"Our culture is medicine": perspectives of Native healers on posttrauma recovery among American Indian and Alaska Native patients

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.

Toward Integration of Trauma, Resilience, and Equity Theory and Practice: A Narrative Review and Call for Consilience

Investigating the roots of health and illness has inspired unprecedented growth in research on trauma and adversity across academic and scientific disciplines. Can this science achieve its potential? How? Much of this research remains siloed and fragmented, limiting integrative approaches to translating science into a unified paradigm. From age-old traditions to the health, social, and basic sciences, this established and rapidly growing body of work has overwhelmingly found that experiences, both positive and negative, profoundly influence life course health. Such convergence across disciplines highlights the complex, intersectional nature and impact of experiences and reveals consilience: agreement of findings across diverse fields. This narrative review explored 400 sources to curate a representative sample of 98 tracing the evolution of trauma theory and practice from the 19th century to the present. It emphasizes research from 1970 to 2022, with a specific focus on adverse childhood experiences, everyday discrimination, sexual and gender minority stress, acculturative stress, and positive childhood experiences. This research reveals how experiences are a cause, catalyst, and key ingredient of health or of illness, disability, and disparities. The review also proposes steps toward a unified paradigm and showcases innovative integrated models and applications. These examples provide a more comprehensive and nuanced understanding and lead to more effective solutions. Recognition of consilience can connect multidimensional insights on trauma, resilience, and equity to spark further cross-sector innovations toward health, prevention, and justice. Realizing the promise of consilience will require a new era of radical intentionality, ongoing dialogue, and interdisciplinary collaboration to achieve necessary system transformation.

Acceptability and feasibility of an intervention for Alaska Native and American Indian couples

Objective

This acceptability and feasibility study assessed a previously tested movie discussion intervention culturally adapted for a tribal health setting.

Background

Despite family and relationships being important in Alaska Native and American Indian (ANAI) cultures, social health interventions supporting committed ANAI couples have not been investigated. Couples watching and discussing movies can promote and sustain relationship health as effectively as intensive skill-building classes.

Method

This study culturally adapted a movie discussion intervention. Multiple stakeholders guided adaptations, including changes to intervention duration, recommended movies, discussion guide, and study measures. Eligible participants were cohabitating adults in a committed relationship, with at least one person in the couple being ANAI. Participants watched and discussed movies over 4 weeks at home or in person. Study measures assessed demographics, relationship characteristics, and intervention acceptability and feasibility.

Results

Twenty-three couples participated: 87% chose at-home participation, 70% completed the intervention. Almost 90% of couples felt comfortable discussing the movies, felt the discussion guide improved communication, and would recommend the intervention to other couples, but 26% were mildly stressed by the discussions.

Conclusion

This intervention was a feasible and acceptable way to help ANAI couples maintain positive relationship features.

Implications

This intervention could support ANAI couples in regions with limited access to behavioral health services.

A mixed-methods study protocol on factors contributing to suicide clusters among Native American youth in a northern plains reservation

Introduction

Suicide and suicide clusters within Native American Reservation communities are devastating to the entire community and increase individuals' risk for suicide over the lifespan. The objective of this paper is to describe the Indigenous community-based participatory research protocol implemented in partnership with the Fort Belknap Indian Community in Montana, United States. The study protocol was developed to understand suicide risk and protective factors, and community-derived solutions, in a reservation community with history of a suicide cluster and high rates of youth suicide.

Methods

In this mixed-methods study, qualitative data from youth, adults, and service providers and quantitative data from 200 adolescents and young adults (aged 14-24 years) were collected in Fort Belknap, Montana from May - December of 2022. Qualitative data were collected first via in-depth interviews and focus groups. Survey questions included validated and pre-tested measures of factors youth experience across socio-ecological levels. Thematic analysis was applied to the qualitative data; and logistic regression models were used to examine relationships within the quantitative data.

Discussion

This study will add a multi-dimensional perspective to our current understanding of (1) risk and protective factors for suicide, community-derived postvention solutions, and insights on community assets, and (2) the current health and psychosocial status of youth in the Fort Belknap community. This study may serve as an exemplar of co-created, culturally safe solutions designed to address mental health resource gaps. Next steps include development of a suicide crisis response tool kit and a culturally aligned postvention intervention that will enhance individual, family, and community survivance.

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.

Development of an Aboriginal Resilience and Recovery Questionnaire - a collaboration between practitioners and help-seeking clients of a Victorian Aboriginal community controlled health service

BACKGROUND

Indigenous experiences and perspectives of resilience, healing and recovery from trauma is gaining increasing attention, with a growing qualitative literature that spans multiple indigenous cultural groups. However, few quantitative measures are available. In this article, development of a preliminary version of the Aboriginal Resilience and Recovery Questionnaire is described.

AIM

The first aim of this study was to describe findings from two focus groups that provided theoretical knowledge and development of items for a draft version of an Aboriginal Resilience Recovery Questionnaire. The second aim of the study was to conduct a preliminary psychometric analysis of the properties of the measure.

DESIGN

Multi-method research design grounded in indigenous research methodologies.

MEASURES

Aboriginal Resilience and Recovery Questionnaire, Australian Aboriginal Version of the Harvard Trauma Questionnaire Trauma symptom subscale, Growth and Empowerment Measure.

RESULTS

(1) Two focus groups with six counselling staff from an Aboriginal health service were run that explored Victorian Aboriginal understandings of resilience, healing, and recovery from trauma. Sixty different protective factors viewed as potentially important to resilience, healing and recovery from trauma were identified by participants. (2) Following a review of the resilience literature, 75 items were reviewed and revised, with additional items developed by the focus group. (3) The final outcome was 60 items selected for a preliminary version of the Aboriginal Resilience Recovery Questionnaire, 50 of which made up 19 different subscales in addition to 10 single items. (4) Structured interviews were conducted with 81 help seeking Aboriginal clients recruited from the same health service. Preliminary psychometric assessment of the Aboriginal Resilience Recovery Questionnaire was undertaken using Principal Components Analysis. Two component subscales were extracted with adequate internal consistency and good convergent and discriminant validity. For both subscales there were moderate to strong positive associations with empowerment, and moderate to strong negative associations with trauma symptom severity.

