Growing from Our Roots: Strategies for Developing Culturally Grounded Health Promotion Interventions in American Indian, Alaska Native, and Native Hawaiian Communities

Using latent class analysis to operationalize a wholistic assessment of Inuit health and well-being

Many indigenous cultures conceptualize health wholistically, whereby physical, mental, spiritual and relational dimensions of health are interconnected. Yet, quantitative approaches to studying Indigenous health remain anchored in western perspectives, that separate the dimensions of health. This paper aims to operationalize a wholistic indicator of health based on the IQI model of Inuit health. Variables from the 2017 Nunavik Health Survey (N = 1196) were selected based on their representativeness of IQI model. Exploratory Latent Class Analysis (LCA) was used to identify wholistic health profiles. Once participants assigned to their health profile, sociodemographic characteristics were compared across profiles, and multinomial regression models were used to examine the relationship between community-level social determinants of health and the profiles. The LCA revealed three health profiles, labelled as "excellent", "good" and "fair" based on the distribution of answers to the indicators. Nunavimmiut in "excellent" and "good" health were more likely to: rate their health positively; be over 30 years old; be in a relationship; and have participated or volunteered in community events. Nunavimmiut in "fair" health tended to report lower levels of community cohesion, family relationships, and emotional support. Intergrating culturally relevant models of health can support improved health status assessments and identify opportunities for health promotion.

Implementation Science for HIV Prevention and Treatment in Indigenous Communities: a Systematic Review and Commentary

PURPOSE OF REVIEW

We systematically reviewed implementation research conducted in Indigenous communities in the Americas and the Pacific that focused on improving delivery of HIV preventive or treatment services. We highlight strengths and opportunities in the literature and outline principles for Indigenous-led, HIV-related implementation science.

RECENT FINDINGS

We identified 31 studies, revealing a consistent emphasis on cultural tailoring of services to Indigenous communities. Common barriers to implementation included stigma, geographic limitations, confidentiality concerns, language barriers, and mistrust. Community involvement in intervention development and delivery emerged as a key facilitator, and nearly half of the studies used community-based participatory research methods. While behavioral HIV prevention, especially among Indigenous youth, was a major focus, there was limited research on biomedical HIV prevention and treatment. No randomized implementation trials were identified. The findings underscore the importance of community engagement, the need for interventions developed within Indigenous communities rather than merely adapted, and the value of addressing the social determinants of implementation success. Aligned to these principles, an indigenized implementation science could enhance the acceptability and reach of critical HIV preventive and treatment services in Indigenous communities while also honoring their knowledge, wisdom, and strength.

Enhancing Nursing Care through Cultural Competence: Focus on the Inupiat Community

INTRODUCTION

This article explores the historical and cultural background of the Inupiat community, highlighting health disparities and emphasizing culturally competent care's role in addressing them.

METHODS

Inupiat health beliefs, communication styles, family dynamics, and dietary habits are examined in relation to Western medical practices within tribal health systems. Strategies for cultural education include curriculum development, simulations, clinical assignments, and partnerships with Inupiat healthcare professionals.

RESULTS

Challenges in providing culturally competent care to the Inupiat community are identified, including barriers in nursing education and legal implications for nursing practice. Strategies for enhancing nursing cultural competency are outlined.

DISCUSSION

This paper advocates integrating cultural competency into nursing practices to improve care for the Inupiat community, focusing on training, education, and policy recommendations. It emphasizes the importance of respecting and integrating Inupiat cultural practices to enhance health outcomes and healthcare experiences.

Cultural tailoring advance care planning for an American Indian community: make your wishes about you

BACKGROUND

Advance care planning empowers people by allowing them some control over certain healthcare decisions in the event they are unable. Yet, advance care planning rates in the American Indian and Alaska Native populations are low. Thus, we culturally tailored the Make Your Wishes About You (MY WAY), an intervention to improve advance care planning access and completion for American Indian peoples.

METHODS

In partnership with an American Indian Tribe, the project took a community-based participatory orientation and relied on a Community Advisory Board and a Professional Advisory Board. The culturally tailoring was a 15-step process. These steps allowed us to ensure that the tailoring reflects community-specific norms and preferences, greater reliance on visual images and local idioms of expression, more appropriate attention to family roles, and inclusion of spiritual elements.

RESULTS

A four-phase cultural tailoring framework emerged with each phase centering around listening, learning, and analyzing with tailoring occurring between each phase. A culturally tailored MY WAY was created, which was delivered in a manner that reflected Tribal citizenss' preferences. Materials included Tribal language, local idioms of expression, attention to family roles, and appropriate inclusion of spiritual elements. The materials were rated high on a content validity index by the advisory board members.

CONCLUSION

There is a growing interest in tailoring existing evidence-based programs with relatively little in the literature offering guidance. By sharing our efforts and experiences in culturally tailoring an advance care planning program for an American Indian Tribe, we hope that it will serve useful for future efforts in ensuring that evidence-based programming reaches those in greatest need. While this project was rooted in the core Indigenous values of community, ceremony or spirituality, language, and place it also lends itself to broader translation across different populations.

Physical Pain Among Urban Native American Emerging Adults: Sociocultural Risk and Protective Factors

OBJECTIVE

American Indian/Alaska Native (AI/AN) people have high rates of physical pain. Pain is understudied in urban-dwelling, AI/AN emerging adults, a group with unique sociocultural risk and protective factors. We explore associations between socioeconomic disadvantage, additional sociocultural factors, and pain among urban AI/AN emerging adults.

METHODS

AI/AN participants aged 18-25 years ( N = 417) were recruited via social media. Regression models tested associations between socioeconomic disadvantage (income and ability to afford health care) and pain as well as additional sociocultural factors (discrimination, historical loss, cultural pride and belonging, visiting tribal lands) and pain. Multigroup regression models tested whether associations between sociocultural factors and pain differed between participants who were socioeconomically disadvantaged and those who were less disadvantaged.

RESULTS

In the full sample, lower income ( b = 1.00-1.48, p < .05), inability to afford health care ( b = 1.00, p = .011), discrimination ( b = 0.12, p = .001), and historical loss ( b = 0.24, p = .006) were positively associated with pain, whereas visiting tribal lands was negatively associated with pain ( b = -0.86 to -0.42, p < .05). In the multigroup model, visiting tribal lands 31+ days was negatively associated with pain only among the less socioeconomically disadvantaged group ( b = -1.48, p < .001).

CONCLUSIONS

Socioeconomic disadvantage may, in part, drive pain disparities among AI/AN emerging adults and act as a barrier to benefitting from visiting tribal lands. Results support a biopsychosocial approach to targeting pain in this population, including addressing socioeconomic challenges and developing culturally informed, strengths-based interventions.

Nā Kānaka Maoli ma nā 'Āina 'Ē: Exploring Place of Residency as a Native Hawaiian Health Predictor During the COVID-19 Pandemic

Little is known about the impacts of living in diaspora from the Hawaiian Islands on Native Hawaiian health. To address this, the authors conducted an exploratory analysis using cross-sectional data from the 2021 Native American COVID-19 Alliance Needs Assessment. A total of 1418 participants identified as Native Hawaiian (alone or in any combination), of which 1222 reported residency in the continental US and 196 in Hawai'i. Residency status in the continental US vs Hawai'i was evaluated as a predictor of survey outcomes using likelihood ratio tests on linear and logistic regression models for linear and binary outcomes, respectively. Results showed that NH residency in the continental US was significantly associated with increased odds of reporting fair or poor self-rated health; increased odds for screening positive for anxiety, depression, and suicidality; and increased odds of health insurance loss (P's < .05). Residency in the continent was also associated with lower odds of reporting a diagnosed chronic health condition (P < .05). Residency in the continental US had no observed effect on the odds that participants engaged cultural activities or cultural coping strategies. These results support the role of place of residency as an important Native Hawaiian health predictor during and beyond the COVID-19 pandemic.

Decolonizing nursing for health equity: A scoping review

BACKGROUND

The recent push to "decolonize nursing" has become a critical movement to address institutional racism, but the term has circulated through nursing circles enough to risk becoming a buzzword.

PURPOSE

This article clarifies "decolonizing nursing" by addressing the following questions: (a) How has "decolonizing nursing" been discussed in nursing research? (b) What specific projects have been implemented to decolonize nursing? (c) How has decolonizing nursing been related to health equity?

METHODS

We conducted a scoping review and searched CINAHL, PubMed, and PsycINFO databases. A total of N = 56 records were included.

DISCUSSION

"Decolonization" has referred to a range of ideas related to resisting Western ideals, legitimizing Indigenous knowledge, and repatriating land and territory especially to Indigenous and dispossessed communities. Few empirical studies have examined the relationship between decolonization or colonialism and specific health outcomes.

CONCLUSION

Decolonization differs from other social justice initiatives. To clarify what decolonizing nursing means, researchers can engage with historical, interdisciplinary, and community-based participatory research. In turn, nursing research will understand colonialism's historical context, provide evidence that supports policies that protect Indigenous territory, and design clinical interventions that promote health equity for dispossessed populations.

