while adjusting for age, race, gender, baseline depressive symptoms, enrollment in a free/reduced-price lunch program, and social support. Discrimination intensity did not significantly predict depressive symptoms among those reporting some frequency of discrimination. Race and social support did not modify either effect. These findings may inform development of interventions to promote mental health among American Indian adolescents.
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Schick MR, Spillane NS, Breines JG, Kahler CW. Positive Psychological Characteristics and Substance Use in First Nation Adolescents. Subst Use Misuse 2022; 57:1196-1206. [PMID: 35481417 DOI: 10.1080/10826084.2022.2069266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BackgroundNorth American Indigenous (NAI) adolescents experience disproportionate harm related to substance use compared to non-Indigenous adolescents. Strengths-based approaches to substance use prevention and treatment are consistent with Indigenous conceptualizations of health, which tend to be holistic and incorporate more spirituality and community than mainstream Western conceptualizations. Despite this, little is known about how positive psychological characteristics that might confer protection relate to substance use among NAI adolescents. Thus, the present study aims to examine the relations among life satisfaction, subjective happiness, self-compassion, and cigarette, marijuana, alcohol, and other drug use. MethodsParticipants were 106 reserve-dwelling First Nation adolescents located in Eastern Canada (Mage= 14.6 years, 50.0% female) who completed a paper-and-pencil survey regarding their substance use and psychological characteristics for a larger community-based participatory research project. ResultsGreater life satisfaction was significantly associated with decreased odds of lifetime (OR = 0.88, 95%CI [0.81, 0.96]) and current cigarette smoking (OR = 0.90, 95%CI [0.82, 0.99]). Greater subjective happiness was significantly associated with decreased odds of current marijuana use (OR = 0.83, 95%CI [0.71, 0.97]). Although significantly correlated with lower lifetime use of other drugs, self-compassion was not significantly associated with lifetime or current odds of substance use after controlling for age, gender, and other positive characteristics. DiscussionThis is one of the first studies to evaluate positive characteristics and substance use in NAI adolescents. Results point to positive characteristics that may be useful in substance use prevention and suggest the need for further research to further elucidate these associations.
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Affiliation(s)
- Melissa R Schick
- Department of Psychology, PATHS Lab, University of Rhode Island, Kingston, Rhode Island, USA
| | - Nichea S Spillane
- Department of Psychology, PATHS Lab, University of Rhode Island, Kingston, Rhode Island, USA
| | - Juliana G Breines
- Department of Psychology, PATHS Lab, University of Rhode Island, Kingston, Rhode Island, USA
| | - Christopher W Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, Rhode Island, USA
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Schick MR, Nalven T, Spillane NS, Crawford MC. Perceived Racial Discrimination, Alcohol Use, and Alcohol-Related Problems: The Moderating Role of Self-Compassion in Reserve-Dwelling First Nation Youth. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2021; 7:405-418. [PMID: 36381241 PMCID: PMC9648674 DOI: 10.1037/tps0000300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
North American Indigenous youth experience disproportionate rates of racial discrimination as well as consequences associated with alcohol use. Self-compassion has been found to be related to both racial discrimination and alcohol use, separately. However, no work to date has examined the role of self-compassion as a moderator of the links among racial discrimination and alcohol use and alcohol-related problems. First Nation adolescents (N = 106, M age = 14.6, 50.0% female) from reserve communities in Eastern Canada completed a pencil-and-paper survey regarding their experiences of racial discrimination, self-compassion, alcohol use, and alcohol-related problems. The associations between racial discrimination and both alcohol use and alcohol-related problems were significantly moderated by self-compassion. Simple slopes analysis revealed that the associations between racial discrimination and alcohol use was significant for those with low (b = 6.03, p = .002) but not high (b = -0.30, p = .88) levels of self-compassion. Similarly, the association between racial discrimination and alcohol-related problems was significant for those with low (b = 21.81, p = .001) but not high (b = 0.64, p = .93) levels of self-compassion. Findings of the present study suggest that low levels of self-compassion may increase risk for alcohol use and experiencing negative alcohol-related consequences in the context of racial discrimination among North American Indigenous adolescents. Future work should examine the utility of interventions targeting self-compassion to examine their effects on responses to racial discrimination and alcohol use.
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Affiliation(s)
- Melissa R Schick
- PATHS Lab, University of Rhode Island Department of Psychology, 142 Flagg Road, Kingston, RI 02881
| | - Tessa Nalven
- PATHS Lab, University of Rhode Island Department of Psychology, 142 Flagg Road, Kingston, RI 02881
| | - Nichea S Spillane
- PATHS Lab, University of Rhode Island Department of Psychology, 142 Flagg Road, Kingston, RI 02881
| | - Michael C Crawford
- PATHS Lab, University of Rhode Island Department of Psychology, 142 Flagg Road, Kingston, RI 02881
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Bommersbach TJ, Jegede O, Stefanovics EA, Rhee TG, Rosenheck RA. Diagnostic remission of substance use disorders: Racial differences and correlates of remission in a nationally representative sample. J Subst Abuse Treat 2021; 136:108659. [PMID: 34785084 DOI: 10.1016/j.jsat.2021.108659] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 08/27/2021] [Accepted: 11/05/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Research has shown racial/ethnic minorities to have similar risk of developing substance use disorders (SUDs) as Whites. However, few studies have compared the likelihood of diagnostic remission (i.e., no longer meeting criteria for current SUDs). METHODS Using nationally representative survey data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), we examined all adults with lifetime SUDs; compared the proportions experiencing diagnostic remission; and used logistic regression analyses to compare Black, Hispanic, and other racial/ethnic minorities to Whites. The research team initially used bivariate comparisons to identify potentially confounding factors also associated with remission. The study used multivariable-adjusted logistic regression analyses to adjust for these potentially confounding covariates. The team conducted separate analyses for alcohol use disorder (AUD) and drug use disorders (DUDs). RESULTS Of 10,916 individuals with lifetime SUDs, 5120 no longer met criteria for an SUD in the past year (55.2% of White, 34.0% of Black, 38.5% Hispanic, and 40.1% of other individuals). In unadjusted analyses, Black, Hispanic, and others were significantly and about half as likely as Whites to have remitted with odds ratios (ORs) of 0.42 (95% CI 0.36-0.48), 0.51 (0.45-0.58), and 0.55 (0.45-0.65), respectively. The study found similar results for both AUD and DUDs. Adjusting for potentially confounding factors only modestly improved the likelihood of remission among racial/ethnic minorities compared to White individuals. CONCLUSION Minority race/ethnicity is robustly associated with reduced likelihood of diagnostic remission from SUDs even after adjusting for other factors. This study could identify only partial moderators of these disparities; these moderators deserve further study.