CONCLUSION

The preliminary results are promising for a strength-based resilience measure developed from the knowledge of Aboriginal practitioners and staff of a counselling service. Further research to address some psychometric limitations in the measure is required. A larger sample size will allow for a common factor analysis to be conducted. The Aboriginal Resilience Recovery Questionnaire has potential to assist Aboriginal Community Controlled Health Organisations and other organisations to evaluate whether services and programs can effectively support community members to strengthen individual, relational, community and cultural resilience resources.

An Updated Narrative Review on the Role of Alcohol Among Indigenous Communities

Purpose of Review

The role of alcohol varies considerably among Indigenous Peoples and is the backdrop of persistent stereotypes despite decades of research. This paper provides an updated narrative review on the alcohol literature among Indigenous communities, highlighting recent studies published since 2017.

Recent Findings

We examined published literature involving alcohol use rates, including abstinence; risk and protective factors; treatment; and recovery, as well as future directions for alcohol prevention and intervention efforts with Indigenous communities.

Summary

Evidence-based alcohol use prevention, intervention, and recovery strategies with Indigenous communities are outlined. Recommendations are provided for researchers, health providers, and public policy advocates to address and better understand alcohol use, treatment, prevention, and recovery among Indigenous Peoples. Specific recommendations include using community-based participatory research strategies and harm reduction approaches to prevent and treat alcohol use problems with Indigenous communities. Future research is needed to elucidate mechanisms of resilience and recovery from Alcohol Use Disorder and possible shifts in perceptions of alcohol use for Indigenous Peoples.

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.

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.

Risk perception, adaptation, and resilience during the COVID-19 pandemic in Southeast Alaska Natives

Indigenous communities worldwide are at higher risk of negative pandemic outcomes, and communities Indigenous to the Arctic are disproportionately affected compared to national majorities. Despite this, their experiences have scarcely been investigated qualitatively and from their own perspectives. We collected and analyzed 22 structured interviews in three Southeast Alaska island communities (Sitka, Hoonah, and Kake) to learn about their perceptions of and experiences with the COVID-19 pandemic. Interviews were analyzed with thematic qualitative analysis in Dedoose. Four primary categories were identified within which to discuss risk and resilience in Southeast Alaska: (1) risk perception, (2) socioeconomic impacts, (3) reactions to public health guidelines, and (4) coping. Primary findings indicate that Southeast Alaska Native communities display considerable resilience and adaptive flexibility despite the significant adversity imposed by the COVID-19 pandemic. Southeast Alaska Native people use historical and traditional knowledge to culturally ground adaptive behaviors to cope with the threat of COVID-19. Interviewees expressed that adaptive, community-centered, and non-individualistic behaviors strongly tied to Native culture minimized the negative epidemiological impacts of the pandemic. Future research can more deeply explore the root causes of the need for adaptiveness and resilience, such as histories of colonialism and marginalization, to emergency situations in Indigenous communities.

Harm reduction acceptability and feasibility in a North American indigenous reserve community

AIMS

The present study assessed community and culturally specific alcohol-related harm among North American Indigenous (NAI) individuals, as well as the acceptability and feasibility of harm reduction approaches in one reserve-based NAI community.

METHODS

Participants lived on or near a NAI reserve in Canada. Semi-structured focus groups were conducted with health care workers (N = 8, 75% NAI) and community members (N = 9, 100% NAI). Self-report questionnaires were administered that measured acceptability and feasibility of harm reduction strategies.

RESULTS

Conventional content analysis revealed loss of culture as culturally specific alcohol-related harm. Health care workers rated harm reduction approaches to be acceptable and feasible, while community participants were more mixed. Majority of participants felt that some harm reduction strategies could provide opportunities for individuals who use alcohol to connect to Indigenous culture and traditions. However, there were mixed findings on whether harm reduction strategies are consistent with Indigenous cultural traditions and values.

CONCLUSION

Future research is needed to evaluate potential utility of harm-reduction approaches for NAI communities.

The Role of Religion, Spirituality and Fasting in Coping with Diabetes among Indian Migrants in Australia: A Qualitative Exploratory Study

Australia has a high proportion of migrants, with an increasing migration rate from India. While many factors influence diabetes self-management among Indian migrants, very little is known about the influence of religious beliefs and spirituality. This study explored the religious beliefs of Indian migrants in Australia and the influence of those beliefs on their diabetes self-management. Semi-structured interviews were conducted with a convenience sample of 23 Indian migrants. All interviews were audio-recorded, transcribed verbatim and thematically analysed. Most participants believed that prayers helped them alleviate stress and improve diabetes management participants also believed that receiving blessings/prayers from religious leaders prevent or cure diseases including diabetes. There were mixed views on beliefs about using insulin obtained from animal sources. Some participants were concerned about the use of animal-based insulin as it was against their religious beliefs and teachings. Some participants believed that religious fasting does not have any impact on their diabetes while others believed that it can be detrimental to their health. Religious beliefs therefore played an important role in how Indian migrants managed their diabetes. Healthcare professionals should consider their patients' religious beliefs during consultations, enlist support, such as religious scholars, to better address people's misconceptions, and identify strategies for effective diabetes management that consider religious beliefs.

Socio-cultural integration and holistic health among Indigenous young adults

BACKGROUND

Research on associations between social integration and wellbeing holds promise to inform policy and practice targets for health promotion. Yet, studies of social connection too frequently rely on overly simplistic measures and give inadequate attention to manifestation and meanings of social integration across diverse groups. We use the term socio-cultural integration to describe expanded assessment of both social and cultural aspects of belonging and connection.