Combating Fraudulent Participation in Urban American Indian and Alaska Native Virtual Health Research: Protocol for Increasing Data Integrity in Online Research (PRIOR)

BACKGROUND

While the advantages of using the internet and social media for research recruitment are well documented, the evolving online environment also enhances motivations for misrepresentation to receive incentives or to "troll" research studies. Such fraudulent assaults can compromise data integrity, with substantial losses in project time; money; and especially for vulnerable populations, research trust. With the rapid advent of new technology and ever-evolving social media platforms, it has become easier for misrepresentation to occur within online data collection. This perpetuation can occur by bots or individuals with malintent, but careful planning can help aid in filtering out fraudulent data.

OBJECTIVE

Using an example with urban American Indian and Alaska Native young women, this paper aims to describe PRIOR (Protocol for Increasing Data Integrity in Online Research), which is a 2-step integration protocol for combating fraudulent participation in online survey research.

METHODS

From February 2019 to August 2020, we recruited participants for formative research preparatory to an online randomized control trial of a preconceptual health program. First, we described our initial protocol for preventing fraudulent participation, which proved to be unsuccessful. Then, we described modifications we made in May 2020 to improve the protocol performance and the creation of PRIOR. Changes included transferring data collection platforms, collecting embedded geospatial variables, enabling timing features within the screening survey, creating URL links for each method or platform of data collection, and manually confirming potentially eligible participants' identifying information.

RESULTS

Before the implementation of PRIOR, the project experienced substantial fraudulent attempts at study enrollment, with less than 1% (n=6) of 1300 screened participants being identified as truly eligible. With the modified protocol, of the 461 individuals who completed a screening survey, 381 did not meet the eligibility criteria assessed on the survey. Of the 80 that did, 25 (31%) were identified as ineligible via PRIOR. A total of 55 (69%) were identified as eligible and verified in the protocol and were enrolled in the formative study.

CONCLUSIONS

Fraudulent surveys compromise study integrity, validity of the data, and trust among participant populations. They also deplete scarce research resources including respondent compensation and personnel time. Our approach of PRIOR to prevent online misrepresentation in data was successful. This paper reviews key elements regarding fraudulent data participation in online research and demonstrates why enhanced protocols to prevent fraudulent data collection are crucial for building trust with vulnerable populations.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04376346; https://www.clinicaltrials.gov/study/NCT04376346.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52281.

Relational community engagement within health interventions at varied outcome scales

Relational community engagement may be a powerful approach with multiple health outcomes. Relational community engagement has the potential to promote health and involves collaborative efforts between multiple stakeholders. The COVID-19 pandemic further highlighted the centrality of community engagement in health crises. Challenges continue to persist, however, in genuinely engaging and empowering communities for better health outcomes. Understanding the multi-level and complex relational nature of community engagement is essential to comprehend its influence on health at micro, meso, and macro scales of influence. The purpose of this narrative review was to synthesize the literature on relational community engagement within varied health interventions at the three major system levels (micro, meso, and macro) to support the development of future research agendas. At the micro level, relational community engagement interventions demonstrated a range of positive outcomes including: increased sense of control, satisfaction, positive behavior, improved knowledge, behavior change, empowerment, and overall positive health and social outcomes. At the meso level, relational community engagement interventions resulted in increased trust between stakeholders and groups/teams, and increased community senses of ownership of interventions, decisions, structures. At the macro level, relational community engagement interventions influenced broader societal factors and had positive impacts on health policy and governance including collaboration between sectors and communities as well as increased access to services. The review highlights the potential versatility and effectiveness of interventions that prioritize relationships, health promotion, and social change while underscoring the significance of holistic and community-centered approaches in addressing diverse health and social challenges.

Provider perspectives on the impact of COVID-19 on treatment of substance use and opioid use disorders among American Indian and Alaska Native adults

Introduction

American Indian/Alaska Native (AI/AN) communities are more likely to suffer negative consequences related to substance misuse. The COVID-19 pandemic exacerbated the opioid poisoning crisis, in combination with ongoing treatment barriers resulting from settler-colonialism, systemic oppression and racial discrimination. AI/AN adults are at greatest risk of COVID-19 related serious illness and death. In collaboration with an Indigenous community advisory board and Tribal leadership, this study explored AI/AN treatment provider perceptions of client-relatives' (i.e., SUD treatment recipients) experiences during the pandemic from 2020 to 2022.

Methods

Providers who underwent screening and were eligible to participate (N = 25) represented 6 programs and organizations serving rural and urban areas in Washington, Utah, and Minnesota. Participants engaged in audio-recorded 60-90 min semi-structured individual interviews conducted virtually via Zoom. The interview guide included 15 questions covering regulatory changes, guidance for telemedicine, policy and procedures, staff communication, and client-relatives' reactions to implemented changes, service utilization, changes in treatment modality, and perceptions of impact on their roles and practice. Interview recordings were transcribed and de-identified. Members of the research team independently reviewed transcripts before reaching consensus. Coding was completed in Dedoose, followed by analyses informed by a qualitative descriptive approach.

Results

Five main domains were identified related to client-relative experiences during the COVID-19 pandemic, as observed by providers: (1) accessibility, (2) co-occurring mental health, (3) social determinants of health, (4) substance use, coping, and harm reduction strategies, and (5) community strengths. Providers reported the distinctive experiences of AI/AN communities, highlighting the impact on client-relatives, who faced challenges such as reduced income, heightened grief and loss, and elevated rates of substance use and opioid-related poisonings. Community and culturally informed programming promoting resilience and healing are outlined.

Conclusion

Findings underscore the impact on SUD among AI/AN communities during the COVID-19 pandemic. Identifying treatment barriers and mental health impacts on client-relatives during a global pandemic can inform ongoing and future culturally responsive SUD prevention and treatment strategies. Elevating collective voice to strengthen Indigenous informed systems of care to address the gap in culturally-and community-based services, can bolster holistic approaches and long-term service needs to promote SUD prevention efforts beyond emergency response efforts.

Do We Belong? Examining the Associations Between Adolescents' Perceptions of School Belonging, Teacher Discrimination, Peer Prejudice and Suicide

In the USA, suicide is a leading cause of death for adolescents ages 12 to 18 (National Institute of Mental Health (NIMH), 2019). Given the urgency of this public health crisis, this paper aims to explore the impact of a sense of school belonging and teacher-based discrimination and peer-based prejudice on suicidal ideation and attempts among Black youth. This secondary analysis used a sample of Black youth (N = 4229; Mage = 16) from the National Longitudinal Study of Adolescents to Adult Health data. Independent variables included a sense of school belonging, school-based teacher discrimination, and school-based peer prejudice; the dependent variable was suicidal thoughts and behaviors. The results of multinomial regression analyses revealed that as Black adolescents' sense of school belonging decreased, they were 35% more likely to be at risk for suicidal ideation and attempts. Findings from our study support the assertion that the school microsystem plays a substantial role in modifying the risk of suicidal behavior among Black youth.

Rates of Recent Adverse Childhood Experiences Among Indigenous Children

The current paper describes rates of recent (past six months) adverse childhood experiences (ACEs) and examines the association of ACEs with cultural connection and depressive symptoms among Indigenous children aged 10 to 14 (N = 177; mean age = 11.8; 48.3% boys; 44.3% girls; 7.4% another gender identity). Children completed baseline surveys as part of a larger evaluation of a culturally grounded, strengths-focused, family-based program to prevent ACEs. Surveys included an inclusive measure of ACEs developed for the current study, an adapted measure of connection to culture, and the Children's Depression Screener. Results for ACEs indicated that 18.6% of Indigenous children reported none, 37.2% reported one to three, and 44.2% reported four or more in the past six months. Importantly, children who reported no ACEs reported greater cultural connection than children who reported one to three ACEs. Depressive symptoms were higher among children who reported one to three and four or more ACEs compared to children who reported no ACEs.

Negative Affect and Drinking among Indigenous Youth: Disaggregating Within- and Between-Person Effects

Negative affect (depression/anxiety) and alcohol use among Indigenous youth in Canada remain a concern for many communities. Disparate rates of these struggles are understood to be a potential outcome of colonization and subsequent intergenerational trauma experienced by individuals, families, and communities. Using a longitudinal design, we examined change in alcohol use and negative affect, and reciprocal associations, among a group of Indigenous adolescents. Indigenous youth (N = 117; 50% male; Mage=12.46-16.28; grades 6-10) from a remote First Nation in northern Quebec completed annual self-reported assessments on negative affect (depression/anxiety) and alcohol use. A Latent Curve Model with Structured Residuals (LCM-SR) was used to distinguish between- and within-person associations of negative affect and alcohol use. Growth models did not support change in depression/anxiety, but reports of drinking increased linearly. At the between-person level, girls reported higher initial levels of depression/anxiety and drinking; depression/anxiety were not associated with drinking. At the within-person level, drinking prospectively predicted increases in depression/anxiety but depression/anxiety did not prospectively predict drinking. When Indigenous adolescents reported drinking more alcohol than usual at one wave of assessment, they reported higher levels of negative affect than expected (given their average levels of depression/anxiety) at the following assessment. Our findings suggest that when Indigenous youth present for treatment reporting alcohol use, they should also be screened for negative affect (depression/anxiety). Conversely, if an Indigenous adolescent presents for treatment reporting negative affect, they should also be screened for alcohol use.

