Culture and context: buffering the relationship between stressful life events and risky behaviors in American Indian youth

The resounding influence of benevolent childhood experiences

Research with Indigenous communities has demonstrated the detrimental impacts of intergenerational trauma and disproportionate adverse childhood experiences (ACEs) on health and behavioral outcomes in adulthood. A more balanced narrative that includes positive childhood experiences is needed. The construct of benevolent childhood experiences (BCEs) facilitates assessment of positive early life experiences and their impact on well-being for Indigenous peoples. We consider associations between BCEs and well-being when taking into account ACEs and adult positive experiences. Participants are from Healing Pathways, a longitudinal, community-based panel study with Indigenous families in the Midwestern United States and Canada. Data for the current analyses are derived from 453 participants interviewed at wave 9 of the study. Participants reported high levels of positive childhood experiences in the form of BCEs, with 86.5% of the wave 9 participants reporting experiencing at least six of seven positive indicators. BCEs were positively associated with young adult well-being. This relationship persisted even when accounting for ACEs and adult positive experiences. While ACEs were negatively correlated with young adult well-being, they were not significantly associated with well-being when considering family satisfaction and receiving emotional support. Evidence of high levels of BCEs reflects realities of strong Indigenous families and an abundance of positive childhood experiences.

Resilience and health in American Indians and Alaska Natives: A scoping review of the literature

American Indians and Alaska Natives suffer from disproportionately high rates of chronic mental and physical health conditions. These health inequities are linked to colonization and its downstream consequences. Most of the American Indian and Alaska Native health inequities research uses a deficit framework, failing to acknowledge the resilience of American Indian and Alaska Native people despite challenging historical and current contexts. This scoping review is based on a conceptual model which acknowledges the context of colonization and its consequences (psychological and health risk factors). However, rather than focusing on health risk, we focus on protective factors across three identified domains (social, psychological, and cultural/spiritual), and summarize documented relationships between these resilience factors and health outcomes. Based on the scoping review of the literature, we note gaps in extant knowledge and recommend future directions. The findings summarized here can be used to inform and shape future interventions which aim to optimize health and well-being in American Indian and Alaska Native peoples.

Trauma and Substance Use among Indigenous Peoples of the United States and Canada: A Scoping Review

Substance use has been identified by Indigenous populations as contributing to health disparities facing their communities. Rates of trauma exposure and post-traumatic stress disorder are higher in Indigenous, compared to non-Indigenous, populations and have been linked to substance use. Historical trauma is thought to be one mechanism underlying substance use and related disorders. The purpose of the present study is to summarize the current state of the literature focusing on the association between trauma (historical and lived) and substance use among Indigenous populations in the United States and Canada. Databases were systematically searched using the preferred reporting items for systematic reviews and meta-analyses statement. The search strategy initially yielded 4,026 articles. After exclusion of ineligible articles, 63 articles remained for synthesis. Results of the present review provide evidence for a positive link between substance use and both historical trauma (i.e., 86.4% of studies) and lived trauma (i.e., 84.7% of studies). Indigenous participants reported that historical trauma and pain related to loss of cultural identity contributed to substance use in their communities. Indigenous participants also consistently described an association between lived trauma and substance use. Despite heterogeneity among Indigenous communities, findings suggest a significant association between trauma and substance use across many different tribes and settings (e.g., reservation/reserve, rural/urban). Indigenous participants identified healing from trauma and reconnecting with culture as necessary components for reducing substance use and maintaining sobriety. With this, the development and implementation of interventions should partner with Indigenous communities in a manner that promotes and enhances cultural values for healing.

Race-Ethnic Differences in the Effects of COVID-19 on the Work, Stress, and Financial Outcomes of Older Adults

OBJECTIVES

This study investigates race-ethnic differences among older non-Hispanic Black, non-Hispanic White, and Hispanic adults' financial, employment, and stress consequences of COVID-19.

METHODS

We use data from the Health and Retirement Study, including the 2020 COVID-panel, to evaluate a sample of 2,929 adults using a combination of bivariate tests, OLS regression analysis, and moderation tests.

RESULTS

Hispanic and non-Hispanic Black older adults experienced more financial hardships, higher levels of COVID-19 stress, and higher rates of job loss associated with COVID-19 relative to their Non-Hispanic White counterparts. Non-Hispanic Black and Hispanic adults reported significantly higher levels of COVID-19 resilience resources, yet, these resources were not protective of the consequences of COVID-19.

DISCUSSION

Understanding how the experiences of managing and coping with COVID-19 stressors differ by race-ethnicity can better inform intervention design and support services.

Indigenous Cultural Identity Protects Against Intergenerational Transmission of ACEs Among Indigenous Caregivers and Their Children

A large body of empirical research has demonstrated that caregiver adverse childhood experiences (ACEs) predict ACEs in one's child, a phenomenon known as the intergenerational transmission of ACEs. Little of this empirical research, however, has focused specifically on Indigenous peoples despite a growing body of theoretical literature and the wisdom of Elders and Traditional Knowledge Keepers that speaks to the presence of this phenomenon within Indigenous communities as well as the protective role of Indigenous cultural identity in preventing the intergenerational transmission of ACEs. The purpose of the current study was to conduct an empirical evaluation of this hypothesis, specifically that Indigenous cultural identity and social support protects against the intergenerational transmission of ACEs among Indigenous peoples and their children in the USA. Participants were 106 Indigenous women caregivers of children ages 10 to 14 in South Dakota who completed surveys. Results showed that Indigenous cultural identity moderated the association between caregiver ACEs and child ACEs. At high levels of cultural identity, there was no association between caregiver ACEs and child ACEs. At low levels of Indigenous cultural identity, however, there was a strong and positive relationship between caregiver ACEs and child ACEs. Social support did not moderate the association between caregiver ACEs and child ACEs. These findings underscore the need for initiatives that enhance Indigenous cultural identity and social support among Indigenous caregivers to prevent the intergenerational transmission of ACEs.

