Voices of Identity: Exploring Identity Development and Transformation among Urban American Indian/Alaska Native Emerging Adults

Emerging adulthood shapes personal, professional, and overall well-being through identity exploration. This study addresses a gap in the minority identity literature by investigating how urban AI/AN emerging adults think about their identity and discussing challenges and protective factors associated with exploring their identity holistically. This mixed-methods study created a sampling framework based on discrimination experiences, cultural identity, social network support, mental health, and problematic substance use. We recruited 20 urban AI/AN emerging adults for interviews. We sought to gain deeper insights into their experiences and discussions surrounding identity formation and exploration. We provide descriptives for demographic characteristics and conducted a thematic analysis of the qualitative data from the interviews. Four themes emerged: a) being an urban AI/AN emerging adult means recognizing that one's identity is multifaceted; b) a multifaceted identity comes with tension of living in multiple worlds; c) the trajectory of one's identity grows over time to a deeper desire to connect with Native American culture; and d) understanding one's Native American background affects one's professional trajectory. Findings underscore the importance of developing programs to support well-being and identity development through cultural connection for urban AI/AN emerging adults.

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

OBJECTIVES

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Traditions and Connections for Urban Native Americans (TACUNA): Utilizing community-based input to develop an opioid prevention intervention for urban American Indian/Alaska Native emerging adults

INTRODUCTION

Although approximately 70% of American Indian/Alaska Native (AI/AN) people reside in urban areas, very few opioid prevention interventions exist for urban AI/AN emerging adults. The study team conducted this study to develop Traditions and Connections for Urban Native Americans (TACUNA), a new opioid prevention intervention for urban AI/AN emerging adults ages 18-25. TACUNA comprises three 2-hour virtual workshops.

METHODS

We conducted thirteen focus groups in three urban communities in northern, central, and southern California (six with urban AI/AN emerging adults ages 18-25 [n = 32], four with parents [n = 26], and three with providers [n = 33]) to identify relevant intervention domains. We then incorporated the results of a rapid analysis of the focus groups to develop intervention workshops followed by a pilot test (n = 15) to further refine the intervention and assess feasibility.

RESULTS

Four major domains emerged from focus groups: 1) historical trauma/cultural identity, 2) AI/AN traditional practices, 3) social networks, and 4) substance use. We incorporated all feedback relating to each theme to enhance content of the TACUNA intervention. Pilot test participants felt that TACUNA content was interesting, addressed their issues and concerns as urban AI/AN emerging adults, and believed that the program could help them to establish cultural and social connections to live healthier lives.

CONCLUSIONS

Research activities demonstrate how a community-informed and culturally grounded opioid prevention intervention can be developed for urban AI/AN emerging adults. Addressing issues and challenges with culturally and developmentally relevant intervention content can help to build resilience and hopefully decrease opioid use among this underserved population.

Exploring Culturally Based Treatment Options for Opioid Use Disorders Among American Indian and Alaska Native Adults in California

OBJECTIVE

American Indian and Alaska Native (AIAN) communities have been severely affected by the opioid epidemic, resulting in high opioid overdose death rates and disrupted community life. An added complexity is the diversity of AIAN communities throughout California, with regional differences, resources, infrastructure, and economic opportunities. This study examined the perspective of 163 AIANs in California to assess culturally based or traditional healing treatment modalities to treat opioid/substance use disorder.

METHOD

A total of 21 adult focus groups were conducted throughout 10 counties in California reaching 20 urban and tribal communities. Eight of these focus groups were conducted in recovery centers and 13 focus groups were conducted in tribal and urban organizations. Interviews were transcribed and coded using NVivo software utilizing an iterative coding approach with a priori domains.

RESULTS

Participants emphasized building a sense of belonging, connecting with their culture, and having awareness of substance use disorder and treatment as protective factors.

CONCLUSIONS

Findings indicate that medications for opioid use disorder programs serving AIAN communities should include cultural components that resonate with urban and tribal communities.

Exploring Culturally Based Treatment Options for Opioid Use Disorders Among American Indian and Alaska Native Adults in California

OBJECTIVE

American Indian and Alaska Native (AIAN) communities have been severely affected by the opioid epidemic, resulting in high opioid overdose death rates and disrupted community life. An added complexity is the diversity of AIAN communities throughout California, with regional differences, resources, infrastructure, and economic opportunities. This study examined the perspective of 163 AIANs in California to assess culturally based or traditional healing treatment modalities to treat opioid/substance use disorder.

METHOD

A total of 21 adult focus groups were conducted throughout 10 counties in California reaching 20 urban and tribal communities. Eight of these focus groups were conducted in recovery centers and 13 focus groups were conducted in tribal and urban organizations. Interviews were transcribed and coded using NVivo software utilizing an iterative coding approach with a priori domains.

RESULTS

Participants emphasized building a sense of belonging, connecting with their culture, and having awareness of substance use disorder and treatment as protective factors.

CONCLUSIONS

Findings indicate that medications for opioid use disorder programs serving AIAN communities should include cultural components that resonate with urban and tribal communities.