Randomized trial in rural Native American homes heated with wood stoves: results from the EldersAIR study

Residential wood burning has both practical and traditional value among many indigenous communities of the United States Mountain West, although household biomass burning also results in emissions that are harmful to health. In a household-level three-arm placebo-controlled randomized trial we tested the efficacy of portable filtration units and education interventions on improving pulmonary function and blood pressure measures among elder participants that use wood stoves for residential heating. A total of 143 participants were assigned to the Education (n=49), Filter (n=47), and Control (n=47) arms. Blood pressure and spirometry measures were collected multiple times during a per-intervention winter period and during a follow-up post-intervention winter period. Despite strong PM2.5 exposure reduction results with the Filter arm (50% lower compared to Control arm), neither this intervention nor the Education intervention translated to improvements in the selected health measures among this population with a mixture of chronic conditions. Intention to treat analysis failed to demonstrate evidence that either of the intervention arms had beneficial effects on the blood pressure or the spirometry measures. Post-hoc evaluation of effect modification for blood pressure and spirometry outcomes did not reveal any interaction influence on the outcomes according to sex, residential smoking, chronic disease history and study area.

Preconception Health of Indigenous Peoples in Australia, Canada, New Zealand, and the United States: A Scoping Review

BACKGROUND

There is increasing recognition of the importance of the preconception period for addressing reproductive and intergenerational health inequities and supporting improved maternal and child health outcomes. This study aimed to understand the extent and type of evidence that exists in relation to preconception health for Indigenous peoples living in high-income countries with similar experiences of colonisation, namely, Australia, New Zealand, Canada, and the United States.

METHODS

This review was conducted as per the JBI methodology and PRISMA Extension for Scoping Reviews. A comprehensive search of PubMed, CINAHL [EBSCO], Ovid Embase, Scopus, and the Wiley Cochrane Library was conducted using keywords and index terms. We included research in English published between January 2010 and June 2023 on quantitative and qualitative primary studies. Data were extracted using a standardised tool, and the analysis included quantitative descriptions and qualitative content analysis.

RESULTS

We identified 360 potential studies and included 57 articles in the review. Most studies were from the United States (n = 36, 63.2%) and Australia (n = 13, 22.8%), and they commonly reported associations between preconception health risk factors and maternal or child health outcomes (n = 27, 48.2%) or described the development, implementation, or evaluation of preconception health interventions (n = 26, 46.4%). Common preconception health areas were pre-pregnancy body mass index or weight (n = 34), alcohol (n = 16), diet (n = 14), physical activity (n = 12), and diabetes (n = 11). Most studies focused exclusively on women (n = 46, 80.7%), and very few included men (n = 3, 5.3%). The study populations were mostly urban and rural (n = 25, 43.9%) or rural only (n = 14, 24.6%); however, the geographical remoteness was often unclear (n = 14, 24.6%).

CONCLUSIONS

While there was some research relating to the preconception health of Indigenous peoples, this review identified considerable research gaps. There is a need for dedicated research into preconception health risk factors and reproductive health outcomes, attitudes and awareness of preconception health, and preconception health interventions for Indigenous peoples.

Reducing Indigenous suicide: Recognizing vital land and food systems for livelihoods

Colonial trauma poses a significant risk to the physical, intellectual, and mental health of Indigenous youth and young adults. Education and mental health scholars are increasingly concerned about the emotional wellbeing of young people, particularly as rates of suicide have increased across the United States. With interest in identifying the unique contextual dynamics involved in understanding Indigenous suicide, this work considers characteristics related to colonialism that may uncover strategies for both educators and mental health practitioners that address disparities. Drawing on a larger ethnographic study, this inquiry asks how settler encroachment upon Indigenous land and food systems is related to death by suicide from the perspective of Cowichan Tribes members. Comprehensive semi-structured interviews were conducted (n = 21); each interview was audio-recorded and transcribed verbatim. Data were analyzed deductively based upon a priori suppositions related to settler colonial theory. Cowichan members' narrated explanations for suicide rooted in disruptions to (1) relationships with the land and (2) traditional food systems. They described how settler encroachment infringed upon their subsistence way of living and introduced incongruent constructions of nature-culture relations (e.g., humans as distinct and separate from the natural world). Settler futurity is secured through the arrogation of territorial dominance coupled with physical or conceptual acts of erasure, placing Indigenous lives and lifeways at risk. One outcome of the disruption to Indigenous collective capacities is a dramatic increase in Indigenous suicide.

Development and Feasibility Pilot Study of Indigenous Recovery Planning: A Community-Engaged Approach to Addressing Substance Use in a Native Community

Although Native (American Indian and Alaska Native [AI/AN]) populations have high rates of abstinence from alcohol, health problems associated with substance use remain a pressing concern in many AI/AN communities. As part of a longstanding community-based participatory research (CBPR) project involving five years of relationship building and three preliminary studies, our team of academic and community co-researchers developed a culturally grounded intervention to facilitate recovery from substance use disorders among tribal members from a rural AI reservation. Our Indigenous Recovery Planning (IRP) intervention consists of six weekly sessions and aims to provide inroads to existing resources in the community, affirm and enhance Native identity, address culturally relevant risk factors, and build upon strengths. Results from a feasibility pilot study (N = 15) suggest that IRP is feasible to implement and acceptable to the community. Although there was insufficient statistical power to conduct hypothesis testing, there were changes between pretest and posttest scores in the expected directions. Future directions and limitations of this research are discussed.

Honoring our teachings: children's storybooks as indigenous public health practice

Introduction

American Indian and Alaska Native (AIAN) communities continue to flourish and innovate in the face of the COVID-19 pandemic. Storytelling is an important tradition for AIAN communities that can function as an intervention modality. To support the needs of AIAN children and caregivers, we (a collaborative workgroup of Indigenous health researchers) developed a culturally grounded storybook that provides pandemic-related public health guidance and mental health coping strategies woven with Inter-Tribal values and teachings.

Methods

A collaborative workgroup, representing diverse tribal affiliations, met via four virtual meetings in early 2021 to discuss evolving COVID-19 pandemic public health guidance, community experiences and responses to emerging challenges, and how to ground the story in shared AIAN cultural strengths. We developed and distributed a brief survey for caregivers to evaluate the resulting book.

Results

The workgroup iteratively reviewed versions of the storyline until reaching a consensus on the final text. An AI artist from the workgroup created illustrations to accompany the text. The resulting book, titled Our Smallest Warriors, Our Strongest Medicine: Honoring Our Teachings during COVID-19 contains 46 pages of text and full-color illustrations. An online toolkit including coloring pages, traditional language activities, and caregiver resources accompanies the book. We printed and distributed 50,024 physical copies of the book and a free online version remains available. An online survey completed by N = 34 caregivers who read the book with their child(ren) showed strong satisfaction with the book and interest in future books.

Discussion

The development of this storybook provides insights for creative dissemination of future public health initiatives, especially those geared toward AIAN communities. The positive reception and widespread interest in the storybook illustrate how braiding AIAN cultural teachings with public health guidance can be an effective way to disseminate health information. This storybook highlights the importance of storytelling as an immersive learning experience through which caregivers and children connect to family, community, culture, and public health guidance. Culturally grounded public health interventions can be effective and powerful in uplifting AIAN cultural values and promoting health and well-being for present and future generations.

Mixed Methods Evaluation of Satisfaction with Two Culturally Tailored Substance use Prevention Programs for American Indian/Alaska Native Emerging Adults

American Indian/Alaska Native (AI/AN) communities are disproportionately affected by the opioid epidemic. AI/AN emerging adults (ages 18-25) in urban areas are at particularly high risk, with the overdose death rate among urban-dwelling AI/AN people 1.4 times higher than rural-dwelling AI/AN people. Despite these challenges, there are no evidence-based culturally tailored prevention or intervention programs to address opioid, alcohol and other drug use among urban AI/AN emerging adults. This study focused on understanding AI/AN emerging adults' experiences with two culturally tailored programs addressing opioid, cannabis, and alcohol use as part of the randomized controlled trial for Traditions and Connections for Urban Native Americans (TACUNA) in order to enhance feasibility of this intervention. Using a convergent mixed methods design at 3-month follow-up, we collected satisfaction and experience ratings and written narratives (total n = 162; intervention n = 77; control n = 85) from a sample of urban-dwelling AI/AN emerging adults who participated in both programs. We analyzed data through simultaneous examination of qualitative and quantitative data. The quantitative ratings show that both programs were rated highly. The qualitative data contextualized these ratings, illustrating pathways through which specific components were perceived to cause desired or observed behavioral change in participants. Among the elements that mattered most to these participants were the convenience of the virtual format, having a comfortable and safe space to share personal stories, and learning new information about their social networks. Negative comments focused on workshop length and inconvenient scheduling. This is one of the first studies to explore participant satisfaction and experience with culturally tailored substance use programming among a historically marginalized and understudied population. It is important to consider the voices of urban-dwelling AI/AN people in program development because hidden factors, such as limited financial resources, limited time, and misalignment with cultural values may prevent existing programs from being feasible.