American Indian Alaska Native (AIAN) adolescents and obesity: the influence of social determinants of health, mental health, and substance use

OBJECTIVE

To explore the prevalence of obesity among American Indian and Alaska Native (AIAN) adolescents aged 12-19 years in association with social determinants of health (SDOH), and mental health and substance use disorders.

METHODS

Guided by the World Health Organization's Social Determinants of Health Framework, we examined data from the Indian Health Service (IHS) Improving Health Care Delivery Data Project from Fiscal Year 2013, supplemented by county-level data from the U.S. Census and USDA. Our sample included 26,226 AIAN adolescents ages 12-19 years. We described obesity prevalence in relationship to SDOH and adolescents' mental health and substance use disorder status. We then fit a multivariable logit generalized linear mixed model to estimate the relationships after adjusting for other individual and county level characteristics.

RESULTS

We observed a prevalence of 32.5% for obesity, 13.8% for mental health disorders, and 5.5% for substance use disorders. Females had lower odds of obesity than males (OR = 0.76, p < 0.001), which decreased with age. Having Medicaid coverage (OR = 1.09, p < 0.01), residing in a county with lower education attainment (OR = 1.17, p < 0.05), and residing in a county with higher rates of poverty (OR = 1.51, p < 0.001) were each associated with higher odds of obesity. Residing in a county with high access to a grocery store (OR = 0.73, p < 0.001) and residing in a county with a higher proportion of AIANs (OR = 0.83, p < 0.01) were each associated with lower odds of obesity. Those with mental health disorders had higher odds of obesity (OR = 1.26, p < 0.001); substance use disorders were associated with decreased odds of obesity (OR = 0.73, p < 0.001).

CONCLUSIONS

Our findings inform future obesity prevention and treatment programs among AIAN youth; in particular, the need to consider mental health, substance use, and SDOH.

Profiles of Ecosystemic Resilience and Risk: American Indian Adolescent Substance Use during the First Year of the COVID-19 Crisis

The COVID-19 pandemic has caused an unprecedented disruption to the lives of American Indian (AI) adolescents. While reservation-area AI youth already have a higher risk of substance use (SU) compared to their non-AI peers, COVID-19 stressors likely exacerbated this risk. However, COVID-19-specific and general resilience factors may have buffered against increased SU over the course of the pandemic. Using a person-centered, ecosystemic framework of resilience, we used latent profile analysis to identify ecosystemic resilience profiles indicated by general and COVID-19-specific risk and resilience factors, then examined inter-profile changes in alcohol and cannabis use after the onset of the COVID-19 pandemic from the spring of 2020 to the spring of 2021. The sample was 2218 reservation-area AI adolescents (7-12th grade; schools = 20; Mage = 15, SD = 1.7; 52% female). Four profiles emerged: Average Risk and Resilience, High Resilience, Low Resilience, and High Risk. Adolescents with a High-Risk profile demonstrated increases in alcohol and cannabis use, while High Resilience youth demonstrated decreases. These findings support the hypothesized COVID-19-specific ecosystemic resilience profiles and the application of a person-centered ecosystemic framework to identify which AI adolescents are most likely to experience substance use changes during a life-altering crisis like COVID-19.

Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use

Objective

The American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults.

Methods

We analyzed baseline self-report data from 254 Native adults ages 18-55 years with recent binge substance use who were enrolled in an evaluation of "EMPWR," a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers.

Results

A little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38).

Conclusion

Our findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.

Cumulative Stressors and Adolescent Substance Use: A Review of 21st-Century Literature

The aim of this review is to assess empirical studies from the last 2 decades that have examined the association between cumulative stressors and adolescent substance use. Cumulative stressors were measured in these studies with adverse childhood experiences or adolescent stressful life events inventories. The 109 articles meeting the eligibility criteria that emerged from the review demonstrated a consistent, yet modest, association between cumulative stressors and adolescent substance use. Of note, several studies found that the associations were moderated or mediated by genetic factors related to cortisol regulation, intrapersonal factors such as low self-control, or interpersonal factors such as peer substance use. The review's findings thus suggest that efforts to reduce the effects of cumulative stressors on substance use could gainfully identify and target these risk moderators and mediators.