METHODS

We examined 7 distinct indicators of socio-cultural integration, identified heterogeneous patterns of responses across these indicators using latent profile analysis, and determined their relevance for wellbeing using survey data from a study with Indigenous communities in the U.S. and Canada. Wellbeing was measured using holistic ratings of self-rated physical, emotional, and spiritual health.

RESULTS

Latent profile analysis (LPA) of responses to the 7 socio-cultural integration variables yielded a 3-class model, which we labeled low, moderate, and high integration. Mean scores on self-rated physical, mental and spiritual health were significantly associated with LPA profiles, such that those in the low integration group had the lowest self-rated health scores and those in the high integration group had the highest health scores. With the exception of similar ratings of cultural identification between low and moderate integration profiles, patterns of responses to the diverse socio-cultural integration measures varied significantly across the 3 latent profiles.

CONCLUSIONS

Results underscore the importance of expanding our assessment of social integration with attention to the interrelationships of family, community, culture, and our environment. Such concepts align with Indigenous conceptions of wellbeing, and have relevance for health across cultures. More concretely, the indicators of socio-cultural integration used in this study (e.g., cultural identity, having a sense of connectedness to nature or family, giving or receiving social support) represent malleable targets for inclusion in health promotion initiatives.

Changes in Sleep-Wake Patterns and Disturbances Before and During COVID-19 in Urban American Indian/ Alaska Native Adolescents

BACKGROUND

COVID-19 has profoundly affected sleep, although little research has focused on high-risk populations for poor sleep health, including American Indian/Alaska Native (AI/AN) adolescents.

METHODS

This is the first longitudinal study to examine changes in sleep with surveys completed before the pandemic and during the early months of COVID-19 in a sample of urban AI/AN adolescents (N = 118; mean age = 14 years at baseline; 63% female). We use a mixed-methods approach to explore how COVID-19 affected urban AI/AN adolescents' sleep, daily routines, and interactions with family and culture. Quantitative analysis examined whether pandemic-related sleep changes were significant and potential moderators of COVID-19's effect on sleep, including family and community cohesion and engagement in traditional practices.

RESULTS

: Findings demonstrate changes in sleep, including increases in sleep duration, delays in bedtimes and waketimes, and increases in sleep-wake disturbances (p's <.001). Higher levels of family cohesion and higher levels of engagement in traditional practices moderated pandemic-related increases in weekday sleep duration. Qualitative analyses revealed changes in adolescents' sleep and daily behaviors, as well as strategies adolescents used to cope with pandemic-related disruptions in sleep and routines.

CONCLUSION

Findings demonstrate positive and negative changes in sleep during COVID-19 stay-at-home orders, including simultaneous increases in sleep duration and sleep-wake disturbances. Results highlight the importance of considering multi-level influences on adolescent sleep, such as early school start times, family dynamics, and cultural factors. A multi-level approach may help guide prevention and intervention efforts to improve adolescent sleep health.

Indigenous Culture-as-Health: A Systematized Literature Review

This paper has two goals regarding cultural rigor, defined as privileging cultural ways of knowing and being as a means to achieving health and well-being for future generations. First, we move the continuum of health practices beyond cultural grounding to include Indigenous Culture-as-Health. Second, this project expands the concept of Indigenous Culture-as-Health in addiction and recovery to include a broader range of health, inclusive of prevention, to further understand this emerging model. Our review of the literature yielded an expanded cultural continuum that includes Indigenous Culture-as-Health, which appears to rely on four modalities: 1) Indigenous ways of knowing, 2) Indigenous cultural practices, 3) place-based/sacred sites, and 4) Indigenous spirituality. For Indigenous health, standards are defined by centuries of ancestral consciousness among Indigenous people across generations, in spite of settler-colonial systems that do not serve them. In other words, Indigenous Culture-as-Health practices contribute to self-determination, sovereignty, and liberation. Incorporating these strategies also will ameliorate other problems related to White supremacy and health, such as epistemic exploitation. Additional implications for prevention practice and policy are described.

Centering the Strengths of American Indian Culture, Families and Communities to Overcome Type 2 Diabetes

Type 2 diabetes (T2D) is a critical Indigenous health inequity rooted in experiences of colonization and marginalization including disproportionate exposure to stressors, disruption of traditional family and food systems, and attacks on cultural practices that have led to more sedentary lifestyles. Thus, an important step in redressing inequities is building awareness of and interventions attuned to unique Indigenous contexts influencing T2D and Indigenous culture as a pathway to community wellbeing. Using a dynamic, stage-based model of intervention development and evaluation, we detail the creation and evolution of a family-based, culturally centered T2D preventive intervention: Together on Diabetes (later Together Overcoming Diabetes) (TOD). The TOD program was built by and for Indigenous communities via community-based participatory research and has been implemented across diverse cultural contexts. The TOD curriculum approaches health through a holistic lens of spiritual, mental, physical and emotional wellness. Preliminary evidence suggests TOD is effective in reducing diabetes risk factors including lowering BMI and depressive symptoms, and the program is viewed favorably by participants and community members. We discuss lessons learned regarding collaborative intervention development and adaptation across Indigenous cultures, as well as future directions for TOD.

Opioid use in indigenous populations: indigenous perspectives and directions in culturally responsive care

In this work, we outline the necessary components for culturally responsive treatment to opioid use disorders in Indigenous communities. First, we examine the context of historical trauma faced by Indigenous groups in the U.S. and how this context may affect successful implementation of treatment. We then outline the strategies of Penobscot Nation and Little Earth in developing holistic treatment regimens for Indigenous peoples, and list policy interventions suited to improve outcomes for Indigenous groups related to opioid use disorders. We conclude with suggestions for future directions in anticolonial strategies for addressing opioid use in Indigenous communities. The combination of culturally responsive treatment, tribal sovereignty in the treatment of opioid use disorders, and effective resource allocation is necessary to affect positive change in Indigenous substance use trajectories.