Neighborhood determinants of sleep and the moderating role of cultural factors among native adolescents

OBJECTIVE

This study examined the association between neighborhood social environment and sleep among urban American Indian and Alaska Native (AI/AN) adolescents as well as the moderating role of cultural factors in this association.

METHOD

The analytic sample included 133 urban AI/AN adolescents (age 12-16, 57.1% female, Mage = 14.03, SDage = 1.35). Perceived neighborhood social environment included safety and cohesion. Cultural factors included AI/AN cultural identification and historical loss. Sleep duration, efficiency, and wake after sleep onset (WASO) were measured via actigraphy. Sleep disturbance was measured via a questionnaire.

RESULTS

Greater neighborhood safety was significantly associated with lower sleep disturbance (b = -2.17, SE = 0.8, p = .008), higher sleep efficiency (b = 1.75, SE = 0.64, p = .006), and lower WASO (b = -8.60, SE = 3.34, p = .01). Neighborhood cohesion was not associated with any sleep outcomes. Cultural factors moderated the association between neighborhood social environment and sleep outcomes (p < .05). Specifically, both neighborhood safety and cohesion were associated with lower sleep disturbance, only among individuals reporting higher levels of AI/AN cultural identification. Further, neighborhood safety was associated with greater sleep efficiency and lower WASO (i.e., better sleep) only among adolescents with higher contemplation of historical loss.

CONCLUSIONS

Findings highlight the importance of considering cultural factors in addressing sleep and health disparities. AI/AN cultural identification and a sense of historical loss may be important targets for identifying adolescents who might benefit the most from policies and interventions focused on improving the social environment in order to improve sleep and other health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Bidirectional Associations Between Daily Sleep and Wake Behaviors in Urban American Indian/Alaska Native Youth

PURPOSE

This is the first study to examine daily, bidirectional associations between sleep and wake behaviors/mood in urban American Indian/Alaska Native (AI/AN) adolescents.

METHODS

Participants were 142 urban AI/AN adolescents (mean age = 14 years, 58% female). Sleep was measured with actigraphy (total sleep time [TST] and sleep efficiency) and daily diary (bedtime, wakeup time, and sleep quality) over seven consecutive days. Wake behaviors (caffeine consumption, physical activity, participation in cultural activities, and electronic use after 8p.m.) and mood upon awakening (higher rating indicates greater happiness) were measured via daily diary for seven consecutive days. Multilevel models examined the degree to which nightly sleep predicted next day's wake behaviors and, conversely, wake behaviors and mood predicted nightly sleep, controlling for age, gender, and weekday/weekend.

RESULTS

Earlier bedtime and wakeup times predicted greater participation in physical activity the following day. Later bedtime and wakeup time, worse sleep quality, and shorter TST predicted greater electronic use the following night. Earlier bedtime and wakeup time and better sleep quality predicted higher mood ratings. Conversely, greater caffeine consumption during the day predicted both later bedtime and wakeup time. Participation in cultural activities is predicted later bedtime. More nighttime electronic use predicted both later bedtime and wakeup time, poorer sleep quality, and worse TST and sleep efficiency. Higher mood ratings in the morning predicted earlier bedtime and later wakeup time.

DISCUSSION

Findings highlight dynamic associations between sleep and wake behaviors and mood in AI/AN adolescents and may elucidate novel pathways for intervention and future research.

A comparison of the substance use related risk and protective factor profiles for American Indian and White American youth: a mixed studies review

Background

American Indian youth are disproportionately impacted by substance use compared to White American youth in the United States. This mixed studies review focused on gathering data to examine the similarities and differences between the risk and protective factor profiles for substance use among American Indian and White American youth aged 10-21.

Methods

A scan of the existing literature was needed to review substance use related risk and protective factors for American Indian and White American youth. Search phrases were created to ensure maximum relevant results from existing literature through 2021. After deduplication, an appraisal tool was utilized to review 343 records. A total of 19 articles were deemed relevant. Data from relevant articles was recorded and categorized into the levels of the Social Ecological Model.

Results

Significant and salient risk and protective factors of substance use for both American Indian and White American youth presented at the individual, interpersonal (family/non-family), and community levels of the Social Ecological Model. A total of 84 factors were found from relevant articles, 55 risk factors and 29 protective factors. When comparing the American Indian and White American youth profiles, a total of 29 unique differences between American Indian (n = 21) and White American youth (n = 8) were identified.

Discussion

Results from this review can be utilized to inform Tribal leaders, stakeholders, and policymakers, which will ultimately influence health intervention strategies and prioritizations. Given the limited evidence though, researchers should be responsive to Tribal communities' call to action for utilizing a culturally rooted approach.

Because We Love You (BeWeL): A protocol for a randomized controlled trial of two brief interventions focused on social and cultural connectedness to reduce risk for suicide and substance misuse in young Alaska Native people

Background

Suicide among young people in Alaska Native (AN) communities was nearly unheard of through the establishment of statehood in 1959, but in the 1970s, AN suicide rates began to double every five years, with most of the increase due to suicide among 15 to 25-year-olds. From 1960-1995, the suicide rate increased by approximately 500% during this period of rapid, imposed social transition. For example, families were forced to live in settlements and children were sent to boarding schools. These disruptions increased conditions associated with suicide risk (e.g., substance use disorders, cultural disconnection), and challenged the community-level social safety net of youth protective factors that might have moderated effects of these traumas. The present study addresses the significant gap in culturally appropriate evidence-based programming to address suicide prevention among AN young people as part of aftercare. Our key research questions and methodology have been informed by AN stakeholders, and the intervention approach is Indigenous-led.

Methods

Our interventions are targeted toward Alaska Native young people ages 14-24 who present with suicide attempt, ideation, or associated risk behaviors, including alcohol-related injury in the Yukon-Kuskokwim region or the Interior. In a randomized controlled trial, 14-24-year-old AN individuals will receive either BeWeL (n = 185), which comprises a 45-minute virtual cultural talk addressing family and ancestral strengths and increasing protective factors, or BeWeL plus motivational interviewing with social networks, which includes an additional 15 minutes focused on discussion of the individual's social networks (n = 185). We will evaluate intervention effects on primary outcomes of suicide-intent risk, depression, anxiety, frequency of alcohol use, and alcohol consequences. Some of our secondary outcomes include individual and community protective factors, social networks, and awareness of connectedness.

Discussion

This project has the potential to expand the range and effectiveness of suicide prevention services for AN young people and will help meet the need in Alaska to link clinical behavioral health services to AN community-based networks, and to engage local cultural resources in aftercare for individuals at risk for suicide. Findings have potential to provide practical information to advance the field of suicide prevention and enhance protective factors and resiliency among this population.

Trial registration

ClinicalTrials.gov Identifier: NCT05360888.

Centering Community Strengths and Resisting Structural Racism to Prevent Youth Suicide: Learning from American Indian and Alaska Native Communities

The persistence of extreme suicide disparities in American Indian and Alaska Native (AI/AN) youth signals a severe health inequity with distinct associations to a colonial experience of historical and on-going cultural, social, economic, and political oppression. To address this complex issue, we describe three AI/AN suicide prevention efforts that illustrate how strengths-based community interventions across the prevention spectrum can buffer suicide risk factors associated with structural racism. Developed and implemented in collaboration with tribal partners using participatory methods, the strategies include universal, selective, and indicated prevention elements. Their aim is to enhance systems within communities, institutions, and families by emphasizing supportive relationships, cultural values and practices, and community priorities and preferences. These efforts deploy collaborative, local approaches, that center on the importance of tribal sovereignty and self-determination, disrupting the unequal power distribution inherent in mainstream approaches to suicide prevention. The examples emphasize the centrality of Indigenous intellectual traditions in the co-creation of healthy developmental pathways for AI/AN young people. A central component across all three programs is a deep commitment to an interdependent or collective orientation, in contrast to an individual-based mental health suicide prevention model. This commitment offers novel directions for the entire field of suicide prevention and responds to calls for multilevel, community-driven public health strategies to address the complexity of suicide. Although our focus is on the social determinants of health in AI/AN communities, strategies to address the structural violence of racism as a risk factor in suicide have broad implications for all suicide prevention programming.

Social-Ecological Resilience of Indigenous Adolescents in the United States and Canada: A Situation-Specific Nursing Theory

For the past decade, resilience research with American Indian/Alaska Native and First Nations/Métis/Inuit adolescents has improved our understanding of how adolescents overcome mental health challenges. A new situation-specific theory is presented to guide nurses in applying the evidence to their practice with Indigenous adolescents in the United States and Canada. The social-ecological resilience of indigenous adolescents (SERIA) theory was derived from integrating ( a ) existing social-ecological frameworks by Bronfenbrenner, Ungar, and Burnette and Figley, ( b ) findings from a systematic review of 78 studies about resilience factors for mental health of Indigenous adolescents, ( c ) clinical experience, and ( d ) Indigenous knowledge.