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Affiliation(s)
- Tanner J Bommersbach
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA.
| | - Oluwole Jegede
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA
| | - Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA; Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, Yale University School of Medicine, 300 George Street, Suite 901, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, USA
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Skewes MC, Gameon JA, Hallum-Montes R, Ricker A. Determinants of Relapse and Opportunities for Growth: Perspectives on Substance Use among American Indian Community Members. J Psychoactive Drugs 2021; 53:474-482. [PMID: 34706631 PMCID: PMC8692388 DOI: 10.1080/02791072.2021.1986241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/17/2021] [Accepted: 09/23/2021] [Indexed: 01/25/2023]
Abstract
Resulting from generations of historical oppression and systemic racism, American Indian and Alaska Native (AI/AN) communities experience serious health disparities associated with substance use disorders (SUDs). As part of a longstanding community-based participatory research intervention development project, our partnership of academic and community co-researchers conducted seven focus groups (N = 35) to understand community stakeholders' perspectives on substance use, relapse, and recovery on a rural AI reservation. Participants included cultural leaders (n = 10), SUD treatment providers (n = 5), people with SUD (n = 10), and affected family members (n = 10). Cultural leaders viewed relapse as symptomatic of historical oppression, whereas other stakeholder groups attributed relapse to individual and interpersonal risk factors such as peer influence, lack of family support, and traumatic stress. All participant groups recognized relapse as a normative aspect of recovering from SUD that presents new opportunities for learning and growth. Specifically, regaining humility, learning to ask for help, recognizing one's triggers, and strengthening commitment to change were identified as learning outcomes for people with SUD. For family members, relapse provided the opportunity to practice forgiveness and compassion, two important cultural values. All groups emphasized the importance of grounding interventions in cultural values and traditions.
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71
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Gonzalez VM, Skewes MC. Belief in the myth of an American Indian/Alaska Native biological vulnerability to alcohol problems among reservation-dwelling participants with a substance use problem. Alcohol Clin Exp Res 2021; 45:2309-2321. [PMID: 34837658 PMCID: PMC8642279 DOI: 10.1111/acer.14703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 08/19/2021] [Accepted: 08/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Belief in the myth of an American Indian/Alaska Native (AIAN)-specific biological vulnerability (BV) to alcohol problems is associated with worse alcohol outcomes among AIAN college students who drink, despite also being associated with greater attempts to reduce drinking. This study examined the association of belief in a BV with alcohol use among reservation-dwelling AI adults with a substance use problem. METHODS Participants (n = 141) who drank alcohol in the past 90 days were selected from a larger AI sample who self-identified as having a substance use problem. Moderated-mediation analyses examined whether belief in a BV was positively associated with alcohol- and substance use-related consequences and whether self-efficacy and craving mediated the association of belief in a BV with alcohol use. RESULTS Among participants who reported using alcohol but not hard drugs (e.g., methamphetamine, opioids), greater belief in a BV was associated with more drinking days, which in turn was associated with greater alcohol-related consequences. Among participants who used alcohol only, belief in a BV was also significantly associated with greater craving, and in turn with more drinking days. Among individuals who used both alcohol and hard drugs, greater belief in a BV was associated with fewer drinking days, but was not significantly associated with substance use-related consequences. No association was found between belief in a BV and self-efficacy to avoid alcohol or drug use. CONCLUSIONS Among individuals who use only alcohol, belief in a BV may contribute to more drinking days and greater alcohol-related consequences through its association with greater craving. This study provides further evidence of the potential harm of internalizing the belief that being AIAN contributes to the risk for alcohol problems, a notion that lacks scientific evidence despite decades of research. The findings highlight the importance of combating societal myths regarding AIAN peoples and the internalization of these stereotypes.
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Schick MR, Kirk-Provencher KT, Goldstein SC, Nalven T, Spillane NS. A Framework for the Adaptation of Positive Psychological Interventions to North American Indigenous Populations. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:913-922. [PMID: 34296375 PMCID: PMC8501455 DOI: 10.1007/s11121-021-01282-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2021] [Indexed: 10/20/2022]
Abstract
Positive psychology research has led to the development of brief interventions designed to promote positive emotions: positive psychological interventions (PPIs). Randomized controlled trials examining PPIs have found them to be effective in increasing well-being and decreasing depressive symptoms. PPIs have been studied in samples consisting primarily of White Americans; however, PPIs may be useful for members of North American Indigenous groups. PPIs align well with Indigenous views on health, which tend to be strengths-based, holistic, and encompassing the whole body (including the medicine wheel's four dimensions of spirit, mind, heart, and body). This paper provides a framework for the adaptation of PPIs for Indigenous communities and a review of preliminary data on the relationships between positive psychological characteristics and health outcomes including substance use. Implications include the potential widespread impact of culturally adapted PPIs given their alignment with Indigenous thoughts on health and relative ease of administration.
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Affiliation(s)
- Melissa R Schick
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA.
| | - Katelyn T Kirk-Provencher
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Silvi C Goldstein
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Tessa Nalven
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
| | - Nichea S Spillane
- PATHS Lab, Department of Psychology, University of Rhode Island, 142 Flagg Road, Kingston, RI, 02881, USA
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Robertson L, Akré ER, Gonzales G. Mental Health Disparities at the Intersections of Gender Identity, Race, and Ethnicity. LGBT Health 2021; 8:526-535. [PMID: 34591707 DOI: 10.1089/lgbt.2020.0429] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: Very little research has examined mental health among transgender people of color using population-based data. The objective of this study was to use large-scale data to examine mental health disparities at the intersections of gender identity, race, and ethnicity. Methods: Data for this study came from transgender (n = 4024) and cisgender (n = 935,793) adults aged 18 years and older in the 2014-2018 Behavioral Risk Factor Surveillance System. We estimated and compared frequent mental distress and lifetime depression diagnoses using multivariable logistic regression models. Regression results are presented as adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Results: After controlling for sociodemographic characteristics and compared with cisgender White adults, transgender White adults (AOR = 1.81; 95% CI = 1.49-2.21), transgender American Indian or Alaska Native (AIAN) adults (AOR = 8.06; 95% CI = 2.03-32.00), and transgender adults of other/multiple races and ethnicities (AOR = 3.15; 95% CI = 1.78-5.59) had higher odds of exhibiting frequent mental distress. Transgender White adults (AOR = 2.07; 95% CI = 1.75-2.46), transgender AIAN adults (AOR = 3.61; 95% CI = 1.06-12.32), and transgender adults of other/multiple races and ethnicities (AOR = 2.37; 95% CI = 1.41-4.01) had higher odds of reporting a lifetime depression diagnosis compared with White cisgender adults. Conclusion: This study serves as a reminder that LGBT health should be analyzed through an intersectional lens as some individuals with multiple marginalized identities may have worse health as a result of double discrimination. Public health practitioners and health care providers should be mindful of the diversity within the transgender population in their work.