Cultural Protection from Polysubstance Use Among Native American Adolescents and Young Adults

Reservation-based Native American youth are at disproportionate risk for high-risk substance use. The culture-as-treatment hypothesis suggests aspects of tribal culture can support prevention and healing in this context; however, the protective role of communal mastery and tribal identity have yet to be fully explored. The objectives of this study were to investigate (1) the relationship between cultural factors and high-risk substance use, which includes polysubstance use, early initiation of alcohol and illicit drugs, and binge drinking, and (2) substance use frequency and prevalence of various substances via cross-sectional design. Multiple logistic regression modeling was used to analyze data from 288 tribal members (15–24 years of age) residing on/near the Fort Peck Reservation in the Northern Plains. When controlling for childhood trauma and school attendance, having at least a high school education (OR = 0.434, p = 0.028), increased communal mastery (OR = 0.931, p = 0.007), and higher levels of tribal identity (OR = 0.579, p = 0.009) were significantly associated with lower odds of polysubstance use. Overall prevalence of polysubstance use was 50%, and binge drinking had the highest single substance prevalence (66%). Prevalence of early initiation of substances (≤ 14 years) was inhalants (70%), alcohol (61%), marijuana (74%), methamphetamine (23%), and prescription drug misuse (23%). Hydrocodone, an opioid, was the most frequently misused prescription drug. Findings indicate programs focused on promoting education engagement, communal mastery, and tribal identity may mitigate substance use for Native American adolescents living in high-risk, reservation-based settings.

Indigenous Youth and Resilience in Canada and the USA: a Scoping Review

Relative to non-Indigenous youth, Indigenous youth have been under-represented when studying pathways to mental wellness. Yet, a broad range of adversity is acknowledged, from intergenerational and ongoing trauma arising from colonial policies. This scoping review explores resilience definitions, measures, key stressors, and what Indigenous youth identify as pathways to their wellness, based on quantitative and qualitative peer-reviewed literature in Canada and the Continental United States. Eight databases (EBSCO, PsycINFO, Science Direct, Social Science Citation Index, Web of Science, PsycARTICLES, and EMBASE) and hand searches of 7 relevant journals were conducted to ensure literature coverage. Two independent reviewers screened each article, with one Indigenous screener per article. The final scoping review analysis included 44 articles. In articles, no Indigenous term for resilience was found, but related concepts were identified ("walking a good path," "good mind," Grandfathers' teachings on 7 values, decision-making for 7 generations into the future, etc.). Few Indigenous-specific measures of resilience exist, with studies relying on Western measures of psychological resilience. Qualitative approaches supporting youth-led resilience definitions yielded important insights. Youth stressors included the following: substance use, family instability, and loss of cultural identity. Youth resilience strategies included the following: having a future orientation, cultural pride, learning from the natural world, and interacting with community members (e.g., relationship with Elders, being in community and on the land). Indigenous traditional knowledge and cultural continuity serve as prominent pathways to Indigenous youth resilience. More research is needed to yield a holistic, youth-centered measure of resilience that includes traditional practices.

The mediation and moderation effect of social support on the relationship between opioid misuse and suicide attempts among native American youth in New Mexico: 2009-2019 Youth Risk Resiliency Survey (NM-YRRS)

BACKGROUND

Suicide attempt and opioid misuse continue to be major behavioral health challenges among American Indians and Alaska Natives (AI/AN). The aim of the study is to evaluate the mediating and moderating role that social support (SS) plays in their association among AI/AN high-school students in New Mexico (NM).

METHODS

An aggregated NM Youth Resiliency and Risk Survey (NM-YRRS, 2009-2019: odd years) dataset was used. Multivariable logistic regression modeling and mediation analysis were conducted while adjusting for confounding variables.

RESULTS

Overall, 12.0 and 14.0% of AI/AN students reported opioid misuse and suicide attempt, respectively. The adjusted odds ratio of suicide attempt in students with high SS relative to low SS who misused opioids was 0.43 (p-value = 0.007). The effect of high SS relative to low SS among males who misused opioids was more pronounced (AOR = 0.24, p-value < 0.0001) compared to females (AOR = 0.43, p-value = 0.007). Relative to low SS, high SS was protective for suicide attempt among AI/AN students who misused opioids and attended school in off-reservation (AOR = 0.42, p-value = 0.012) communities, rural communities (AOR = 0.44, p = 0.040), and in communities that are both rural and off-reservation (AOR = 0.39, p = 0.035). Overall, 23.64, and 41.05% of the association between opioid misuse, and suicide attempt was mediated and moderated by SS, respectively. The mediation effect of SS was lowest for rural, on-reservation schools.

CONCLUSION

More resources need to be allocated to rural on-reservation schools to enhance social support. The study highlights key insights into the significant role SS plays in promoting health and mitigating the association between opioid misuse and suicide attempt.

Substance and Behavioral Addictions among American Indian and Alaska Native Populations

OBJECTIVE

This paper examines substance and behavioral addictions among American Indian and Alaska Natives (AIAN) to identify the structural and psychosocial risk and cultural protective factors that are associated with substance use and behavioral addictions.

METHODS

Five databases were used to search for peer reviewed articles through December 2021 that examined substance and behavioral addictions among AIANs.

RESULTS

The literature search identified 69 articles. Numerous risk factors (i.e., life stressors, severe trauma, family history of alcohol use) and protective factors (i.e., ethnic identity, family support) influence multiple substance (i.e., commercial tobacco, alcohol, opioid, stimulants) and behavioral (e.g., gambling) addictions.

CONCLUSIONS

There is a dearth of research on behavioral addictions among AIANs. Unique risk factors in AIAN communities such as historical trauma and socioeconomic challenges have interfered with traditional cultural resilience factors and have increased the risk of behavioral addictions. Future research on resilience factors and effective prevention and treatment interventions could help AIANs avoid behavioral addictions.