Addressing experiences of trauma within Indigenous-focused substance use residential treatment: a systematic review and environmental scan

Indigenous individuals in Canada disproportionally experience higher rates of substance use concerns. This study examined clinical practices currently implemented with Indigenous-led residential treatment facilities to simultaneously address substance use and post-traumatic stress. A systematic review of relevant literature retrieved published approaches to address these concurrent disorders with Indigenous individuals. This review retrieved 35 sources related to trauma and substance use treatment among Indigenous individuals or communities. Among these sources, all leveraged cultural approaches as a dual treatment for trauma symptoms and substance use. Inconsistent results were reported among those sources (n = 3) who analyzed comparisons with wait-list controls or used randomized-controlled designs. Using culture-as-treatment was elaborated upon in the second goal of this study: an environmental scan of Indigenous-led treatment programs and qualitative interviews with 10 treatment center staff to understand how programs may address both substance use and traumatic symptoms among Indigenous-led substance use treatment centers across Canada. When we searched the websites of these centers, we found that approximately 38% (16 of 43) of treatment centers discussed implementing some form of treatment that addressed trauma symptoms in conjunction with primary substance use. Among the 10 staff participants, all discussed how trauma can impede client success in treatment, and ACE-specific programming is useful within their respective treatment programs. Results showed that when manualized treatments are used, they must be adapted to meet the specific needs of Indigenous communities, and culture-as-treatment is a popular approach among Indigenous-led treatment centers, particularly for addressing trauma symptoms.

Ground-up approach to understanding the impacts of historical trauma in one reserve-dwelling first nations community

OBJECTIVE

First Nations peoples experience disproportionate health inequities compared to most non-Indigenous populations. Historical trauma is one factor that has received growing attention in relation to health inequities among First Nations populations. The goal of the present study was to improve understanding of the specific forms, impacts, and mechanisms of transmission of events that lead to historical trauma and the historical trauma response in First Nations peoples.

METHOD

Five focus groups were conducted among adult members of one First Nations community in Canada (N = 34; 70.4% female).

RESULTS

Conventional content analysis revealed the numerous forms that historical trauma take in this First Nations community; individual-, familial-, community-, and societal-level impacts of historical trauma; and ways in which historical trauma has been transmitted in this community. Loss of culture, alcohol use, and parenting were major themes identified across these domains.

CONCLUSIONS

Findings provide important information on the experience of historical trauma in one First Nations community, highlighting the roles of loss of culture; alcohol use; and parenting in the forms, impacts, and transmission of historical trauma. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Unsettling Settler Colonialism in Research: Strategies Centering Native American Experience and Expertise in Responding to Substance Misuse and Co-occurring Sexual Risk-Taking, Alcohol-Exposed Pregnancy, and Suicide Prevention Among Young People

Native American (NA) populations in the USA (i.e., those native to the USA which include Alaska Natives, American Indians, and Native Hawaiians) have confronted unique historical, sociopolitical, and environmental stressors born of settler colonialism. Contexts with persistent social and economic disadvantage are critical determinants of substance misuse and co-occurring sexual risk-taking and suicide outcomes, as well as alcohol exposed pregnancy among NA young people (i.e., adolescents and young adults). Despite intergenerational transmission of resistance and resiliencies, NA young people face continued disparities in substance misuse and co-occurring outcomes when compared to other racial and ethnic groups in the USA. The failure in progress to address these inequities is the result of a complex set of factors; many of which are structural and rooted in settler colonialism. One of these structural factors includes barriers evident in health equity research intended to guide solutions to address these disparities yet involving maintenance of a research status quo that has proven ineffective to developing these solutions. Explicitly or implicitly biased values, perspectives, and practices are deeply rooted in current research design, methodology, analysis, and dissemination and implementation efforts. This status quo has been supported, intentionally and unintentionally, by researchers and research institutions with limited experience or knowledge in the historical, social, and cultural contexts of NA communities. We present a conceptual framework illustrating the impact of settler colonialism on current research methods and opportunities to unsettle its influence. Moreover, our framework illustrates opportunities to resist settler colonialism in research. We then focus on case examples of studies from the Intervention Research to Improve Native American Health program, funded by the NIH, that impact substance use and co-occurring health conditions among NA young people.

Discrimination and school outcomes in first nation youth: The role of positive psychological characteristics

INTRODUCTION

Positive psychological characteristics have been found to be associated with discrimination and school outcomes separately; however, no work has examined these associations together or in North American Indigenous (NAI) populations. NAI adolescents experience high rates of racial discrimination. Because discrimination has a detrimental impact on academic outcomes it is critical to identify factors that could buffer this impact. The purpose of this study was to examine the indirect effect of racial discrimination on three distinct school outcomes (i.e., attitudes toward school, grades, and educational attainment goals) through the pathway of three positive psychological characteristics (i.e., satisfaction with life, subjective happiness, and self-compassion).

METHODS

First Nation adolescents living on a rural reserve in Eastern Canada (N = 106, Mage  = 14.6 years, 50.0% female) completed a pencil-and-paper survey in Spring 2017 as part of a larger community-based participatory research study.

RESULTS

In the model examining school attitudes, indirect effects through subjective happiness (b = -0.21, 95% confidence interval (CI): [-0.53, -0.03]) and self-compassion (b = -0.19, 95% CI: [-0.39, -0.04]), but not satisfaction with life, were significant. In the model examining grades, only the specific indirect effect through subjective happiness was significant (b = -0.27, 95% CI: [-0.59 -0.07]). Similarly, in the model examining school goals, only the indirect effect through subjective happiness was significant (b = -0.40, 95% CI: [-0.94, -0.08]). The direct effects of discrimination on school attitudes (b = 0.02, 95% CI: [-0.52, 0.56]), grades (b = 0.16, 95% CI: [-0.39, 0.71]), and school goals (b = -0.03, 95% CI: [-0.90, 0.84]) were not significant after controlling for positive psychological characteristics.

DISCUSSION

Schools should foster positive emotions to enhance academic outcomes, especially for NAI youth who are more likely to experience racial discrimination.

Social Networks, Cultural Pride, and Historical Loss Among Non-Reservation American Indian / Alaska Native Emerging Adults

Health disparities among American Indian/Alaska Native (AI/AN) populations in the United States are the result of historical traumas, such as colonization, forced relocation, and federal policies focused on cultural assimilation. Culturally-tailored health interventions aim to address intergenerational trauma by emphasizing cultural strengths and building positive social connections. In this article, we explore the social network characteristics of participants of the first culturally-tailored health intervention for AI/AN emerging adults (18-25) living outside of tribal lands. Participants (N = 150; 86% female) were recruited across the United States via social media and completed online egocentric network interviews prior to the start of intervention workshops. Participants' networks were diverse in composition and structure. They were primarily composed of family and friends, were people they had regular contact with, were similar age, and provided participants with support. We tested for significant associations between network characteristics, individual characteristics (age, gender, travel to reservations, speaking tribal languages, etc.) and two dependent measures: 1) cultural pride and belongingness and 2) thoughts of historical loss. Multiple regression results show that higher proportions of network members who discussed AI/AN identity with participants and having more network members who engage in traditional practices was associated with stronger cultural pride and belongingness. Higher proportions of network members having discussion of AI/AN identity with participants was also associated with more frequent thoughts of historical loss. Controlling for network factors, no individual characteristics were associated with either dependent variable. We discuss implications for the development of culturally-tailored health interventions.

Coming together for something good: recommendations from a scoping review for dissemination and implementation science to improve indigenous substance use disorder treatment

Introduction

Dissemination and Implementation (D&I) science is growing among Indigenous communities. Indigenous communities are adapting and implementing evidence-based treatments for substance use disorders (SUD) to fit the needs of their communities. D&I science offers frameworks, models, and theories to increase implementation success, but research is needed to center Indigenous knowledge, enhancing D&I so that it is more applicable within Indigenous contexts. In this scoping review, we examined the current state of D&I science for SUD interventions among Indigenous communities and identified best-practice SUD implementation approaches.

Methods

PubMed and PsycINFO databases were queried for articles written in English, published in the United States, Canada, Australia, and New Zealand. We included key search terms for Indigenous populations and 35 content keywords. We categorized the data using the adapted and extended Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework that emphasizes equity and sustainability. RE-AIM has also been used as a primary model to consistently identify implementation outcomes.

Results

Twenty articles were identified from the original unduplicated count of over 24,000. Over half the articles discussed processes related to Reach, Adoption, and Implementation. Effectiveness was discussed by 50% of the studies (n = 10), with 25% of the articles discussing Maintenance/sustainability (n = 4). Findings also highlighted the importance of the application of each RE-AIM domain for meaningful, well-defined community-engaged approaches.

Conclusion

Finding indicated a need to prioritize Indigenous methods to culturally center, re-align and adapt Western treatments and frameworks to increase health equity and improve SUD treatment outcomes. Utility in the use of the modified RE-AIM and the continued modification for Indigenous communities was also noted.