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Affiliation(s)
- Lee Robertson
- Department of Psychology and Health, and Society, Vanderbilt University, Nashville, Tennessee, USA
| | - Ellesse-Roselee Akré
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gilbert Gonzales
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee, USA
- Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Allwood MA, Ford JD, Levendosky A. Introduction to the Special Issue: Disproportionate trauma, stress, and adversities as a pathway to health disparities among disenfranchised groups globally. J Trauma Stress 2021; 34:899-904. [PMID: 34644429 DOI: 10.1002/jts.22743] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/08/2021] [Indexed: 11/09/2022]
Abstract
Globally, individuals and communities that are marginalized based on their identities are at heightened risk for exposure to traumatic stress and socioeconomic hardship. Marginalization and disproportionate risk for many types of adversities correspond with disparities in physical health, mental health, and overall well-being. Together, the 12 empirical studies, one systematic review, and commentary in this special issue of the Journal of Traumatic Stress highlight the impact of discrimination and disproportionate adversity among groups marginalized based on race, ethnicity, nativity, caste, gender identity, sexual orientation, economic status, and medical status. Although most studies in this issue focus on the United States, the articles that focus on disparities and risk factors in India, El Salvador, Uganda, and Burundi provides a multicontinent global perspective. The global perspective, including the impact of the global pandemic, invites further examination of how disproportionate exposure to traumatic stress and adversity are associated with inequitable burden and health disparities worldwide. This special issue further highlights the developmental and multigenerational burden of systemic marginalization by including studies of children, young adults, adults, and parent-child dyads. Pathways for change and intervention are illustrated through a liberatory consciousness perspective, with one study utilizing liberatory media skills (e.g., positive media images and messages) to mitigate the adverse effects of trauma exposure on at-risk young adults of color. Worldwide, research on the effects of trauma, stress, and adversities must examine contextual factors (e.g., economic hardship), marginalization (e.g., discrimination, identity factors), and the differential impact on health among individuals and communities.
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Affiliation(s)
- Maureen A Allwood
- Department of Psychology, John Jay College of Criminal Justice, City University of New York, New York, New York, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, Connecticut, USA
| | - Alytia Levendosky
- Department of Psychology, Michigan State University, East Lansing, Michigan, USA
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Ramos GG, West AE, Begay C, Telles VM, D'Isabella J, Antony V, Soto C. Substance use disorder and homelessness among American Indians and Alaska Natives in California. J Ethn Subst Abuse 2021; 22:350-371. [PMID: 34339341 DOI: 10.1080/15332640.2021.1952125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
American Indian and Alaska Native (AIAN) communities have higher rates of substance use than other racial and ethnic groups. Substance use disorder (SUD) is tied to the increased risk of experiencing homelessness. National policies have also led to the disproportionate rates of homelessness among AIAN communities. However, specific experiences related to the occurrence of SUD and homelessness among AIAN in California, as well as seeking and accessing SUD treatment, are not well understood. This study explored potential SUD risk and resilience factors for AIANs experiencing homelessness and their experiences when seeking services for SUD. Nineteen interviews were conducted in northern, central, and southern California. Thematic analysis was used for these data. The five primary codes were: (1) risk factors for SUD, (2) resilience related to SUD service seeking, (3) services available, (4) barriers accessing services, and (5) services needed. Based on the results, themes for risk were trauma, mental health, and community conditions. Themes for resilience were identified at individual and community levels and included personal motivation and community support and inclusiveness. Themes for services available were limited knowledge about service types and services' location. The themes for barriers accessing services were identified at internal and external levels, and included lack of readiness and transportation challenges, respectively. Themes for services needed included continuum of care, integrated care, and culturally sensitive services. Findings highlight the importance of addressing the potential risk factors and service needs of AIANs experiencing homelessness to provide comprehensive and culturally sensitive services to reduce substance use.
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Affiliation(s)
- G G Ramos
- University of Southern California, Los Angeles, CA, USA
| | - A E West
- University of Southern California, Los Angeles, CA, USA
| | - C Begay
- University of Southern California, Los Angeles, CA, USA
| | - V M Telles
- University of Southern California, Los Angeles, CA, USA
| | - J D'Isabella
- University of Southern California, Los Angeles, CA, USA
| | - V Antony
- University of Southern California, Los Angeles, CA, USA
| | - C Soto
- University of Southern California, Los Angeles, CA, USA
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Gall A, Anderson K, Howard K, Diaz A, King A, Willing E, Connolly M, Lindsay D, Garvey G. Wellbeing of Indigenous Peoples in Canada, Aotearoa (New Zealand) and the United States: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115832. [PMID: 34071636 PMCID: PMC8198891 DOI: 10.3390/ijerph18115832] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/20/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022]
Abstract
Despite the health improvements afforded to non-Indigenous peoples in Canada, Aotearoa (New Zealand) and the United States, the Indigenous peoples in these countries continue to endure disproportionately high rates of mortality and morbidity. Indigenous peoples' concepts and understanding of health and wellbeing are holistic; however, due to their diverse social, political, cultural, environmental and economic contexts within and across countries, wellbeing is not experienced uniformly across all Indigenous populations. We aim to identify aspects of wellbeing important to the Indigenous people in Canada, Aotearoa and the United States. We searched CINAHL, Embase, PsycINFO and PubMed databases for papers that included key Indigenous and wellbeing search terms from database inception to April 2020. Papers that included a focus on Indigenous adults residing in Canada, Aotearoa and the United States, and that included empirical qualitative data that described at least one aspect of wellbeing were eligible. Data were analysed using the stages of thematic development recommended by Thomas and Harden for thematic synthesis of qualitative research. Our search resulted in 2669 papers being screened for eligibility. Following full-text screening, 100 papers were deemed eligible for inclusion (Aotearoa (New Zealand) n = 16, Canada n = 43, United States n = 41). Themes varied across countries; however, identity, connection, balance and self-determination were common aspects of wellbeing. Having this broader understanding of wellbeing across these cultures can inform decisions made about public health actions and resources.
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Affiliation(s)
- Alana Gall
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia; (K.A.); (A.D.); (D.L.); (G.G.)
- Correspondence:
| | - Kate Anderson
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia; (K.A.); (A.D.); (D.L.); (G.G.)
| | - Kirsten Howard
- School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia;
| | - Abbey Diaz
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia; (K.A.); (A.D.); (D.L.); (G.G.)
| | - Alexandra King
- Department of Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 2Z4, Canada;
| | - Esther Willing
- Kōhatu–Centre for Hauora Māori, University of Otago, Dunedin 9054, New Zealand;
| | - Michele Connolly
- International Group for Indigenous Health Measurement, Columbia, MD 21045, USA;
| | - Daniel Lindsay
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia; (K.A.); (A.D.); (D.L.); (G.G.)
| | - Gail Garvey
- Wellbeing and Preventable Chronic Disease Division, Menzies School of Health Research, Charles Darwin University, Casuarina, NT 0810, Australia; (K.A.); (A.D.); (D.L.); (G.G.)