Indigenous standpoint theory as a theoretical framework for decolonizing social science health research with American Indian communities

Theoretical frameworks rooted in Western knowledge claims utilized for public health research in the social sciences are not inclusive of American Indian communities. Developed by Indigenous researchers, Indigenous standpoint theory builds from and moves beyond Western theoretical frameworks. We argue that using Indigenous standpoint theory in partnership with American Indian communities works to decolonize research related to American Indian health in the social sciences and combats the effects of colonization in three ways. First, Indigenous standpoint theory aids in interpreting how the intersections unique to American Indians including the effects of colonization, tribal and other identities, and cultural context are linked to structural inequalities for American Indian communities. Second, Indigenous standpoint theory integrates Indigenous ways of knowing with Western research orientations and methodologies in a collaborative process that works to decolonize social science research for American Indians. Third, Indigenous standpoint theory promotes direct application of research benefits to American Indian communities.

“Then Who Are You?”: Young American Indian and Alaska Native Women Navigating Cultural Connectedness in Dating and Relationships

Despite disproportionately high rates of intimate partner violence among American Indian and Alaska Native (AI/AN) women and associations between adolescent dating violence and partner violence in adulthood, little to no research has focused on dating and relationships among AI/AN adolescents. Using exploratory thematic analysis with focus group data (N = 16), we explore this topic among a sample of young AI/AN women (ages 15–17). Results suggest that dating may enhance or inhibit connections to culture or tribal identity. Moreover, responsibility for sustaining cultural knowledge, practices, and lineage may influence choices of reproductive partners for Native women living within colonial structures of governance. The greatest threat in relationships were similar to those from settler colonialism—loss of culture and consequently, self. Promoting healthy relationships among this population should include cultural safety, identity, and involvement, as well as a focus on broader systems, including enrollment policies, that may influence these relationships. Supportive networks and mentorship related to identity and cultural involvement should be available for young AI/AN women. In response to this Special Issue’s call for work that offers creative approaches to conveying knowledge and disruptions to what are considered acceptable narrative approaches we offer illustrations as well as text.

Culture, Social Support, and Diabetes Empowerment Among American Indian Adults Living With Type 2 Diabetes

OBJECTIVE | Type 2 diabetes represents a major health disparity for many American Indian/Alaska Native (AIAN) communities, in which prevalence rates are more than double that of the general U.S. population. Diabetes is a major indicator for other comorbidities, including the leading cause of death for AIANs (i.e., cardiovascular disease). This study investigated associations between protective factors (social support and cultural factors) and self-reported empowerment to manage illness. DESIGN AND METHODS | Participants were drawn from a random sample of tribal clinic records. Data included results from computer-assisted personal interviews with 192 American Indian adults with a diagnosis of type 2 diabetes living on or near a reservation. Community Research Councils, developed at each of the five partnering Anishinaabe reservations, oversaw protocols and procedures in this community-based participatory research collaboration. RESULTS | Multiple ordinary least squares regression models determined that general social support and diabetes-specific social support are positively related to diabetes empowerment. These associations persisted when both social support measures were added to the model, indicating independent effects of different types of social support. Cultural identity and cultural practices were positively related to diabetes empowerment in bivariate analyses; however, both measures dropped from statistical significance after accounting for all other covariates. An interaction term revealed a moderation effect through which cultural identity amplified the positive relationship between social support and diabetes empowerment. CONCLUSION | Results moderately support policy and risk-reduction efforts aiming at expanding social support networks into multiple domains and reinforcing cultural identity and cultural practices.

Examination of Recreational and Spiritual Peyote Use Among American Indian Youth

OBJECTIVE

Some American Indians legally use hallucinogenic substances as part of religious and spiritual ceremonies. Research to date has either failed to differentiate spiritual versus recreational use or has categorized hallucinogen use in an "other drug" or "illegal drug" category. This approach could contribute to ineffectual models of prevention and treatment intervention and limit understanding of hallucinogen use in American Indian cultures.

METHOD

This study is a secondary data analysis of an ongoing epidemiologic and etiologic investigation of substance use among American Indian youth (N = 3,861). Two Firth logistic regression models were run with (a) spiritual peyote use and (b) recreational peyote use as the dependent variables, and grade, sex, 30-day alcohol use, 30-day marijuana use, religiosity, religious affiliation, and cultural identity as predictors, as well as a grade by sex interaction term.

RESULTS

Grade, sex, religious affiliation, and the interaction term did not predict either recreational or spiritual peyote use. Thirty-day alcohol and marijuana use predicted both spiritual and recreational peyote use, but the effects were stronger for predicting recreational use. Religiosity and cultural identity predicted spiritual but not recreational use, such that American Indian youth who identified as more religious and identified more strongly with their culture were more likely to report using peyote for spiritual purposes.

CONCLUSIONS

Our results suggest that current self-reported use of alcohol and/or marijuana by American Indian youth indicates an increased likelihood of using peyote. In addition, use of Firth logistic regression models proved feasible for analyzing rare events like peyote use.