Lessons learned and future directions: A scoping review of American Indian and Alaska Native participants in the National Drug Abuse Treatment Clinical Trials Network

INTRODUCTION

American Indian and Alaska Native (AI/AN) populations are disproportionately affected by substance use disorders (SUDs) and related health disparities in contrast to other ethnoracial groups in the United States. Over the past 20 years, substantial resources have been allocated to the National Institute on Drug Abuse Clinical Trials Network (CTN) to disseminate and implement effective SUD treatments in communities. However, we know little about how these resources have benefitted AI/AN peoples with SUD who arguably experience the greatest burden of SUDs. This review aims to determine lessons learned about AI/AN substance use and treatment outcomes in the CTN and the role of racism and Tribal identity.

METHOD

We conducted a scoping review informed by the Joanna Briggs framework and PRISMA Extension for Scoping Reviews checklist and explanation. The study team conducted the search strategy within the CTN Dissemination Library and nine additional databases for articles published between 2000 and 2021. The review included studies if they reported results for AI/AN participants. Two reviewers determined study eligibility.

RESULTS

A systematic search yielded 13 empirical articles and six conceptual articles. Themes from the 13 empirical articles included: (1) Tribal Identity: Race, Culture, and Discrimination; (2) Treatment Engagement: Access and Retention; (3) Comorbid Conditions; (4) HIV/Risky Sexual Behaviors; and (5) Dissemination. The most salient theme was Tribal Identity: Race, Culture, and Discrimination, which was present in all articles that included a primary AI/AN sample (k = 8). Themes assessed but not identified for AI/AN peoples were Harm Reduction, Measurement Equivalence, Pharmacotherapy, and Substance Use Outcomes. The conceptual contributions used AI/AN CTN studies as exemplars of community-based and Tribal participatory research (CBPR/TPR).

CONCLUSION

CTN studies conducted with AI/AN communities demonstrate culturally congruent methods, including CBPR/TPR strategies; consideration/assessment of cultural identity, racism, and discrimination; and CBPR/TPR informed dissemination plans. Although important efforts are underway to increase AI/AN participation in the CTN, future research would benefit from strategies to increase participation of this population. Such strategies include reporting AI/AN subgroup data; addressing issues of cultural identity and experiences of racism; and adopting an overall effort for research aimed at understanding barriers to treatment access, engagement, utilization, retention, and outcomes for both treatment and research disparities for AI/AN populations.

Relationship between food insecurity and a gestational diabetes risk reduction intervention: outcomes among American Indian and Alaska Native adolescent and young adult females

American Indian and Alaska Natives (AI/ANs) are disproportionately impacted by gestational diabetes mellitus (GDM), subsequent type 2 diabetes, and food insecurity. It is prudent to decrease risk of GDM prior to pregnancy to decrease the intergenerational cycle of diabetes in AI/AN communities. The purpose of this project is to describe and examine food insecurity, healthy eating self-efficacy, and healthy eating behaviors among AI/AN females (12-24 years old) as related to GDM risk reduction. Methods included: secondary analysis of healthy eating self-efficacy and behaviors, and household-level food insecurity measures from an randomized controlled trial that tested the effect of engagement in a GDM risk reduction educational intervention on knowledge, behavior, and self-efficacy for GDM risk reduction from baseline to 3-month follow-up. Participants were AI/AN daughters (12-24 years old) and their mothers (N = 149 dyads). Researchers found that more than one-third (38.1%) reported food insecurity. At baseline food insecurity was associated with higher levels of eating vegetables and fruit for the full sample (p = .045) and cohabitating dyads (p = .002). By 3 months healthy eating self-efficacy (p = .048) and limiting snacking between meals (p = .031) improved more in the control group than the intervention group only for cohabitating dyads. For the full sample, the intervention group had increases in times eating vegetables (p = .022) and fruit (p = .015), whereas the control group had declines. In the full sample, food insecurity did not moderate the group by time interaction for self-efficacy for healthy eating (p ≥ .05) but did moderate the group by time interaction for times drinking soda (p = .004) and days eating breakfast (p = .013). For cohabitating dyads, food insecurity did moderate self-efficacy for eating 3 meals a day (p = .024) and days eating breakfast (p = .012). These results suggest food insecurity is an important factor regarding the efficacy of interventions designed to reduce GDM risk and offer unique insight on "upstream causes" of GDM health disparities among AI/AN communities.

Risk and protective factors of social networks on alcohol, cannabis, and opioid use among urban American Indian/Alaska Native emerging adults

OBJECTIVES

Assess associations between social networks and urban American Indian/Alaska Native emerging adults' alcohol, cannabis, and opioid use and intentions.

METHOD

American Indian/Alaska Native participants ages 18-25 (N = 150; 86% female) were recruited across the United States from 12/20 to 10/21 via social media. Participants named up to 15 people whom they talked with most over the past 3 months and reported who (a) used alcohol and cannabis heavily or used other drugs (e.g., opioid use), (b) engaged in traditional practices, and (c) provided support. They also reported past 3-month alcohol, cannabis, and opioid use and intentions to use.

RESULTS

Having a higher proportion of network members engaging in regular cannabis and heavy alcohol use (but not other drugs) was associated with more frequent cannabis use and stronger cannabis use intentions. Participants with higher proportions of members engaging in heavy alcohol use, regular cannabis use, or other drug use and who did not engage in traditional practices were more likely to report cannabis use and greater intentions to use cannabis and drink alcohol. In contrast, participants with higher proportions of network members engaging in traditional practices and who did not report heavy alcohol use, regular cannabis use, or other drug use were less likely to report intentions to use cannabis or drink alcohol.

CONCLUSIONS

Findings emphasize what many studies have shown among various racial/ethnic groups-having network members who use substances increases the chance of use. Findings also highlight that traditional practices may be an important part of the prevention approach for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Understanding how whānau-centred initiatives can improve Māori health in Aotearoa New Zealand

This article highlights the significance of prioritizing Indigenous voices and knowledge systems, using whānau-centred initiatives (a concept that encompasses the broader family and community) as a foundation for health promotion within an Indigenous context. Tū Kahikatea, a conceptual framework, is used to demonstrate the relationship between the values underpinning different whānau-centred initiatives and their corresponding outcomes. The framework highlights the capacity of whānau-centred initiatives to support whānau in attaining mana motuhake, which represents collective self-determination and the ability to exercise control over their own future. By doing so, these initiatives contribute to the improvement of whānau health outcomes. With recent changes to Aotearoa New Zealand's health system, the findings underscore the benefits and potential of whānau-centred initiatives in enhancing whānau health outcomes, and advocate for continued strengths-based practices in Aotearoa New Zealand's health system. By bridging the gap between academia and grassroots community action, the article demonstrates the potential of whānau-centred initiatives and contributes to a global call for integrating Indigenous viewpoints and practices into Westernized healthcare, in order to improve Indigenous health outcomes.

Baseline results from NenŨnkUmbi/EdaHiYedo: A randomized clinical trial to improve sexual and reproductive health among American Indian adolescents

We report on baseline findings from NenUnkUmbi/EdaHiYedo, a community based participatory research randomized controlled trial with American Indian adolescents to reduce sexual and reproductive health disparities. American Indian adolescents aged 13-19 years participated in a baseline survey that was administered in five schools. We used zero-inflated negative binomial regression to evaluate how the count of protected sexual acts was associated with independent variables of interest. We stratified models by self-reported gender of adolescents and tested for a two-way interaction effect between gender and the independent variable of interest. Two hundred twenty-three girls and 222 boys (n = 445) were sampled. The average number of lifetime partners was 1.0 (standard deviation = 1.7). Each additional lifetime partner was associated with a 50% increase in the number of protected sexual acts incident rate ratio (IRR = 1.5, 95% confidence interval [CI] 1.1-1.9) and more than a twofold increase in the likelihood of not having protected sexual acts (adjusted odd ratio [aOR] = 2.6, 95% CI 1.3-5.1). Each additional number of substances used in adolescentss' lifetime was associated with an increased likelihood of not having protected sexual acts (aOR = 1.2, 95% CI 1.0-1.5). In boys, each one standard deviation increase in depression severity was associated with a 50% reduction in the number of times a condom was used adjusted IRR (aIRR = 0.5, 95% CI 0.4-0.6, p < .001). Each 1-unit increase in positive prospections of pregnancy was associated with a pronounced decrease likelihood of not having protected sexual acts (aOR = 0.01, 95% CI 0.0-0.1). Findings support the importance of tribally driven tailoring of sexual and reproducive health interventions and services for American Indian adolescents.

The role of culture in the association between racial discrimination and alcohol use among North American Indigenous adolescents reporting recent drinking

BACKGROUND

North American Indigenous (NAI) communities have identified alcohol use as a primary health concern. Experiences of racial discrimination are associated with greater alcohol use, but findings are mixed regarding the role of culture in this relationship. The goal of the present study was to examine the role of culture in the association between racial discrimination and alcohol use.