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Qeadan F, Madden EF, Bern R, Parsinejad N, Porucznik CA, Venner KL, English K. Associations between opioid misuse and social relationship factors among American Indian, Alaska Native, and Native Hawaiian college students in the U.S. Drug Alcohol Depend 2021; 222:108667. [PMID: 33771399 DOI: 10.1016/j.drugalcdep.2021.108667] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Revised: 01/23/2021] [Accepted: 01/31/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite declining overall rates of opioid misuse among college students, racial and ethnic differences in percentage and correlates of opioid misuse among student populations remains unclear. This study seeks to estimate percentages of opioid misuse among American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) college students and determine whether problems in social bonds affect AI/AN/NH opioid misuse. METHODS Guided by social relationship factors associated with substance use in the Social Development Model, we used 2015-2019 data from the American College Health Association-National College Health Assessment survey in multivariable logistic regression models to examine the role of social bonds with peers and family in opioid misuse (prescription and non-prescription) among AI/AN/NH college students across the U.S. RESULTS The percentage of opioid misuse was highest among AI/AN/NH college students (7.12 %) relative to other race/ethnicity groups. AI/AN/NH college students who reported experiencing loneliness (aOR: 1.68; 95 % CI 1.33-2.12; P < .0001), difficult social relationships (aOR: 1.27; 95 % CI 1.04-1.55; P = 0.0196), family problems (aOR: 1.32; 95 % CI 1.07-1.63; P = 0.0097), and intimate partner violence (aOR: 1.92; 95 % CI 1.56-2.36; P < .0001) were significantly more likely to misuse opioids than students who did not report experiencing these relationship problems. CONCLUSIONS Relationship problems with peers and family increase AI/AN/NH college student risk for opioid misuse, indicating opportunities for colleges to support programs addressing healthy social relationships as a means to reduce opioid misuse among AI/AN/NH students.
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Affiliation(s)
- Fares Qeadan
- University of Utah School of Medicine, Department of Family and Preventive Medicine, United States.
| | - Erin F Madden
- Wayne State University, Department of Family Medicine and Public Health Sciences, United States
| | - Rona Bern
- University of Utah School of Medicine, Department of Family and Preventive Medicine, United States
| | - Nasim Parsinejad
- University of Utah School of Medicine, Department of Family and Preventive Medicine, United States
| | - Christina A Porucznik
- University of Utah School of Medicine, Department of Family and Preventive Medicine, United States
| | - Kamilla L Venner
- University of New Mexico, Department of Psychology, Center on Alcohol, Substance use, And Addiction (CASAA), United States
| | - Kevin English
- Albuquerque Area Southwest Tribal Epidemiology Center, New Mexico, United States
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Boyd T, Stipek J, Kraft A, Muskrat J, Hallgren KA, Alexander C, Greenfield B. Quantifying opioid use disorder Cascade of Care outcomes in an American Indian tribal nation in Minnesota. Drug Alcohol Depend 2021; 222:108661. [PMID: 33775445 PMCID: PMC8608378 DOI: 10.1016/j.drugalcdep.2021.108661] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 01/10/2023]
Abstract
American Indian communities in Minnesota have been disproportionately impacted by the opioid use disorder (OUD) epidemic, which tribal communities have taken numerous steps to address. The Cascade of Care is a public health framework for measuring population-level OUD risk, treatment engagement, treatment retention, and recovery outcomes, which can help communities monitor the impact of responses to the OUD epidemic and identify where treatment- and recovery-related barriers and facilitators may exist. However, no studies have quantified the Cascade of Care stages within tribal communities and the extent to which these stages can be quantified using existing data sources is unknown. We utilized data from the Minnesota Drug and Alcohol Abuse Normative Evaluation System (DAANES) to quantify OUD Cascade of Care stages for an American Indian tribal nation in Minnesota and for the entire state. DAANES data indicated 269 individuals in the tribal community received treatment for opioid-related problems in 2018. Among them, an estimated 65-99 % initiated medications for OUD and an estimated 13-41 % were retained in treatment for at least 180 days. Existing state-level data can provide information about Cascade of Care stages for American Indian communities, particularly with regard to treatment admission, initiation of medications for OUD, and treatment retention. Additional data sources are needed to measure population-level OUD risk, recovery, and cultural and contextual factors that may impact treatment and recovery.
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Affiliation(s)
- Thaius Boyd
- University of Minnesota Medical School, Duluth Campus, 1035 University Dr, Duluth, MN, 55812, United States.
| | - Jordan Stipek
- University of Minnesota Medical School, Duluth Campus, 1035 University Dr, Duluth, MN, 55812, United States
| | - Alex Kraft
- University of Minnesota Medical School, Duluth Campus, 1035 University Dr, Duluth, MN, 55812, United States
| | - Judge Muskrat
- University of North Dakota School of Medicine and Health Sciences, 1301 N Columbia Rd, Grand Forks, ND, 58203, United States
| | - Kevin A Hallgren
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, United States
| | | | - Brenna Greenfield
- University of Minnesota Medical School, Duluth Campus, 1035 University Dr, Duluth, MN, 55812, United States
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Gameon JA, Skewes MC. Historical trauma and substance use among American Indian people with current substance use problems. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2021; 35:295-309. [PMID: 33829816 PMCID: PMC8084991 DOI: 10.1037/adb0000729] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE In the United States, American Indian and Alaska Native (AI/AN) people suffer health inequities associated with alcohol and other drug use and also experience historical trauma symptoms resulting from colonization. Research suggests that historical trauma may be associated with substance use among AI/ANs. METHOD As part of a Community-Based Participatory Research project with tribal partners from a rural AI reservation, our team collected cross-sectional survey data from 198 tribal members who self-identified as having substance use problems. We examined associations between historical trauma thoughts, historical trauma symptoms, and substance use outcomes. We also examined historical trauma symptoms, current trauma symptoms, awareness of systemic discrimination, and ethnic identity as moderators of the associations between historical trauma thoughts and substance use variables. RESULTS Historical trauma thoughts, controlling for symptoms, were associated with greater abstinent days, fewer heavy alcohol use days, fewer drinks per drinking day, and fewer drug use days; historical trauma symptoms, controlling for thoughts, were associated only with fewer abstinent days. Moderation analyses showed that historical trauma thoughts were associated with better substance use outcomes when historical trauma symptoms were low, current trauma symptoms were low, awareness of systemic discrimination was high, and ethnic identity was high. CONCLUSION When distressing trauma symptoms are low, historical trauma thoughts may act as a protective factor or as a marker for other factors associated with better substance use outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Kelley A, Steinberg R, McCoy TP, Pack R, Pepion L. Exploring recovery: Findings from a six-year evaluation of an American Indian peer recovery support program. Drug Alcohol Depend 2021; 221:108559. [PMID: 33548899 DOI: 10.1016/j.drugalcdep.2021.108559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 11/16/2020] [Accepted: 01/02/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES We aimed to identify correlates of short-term recovery among American Indians who participated in the Transitional Recovery and Culture (TRAC) Program, a Peer Recovery Support (PRS) program. Research aims (As) were A1. How do recovery capital resources and indicators of recovery differ between TRAC participants who completed a six-month follow-up and those who did not? A2. How much did recovery capital resource measures change between intake and six-month follow-up? A3. Which recovery capital resources are associated with balanced recovery? METHODS We used the medicine wheel evaluation framework. Each concept within the framework - spiritual, emotional, mental, and physical health - was incorporated into a composite recovery outcome variable. TRAC enrolled 422 American Indians from 2014 to 2019 living in Montana and Wyoming. Six-month change was examined among 214 program participants that completed the six-month program. RESULTS We observed significant change for the following recovery capital resources: stable housing, being occupied, attending recovery groups, interacting with family and friends, past substance use activity, and self-reported health status. Logistic regression results for balanced short-term recovery showed that improving or maintaining occupation (AOR = 6.73, p = 0.0026), interacting with family or friends (AOR = 4.66, p = 0.0050), and still receiving services at follow-up (AOR = 2.25, p = 0.0487) were associated with significant increased odds of higher balanced short-term recovery scores. CONCLUSION PRS helps American Indian people achieve short-term recovery. Future efforts should focus on how to retain peers in PRS programs, and the recovery capital needed to sustain long-term recovery.