Applying culturalist methodologies to discern COVID-19's impact on communities of color

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately impacted communities of color (CoC) amid increasing incidents of racial injustices and racism. In this article, we describe our culturalist methodologies for designing and implementing a multi-ethnic, interdisciplinary national needs assessment developed in partnership with CoC. Instead of a typical western-centric social science approach that typically ignores and perpetuates structural racism and settler colonialism, the research team implemented culturalist and community-partnered approaches that were further contextualized to the context of structural racism and settler colonialism. The culturalist approach yielded two sets of themes both related to the impact of the pandemic on CoC. The first set involved syndemic factors that contribute to the adverse impact of COVID-19. These include historical trauma; racism, racial stress, and discrimination; and cultural mistrust. The second set consisted of factors that potentially mitigate the impact of the COVID-19. These include cultural protective factors; community engagement; communal ethos, and data disaggregation. Our methodologies and the resulting findings encourage research praxis that uplifts the shared effects of the social determinants of health while honoring unique cultural and contextual experiences-a lesson that social science researchers largely have yet to learn.

Depression or resilience? A participatory study to identify an appropriate assessment tool with Kanien'kéha (Mohawk) and Inuit in Quebec

PURPOSE

We present a study on selection of a psychometric scale to be clinically used among Indigenous people with depression. Our aim was to select a psychometric tool for cultural adaptation with Mohawk and Inuit in Quebec.

METHODS

We selected three depression scales and three protective factor scales based on: strong validity for psychometric properties, evidence for good psychometric qualities across translations, avoidance of cognitively complex sentences, brevity, and clarity. We submitted the scales for consultation, and followed qualitative participatory methods with Mohawks of Kahnawake and Inuit from Nunavik living in an urban environment. We collected data through ten focus groups with advisory committees, and carried out a thematic analysis of the information.

RESULTS

The advisory groups considered the measurement scales to be unsafe. The major components that hindered their acceptance were: numeric rating, self-evaluation (versus supportive interaction), and a focus on symptoms rather than supportive factors. The participants preferred the Growth and Empowerment Measure due to its empowering approach. They voiced that it is necessary to develop a culturally sensitive and safe tool which facilitates interactions between the person and the practitioner.

CONCLUSION

This project provides valuable information about the perspectives of local Indigenous peoples regarding mental health and factors of empowerment and resilience. The ideal tool should be flexible in terms of the content and its use as compared to the conventional psychometric strategies. A tool developed with the Indigenous perspective on wellbeing could be used in psychological and psychiatric intervention as well as in social and community services.

Integrating traditional practices and social network visualization to prevent substance use: study protocol for a randomized controlled trial among urban Native American emerging adults

BACKGROUND

Nonmedical use of prescription opioids (defined as taking opioid medications for hedonic effects or in a manner other than prescribed) and the use of heroin have emerged in recent years as major public health concerns in the United States. Of particular concern is the prevalence of opioid use among emerging adults (ages 18-25), as this is a developmental period of heightened vulnerability and critical social, neurological, and psychological development. Data from 2015 show that American Indian/Alaska Native (AI/AN) people have the highest rates of diagnosis for opioid use disorders (OUDs). One recent study found that the overdose death rate among urban-dwelling AI/AN individuals was 1.4 times higher compared to those living in rural areas. To date, there are no evidence-based prevention programs addressing opioid use among urban AI/AN emerging adults that integrate culturally-appropriate strategies with evidence-based treatment. Traditions and Connections for Urban Native Americans (TACUNA) builds on our prior work with AI/AN communities across California to develop and evaluate culturally appropriate programming to address opioid, alcohol, and cannabis use among urban AI/AN emerging adults.

METHODS/DESIGN

In a randomized controlled trial, 18-25 year old urban AI/AN emerging adults will receive either TACUNA (n = 185), which comprises three virtual workshops utilizing motivational interviewing, social network visualization, and integrating traditional practices and a wellness circle, or one virtual culturally sensitive opioid education workshop (n = 185). We will evaluate intervention effects on primary outcomes of frequency of opioid, alcohol, and cannabis use, as well as secondary outcomes of social network characteristics and cultural connectedness, over a 12-month period.

DISCUSSION

This project has the potential to expand the range and effectiveness of opioid, alcohol, and cannabis services for urban AI/AN emerging adults by addressing the opioid epidemic and use of other substances at both the community and individual level. In addition, it provides important culturally grounded conceptual and practical information to advance the field of substance use interventions and enhance resiliency among this population.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020 https://clinicaltrials.gov/ct2/show/record/NCT04617938 .

The Association of Cultural Participation and Social Engagement With Self-Reported Diagnosis of Memory Problems Among American Indian and Alaska Native Elders

Objective: This study examines the association of cultural participation and social engagement with self-reported diagnosis of memory problems among older American Indians and Alaska Natives (AI/ANs). Method: We conducted a cross-sectional study of 14,827 AI/ANs using data from the 2014-2017 cycle of the Identifying Our Needs: A Survey of Elders (ION). Logistic regression was used to examine the association of cultural participation and social engagement with self-reported diagnosis of memory problems. Results: Compared to older AI/ANs who reported high cultural participation and/or high social engagement, those characterized by low cultural participation and/or low social engagement exhibited significantly higher odds of a self-reported diagnosis of memory problems (OR = 1.863, 95% CI: [1.269, 2.734], p = .001). Discussion: Older AI/ANs who described either or both low cultural participation and low social engagement endorsed far more self-reported diagnoses of memory problems, suggesting a strong association that warrants further study for potential causality.