Identification with ancestral culture is associated with fewer internalizing problems among older Naskapi adolescents

The manifestations of externalizing and internalizing behaviors among minority adolescents might best be understood by examining their relation to culturally specific factors, such as cultural identity, as well as to factors that seem to be relevant across cultures, such as age and gender. In this study, we examined the roles of age and gender in moderating the relation between self-reported cultural identity and externalizing and internalizing problems and the interaction between Indigenous and Mainstream cultural identity in relation to problematic behaviors. The participants included 61 students (32 female) with a mean age of 14.5 years (SD = 1.69) from a Naskapi reserve in Quebec, Canada. Age moderated the relation between identification with Indigenous culture and internalizing symptomatology. Indigenous and Mainstream cultural identity did not interact in predicting internalizing or externalizing problems. Consistent with the available evidence regarding the centrality of identity in adolescent development, the magnitude of the inverse relation between identification with Indigenous culture and number of clinical internalizing symptoms appears to increase in significance later in adolescence. The lack of an interaction between Indigenous and Mainstream cultural identity in relation to internalizing and externalizing problems suggests that it is the need to consider both cultures individually without the assumption that one negates the other.

Sources of Stress Among Midwest American Indian Adults with Type 2 Diabetes

Despite alarming health disparities among American Indians (AIs) and acknowledgement that stressors negatively influence health, conceptualization of the full spectrum of stressors that impact Indigenous communities is underdeveloped. To address this gap, we analyze focus group transcripts of AI adults with type 2 diabetes from five tribal communities and classify stressors using an inductive/deductive analytical approach. A Continuum of American Indian Stressor Model was constructed from categorization of nineteen stressor categories within four domains. We further identified poverty, genocide, and colonization as fundamental causes of contemporary stress and health outcomes for AIs and conclude that stressors are generally experienced as chronic, regardless of the duration of the stressor. This work on AI-specific stressors informs future health research on the stress burden in AI communities and identifies target points for intervention and health promotion.

Moving the prevention timeline: A scoping review of the literature on precursors to sexual risk in early adolescence among youth of color

INTRODUCTION

Sexual health disparities are leading causes of morbidity among youth of color in the United States. We conducted a scoping review of the literature on precursors to sexual risk-taking among young adolescents of color (ages 10-14) to assess precedents of sexual experience and their utility as measurable proximal constructs and behaviors gauging sexual risk and sexual risk prevention efforts.

METHODS

This study was conducted using the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. We searched for quantitative studies that assessed the relationships between precursors and subsequent sexual behaviors, incorporated youth of color, and specified young adolescents as the study sample. All articles were in English, however we explored both U.S. and International databases.

RESULTS

The database search yielded 11 studies published between 2000 and 2017. Most literature focused on youth in urban settings, and on Black and Latinx youth, while only two addressed the special circumstances of American Indian and Alaska Native youth. Sex expectancies outcomes for youth of color were likely to predict sexual risk taking and self-efficacy about sex was related to abstinence.

CONCLUSIONS

Etiologic studies that seek to understand precursors to sexual risk taking among youth of color are limited and this paucity truncates the ability to develop sexual risk prevention programs for the age group in which prevention is most needed.

Spirituality, Ethnic Identity, and Substance Use among American Indian/Alaska Native Adolescents in California

Background. American Indian/Alaska Native (AIAN) adolescents have a higher prevalence of commercial tobacco, alcohol, and marijuana use than other racial/ethnic groups in the United States. It is unclear whether cultural factors such as ethnic identity, spirituality, and ceremonial use of traditional tobacco are associated with substance use, especially use of emerging tobacco products such as electronic cigarettes, among AIAN adolescents. Methods. This study investigated the association between hypothesized cultural protective factors (ethnic identity, spirituality, and ceremonial use of traditional tobacco) and past-month use of commercial cigarettes, e-cigarettes, marijuana, blunts, and alcohol among 156 AIAN adolescents in California (mean age = 15.3 years, 55% female). Adolescents from six AIAN schools and afterschool programs completed paper-and-pencil surveys. We used Logistic regression analyses to identify the significant cultural correlates of past-month substance use, controlling for demographic covariates. Results. As hypothesized, strong ethnic identity was protective against cigarette, marijuana, and alcohol use. However, it was not protective against e-cigarette or blunt use. Spirituality was associated with an increased risk of cigarette and marijuana use. Previous ceremonial use of traditional tobacco was not associated with past-month recreational substance use. Conclusions. Results indicate that the associations between cultural factors and substance use vary across substances. Future research should identify cultural factors that protect AIAN adolescents against use of newer products such as e-cigarettes and blunts.

Revisiting resilience: Examining the relationships between stress, social support, and drinking behavior among black college students with parental substance use disorder histories

The study examined the role social support plays in the relationship between life stress and problem alcohol use behavior in a sample of Black emerging adults in college with histories of parental substance use disorders (SUD). Participants were 1,007 Black emerging adult college students, recruited as part of a larger multi-wave, multisite, study investigating coping behavior among emerging adults in college. Findings suggest that Black college students with parental SUDs engage in riskier and coping motivated drinking behaviors more than those without such histories, and their alcohol use behaviors are more strongly linked to experiencing life stress, despite similar levels of perceived social support. Social support from friends and sufficient global social support help to mediate this adverse relationship. Parental SUD may serve as a readily identifiable risk factor for risky drinking behavior among Black college students. Implications for future research and clinical practice are presented.

Self-esteem, cultural identification, and substance use among American Indian youth

OBJECTIVES

Determine potential mediating and moderating effects of self-esteem on the relationship between cultural identification and substance use among American Indian (AI) youth.

METHODS

Anonymous surveys were administered to middle and high school AI students assessing levels of last month alcohol and marijuana use, cultural identification, and self-esteem. Structural equation modeling assessed potential mediating and moderating effects of self-esteem on the relationship between AI and white identification on alcohol and marijuana use.