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Affiliation(s)
- Allyson Kelley
- Allyson Kelley & Associates PLLC, 69705 Lake Drive Sisters, OR, 97759, USA.
| | - Rachel Steinberg
- Colorado School of Public Health, Anschutz Medical Campus, Denver Colorado, 13001 E. 17th Place Mail Stop B119, Aurora, CO, 80045, USA.
| | - Thomas P McCoy
- University of North Carolina at Greensboro, PO Box 26170, Greensboro, NC, 27402-6170, USA.
| | - Roy Pack
- Rocky Mountain Tribal Leaders Council, 2929 3rd Ave N, Ste 300 Billings, MT, 59101, USA.
| | - Lita Pepion
- Rocky Mountain Tribal Leaders Council, 2929 3rd Ave N, Ste 300 Billings, MT, 59101, USA.
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Spillane NS, Schick MR, Goldstein SC, Nalven T, Kahler CW. The protective effects of self-compassion on alcohol-related problems among First Nation adolescents. ADDICTION RESEARCH & THEORY 2021; 30:33-40. [PMID: 36238694 PMCID: PMC9555812 DOI: 10.1080/16066359.2021.1902994] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 06/14/2023]
Abstract
Given the disproportionate alcohol-related consequences experienced by North American Indigenous youth, there is a critical need to identify related risk and protective factors. Self-compassion, which has been found to mitigate the effects of trauma exposure, may serve as one such protective factor given the high-degree of historical trauma and contemporary discrimination identified as contributing to the alcohol-related disparities experienced by Indigenous communities. However, no research has examined how self-compassion (i.e., the ability to be kind and accepting and to extend compassion towards oneself) plays a unique role in Indigenous peoples' experiences with alcohol. First Nation adolescents between the ages of 11 and 18 living on a reserve in Eastern Canada (N=106, M age =14.6, 50.0% female) completed a pencil-and-paper survey regarding their alcohol use, alcohol-related problems, and self-compassion. Self-compassion was significantly inversely associated with alcohol-related problems (b=-.51, p=.01, 95%CI [-.90, -.12], and significantly interacted with frequency of alcohol use in predicting alcohol-related problems (b=-.42, p=.04, 95%CI [-.82, -.03]). Simple slopes analyses revealed that the association between frequency of alcohol use and frequency of experiencing alcohol-related problems was significant and positive at low (b=4.68, p<.001, 95%CI [2.62, 6.73]), but was not significant at high (b=-.29, p=.89, 95%CI [-4.35, 3.77]) levels of self-compassion. Binary logistic regression revealed that higher scores of self-compassion were associated with a lower odds of being in the high-risk group for AUD (OR=0.90, 95%CI [0.83, 0.98], p=.02). Our results suggest self-compassion may be protective against experiencing alcohol problems in Indigenous youth and thus may be a target for behavioral interventions.
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Affiliation(s)
- Nichea S. Spillane
- PATHS lab, Department of Psychology, University of Rhode Island, Kingston RI
| | - Melissa R. Schick
- PATHS lab, Department of Psychology, University of Rhode Island, Kingston RI
| | - Silvi C. Goldstein
- PATHS lab, Department of Psychology, University of Rhode Island, Kingston RI
| | - Tessa Nalven
- PATHS lab, Department of Psychology, University of Rhode Island, Kingston RI
| | - Christopher W. Kahler
- Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence RI 02912
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Krawczyk N, Garrett B, Ahmad NJ, Patel E, Solomon K, Stuart EA, Saloner B. Medications for opioid use disorder among American Indians and Alaska natives: Availability and use across a national sample. Drug Alcohol Depend 2021; 220:108512. [PMID: 33508692 DOI: 10.1016/j.drugalcdep.2021.108512] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 12/16/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND American Indians and Alaska Natives (AI/ANs) are disproportionately affected by the opioid overdose crisis. Treatment with medications for opioid use disorder (MOUD) can significantly reduce overdose risk, but no national studies to date have reported on the extent to which AI/ANs access these treatments overall and in relation to other groups. METHODS The current study used two national databases - the 2018 National Survey on Substance Abuse Treatment Services and the 2017 Treatment Episode Dataset - to estimate the extent to which MOUD is available and used among AI/ANs across the U.S. RESULTS We found that facilities serving AI/ANs (N = 1,532) offered some MOUD at similar rates as other facilities (N = 13,277) (39.6 vs. 40.6 %, p = 0.435) but were less likely to offer the standard of care with buprenorphine or methadone maintenance (22.4 % vs. 27.6 %, p < 0.001). AI/AN clients in specialty treatment (N = 8,136) exhibited slightly higher MOUD use (40.0 % vs. 38.6 %, p = 0.009) relative to other race groups (N = 673,938). AI/AN clients were also more likely to exhibit greater prescription opioid use and methamphetamine co-use relative to other groups. AI/AN clients in the South (aOR:0.23[95 %CI: 0.19-0.28] or referred by criminal justice sources (aOR:0.13[95 %CI: 0.11-0.16] were least likely to receive MOUD. CONCLUSIONS We conclude that most AI/ANs in specialty treatment do not receive medications for opioid use disorder, and that rates of MOUD use are similar to those of other race groups. Efforts to expand MOUD among AI/ANs that are localized and cater to unique characteristics of this population are gravely needed.