Valuing Cultural Activities Moderating the Association Between Alcohol Expectancies and Alcohol Use Among First Nation Adolescents

OBJECTIVE

Indigenous youth often exhibit high rates of alcohol use and experience disproportionate alcohol-related harm. We examined the moderating role that valuing cultural activities has on the relationship between positive alcohol expectancies and alcohol use and heavy drinking in a sample of Indigenous youth.

METHOD

First Nation adolescents between ages 11 and 18 living on a reserve in eastern Canada (N = 106; mean age = 14.6; 50.0% female) completed a pencil-and-paper survey regarding their positive alcohol expectancies, alcohol use, and beliefs about the importance of cultural activities.

RESULTS

A significant interaction was identified between positive alcohol expectancies and valuing cultural activities on past-3-month alcohol use (b = -0.01, SE = 0.001, p < .001) and past-3-month heavy drinking (b = -0.01, SE = 0.001, p < .001). Simple slopes analysis revealed that the association between positive alcohol expectancies and past-3-month alcohol use and heavy drinking was significant for those with low (b = 0.06, SE = 0.007, p < .001; b = 0.07, SE = 0.008, p < .001; respectively) but not high levels of valuing cultural activities (b = 0.01, SE = 0.008, p = .12; b = 0.01, SE = 0.009, p = .08; respectively).

CONCLUSIONS

Highly valuing cultural activities may interrupt the relationship between positive alcohol expectancies and alcohol use. This suggests that community interventions and treatment programs targeting alcohol use among Indigenous adolescents should prioritize increasing the value of cultural activities by perhaps making them more available.

Valuing Cultural Activities Moderating the Association Between Alcohol Expectancies and Alcohol Use Among First Nation Adolescents

OBJECTIVE

Indigenous youth often exhibit high rates of alcohol use and experience disproportionate alcohol-related harm. We examined the moderating role that valuing cultural activities has on the relationship between positive alcohol expectancies and alcohol use and heavy drinking in a sample of Indigenous youth.

METHOD

First Nation adolescents between ages 11 and 18 living on a reserve in eastern Canada (N = 106; mean age = 14.6; 50.0% female) completed a pencil-and-paper survey regarding their positive alcohol expectancies, alcohol use, and beliefs about the importance of cultural activities.

RESULTS

A significant interaction was identified between positive alcohol expectancies and valuing cultural activities on past-3-month alcohol use (b = -0.01, SE = 0.001, p < .001) and past-3-month heavy drinking (b = -0.01, SE = 0.001, p < .001). Simple slopes analysis revealed that the association between positive alcohol expectancies and past-3-month alcohol use and heavy drinking was significant for those with low (b = 0.06, SE = 0.007, p < .001; b = 0.07, SE = 0.008, p < .001; respectively) but not high levels of valuing cultural activities (b = 0.01, SE = 0.008, p = .12; b = 0.01, SE = 0.009, p = .08; respectively).

CONCLUSIONS

Highly valuing cultural activities may interrupt the relationship between positive alcohol expectancies and alcohol use. This suggests that community interventions and treatment programs targeting alcohol use among Indigenous adolescents should prioritize increasing the value of cultural activities by perhaps making them more available.

Parenting in 2 worlds: Effects of a culturally grounded parenting intervention for urban American Indians on participant cultural engagement

BACKGROUND

Culturally appropriate, evidence-based prevention programs are seldom available to the growing majority of American Indians (AIs) who now live in cities. Parenting in 2 Worlds (P2W), a culturally grounded parenting intervention, was created to strengthen family functioning and reduce behavioral health risks in urban AI families from diverse tribal backgrounds.

OBJECTIVES

This study reports on the AI cultural engagement of the P2W participants as an outcome of the intervention.

METHOD

Data came from 575 parents of AI children (ages 10-17) in a randomized controlled trial in three Arizona cities. Parents were recruited through urban Indian centers and randomized to P2W or to an informational family health curriculum, Healthy Families in 2 Worlds (HF2W). Both P2W and HF2W consisted of 10 workshops delivered weekly by AI community facilitators. Pretests and posttests measured identification and engagement with traditional AI heritage, culture and practices. Tests of the efficacy of P2W versus HF2W used baseline adjusted regression models using FIML estimation to adjust for attrition, including random effects (site, facilitator), and controlling dosage. Moderated treatment effects by pretest levels of cultural engagement were tested with mean centered interactions.

RESULTS

Compared to parents in HF2W, those in P2W reported significantly larger increases in AI ethnic identity, AI spirituality, and positive mainstream cultural identification. Increases in cultural engagement were significantly larger for P2W participants who were relatively less culturally engaged at pretest.

CONCLUSIONS

Culturally adapted parenting interventions like P2W that effectively build on AI cultural heritage can also promote greater AI cultural identification and involvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Traditional Indigenous medicine in North America: A scoping review

Background

Despite the documented continued use of traditional healing methods, modalities and its associated practitioners by Indigenous groups across North America, it is presumed that widespread knowledge is elusive amongst most Western trained health professionals and systems. This despite that the approximately 7.5 million Indigenous peoples who currently reside in Canada and the United States (US) are most often served by Western systems of medicine. A state of the literature is currently needed in this area to provide an accessible resource tool for medical practitioners, scholars, and communities to better understand Indigenous traditional medicine in the context of current clinical care delivery and future policy making.

Methods

A systematic search of multiple databases was performed utilizing an established scoping review framework. A consequent title and abstract review of articles published on traditional Indigenous medicine in the North American context was completed.

Findings

Of the 4,277 published studies identified, 249 met the inclusion criteria divided into the following five categorical themes: General traditional medicine, integration of traditional and Western medicine systems, ceremonial practice for healing, usage of traditional medicine, and traditional healer perspectives.

Conclusions

This scoping review was an attempt to catalogue the wide array of published research in the peer-reviewed and online grey literature on traditional Indigenous medicine in North America in order to provide an accessible database for medical practitioners, scholars, and communities to better inform practice, policymaking, and research in Indigenous communities.