RESULTS

No mediating effects were found for middle school students. Among high school students, no mediating effects were found for alcohol. Among female high school students, a small mediating effect was found between AI identification and marijuana use, with AI identification protecting against use. Across all students, no moderating effects of self-esteem were found.

CONCLUSIONS

The literature on cultural identification and substance use among minority youth is unclear. It was anticipated that consideration of self-esteem as a potential mediator or moderator might help clarify some of the confusion. However, no moderating effects were found and mediating effects were limited to female high school students for marijuana. Consideration should be given to assessing other measures of cultural identification and subscales of self-esteem to confirm that these findings are robust.

Native American adolescent narrative written stories of stress

OBJECTIVE(S)

The purpose of this paper is to report study findings related to themes of stress and coping strategies experienced by non-reservation-based Native American adolescents as expressed by their written stories.

DESIGN

A qualitative descriptive narrative approach was used to capture written stories of stress.

ANALYSIS

Key concepts and themes were identified by using the consensual qualitative research (CQR) approach from the participant's stories of stress.

RESULTS

Written stories of stress were collected and analyzed from a convenience sample of 179 Native American adolescent's ages 13-18-years old. Five major themes related to experiences of stress emerged from the stories including (a) relationships, (b) responsibilities, (c) socioeconomic status, (d) negative coping strategies, and (e) positive coping through Native-Reliance.

CONCLUSION

The findings reveal the importance of understanding the types and response to stress experienced by Native American adolescents.

Assessment of culture and environment in the Adolescent Brain and Cognitive Development Study: Rationale, description of measures, and early data

Neurodevelopmental maturation takes place in a social environment in addition to a neurobiological one. Characterization of social environmental factors that influence this process is therefore an essential component in developing an accurate model of adolescent brain and neurocognitive development, as well as susceptibility to change with the use of marijuana and other drugs. The creation of the Culture and Environment (CE) measurement component of the ABCD protocol was guided by this understanding. Three areas were identified by the CE Work Group as central to this process: influences relating to CE Group membership, influences created by the proximal social environment, influences stemming from social interactions. Eleven measures assess these influences, and by time of publication, will have been administered to well over 7,000 9-10 year-old children and one of their parents. Our report presents baseline data on psychometric characteristics (mean, standard deviation, range, skewness, coefficient alpha) of all measures within the battery. Effectiveness of the battery in differentiating 9-10 year olds who were classified as at higher and lower risk for marijuana use in adolescence was also evaluated. Psychometric characteristics on all measures were good to excellent; higher vs. lower risk contrasts were significant in areas where risk differentiation would be anticipated.

Substance Use Prevention for Urban American Indian Youth: A Efficacy Trial of the Culturally Adapted Living in 2 Worlds Program

This article describes a small efficacy trial of the Living in 2 Worlds (L2W) substance use prevention curriculum, a culturally adapted version of keepin' it REAL (kiR) redesigned for urban American Indian (AI) middle school students. Focused on strengthening resiliency and AI cultural engagement, L2W teaches drug resistance skills, decision making, and culturally grounded prevention messages. Using cluster random assignment, the research team randomized three urban middle schools with enrichment classes for AI students. AI teachers of these classes delivered the L2W curriculum in two schools; the remaining school implemented kiR, unadapted, and became the comparison group. AI students (N = 107) completed a pretest questionnaire before they received the manualized curriculum lessons, and a posttest (85% completion) 1 month after the final lesson. We assessed the adapted L2W intervention, compared to kiR, with paired t tests, baseline adjusted general linear models, and effect size estimates (Cohen's d). Differences between the L2W and kiR groups reached statistically significant thresholds for four outcomes. Youth receiving L2W, compared to kiR, reported less growth in cigarette use from pretest to posttest, less frequent use of the Leave drug resistance strategy, and less loss of connections to AI spirituality and cultural traditions. For other substance use behaviors and antecedents, the direction of the non-significant effects in small sample tests was toward more positive outcomes in L2W and small to medium effect sizes. Results suggest that evidence-based substance use prevention programs that are culturally adapted for urban AI adolescents, like L2W, can be a foundation for prevention approaches to help delay initiation and slow increases in substance use. In addition to study limitations, we discuss implementation challenges in delivering school-based interventions for urban AI populations.

Developmental Assets and Risky Sexual Behaviors among American Indian Youth

This study examined the relationship between developmental assets during early and mid-adolescence and early adult sexual behaviors among American Indians using a subsample from the National Longitudinal Study of Adolescent Health (N = 465). Grounded in an assets framework, the authors explored the protective role of personal, family, school, and community assets as well as cumulative assets for sexual behaviors including early sexual debut, number of sexual partners, and frequency of condom use. The results indicated that certain assets during early and mid-adolescence, such as self-control, family support, and school attachment were protective for various risky sexual behaviors in early adulthood. Furthermore, cumulative assets emerged as an important predictor of sexual behaviors. These findings highlight the utility of applying a developmental asset framework to understand protective factors among American Indian youth.

Self-Efficacy About Sexual Risk/Protective Behaviors: Intervention Impact Trajectories Among American Indian Youth

For adolescents, normative development encompasses learning to negotiate challenges of sexual situations; of special importance are skills to prevent early pregnancy, HIV, and other sexually transmitted diseases. Disparities in sexual risk among American Indian youth point to the importance of intervening to attenuate this risk. This study explored the impact of Circle of Life (COL), an HIV prevention intervention based on social cognitive theory, on trajectories of self-efficacy (refusing sex, avoiding sexual situations) among 635 students from 13 middle schools on one American Indian reservation. COL countered a normative decline of refusal self-efficacy among girls receiving the intervention by age 13, while girls participating at age 14 or older, girls in the comparison group, and all boys showed continuing declines.