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Affiliation(s)
- Noa Krawczyk
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
| | - Brady Garrett
- Cherokee Nation Behavioral Health, Tahlequah, OK, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public, Health, Baltimore, MD, USA
| | - N Jia Ahmad
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public, Health, Baltimore, MD, USA
| | - Esita Patel
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public, Health, Baltimore, MD, USA
| | - Keisha Solomon
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public, Health, Baltimore, MD, USA
| | - Elizabeth A Stuart
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Brendan Saloner
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public, Health, Baltimore, MD, USA
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Sussman S, Unger JB, Begay C, Moerner L, Soto C. Prevalence, Co-Occurrence, and Correlates of Substance and Behavioral Addictions Among American Indian Adolescents in California. JOURNAL OF DRUG EDUCATION 2021; 50:31-44. [PMID: 34018408 DOI: 10.1177/00472379211017038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The present study investigated the prevalence and co-occurrence of addictions to tobacco, alcohol, other drugs, food/eating, the internet, texting, video games, shopping, love, sex, exercise, work, and gambling among American Indian (AI) youth in California. As with previous work in other cultural groups, the most prevalent addictions were love, internet, and exercise, though prevalence and co-occurrence of these addictions were relatively high among AI youth. A negative life events measure was associated with all the addictions, suggesting that life stressors are associated with high rates of multiple types of addictions among AI youth. There is a need for more research to better understand the relations of life stressors with multiple addictions among AI youth as well as how to remediate these behaviors.
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Affiliation(s)
- Steve Sussman
- Department of Preventive Medicine, 12223University of Southern California Keck School of Medicine, Los Angeles, United States
| | - Jennifer B Unger
- Department of Preventive Medicine, 12223University of Southern California Keck School of Medicine, Los Angeles, United States
| | - Cynthia Begay
- Department of Preventive Medicine, 12223University of Southern California Keck School of Medicine, Los Angeles, United States
| | - Lou Moerner
- Department of Preventive Medicine, 12223University of Southern California Keck School of Medicine, Los Angeles, United States
| | - Claradina Soto
- Department of Preventive Medicine, 12223University of Southern California Keck School of Medicine, Los Angeles, United States
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Skewes MC, Gonzalez VM, Gameon JA, FireMoon P, Salois E, Rasmus SM, Lewis JP, Gardner SA, Ricker A, Reum M. Health Disparities Research with American Indian Communities: The Importance of Trust and Transparency. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:302-313. [PMID: 32652706 PMCID: PMC7772225 DOI: 10.1002/ajcp.12445] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
American Indian and Alaska Native (AI/AN) communities experience notable health disparities associated with substance use, including disproportionate rates of accidents/injuries, diabetes, liver disease, suicide, and substance use disorders. Effective treatments for substance use are needed to improve health equity for AI/AN communities. However, an unfortunate history of unethical and stigmatizing research has engendered distrust and reluctance to participate in research among many Native communities. In recent years, researchers have made progress toward engaging in ethical health disparities research by using a community-based participatory research (CBPR) framework to work in close partnership with community members throughout the research process. In this methodological process paper, we discuss the collaborative development of a quantitative survey aimed at understanding risk and protective factors for substance use among a sample of tribal members residing on a rural AI reservation with numerous systems-level barriers to recovery and limited access to treatment. By using a CBPR approach and prioritizing trust and transparency with community partners and participants, we were able to successfully recruit our target sample and collect quality data from nearly 200 tribal members who self-identified as having a substance use problem. Strategies for enhancing buy-in and recruiting a community sample are discussed.
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Affiliation(s)
- Monica C. Skewes
- Department of Psychology, Montana State University, Bozeman, MT, USA
| | - Vivian M. Gonzalez
- Department of Psychology, University of Alaska Anchorage, Anchorage, AK, USA
| | - Julie A. Gameon
- Department of Psychology, Montana State University, Bozeman, MT, USA
| | | | - Emily Salois
- Center for American Indian and Rural Health Equity, Montana State University, Bozeman, MT, USA
| | - Stacy M. Rasmus
- Center for Alaska Native Health Research, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Jordan P. Lewis
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| | - Scott A. Gardner
- Department of Psychology, Montana State University, Bozeman, MT, USA
| | | | - Martel Reum
- Fort Peck Community College, Poplar, MT, USA
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Brown DG, Flanagan JC, Jarnecke A, Killeen TK, Back SE. Ethnoracial differences in treatment-seeking veterans with substance use disorders and co-occurring PTSD: Presenting characteristics and response to integrated exposure-based treatment. J Ethn Subst Abuse 2020; 21:1141-1164. [PMID: 33111647 DOI: 10.1080/15332640.2020.1836699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Substance use disorders (SUD) and posttraumatic stress disorder (PTSD) frequently co-occur. While previous research has examined ethnoracial differences among individuals with either SUD or PTSD, little research to date has focused on individuals with co-occurring SUD/PTSD. The current study addresses this gap in the literature. METHOD Participants were 79 military veterans (91% male; 38% African American [AA] and 62% White) with current SUD/PTSD who were randomized to receive Concurrent Treatment of PTSD and Substance Use Disorders using Prolonged Exposure (COPE) or Relapse Prevention (RP). Primary outcomes included substance use and self-reported and clinician-rated PTSD symptoms. RESULTS At baseline, AA participants were significantly older, reported greater substance and alcohol use, and tended to report higher PTSD severity than White participants. AA participants evidenced greater decreases in substance and alcohol use during treatment, but greater increases in substance and alcohol use during follow-up as compared to White participants. All participants decreased alcohol consumption during treatment; however, AA participants in the COPE condition and White participants in the RP condition evidenced the steepest decreases in average number of drinks per drinking day (DDD) during treatment. Additionally, White participants receiving RP reported greater increases in DDD during follow-up compared to AA participants. CONCLUSION Overall, integrated treatment for co-occurring SUD/PTSD was effective for both AA and White participants; however, some important differences emerged by ethnoracial group. Findings suggest that greater attention to race and ethnicity is warranted to better understand the needs of diverse patients with SUD/PTSD and to optimize treatment outcomes.
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Affiliation(s)
- Delisa G Brown
- Medical University of South Carolina, Charleston, South Carolina
| | - Julianne C Flanagan
- Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson VAMC, Charleston, South Carolina
| | - Amber Jarnecke
- Medical University of South Carolina, Charleston, South Carolina
| | | | - Sudie E Back
- Medical University of South Carolina, Charleston, South Carolina.,Ralph H. Johnson VAMC, Charleston, South Carolina
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Wong MS, Steers WN, Hoggatt KJ, Ziaeian B, Washington DL. Relationship of neighborhood social determinants of health on racial/ethnic mortality disparities in US veterans-Mediation and moderating effects. Health Serv Res 2020; 55 Suppl 2:851-862. [PMID: 32860253 PMCID: PMC7518818 DOI: 10.1111/1475-6773.13547] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine mediation and moderation of racial/ethnic all-cause mortality disparities among Veteran Health Administration (VHA)-users by neighborhood deprivation and residential segregation. DATA SOURCES Electronic medical records for 10/2008-9/2009 VHA-users linked to National Death Index, 2000 Area Deprivation Index, and 2006-2009 US Census. STUDY DESIGN Racial/ethnic groups included American Indian/Alaskan Native (AI/AN), Asian, non-Hispanic black, Hispanic, Native Hawaiian/Other Pacific Islander, and non-Hispanic white (reference). We measured neighborhood deprivation by Area Deprivation Index, calculated segregation for non-Hispanic black, Hispanic, and AI/AN using the Isolation Index, evaluated mediation using inverse odds-weighted Cox regression models and moderation using Cox regression models testing for neighborhood*race/ethnicity interactions. PRINCIPAL FINDINGS Mortality disparities existed for AI/ANs (HR = 1.07, 95%CI:1.01-1.10) but no other groups after covariate adjustment. Neighborhood deprivation and Hispanic segregation neither mediated nor moderated AI/AN disparities. Non-Hispanic black segregation both mediated and moderated AI/AN disparities. The AI/AN vs. non-Hispanic white disparity was attenuated for AI/ANs living in neighborhoods with greater non-Hispanic black segregation (P = .047). Black segregation's mediating effect was limited to VHA-users living in counties with low black segregation. AI/AN segregation also mediated AI/AN mortality disparities in counties that included or were near AI/AN reservations. CONCLUSIONS Neighborhood characteristics, particularly black and AI/AN residential segregation, may contribute to AI/AN mortality disparities among VHA-users, particularly in communities that were rural, had greater black segregation, or were located on or near AI/AN reservations. This suggests the importance of neighborhood social determinants of health on racial/ethnic mortality disparities. Living near reservations may allow AI/AN VHA-users to maintain cultural and tribal ties, while also providing them with access to economic and other resources. Future research should explore the experiences of AI/ANs living in black communities and underlying mechanisms to identify targets for intervention.
