Keeping busy: a Yup’ik/Cup’ik perspective on health and aging

OBJECTIVES

Knowledge of cultural beliefs about health and how they influence life choices and intervention is essential in forming health policy and health promotion programs to meet the growing needs of aging minority populations. This study explores cultural beliefs and practices of health and well-being of Yup'ik/Cup'ik women in two rural villages in southwestern Alaska.

STUDY DESIGN

Exploratory, descriptive qualitative study.

METHODS

Interviews were conducted with 15 mid-life and older women to address two key research questions: 1) How do Yup'ik/Cup'ik women define health and wellbeing; and 2) What environmental, social, and cultural factors contribute to healthy aging?

RESULTS

The women in this study define health aging within the framework of subsistence living-keeping busy, walking, eating subsistence foods, and respect for elders. These beliefs and practices promote a strong, active body and mind, vital components to healthy aging.

CONCLUSIONS

While many health beliefs and practices appear very different from those current in research on aging, many commonalities and similarities emerge-concern for family, importance of physical activity and healthy diet. A significant finding of this study is that traditional Yup'ik/ Cup'ik ways of living parallel that of current research findings on what constitutes healthy aging in mainstream populations.

Sharing results from complex disease genetics studies: a community based participatory research approach

OBJECTIVES

Dissemination of research results to communities builds capacity of the community to understand and utilize the results. The objective of this manuscript was to propose a culturally appropriate approach to disseminate complex disease genetics research findings in small Alaska Native communities.

STUDY DESIGN

The Center for Alaska Native Health Research is a community-based participatory research project (CBPR) directed at understanding the interactions between genetic, nutritional and psychosocial risk factors for obesity, diabetes, and cardiovascular disease in Yup'ik Eskimos.

METHODS

We have consulted with regional healthcare providers, tribal leaders, and university-, local-, and national-institutional review boards to identify potential mechanisms for sharing population-based genetics research results or progress.

RESULTS

We propose a six step CBPR-approach to conducting genetics research in isolated identifiable communities. This CPBR-approach includes generating a common research question, determining community interest, recruitment, capacity building, sharing power and control, avoiding group harm, and development of culturally appropriate dissemination procedures.

CONCLUSIONS

Research scientists and community members should both benefit from population-based genetics research. Although we are just beginning our discussions with regard to sharing genetics research progress and findings, we believe that it is essential move forward as co-researchers in the CBPR enterprise.

Stress, coping, and well-being among the Yup`ik of the Yukon-Kuskokwim Delta: the role of enculturation and acculturation

OBJECTIVES

To report on the relationships between cultural identity and stress, coping, and psychological well-being in Yup'ik communities.

STUDY DESIGN

A quantitative self-administered questionnaire.

METHODS

A health and wellness survey was completed by a total of 488 Yup'ik participants (284 women and 204 men) from 6 rural villages in the Yukon-Kuskokwim Delta region. Respondents were fairly equally distributed across an age range of 14 to 94 (mean +/- SD = 38.50 +/- 17.18).

RESULTS

Participants who reported living more of a Kass'aq way of life (greater acculturation) reported experiencing greater psychosocial stress, less happiness, and greater use of drugs and alcohol to cope with stress. Participants who reported identifying more with a traditional Yup'ik way of life reported greater happiness, more frequent use of religion and spirituality to cope with stress, and less frequent use of drugs and alcohol to cope with stress.

CONCLUSIONS

In conjunction with previous research, the data strongly indicates that in general, Yup'ik people in the Y-K Delta tend to associate stress and negative health outcomes with the process of acculturation, and health and healing with the process of enculturation. Research that focuses on documenting the intrinsic strengths of indigenous worldviews may contribute to positive transformations in community health.