A Cautionary Tale: Examining the Interplay of Culturally Specific Risk and Resilience Factors in Indigenous Communities

Efforts to build empirical evidence for the protective effects of Indigenous cultural factors on psychological health have yielded mixed findings. We examine the interplay of previously hypothesized culturally relevant risk (discrimination, historical loss) and protective (spiritual activities) factors among Indigenous people. The sample includes 569 Indigenous adolescents (M age = 17.23, SD = 0.88; 51.0% girls) and 563 Indigenous adult caregivers (M age = 44.66, SD = 9.18; 77.4% women). Our central finding was that indigenous spirituality was associated with poorer psychological outcomes across several domains (depressive symptoms, anger, anxiety, somatization and interpersonal difficulties), but observed effects were attenuated once perceived discrimination and historical losses were added to statistical models. Thus, consideration of relevant stressors drastically changed our conclusions, underscoring the uncertain dynamics through which specific Indigenous cultural factors impact mental health. Researchers should work in collaboration with Indigenous communities to improve measurement and empirical investigation of these complex constructs.

Racial Discrimination, Cultural Resilience, and Stress

OBJECTIVE

Racial discrimination is a social determinant of health for First Nations people. Cultural resilience has been regarded as a potentially positive resource for social outcomes. Using a compensatory model of resilience, this study sought to determine if cultural resilience (compensatory factor) neutralized or offset the detrimental effect of racial discrimination (social risk factor) on stress (outcome).

METHODS

Data were collected from October 2012 to February 2013 (N = 340) from adult members of the Kettle and Stony Point First Nation community in Ontario, Canada. The outcome was perceived stress; risk factor, racial discrimination; and compensatory factor, cultural resilience. Control variables included individual (education, sociability) and family (marital status, socioeconomic status) resilience resources and demographics (age and gender). The model was tested using sequential regression.

RESULTS

The risk factor, racial discrimination, increased stress across steps of the sequential model, while cultural resilience had an opposite modest effect on stress levels. In the final model with all variables, age and gender were significant, with the former having a negative effect on stress and women reporting higher levels of stress than males. Education, marital status, and socioeconomic status (household income) were not significant in the model. The model had R(2) = 0.21 and adjusted R(2) = 0.18 and semipartial correlation (squared) of 0.04 and 0.01 for racial discrimination and cultural resilience, respectively.

CONCLUSIONS

In this study, cultural resilience compensated for the detrimental effect of racial discrimination on stress in a modest manner. These findings may support the development of programs and services fostering First Nations culture, pending further study.

Moderating effects of perceived social benefits on inhalant initiation among American Indian and White youth

This study examined whether perceived social benefits moderated the relationship between social influence variables (school attachment, peer inhalant use, perceived family caring, and parental monitoring) and stage of inhalant initiation (Study 1) and lifetime inhalant use (Study 2). Participants were 7th to 12th grade students attending schools on or near American Indian reservations, with comparisons made between American Indian and White students. A total of 3,498 American Indian and 1,596 White students were surveyed. Differences in mean levels of social influence variables were found across ethnicity and stage of inhalant initiation and lifetime inhalant use. Structural equation models were evaluated to examine variable relationships for the 2 studies. For Study 1, social influence variables did not clearly differentiate early versus later inhalant initiators, and perceived social benefits failed to serve as a moderator. More differences were observed between users and nonusers across measures of social influence (Study 2). Perceived social benefits generally did not moderate the relationships, with 2 exceptions. Low perceived social benefits provided greater protection against the influence of peers on lifetime inhalant use among White students, whereas high perceived social benefits increased risk of peer influence among American Indian students. (PsycINFO Database Record

Stressful life events, ethnic identity, historical trauma, and participation in cultural activities: Associations with smoking behaviors among American Indian adolescents in California

INTRODUCTION

American Indian (AI) adolescents have the highest prevalence of commercial tobacco use of any ethnic group in the United States. This study examines ethnic identity (EI), participation in cultural activities, and stressful life events (SLEs) as correlates of smoking and examines historical trauma (HT) as a mediator of these associations.

METHODS

California AI youth (N = 969, ages 13-19, recruited from 49 tribal youth organizations and cultural activities in urban and reservation areas in California) completed a tobacco survey. Structural equation modeling was used to test a model examining HT as a potential mediator of the associations of EI, participation in cultural activities, and SLEs with cigarette smoking.

RESULTS

Model fit was adequate. EI, participation in cultural activities, and SLEs predicted HT. HT mediated the associations of participation in cultural activities and SLEs with past-month smoking. Stronger EI predicted greater past-month smoking and this effect was mediated by greater HT. The direct effects from HT to both smoking outcomes were positive and the direct effect from EI to past-month smoking was negative.

CONCLUSIONS

HT is a risk factor for cigarette smoking both directly and in mediating the links of EI, cultural activities, and SLEs. More efforts are needed to help AI youth to process these thoughts and empower themselves to contribute to their own lives and those of their families and communities without resorting to unhealthy addictive behaviors such as commercial tobacco use.