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Affiliation(s)
- Michelle S. Wong
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP)VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
| | - W. Neil Steers
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP)VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
| | - Katherine J. Hoggatt
- San Francisco VA Healthcare SystemSan FranciscoCAUSA
- Department of MedicineUniversity of CaliforniaSan FranciscoCAUSA
| | - Boback Ziaeian
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP)VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Division of Cardiology, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
| | - Donna L. Washington
- VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP)VA Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Division of General Internal Medicine and Health Services Research, Department of MedicineDavid Geffen School of Medicine at UCLALos AngelesCAUSA
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History of sexual assault, past-year alcohol use, and alcohol-related problems in American Indian adolescents. Addict Behav 2020; 108:106441. [PMID: 32315934 DOI: 10.1016/j.addbeh.2020.106441] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 01/09/2023]
Abstract
American Indian (AI) adolescents have been found to experience higher rates of sexual violence, alcohol misuse, and alcohol-related consequences compared to other racial and ethnic groups. Adolescent alcohol use and sexual assault experiences have been linked to increased negative consequences across physical and mental health, school, work, and legal domains. The purpose of the present study was to examine the associations among endorsing a history of experiencing sexual assault, past-year alcohol use, and experiences of alcohol-related problems, and to examine how these associations differed across sex, using a large, nationally-representative sample of reservation-dwelling AI adolescents. The present study utilized secondary data analysis of a sample of 3498 AI 7th to 12th grade students from a larger national epidemiological study. Participants completed The American Drug and Alcohol Survey™ to assess their alcohol use, sexual assault history, and alcohol-related consequences. Multilevel regression analyses revealed a significant effect of an alcohol use by sex by sexual assault history interaction on experiencing alcohol-related problems (b = -0.88, 95%CI [-1.55, -0.22], p = .009). Furthermore, results revealed that males who endorsed a history of experiencing sexual assault demonstrated the strongest relationship between past-year alcohol use and alcohol-related consequences (b = 2.60, p < .001). Results indicate the importance of early intervention for alcohol use, alcohol-related problems, and sexual assault, perhaps particularly among adolescent males. Future research should examine the directionality between alcohol-use and sexual assault among AI adolescents.
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Garcia V, Pagano A, Recarte C, Lee JP. La Cultura Cura: Latino Culture, Shared Experiences, and Recovery in Northern Californian Anexos. ALCOHOLISM TREATMENT QUARTERLY 2020; 39:47-62. [PMID: 34305300 PMCID: PMC8294478 DOI: 10.1080/07347324.2020.1803167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article examines the anexo's use of Latino culture and shared experiences to promote recovery and its appeal to 1.5- and second-generation Latinos. Anexos are grassroots recovery groups with origins in Mexico that offer a residential Alcoholics Anonymous program in Latino communities. Data were gathered from a two-year (2014-2016) ethnographic study of anexos in Northern California and were analyzed thematically. Despite having access to publicly funded treatment, many 1.5- and second-generation Latinos accessed anexos based on cultural familiarity, shared experiences, and a desire to recuperate cultural practices lost during their substance use.
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Affiliation(s)
- Victor Garcia
- Department of Anthropology and Mid-Atlantic Research and Training Institute for Community and Behavioral Health (MARTI-CBH), Indiana University of Pennsylvania, Indiana, Pennsylvania, USA
| | - Anna Pagano
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
| | - Carlos Recarte
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
| | - Juliet P. Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, California, USA
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Ferdinand A, Lambert M, Trad L, Pedrana L, Paradies Y, Kelaher M. Indigenous engagement in health: lessons from Brazil, Chile, Australia and New Zealand. Int J Equity Health 2020; 19:47. [PMID: 32731870 PMCID: PMC7393707 DOI: 10.1186/s12939-020-1149-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 02/27/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Given the persistence of Indigenous health inequities across national contexts, many countries have adopted strategies to improve the health of Indigenous peoples. Governmental recognition of the unique health needs of Indigenous populations is necessary for the development of targeted programs and policies to achieve universal health coverage. At the same time, the participation of Indigenous peoples in decision-making and program and policy design helps to ensure that barriers to health services are appropriately addressed and promotes the rights of Indigenous peoples to self-determination. Due to similar patterns of Indigenous health and health determinants across borders, there have been calls for greater global collaboration in this field. However, most international studies on Indigenous health policy link Anglo-settler democracies (Canada, Australia, Aotearoa/New Zealand and the United States), despite these countries representing a small fraction of the world's Indigenous people. AIM This paper examines national-level policy in Australia, Brazil, Chile and New Zealand in relation to governmental recognition of differential Indigenous health needs and engagement with Indigenous peoples in health. The paper aims to examine how Indigenous health needs and engagement are addressed in national policy frameworks within each of the countries in order to contribute to the understanding of how to develop pro-equity policies within national health care systems. METHODS For each country, a review was undertaken of national policies and legislation to support engagement with, and participation of, Indigenous peoples in the identification of their health needs, development of programs and policies to address these needs and which demonstrate governmental recognition of differential Indigenous health needs. Government websites were searched as well as the following databases: Google, OpenGrey, CAB Direct, PubMed, Web of Science and WorldCat. FINDINGS Each of the four countries have adopted international agreements regarding the engagement of Indigenous peoples in health. However, there is significant variation in the extent to which the principles laid out in these agreements are reflected in national policy, legislation and practice. Brazil and New Zealand both have established national policies to facilitate engagement. In contrast, national policy to enable engagement is relatively lacking in Australia and Chile. Australia, Brazil and New Zealand each have significant initiatives and policy structures in place to address Indigenous health. However, in Brazil this is not necessarily reflected in practice and although New Zealand has national policies these have been recently reported as insufficient and, in fact, may be contributing to health inequity for Māori. In comparison to the other three countries, Chile has relatively few national initiatives or policies in place to support Indigenous engagement or recognise the distinct health needs of Indigenous communities. CONCLUSIONS The adoption of international policy frameworks forms an important step in ensuring that Indigenous peoples are able to participate in the formation and implementation of health policy and programs. However, without the relevant principles being reflected in national legislature, international agreements hold little weight. At the same time, while a national legislative framework facilitates the engagement of Indigenous peoples, such policy may not necessarily translate into practice. Developing multi-level approaches that improve cohesion between international policy, national policy and practice in Indigenous engagement in health is therefore vital. Given that each of the four countries demonstrate strengths and weaknesses across this causal chain, cross-country policy examination provides guidance on strengthening these links.