METHODS

Across two studies (Study 1: N = 52; Study 2: N = 1743), NAI adolescents living on or near NAI reservations who reported recent alcohol use completed self-report measures of racial discrimination, cultural affiliation, and alcohol use (e.g., frequency).

RESULTS

Bivariate correlations revealed a significant positive association between racial discrimination and alcohol use (Study 1: r = 0.31, p = 0.029; Study 2: r = 0.14, p < 0.001) but not between cultural affiliation and alcohol use. Racial discrimination and cultural affiliation were significantly positively correlated in Study 1 (r = 0.18, p < 0.001), but not in Study 2. Across both studies, the interactions between racial discrimination and cultural affiliation significantly predicted alcohol use in unadjusted models (Study 1: b = 0.70, SE = 0.32, p = 0.033, 95% CI [0.06, 1.33]; Study 2: b = 0.01, SE = 0.01, p = 0.041, 95% CI [0.001, 0.03]), such that the association between racial discrimination and alcohol use was stronger for adolescents reporting high (vs. low) levels of cultural affiliation. In adjusted models controlling for age and sex, the interaction between racial discrimination and cultural affiliation remained significant in Study 2 (b = 0.01, SE = 0.01, p = 0.0496, 95% CI [0.00002, 0.03]) but was no longer significant in Study 1.

CONCLUSIONS

Findings speak to the need to reduce racial discrimination against NAI youth and to consider youths' different needs based on level of cultural affiliation to reduce subsequent alcohol consumption.

Culturally Relevant Physical Activity in the Behavioral Risk Factor Surveillance System in Hawai'i

INTRODUCTION

Culturally relevant physical activity is a promising field for chronic disease prevention and management. Native Hawaiians and Other Pacific Islanders have higher rates of physical inactivity than other racial or ethnic groups and increased risk of chronic disease. The study objective was to provide population-level data from Hawai'i on lifetime experiences in the Native Hawaiian Indigenous practices of hula and outrigger canoe paddling across demographic and health factors to identify opportunities for public health intervention, engagement, and surveillance.

METHODS

Questions about hula and paddling were added to the Hawai'i 2018 and 2019 Behavioral Risk Factor Surveillance System (N = 13,548). We considered level of engagement by demographic categories and health status indicators, accounting for the complex survey design.

RESULTS

Overall, 24.5% of adults engaged in hula and 19.8% in paddling in their lifetime. Prevalence of engagement was higher among Native Hawaiians (48.8% hula, 41.5% paddling) and Other Pacific Islanders (35.3% hula, 31.1% paddling) than among other racial and ethnic groups. In adjusted rate ratios, experience in these activities was strong across age groups, education, sex, and income levels, particularly among Native Hawaiians and Other Pacific Islanders.

CONCLUSION

Throughout Hawai'i, hula and outrigger canoe paddling are important and popular cultural practices with high physical activity demands. Participation was notably high for Native Hawaiians and Other Pacific Islanders. Surveillance information around culturally relevant physical activities can benefit public health programming and research from a strength-based community perspective.

"Make Stories That Will Always Be There": Eagle Books' Appeal, Sustainability, and Contributions to Public Health, 2006-2022

PURPOSE AND OBJECTIVES

We aimed to determine why the Eagle Books, an illustrated series for American Indian and Alaska Native (AIAN) children to address type 2 diabetes, remain viable long after their release. We sought to answer 2 questions: Why did the books maintain popularity? What factors have sustained them?

INTERVENTION APPROACH

Type 2 diabetes burgeoned in the US after World War II, compounding a long legacy of injustices for AIAN peoples. By the 1980s, their rates soared above those of White people. Concerned for future generations, Tribal Leaders suggested that the Centers for Disease Control and Prevention and Indian Health Service use traditional storytelling to teach children about staying healthy. Public health interventions are most effective when culture and history are integrated into health education, particularly stories to address a relatively new disease for AIAN peoples.

EVALUATION METHODS

From 2008 through 2013, we conducted a case study among 8 tribal communities to evaluate the uptake of the Eagle Books across Indian Country. To understand the Eagle Books' sustained appeal, in 2022 we reanalyzed the original case study themes and analyzed for the first time themes that emerged from evaluation results in the Eagle Books' program literature. These were programs that had independently evaluated their use of the Eagle Books and published their findings.

RESULTS

Outcomes demonstrated continuous application of the Eagle Books in diverse community interventions, influencing children's healthy choices. Community implementers described sustainability components, such as the books' versatility, flexibility of use, and availability online and in print.

IMPLICATIONS FOR PUBLIC HEALTH

Historical, social, economic, and environmental health determinants intersect with biological and behavioral factors to weave a complex web of causation for type 2 diabetes, beginning early in life. Compelling, colorful stories reflecting traditional wisdom and respect for Western and Indigenous science - through the eyes of a wise eagle, a clever rabbit, a tricky coyote, and kids in T-shirts and sneakers - can positively influence community health.

Evidence of secular trends during the COVID-19 pandemic in a stepped wedge cluster randomized trial examining sexual and reproductive health outcomes among Indigenous youth

BACKGROUND

Nen ŨnkUmbi/EdaHiYedo ("We Are Here Now," or NE) is an intervention to prevent STIs, HIV, HCV, and teen pregnancy among Assiniboine and Sioux youth of the Fort Peck Reservation in the state of Montana in the USA. A cluster-randomized stepped-wedge design (SWD) trial is used to evaluate NE, where clusters are schools. The purpose of this study is to evaluate whether there is evidence of a secular trend associated with the COVID-19 pandemic.

METHODS

The original study design is a cluster-randomized stepped-wedge design (SWD), in which five schools that youth from Fort Peck attend are the clusters to be randomized into the intervention one at a time, with all schools eventually being randomized to the intervention across three steps. N/E is a 5-year study involving 456 15- to 18-year-old youth. For this study, we use a mixed quantitative and qualitative methods approach to understand how the COVID-19 pandemic may have been associated with the study's primary outcome variables. Data were drawn from the first cluster exposed to the intervention and one control cluster that did not yet receive the intervention during the period in which COVID-19 mitigation efforts were being implemented. A pre-post COVID questionnaire was added to core measures administered, and semistructured qualitative interviews were conducted with youths regarding their perceptions of how the pandemic altered their sexual behaviors.

RESULTS

One hundred eighteen youth responded to the questionnaire and 31 youth participated in semistructured qualitative interviews. Youth reporting having sex with less people due to COVID-19 reported more sex acts (incident rate ratio (IRR)=3.6, 95% CI 1.6-8.1) in comparison to those who did not report having sex with less people, and youth who reported having sex with the same amount of people due to COVID-19 reported less sex acts (IRR=0.31, 95% CI 0.14-0.7) in comparison to those who did not report having sex with the same amount of people. Youth reporting having sex less times due to COVID-19 experienced a greater number of sex acts in comparison to those who did not report having sex less times (IRR=2.7, 1.2-6.4). Results suggest that more sexually active individuals reported perceiving having sex with less people and less frequent engagement in sex during the pandemic. It is possible that the COVID-19 pandemic period was associated with a truncation in the distribution of sexual activity that would bias an estimate of the intervention's effect.

CONCLUSION

Findings suggest evidence of a secular trend. This trend must be accounted for at trial end, and sensitivity analyses are recommended. Documenting and reporting on these findings encourages transparent reporting during the implementation of a SWD trial during a global pandemic, and informs endline analyses.

TRIAL REGISTRATION

This trial is registered with the Clinical trials registry of the US National Library of Medicine at the National Institutes of Health (NIH). It was registered on October 1, 2018. The study presented in this manuscript is funded by NIH National Institute on Minority Health and Health Disparities (NIMHD), Award # R01MD012761-01, Elizabeth Rink (Principal Investigator). The study's ClinicalTrials.gov number is NCT03694418.

Communication and Perspectives About COVID-19 and Vaccinations Among Native Americans

The COVID-19 pandemic disproportionately affected Native American people and communities across the United States. Despite unequal losses during the pandemic, Native Americans have high vaccination rates. We provide insight into perspectives of COVID-19 and vaccinations through in-depth interviews with Native Americans. Through this research, we provide a holistic view of how Native Americans perceive vaccines by pairing Indigenous perspectives of risk and the Health Belief Model. We discuss the importance of tribal sovereignty in developing health communication strategies, and the need for messaging that is trusted and culturally appropriate.

Developing culturally-responsive health promotion: insights from cultural experts

Culturally-responsive health promotion initiatives are important to the creation of health equity for Indigenous and minority populations and these initiatives are complex and time-intensive to establish. The knowledge and resources of cultural experts are often pivotal in programs, yet there is minimal research on effective collaborations. The KāHOLO Project demonstrated strong success in the management of uncontrolled hypertension in the high-risk Indigenous population through a 6-month program based on the Hawaiian cultural dance of hula. This program was developed utilizing a community-based participatory research approach and implemented by cultural experts. To better understand the effectiveness of the research endeavor and program, six experienced hula experts and educators who delivered the community-based program were interviewed. As skilled and trusted cultural experts they set a safe supportive learning environment that promoted health and cultural goals. They articulated it was important that the program maintained cultural priorities and integrity. Through the methodical establishment of mutual respect, cooperation on research protocols and requirements was achieved. The development of cultural experts as health allies offers important inroads to the inclusion of minority and Indigenous cultures in health programming.