Maternal depressive symptoms during childhood and risky adolescent health behaviors

OBJECTIVE

Maternal depression is a risk factor for adolescent depression; however, the effect of childhood exposure to maternal depression on adolescent engagement in health risk behaviors (eg, substance use, delinquency) is unclear.

METHODS

We examined the relationship between maternal depressive symptoms (child's age 4-15) and engagement in health risk behaviors at age 16 to 17 by using data from 2910 mother-youth pairs in a nationally representative prospective Canadian cohort. Maternal depressive trajectories were estimated through finite mixture modeling, and multiple regression analyses examined the relationship between maternal depressive symptoms and engagement in various health risk behaviors (linear regression) and age of debut of various behaviors (Cox regression).

RESULTS

Five trajectories of maternal depressive symptoms were found: recurrent maternal symptoms, midchildhood exposure to maternal symptoms, adolescent exposure to maternal symptoms, mild maternal symptoms, and low symptoms. Adolescents exposed to maternal depressive symptoms during middle childhood were more likely to use common substances (alcohol, cigarettes, marijuana), engage in violent and nonviolent delinquent behavior, and have an earlier debut ages of cigarette, alcohol, marijuana, and hallucinogen use.

CONCLUSIONS

The results of this study suggest that exposure to maternal depressive symptoms, particularly in middle childhood, is associated with greater and earlier engagement in health risk behaviors.

Provider and state perspectives on implementing cultural-based models of care for american Indian and alaska native patients with substance use disorders

American Indians/Alaska Natives (AI/ANs) suffer disproportionate rates of substance use disorders compared to Americans overall. Providers serving AI/AN communities are drawing from a diverse toolkit of treatment strategies that incorporate Native worldviews and community-shared values in order to improve outcomes. This paper describes findings from interviews with 22 program directors and 18 representatives from Single State Authorities on substance abuse. Interviews assessed provider and state efforts to increase AI/AN client engagement and to improve the quality of care through culturally relevant interventions. Results suggested that providers employed flexibility and originality to cultural-based programs by broadening established practices, adopting outside traditions, and creating new ones to fit client needs. However, gaps in state-tribal collaborations and inter-group complexities such as staff-based tensions, a widening generational divide, and blurred consensus of "tradition" affect service delivery. Overall, respondents underlined the critical role culturally relevant care plays in individual and community healing.

Protective factors in American Indian communities and adolescent violence

With their distinct cultural heritage and rural boundaries, American Indian reservation communities offer a unique opportunity to explore protective factors that help buffer adolescents from potential risk behaviors such as violence. Prior published research on Indian communities has not explored three potential protective factors for violence-parental monitoring of adolescents and friends, adolescents' self-efficacy to avoid fighting, and adolescents' interest in learning more about their traditional culture. This paper explores the relationship between these factors and reduced risk of reported violence. In 1998, 630 American Indian students in grades 6-12 were surveyed in five Midwestern, rural Indian reservation schools. Path analysis was used to identify the direct and indirect association of the three potential protective factors with reduced violence behavior. There were significant gender differences both in perceived parental monitoring and in adolescents' self-efficacy. For female adolescents, parental monitoring had the strongest inverse relationship with female adolescents' involvement in violence. Female adolescents' self-efficacy and their interest in learning more about their culture were also inversely associated with violence and therefore potentially important protectors. Male adolescents who reported more interest in learning the tribe's culture had better self-efficacy to avoid violence. However, self-efficacy did not successfully predict their reported involvement in peer violence. These findings support exploring gender differences, parental monitoring, self-efficacy training as well as cultural elements in future violence intervention studies. Further investigation is needed to identify protective factors for risk behaviors among male adolescents and test the generalizability to non-reservation based adolescents.

Race, coping strategies, and substance use behaviors: a preliminary analysis examining white and American Indian adolescents

The association between stress exposure and substance use has been the subject of numerous studies. However, no prior study has explored the role of coping strategies in moderating the stress-substance use association for American Indian adolescents. Our preliminary study of coping strategies and substance use among a sample (n = 568) of rural American Indian and white adolescents revealed a number of similarities across both groups, but also some important differences. Results of logistic regression analyses revealed that the relationship between an avoidant coping strategy and marijuana use differed for whites and American Indians. Study limitations and future research directions are discussed.

Gender, Race, and Delinquent Behavior: An Extension of Power-Control Theory to American Indian Adolescents

Research testing Hagan's power-control theory has largely been tested with samples of non-Hispanic whites. We extend prior research by testing the theory's merits with a sample of American Indian (AI) adolescents. Overall, we find mixed support for the theory's merits. However, we find that our measure of patriarchy is a robust predictor of AI female delinquent activity. We also find that a grandparent in the household serves to greatly reduce involvement in violent behavior among AI females. Compared to a sample of non-Hispanic whites, these results reveal the importance of testing explanations of deviant behavior across racial and ethnic groups.

Methamphetamine use among rural White and Native American adolescents: an application of the stress process model

Methamphetamine use has been identified as having significant adverse health consequences, yet we know little about the correlates of its use. Additionally, research has found that Native Americans are at the highest risk for methamphetamine use. Our exploratory study, informed by the stress process model, examines stress and stress buffering factors associated with methamphetamine use among a cross-sectional sample of rural White and Native American adolescents (n = 573). Results of logistic regression analyses revealed mixed support for the stress process model; while stress exposure and family methamphetamine use predicted past year methamphetamine use, the inclusion of these variables failed to attenuate the association between race and past year use.