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Affiliation(s)
- Angeline Ferdinand
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, Australia.
| | - Michelle Lambert
- Ngāi Tahu Māori Health Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Leny Trad
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Leo Pedrana
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
| | - Yin Paradies
- Alfred Deakin Institute for Citizenship and Globalisation, Faculty of Arts and Education, Deakin University, Burwood, Australia
| | - Margaret Kelaher
- Centre for Health Policy, School of Population and Global Health, University of Melbourne, Parkville, Australia
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Prince MA, Conner BT, Davis SR, Swaim RC, Stanley LR. Risk and Protective Factors of Current Opioid Use Among Youth Living on or Near American Indian Reservations: An Application of Machine Learning. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2020; 7:130-140. [PMID: 34447859 PMCID: PMC8386181 DOI: 10.1037/tps0000236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Opioid use among youth, particularly among American Indian (AI) youth, is rising, resulting in a large number of accidental overdoses and deaths. In order to develop effective prevention strategies, we need to use exploratory data analysis to identify previously unknown predictors of opioid use among youth living on or near reservations. The present study is an application of Machine Learning, a type of exploratory data analysis, to the Our Youth, Our Future epidemiological survey (N = 6482) to determine salient risk and protective factors for past 30-day opioid use. The Machine Learning algorithm identified 11 salient risk and protective factors. Importantly, highest risk was conferred for those reporting recent cocaine use, having ever tried a narcotic other than heroin, and identifying as American Indian. Protective factors included never having tried opioids other than heroin, infrequent binge drinking, having fewer friends pressuring you to use illicit drugs, initiating alcohol use at a later age, and being older. This model explained 61% of the variance in the training sample and, on average, 24% of the variance in the bootstrapped samples. Taken together, this model identifies known predictors of 30-day opioid use, for example, recent substance use, as well as unknown predictors including being AI, Snapchat use, and peer encouragement for use. Notably, recent cocaine use was a more salient predictor of recent opioid use than lifetime opioid use.
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Affiliation(s)
- Mark A. Prince
- Department of Psychology, Colorado State University
- Tri-Ethnic Center for Prevention Research, Colorado State University
| | - Bradley T. Conner
- Department of Psychology, Colorado State University
- Tri-Ethnic Center for Prevention Research, Colorado State University
| | | | - Randall C. Swaim
- Department of Psychology, Colorado State University
- Tri-Ethnic Center for Prevention Research, Colorado State University
| | - Linda R. Stanley
- Tri-Ethnic Center for Prevention Research, Colorado State University
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Blume AW. An Indigenous American Conceptualization of Substance Abuse and Its Treatment. ALCOHOLISM TREATMENT QUARTERLY 2020. [DOI: 10.1080/07347324.2020.1741330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Arthur W. Blume
- Department of Psychology VCLS 208L, Washington State University, Vancouver, Washington, USA
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93
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Risk and protective factors for opioid misuse in American Indian adolescents. Drug Alcohol Depend 2020; 206:107736. [PMID: 31765857 PMCID: PMC6980750 DOI: 10.1016/j.drugalcdep.2019.107736] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 11/06/2019] [Accepted: 11/09/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND American Indian (AI) youth have disproportionately high rates of both heroin and other opioid misuse and recently have seen a large increase in negative outcomes due to opioid misuse. To address the dearth of research on within-group risk factors for heroin and other opioid misuse in AI adolescents, the goal of the present study is to explore the influence of peer, family, and school factors on opioid use among AI youth. METHODS Participants (n = 3498, 49.5 % female, Mage = 14.8) were drawn from a large school-based sample of AI youth living on or near reservations, across six geographic regions, between 2009 and 2013. Participants completed a self-report questionnaire regarding substance use and related factors. Multilevel logistic regression was utilized to examine the role of peer, family, and school-related factors on past-month and lifetime heroin and other opioid misuse. RESULTS Greater peer substance use (OR = 1.14, p<0.001), lower family disapproval of use (OR = .98, p = 0.01), and lower school performance (OR = .90, p = 0.01) were associated with greater likelihood of lifetime opioid misuse. Greater peer substance use (OR = 1.05, p<0.001) and lower family disapproval of use (OR = .99, p = 0.04) were associated with greater likelihood of past month opioid misuse. Greater peer substance use was the only variable significantly related to greater likelihood of lifetime (OR = 1.15, p<0.001) or past month heroin use (OR = 1.02, p = 0.047). CONCLUSIONS Findings highlight the need for interventions and offer potential factors to consider in developing interventions for heroin and/or other opioid misuse among AI adolescents.
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Skewes MC, Hallum-Montes R, Gardner SA, Blume AW, Ricker A, FireMoon P. Partnering with Native Communities to Develop a Culturally Grounded Intervention for Substance Use Disorder. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 64:72-82. [PMID: 31290571 PMCID: PMC6750990 DOI: 10.1002/ajcp.12354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Studies have documented serious disparities in drug and alcohol-related morbidity and mortality among American Indians and Alaska Natives (AI/ANs) compared to other ethnic groups in the U.S. despite high rates of abstinence in these groups. Further complicating these health disparities are barriers to accessing evidence-based treatments that are culturally appropriate and acceptable. As part of a research program to promote health equity in rural communities, we developed an academic-community partnership to create a culturally grounded intervention for adults with substance use disorder (SUD) residing on a rural AI reservation. We describe the early phases of our long-term Community Based Participatory Research project and report findings from the first study we conducted. This key informant interview study consisted of in-depth qualitative interviews with 25 tribal members knowledgeable about substance use and recovery on the reservation. The goal was to understand social norms and cultural conceptualizations of substance use to inform the development of a sustainable, community-driven intervention. Participants reported that a holistic approach to recovery that emphasizes spiritual, cultural, and interpersonal harmony and connectedness was important to the community and would be necessary for the intervention to succeed. They also emphasized the need for a multi-level intervention targeting individuals, families, and the community as a whole. Through this initial study, we not only gained valuable information that will be used to guide future research and treatment efforts, but we also strengthened our partnership and built trust with the community. In this manuscript we tell the story of the development of our project and describe our shared vision for future directions.
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