Enhancing American Indians'/Alaska Natives' Knowledge, Confidence, and Community During the Medical School Application Process: Findings From the Northwest Native American Center of Excellence

PURPOSE

To describe a Medical School Applicant Workshop (MSAW); present lessons learned about its impact on American Indian/Alaska Native (AIAN) participants' knowledge, confidence, and sense of community; and report on participants' medical school application progress 1 year after workshop completion.

METHOD

The Northwest Native American Center of Excellence at Oregon Health & Science University developed and implemented an annual 1-day AIAN MSAW in 2018. The main objectives of the workshop are for participants to gain insights into the medical school application process; learn strategies to competitively apply; receive feedback on their personal statement and mock interviews; and discuss the medical school application process with AIAN faculty, admissions deans, and peer-mentors. Recruitment of AIAN participants occurred via email; social media; text messaging; medical association contacts; and AIAN and science, technology, engineering, and mathematics organizations. Two surveys were administered: one immediately after and another 1-year after the workshop.

RESULTS

Forty AIAN MSAW participants were accepted in 2018-2020. Findings indicate statistically significant increases in participants' self-reported knowledge of the medical school application process and in their self-reported confidence. Participants reported meeting other AIAN students was highly beneficial and feeling connected to a community of AIAN health professionals after attending the workshop. Among the 25 participants who completed the 1-year follow-up survey, 12 (48.0%) indicated applying to medical school; all 12 of these participants were invited to interview, and 11 were offered acceptance to at least one medical school.

CONCLUSIONS

Completing the MSAW increased participants' knowledge, confidence, and sense of community. If other programs and institutions were to consider using the MSAW model to reduce barriers and provide supports specifically designed for AIANs before and during the medical school application process, medical schools may stand to further increase AIAN representation in the physician workforce and ultimately to decrease health inequities among AIANs.

Family listening/circle program: The experience of community action projects to promote family and community wellness in three tribal communities in New Mexico

Introduction

The Family Listening/Circle Program (FLCP) is a community-based participatory research (CBPR), culture-centered, intergenerational family strengthening program that was co-developed in partnership with the University of New Mexico's Center for Participatory Research (UNM-CPR) and three tribal communities (Pueblo of Jemez, Ramah Navajo, and Mescalero Apache) in New Mexico. The Family Listening/Circle Program brings together fourth and fifth graders, their parents, caregivers, and elders to reduce risky behaviors associated with the initiation of substance use among the youth, and to strengthen family communication and connectedness to culture and language as protective factors.

Methods

The tribal research teams (TRTs) from each community worked with UNM-CPR to co-create, pilot, implement, and evaluate the tribally-specific FL/CP curricula centered in their own tribal histories, language, knowledge, visions, and actions for the future. A key component of the FL/CP involved the planning and completion of community action projects (CAPs) by participating families. During the final session of the program, the families present their community action projects on poster boards, with children leading the presentations. The TRTs and UNM team document narratives of what was shared and learned by the families.

Results

The CAPs provide an empowerment and community benefit focus based on Paulo Freire's philosophy that people can become agents of change if they identify and work on issues that are important to them. The community action projects are also centered in Indigenous values and practices of reciprocity, responsibility, and being active members of the community.

Discussion

The CAPs added unique contributions to the Family Listening/Circle Program as the participants' learnings were strengthened when they had the opportunity to give back to their communities. The CAPs were important to document as they illustrated the potential range of effectiveness with their capacity to empower participants to address challenges within their communities, strengthen cultural norms and values, and improve the wellbeing of community members.

Gender-based differences in abstention and desistance from drug use among American Indian adolescents

Informed by the social control theoretical perspective, this study intends to identify the factors more likely to differentiate American Indian (AI) adolescents who never used illicit drugs (abstainers) and those who used drugs in the past but did not report recent drug usage (desisters) from their peers who reported lifetime and recent drug usage (persisters). This secondary analysis is based on data from a multi-site study conducted between 2009 and 2013. It is based on a gender-balanced sample (N = 3,380) of AI adolescents (50.50% male; Mean age = 14.75; SD = 1.69) representing the major AI languages and cultural groups in the U.S. Half of the AI adolescents reported lifetime drug use (50.40%), 37.50% never used drugs, and 12.10% stopped using drugs. When controlling for the variables included in the analysis, AI boys were significantly more likely than AI girls to desist from drug use. Both boys and girls who never used drugs tended to be younger, were less likely to have delinquent friends and a lower level of self-control, had stronger bonds to school, but lower levels of family attachment, and reported increased parental supervision. Compared to drug users, desisters associated significantly less with delinquent peers. While school attachment, self-control, and parental monitoring did not differentiate female desisters from female drug users, adolescent boys who desisted from drug use were more likely to report higher levels of school attachment and parental monitoring and their level of self-control was less likely to be low.

"It's Always About Sharing, and Caring, and Loving, and Giving": Decolonized and Transcendent Indigenist Foodways Fostering Health and Resilience

Centuries of historical oppression have targeted and undermined Indigenous foodways, which fundamentally disrupts the culture and wellness, yet decolonized, resilient, and transcendent Indigenist practices persist. The purpose of this research was to use the framework of historical oppression, resilience, and transcendence (FHORT) to understand foodway practices among Indigenous Peoples. Given a limited understanding of how foodways may promote health and wellness the focal research questions for this critical ethnographic inquiry were: (a) How do participants describe Indigenist foodways? (b) How do Indigenist foodways reflect decolonized values and practices? and (c) How may Indigenist foodways be promotive for health and wellness? Data were drawn from 31 participants across a rural, reservation-based Southeast (SE) region and an urban Northwest (NW) region. Reconstructive data analysis revealed the following emergent themes: (a) Indigenous Values of Generosity Expressed Through Foodways: "It's Always About Sharing, and Caring, and Loving, and Giving"; (b) Gardening, Subsistence, and Food Sharing: "You Bring Enough for Everybody to Share"; (c) Decolonized Feasts and Foodways: "Everybody Pitch in and Help as Much as They Can." Despite centuries of historical oppression, participants reported decolonized values, worldviews, and foodways that reflected unity, cooperation, sharing, and social cohesion and caring, which were promotive factors for family resilience, health, and cultural identification. This research provides promising pathways about how Indigenist foodways remain salient in daily and cultural life, reflect decolonized values and practices, and may be promotive for health and wellness within the natural world.

Centering culture in the treatment of opioid use disorder with American Indian and Alaska Native Communities: Contributions from a National Collaborative Board

American Indian/Alaska Native (AI/AN) communities are disproportionally impacted by the opioid overdose epidemic. There remains a dearth of research evaluating methods for effectively implementing treatments for opioid use disorder (OUD) within these communities. We describe proceedings from a 2-day Collaborative Board (CB) meeting tasked with developing an implementation intervention for AI/AN clinical programs to improve the delivery of medications to treat OUD (MOUD). The CB was comprised of Elders, cultural leaders, providers, individuals with lived experience with OUD, and researchers from over 25 communities, organizations, and academic institutions. Conversations were audio-recorded, transcribed, and coded by two academic researchers with interpretation oversight provided by the CB. These proceedings provided a foundation for ongoing CB work and a frame for developing the program-level implementation intervention using a strength-based and holistic model of OUD recovery and wellbeing. Topics of discussion posed to the CB included engagement and recovery strategies, integration of extended family traditions, and addressing stigma and building trust with providers and clients. Integration of traditional healing practices, ceremonies, and other cultural practices was recommended. The importance of centering AI/AN culture and involving family were highlighted as priorities for the intervention.

A Report on the Ke Ola O Ka 'Āina: 'Āina Connectedness Scale

Optimal health from a Native Hawaiian worldview is achieved by being pono (righteous) and maintaining lōkahi (balance) with all our relations, including our relationships as Kānaka (humankind) with 'Āina (land, nature, environment, that which feeds) and Akua (spiritual realm). The purpose of this study is to explore the role of 'Āina connectedness in Native Hawaiian health and resilience to inform the development of the 'Āina Connectedness Scale. Qualitative methods were conducted with 40 Native Hawaiian adults throughout Hawai'i. Three themes emerged: (1) 'Āina is everything; (2) Connection to 'Āina is imperative to health; and (3) Intergenerational health, healing, and resilience are reflected through intergenerational connectedness with 'Āina. Qualitative findings, supplemented with a scoping review of land, nature, and cultural connectedness scales, led to the development of the 'Āina Connectedness Scale, which examined the degree to which people feel connected to 'Āina, with implications for future research. 'Āina connectedness may address concerns related to health disparities that stem from colonization, historical trauma, and environmental changes and better our understanding of Native Hawaiian health by fostering stronger ties to land. Resilience- and 'Āina-based approaches are critically important to health equity and interventions that aim to improve Native Hawaiian health.