Depression Symptoms and Cognitive Test Performance in Older American Indians: The Strong Heart Study

BACKGROUND

American Indians have excess risk of depression, which can contribute to cerebrovascular and cognitive disability, with effects on memory, processing speed, executive function, and visuospatial ability. However, studies examining depression and cognition in American Indians are limited; this study aims to report associations of depression with general cognition, verbal fluency and memory, and processing speed.

DESIGN

Cohort study.

SETTING

The Cerebrovascular Disease and its Consequences in American Indians study was an ancillary examination of Strong Heart Study participants from 3 U.S. regions.

PARTICIPANTS

All eligible were included in this analysis (N=818).

MEASUREMENTS

Participants completed evaluations for depressive symptomology, cognition, and physical function-including Center for Epidemiologic Studies Depression (CESD), Modified Mini-Mental State Examination (3MSE), Wechsler Adult Intelligence Scale-Fourth Edition coding (WAIS), Controlled Oral Word Association (COWA), California Verbal and Learning Test, Halstead finger tapping, grip strength, and Short Physical Performance Battery (SPPB) tests. Linear mixed models were adjusted for site, age, sex, education, income, marital status, alcohol, smoking, diabetes, hypertension, obesity, cholesterol, stroke, infarct, and hemorrhage.

RESULTS

Symptoms of depression were common, with 20% (N=138) endorsing CES-D scores of 16+. More depressive symptoms were associated with older age, female sex, lower education, lower income, non-married status, not using alcohol, not smoking, hypertension, diabetes, and stroke. In adjusted analyses, processing speed (WAIS: β -0.13, 95%CI -0.25, -0.03), general cognition (3MSE: β -0.10, 95%CI -0.17, -0.03), verbal fluency (COWA: β -0.10, 95%CI -0.19, -0.01), and motor function (SPPB: β -0.05, 95%CI -0.07, -0.03) were significantly associated with more symptoms of depression.

CONCLUSION

These findings maybe informative for health disparities populations, especially those with depressive risk. Clinicians may require particular training in cultural humility. Future studies should validate use of the CES-D scale in this population; longitudinal studies may focus on causal mechanisms and potential secondary prevention, such as social support. J Am Geriatr Soc 68:1739-1747, 2020.

Motivational interviewing and culture for urban Native American youth (MICUNAY): A randomized controlled trial

To date, few programs that integrate traditional practices with evidence-based practices have been developed, implemented, and evaluated with urban American Indians/Alaska Natives (AI/ANs) using a strong research design. The current study recruited urban AI/AN teens across northern, central, and southern California during 2014-2017 to participate in a randomized controlled trial testing two cultural interventions that addressed alcohol and other drug (AOD) use. Adolescents were 14-18 years old (inclusive), and either verbally self-identified as AI/AN or were identified as AI/AN by a parent or community member. We tested the added benefit of MICUNAY (Motivational Interviewing and Culture for Urban Native American Youth) to a CWG (Community Wellness Gathering). MICUNAY was a group intervention with three workshops that integrated traditional practices with motivational interviewing. CWGs were cultural events held monthly in each city. AI/AN urban adolescents (N = 185) completed a baseline survey, were randomized to MICUNAY + CWG or CWG only, and then completed a three- and six-month follow-up. We compared outcomes on AOD use, spirituality, and cultural identification. Overall, AOD use remained stable over the course of the study, and we did not find significant differences between these two groups over time. It may be that connecting urban AI/AN adolescents to culturally centered activities and resources is protective, which has been shown in other work with this population. Given that little work has been conducted in this area, longer term studies of AOD interventions with urban AI/AN youth throughout the U.S. are suggested to test the potential benefits of culturally centered interventions.

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

Given the paucity of empirically based health promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts "from the ground up." Drawing on five diverse community-based Native health intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of (1) original instructions, (2) relational restoration, (3) narrative-[em]bodied transformation, and (4) indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledge and health-positive messages for individual to multi-level community interventions.

Considerations for psychedelic therapists when working with Native American people and communities

Although Native American communities are unique in their beliefs, traditions, and languages, there are some fundamental common belief systems shared by most Native American cultures. Therapists and other practitioners engaging in a healing relationship with Native Peoples should be aware of these fundamental aspects of the Native American culture. This includes trust/respect, confidentiality outside of the context therapeutic setting, culturally based therapy that is inclusive of Native American traditions, and culture, and making efforts to gain an understanding of the culture with which one will be interacting.

Mental health issues among indigenous communities and the role of traditional medicine

INTRODUCTION

Mental health in indigenous communities is a relevant issue for the World Health Organization (WHO). These communities are supposed to live in a pure, clean and intact environment. Their real condition is far different from the imaginary; they are vulnerable populations living in difficult areas, exposed to pollution, located far from the health services, exposed to several market operations conducted to extract natural resources, facing criminal groups or illegal exploitation of land resources. These factors may have an impact on mental health of indigenous population.

METHODS

We reviewed all papers available on PubMed, EMBASE and The Cochrane Library until December 2018. We focused on those factors affecting the changes from a traditional to a post-modern society and reviewed data available on stress-related issues, mental distress affecting indigenous/aboriginal communities and the role of Traditional Medicine (TM). We reviewed articles from different countries hosting indigenous communities.

RESULTS

The incidence of mental distress and related phenomena (e.g. collective suicide, alcoholism and violence) among indigenous populations is affected by political and socio-economic variables. The mental health of these populations is poorly studied and described even if mental illness indicators are somewhat alarming. TM still seems to have a role in supporting affected people and may reduce deficiencies due to poor access to medical insurance/coverage, psychiatry and psychotherapy. It would be helpful to combine TM and modern medicine in a healthcare model to face indigenous populations' health needs.