Integrating Motivational Interviewing and Traditional Practices to Address Alcohol and Drug Use Among Urban American Indian/Alaska Native Youth

American Indians/Alaska Natives (AI/AN) exhibit high levels of alcohol and drug (AOD) use and problems. Although approximately 70% of AI/ANs reside in urban areas, few culturally relevant AOD use programs targeting urban AI/AN youth exist. Furthermore, federally-funded studies focused on the integration of evidence-based treatments with AI/AN traditional practices are limited. The current study addresses a critical gap in the delivery of culturally appropriate AOD use programs for urban AI/AN youth, and outlines the development of a culturally tailored AOD program for urban AI/AN youth called Motivational Interviewing and Culture for Urban Native American Youth (MICUNAY). We conducted focus groups among urban AI/AN youth, providers, parents, and elders in two urban communities in northern and southern California aimed at 1) identifying challenges confronting urban AI/AN youth and 2) obtaining feedback on MICUNAY program content. Qualitative data were analyzed using Dedoose, a team-based qualitative and mixed methods analysis software platform. Findings highlight various challenges, including community stressors (e.g., gangs, violence), shortage of resources, cultural identity issues, and a high prevalence of AOD use within these urban communities. Regarding MICUNAY, urban AI/AN youth liked the collaborative nature of the motivational interviewing (MI) approach, especially with regard to eliciting their opinions and expressing their thoughts. Based on feedback from the youth, three AI/AN traditional practices (beading, AI/AN cooking, and prayer/sage ceremony) were chosen for the workshops. To our knowledge, MICUNAY is the first AOD use prevention intervention program for urban AI/AN youth that integrates evidence-based treatment with traditional practices. This program addresses an important gap in services for this underserved population.

The relevance of cultural activities in ethnic identity among California Native American youth

This study analyzed data from a large statewide sample of Native American adolescents throughout California to determine whether participation in cultural practices was associated with stronger ethnic identity. The Multigroup Ethnic Identity Measure (MEIM) scale was used to measure the ethnic identity of 945 Native American adolescents (416 male, 529 female) aged 13 - 19 across California. Respondents who participated in cultural activities including pow-wows, sweat lodge, drum group and roundhouse dance reported significantly higher Native American ethnic identity than their counterparts who did not take part in cultural activities. The association between cultural activities and ethnic identity was only significant among urban youth and not among reservation youth. Higher grades in school were associated with ethnic identity among females but not among males. Findings from this study show a strong association between cultural activities and traditional practices with tribal enculturation among Native American youth in California. Cultural-based practices to enhance Native identity could be useful to improve mental and behavioral health among Native American youth.

Cardiovascular disease risk factor awareness in American Indian communities: the strong heart study

OBJECTIVE

To use data from the longitudinal Strong Heart Study (SHS) to determine the level of awareness about risk factors for heart disease among 13 populations of American Indians in Arizona, Oklahoma, and South/ North Dakota. The aim of this study is to assess awareness of nine major risk factors for heart disease among participants in SHS.

METHODS

During July 1993 to December 1995 (phase II of SHS), 3638 participants ages 46 to 80 years (mean age 60) were asked if nine known risk factors for cardiovascular disease affect a person's chances of getting heart disease; 3226 (89%) participants completed the study and met the method reliability criteria for inclusion.

RESULTS

Among each of the nine risk factors, the percentage of correct answers provided by study participants ranged from 70% (family history of heart disease) to 90% (being very overweight). Participants with hypertension (90% vs 86%, P<.05) and diabetes mellitus (81% vs 71%, P<.05) were more likely than those without these disorders to know they were heart disease risk factors. For all nine risk factors, the percentage of correct answers was lower (P<.05) among smokers than among nonsmokers. In multivariate logistic regression analyses, female sex, advanced education, and being from Oklahoma were significantly associated with heart disease awareness.

CONCLUSION

Although overall risk factor awareness for heart disease was high, subgroups were identified who could benefit from culturally appropriate health education and other interventions to motivate health prevention actions, especially for smoking.

Cancer risk factors in three Sioux tribes. Use of the Indian-specific health risk appraisal for data collection and analysis

Cancer mortality rates for Aberdeen Area Indians exceed U.S. rates with lung cancer being the leading cause of cancer death. The Sioux Cancer Study, an ancillary study of the Strong Heart Study, investigated cancer and cancer risk factors among tribal members aged 45-74 in three Sioux tribes in North and South Dakota. An Indian-specific health risk appraisal was used to collect data and provide specific recommendations to participants. The high rates of smoking (56% for men and 48% for women) explain the high lung cancer mortality rates. Intensive smoking cessation and prevention programs will likely have the greatest impact in reducing preventable cancer deaths. More accessible cervical and breast cancer screening provided by female health care providers is needed to reduce preventable cancer deaths among Sioux women. Pap smear screening is an especially high priority since cervical cancer mortality is 4.4 times higher than U.S. rates, all races. Programs targeted to reduce obesity and excessive alcohol use will also likely reduce preventable cancer deaths associated with high rates of obesity, diabetes and binge drinking. Community-based cancer prevention and control programs tailored to the cancer risk factor profile of the community are the best strategy to reduce preventable cancer deaths in Indian communities.