CONCLUSION

This review confirms the impact of societal changes, environmental threats and exploitation of natural resources on the mental health of indigenous populations. Global Mental Health needs to deal with the health needs of indigenous populations as well as psychiatry needs to develop new categories to describe psychopathology related to social variance as recently proposed by the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5).

Sami yoik, Sami history, Sami health: a narrative review

Music as a possible health-promoting agent has attained increasing academic and scientific interest over the last decades. Nonetheless, possible connections between indigenous singing traditions and health beyond traditional ceremonial healing practices are still under-researched worldwide.

The Sami, the indigenous people living in Northern Fennoscandia, have a distinct ancient vocal music tradition called “yoik” practiced from immemorial times. The Sami share a history of assimilation with many indigenous people. During this period of nearly 400 years, yoik alongside other cultural markers was under hard pressure and even banned at times.

Compared to other indigenous people in the Arctic, Sami public health shows few significant unfavourable differences to the majority population. The potential role of yoik as a protective health and resilience factor within the Sami culture is the topic of this review. We suggest a two stage model for the health promoting effects of yoik through i) emotion regulation and stress relief on the level of the individual, and ii) as a socio-cultural resilience factors within the Sami population. This review is to be understood as theory-building review article striving for a scholarly review of the literature.

The qasgiq model as an indigenous intervention: Using the cultural logic of contexts to build protective factors for Alaska Native suicide and alcohol misuse prevention

OBJECTIVES

The foundational role culture and Indigenous knowledge (IK) occupy within community intervention in American Indian and Alaska Native (AIAN) communities is explored. To do this, we define community or complex interventions, then critically examine ways culture is translated into health interventions addressing AIAN disparities in existing programs and research initiatives. We then describe an Indigenous intervention based in the cultural logic of its contexts, as developed by Alaska Native communities. Yup'ik coauthors and knowledge keepers provided their critical and theoretical perspectives and understandings to the overall narrative, constructing from their IK system an argument that culture is prevention.

CONCLUSIONS

The intervention, the Qungasvik (phonetic: koo ngaz vik; "tools for life") intervention, is organized and delivered through a Yup'ik Alaska Native process the communities term qasgiq (phonetic: kuz gik; "communal house"). We describe a theory of change framework built around the qasgiq model and explore ways this Indigenous intervention mobilizes aspects of traditional Yup'ik cultural logic to deliver strengths-based interventions for Yup'ik youth. This framework encompasses both an IK theory-driven intervention implementation schema and an IK approach to knowledge production. This intervention and its framework provide a set of recommendations to guide researchers and Indigenous communities who seek to create Indigenously informed and locally sustainable strategies for the promotion of health and well-being. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Native American Perspectives on Health and Traditional Ecological Knowledge

BACKGROUND

Traditional ecological knowledge (TEK) is a conceptual framework that highlights Indigenous knowledge (IK) systems. Although scientific literature has noted the relevance of TEK for environmental research since the 1980s, little attention has been given to how Native American (NA) scholars engage with it to shape tribal-based research on health, nor how non-Native scholars can coordinate their approaches with TEK. This coordination is of particular importance for environmental health sciences (EHS) research exploring interdisciplinary approaches and the integration of environmental and human health.

OBJECTIVE

Our perspective on TEK arose from a series of Health and Culture Research Group (HCRG) workshops that identified gaps in existing EHS methodologies that are based on a reliance on Euro-American concepts for assessing environmental exposures in tribal communities. These prior methods neither take into account cultural behavior nor community responses to these. Our objective is to consider NA perspectives on TEK when analyzing relationships between health and the environment and to look at how these may be applied to address this gap.

DISCUSSION

The authors—the majority of whom are NA scholars—highlight two research areas that consider health from a TEK perspective: food systems and knowledge of medicinal plants. This research has yielded data, methods, and knowledge that have helped Indigenous communities better define and reduce health risks and protect local natural food resources, and this TEK approach may prove of value to EHS research.

CONCLUSION

NA perspectives on TEK resulting from the HCRG workshops provide an opportunity for developing more accurate Indigenous health indicators (IHI) reflecting the conceptualizations of health maintained in these communities. This approach has the potential to bridge the scientific study of exposure with methods addressing a tribal perspective on the sociocultural determinants of health, identifying potential new areas of inquiry in EHS that afford nuanced evaluations of exposures and outcomes in tribal communities. https://doi.org/10.1289/EHP1944.

Psychotropic Medication Patterns for American Indian Children in Foster Care

OBJECTIVE

This study assesses the effects of race, age, sex, and time spent in foster care on rates of psychotropic medication use for children in foster care in 2012.

METHODS

Using existing electronic records through county Social Service and Minnesota Medical Assistance databases, 626 children were identified using the inclusion criteria of having been in foster care for at least 30 days during 2012 in St. Louis County, Minnesota. All prescriptions for dispensed psychotropic medications were identified into the following classes: antidepressants, attention-deficit/hyperactivity disorder (ADHD) medications, antipsychotics, alpha-agonists, and other (including anticonvulsants/mood stabilizers, lithium, benzodiazepines, and sedative hypnotics).

RESULTS

Overall, 26% of children were dispensed at least one psychotropic medication during the year with the percentage of children on medication for each race as follows: American Indian (AI) 23.3%, European American (EA) 29.2%, and African American (AA) 18.3%. AI children were significantly less likely to be dispensed any psychotropic medication and ADHD medication. EA children, males, and older children received psychotropic medications from significantly more classes than AI or AA children, females, and younger children. Males were significantly more likely to be dispensed alpha-agonists, antipsychotics, and ADHD medications. Increased time since placement into foster care was also significantly associated with increased dispensing rates of antidepressants, ADHD medication, and multiple medication classes.

CONCLUSIONS

The results of this study show that non-EA children, in particular AI children, were dispensed psychotropics both overall and across different medication classes less often compared to other racial groups. While the reasons for this difference are not known, future studies are needed to address whether mental health needs of all children in foster care are being appropriately addressed, accounting for need and patient preference.

Yoik experiences and possible positive health outcomes: an explorative pilot study

Background: Yoik is an old vocal music tradition of Sami, the indigenous people inhabiting Northern Fennoscandia and Kola peninsula in Russia. Studies of music therapy (MT) and especially singing have documented improvements in social and overall functioning in people with severe mental disorders and positive effect on depressive symptoms and sleep quality. Possible connections between yoik and health are so far underexplored.

Objectives: The overall aim of this study was to explore whether yoik may have the potential to positively influence people’s health and well-being. The research questions were: 1. What are different persons’ experiences with yoik? 2. Can yoik experiences be related to health outcomes?

Methods: Explorative, qualitative interviews with 13 participants were conducted in the Norwegian counties Finnmark, Troms, Nordland, and Trøndelag.

Findings: The findings suggest qualities in yoik that are comparable to positive effects of Music Therapy (MT) in general. Yoik may contribute to emotion management, i.e. processing negative emotions and inducing positive ones in people acknowledging yoik as something positive.

Conclusion: Yoik may be considered an important marker of social and cultural belonging for many Sami people. Yoik seems to have an underresearched potential as an intervention in culture sensitive healthcare and health promotion work that deserves to be further investigated.

Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes

This study examined the prevalence of screened posttraumatic stress disorder (PTSD) and associated diabetes-related outcomes. A sample of American Indian adults with type 2 diabetes (n = 218) participated in interviewer-administered surveys. Using a cutoff of 3 on the Primary Care PTSD screener, 21.8 % of participants screened positive for PTSD. PTSD symptoms were negatively associated with self-rated health status and positively associated with past year hospitalization after controlling for several demographic factors, but not after controlling for depressive symptoms. Past month frequency of hyperglycemia symptoms was not related to PTSD symptoms. When grouped by mental health conditions (neither screened PTSD nor depressive symptoms, screened PTSD only, depressive symptoms only, and both), those with both screened PTSD and depressive symptoms reported the highest proportion of any past month hyperglycemia, past year hospitalization, and low self-rated health status. Screened PTSD, especially in those with comorbid depressive symptoms, is an important consideration in diabetes care.

Functional outcomes during inpatient rehabilitation for American Indian and Alaska Native children with traumatic brain injury

PURPOSE

American Indian/Alaska Native (AI/AN) people have the highest traumatic brain injury (TBI)-related mortality in the United States, but little is known about AI/AN children who survive traumatic brain injury (TBI). This study compares function and factors associated with discharge function between AI/AN and White children with TBI during inpatient rehabilitation.

METHODS

Retrospective national cohort study of 114 AI/AN and 7,267 White children aged 6 months-18 years who received inpatient TBI rehabilitation between 2002-2012 at facilities utilizing the Uniform Data System for Medical Rehabilitation\scriptsize®. The outcome measure was developmental functional quotients (DFQ is the FIM\scriptsize® or WeeFIM\scriptsize® score divided by age norms x 100) at discharge.

RESULTS

AI/AN race was not associated with motor (regression coefficient (β) 0.18, 95% confidence interval (CI) -2.39, 2.76) or cognitive (β -1.54, 95% CI -3.75, 0.67) function. Among a subgroup with loss of consciousness > 24 hours (AI/AN n= 13, White n= 643), AI/AN race was associated with lower motor DFQ (β -12.83, 95% CI -25.39, -0.34).

CONCLUSIONS

Overall, AI/AN race was not associated with inpatient rehabilitation function for children with TBI, but providers should not assume AI/ANs with more severe injuries have equitable outcomes.

Using Photovoice with youth to develop a drug prevention program in a rural Hawaiian community

INTRODUCTION

Substance use represents a significant and persistent health disparity among Native Hawaiian youth and communities. A community-university participatory action research project was conducted to develop a Native Hawaiian model of drug prevention.

METHODS

Ten youth participated in eight Photovoice focus groups. Focus group transcripts and the youths' SHOWED (see, happening, our, why, empower, do) worksheets were analyzed.

RESULTS

Emergent analyses are described regarding focus group theme identification and the meaning of each theme. Youth-selected exemplary photographs and researcher-selected exemplary quotations are provided.

IMPLICATIONS

Native Hawaiian drug prevention will be place-based in culturally significant community locations, experiential, and guided by multigenerational teaching and learning.

Posttraumatic stress disorders in the Nanai after pollution of the Amur River: ethnocultural analysis

OBJECTIVES

Chemical pollution of the Amur River has seriously damaged traditions and caused posttraumatic stress disorder (PTSD) among the Nanai, the indigenous people living along this river. This study was performed to clarify the ethnographic characteristics of PTSD in this unique population.

METHODS

The study group consisted of 75 male and 112 female randomly selected volunteers. PTSD severity measured using scores of the Impact of Event Scale--Revised (Total-I) and Clinical-Administered PTSD Scale (Total-C) was estimated according to demographic and ethnocultural backgrounds, clinical status, and ethnopsychological attitudes toward the Amur River.

RESULTS

The differences in averages of Total-I and Total-C were not always the same in the groups divided by ethnographic information. Logistic regression analysis with a dependent variable, possibly without PTSD (Total-I <34 and Total-C <40)/possibly with PTSD (either Total-I ≥34 or Total-C ≥40), and categorical independent variables using ethnographic information extracted a low score when 'priority values' and 'the Amur River for me is' was "profession" and a high score when 'dominant role in spousal relationship' was "self," when 'predominant forms of response in stressful situations' was "try to organize," when 'preferred method of medical treatment' was specific for the Nanai, when "rely on something mystical" was manifested, and when the Amur River was believed to be "sacred".

CONCLUSION

Those with a pragmatic attitude were less likely to have PTSD. However, those who were required to make decisions within close relationships and were intimate with the Nanai tradition and the Amur River had increased likelihood of PTSD.