Counseling Intervention and American Indian Tradition

The training of American Indian counseling and community psychologists should move away from conventional counseling tenets toward the use of culturally sensitive mental health approaches that maintain American Indian values. In this article, unique American Indian social and psychological perspectives concerning the process and theory of counseling are contrasted with the individualistic focus, style, and outcomes of therapy as practiced in America today. Empirical studies are reviewed concerning the role of social influences in the counseling process as perceived by American Indians and the types of problems Indians present in counseling. The under use of mental health services by American Indian is is associated with the tension surrounding power differentials in counseling relationships and perceived conflicting goals for acculturation between counselors and Indian clients. In addition, three types of psychological intervention-social learning, behavioral, and network -are reviewed and summarized for their contributions and implications for training counselors in effective mental health service delivery with American Indians.

Creating Qungasvik (a Yup'ik intervention "toolbox"): case examples from a community-developed and culturally-driven intervention

This paper describes the development of a Yup'ik Alaska Native approach to suicide and alcohol abuse prevention that resulted in the creation of the Qungasvik, a toolbox promoting reasons for life and sobriety among youth. The Qungasvik is made up of thirty-six modules that function as cultural scripts for creating experiences in Yup'ik communities that build strengths and protection against suicide and alcohol abuse. The Qungasvik manual represents the results of a community based participatory research intervention development process grounded in culture and local process, and nurtured through a syncretic blending of Indigenous and Western theories and practices. This paper will provide a description of the collaborative steps taken at the community-level to develop the intervention modules. This process involved university researchers and community members coming together and drawing from multiple sources of data and knowledge to inform the development of prevention activities addressing youth suicide and alcohol abuse. We will present case examples describing the development of three keystone modules; Qasgiq (The Men's House), Yup'ik Kinship Terms, and Surviving Your Feelings. These modules each are representative of the process that the community co-researcher team took to develop and implement protective experiences that: (1) create supportive community, (2) strengthen families, and (3) give individuals tools to be healthy and strong.

A protective factors model for alcohol abuse and suicide prevention among Alaska Native youth

This study provides an empirical test of a culturally grounded theoretical model for prevention of alcohol abuse and suicide risk with Alaska Native youth, using a promising set of culturally appropriate measures for the study of the process of change and outcome. This model is derived from qualitative work that generated an heuristic model of protective factors from alcohol (Allen et al. in J Prev Interv Commun 32:41-59, 2006; Mohatt et al. in Am J Commun Psychol 33:263-273, 2004a; Harm Reduct 1, 2004b). Participants included 413 rural Alaska Native youth ages 12-18 who assisted in testing a predictive model of Reasons for Life and Reflective Processes about alcohol abuse consequences as co-occurring outcomes. Specific individual, family, peer, and community level protective factor variables predicted these outcomes. Results suggest prominent roles for these predictor variables as intermediate prevention strategy target variables in a theoretical model for a multilevel intervention. The model guides understanding of underlying change processes in an intervention to increase the ultimate outcome variables of Reasons for Life and Reflective Processes regarding the consequences of alcohol abuse.

People awakening: collaborative research to develop cultural strategies for prevention in community intervention

The consequences of alcohol use disorder (AUD) and suicide create immense health disparities among Alaska Native people. The People Awakening project is a long-term collaboration between Alaska Native (AN) communities and university researchers seeking to foster health equity through development of positive solutions to these disparities. These efforts initiated a research relationship that identified individual, family, and community protective factors from AUD and suicide. AN co-researchers next expressed interest in translating these findings into intervention. This led to development of a strengths-based community intervention that is the focus of the special issue. The intervention builds these protective factors to prevent AUD and suicide risk within AN youth, and their families and communities. This review provides a critical examination of existing literature and a brief history of work leading to the intervention research. These work efforts portray a shared commitment of university researchers and community members to function as co-researchers, and to conduct research in accord with local Yup'ik cultural values. This imperative allowed the team to navigate several tensions we locate in a convergence of historical and contemporary ecological contextual factors inherent in AN tribal communities with countervailing constraints imposed by Western science.

Introduction to ecological description of a community intervention: building prevention through collaborative field based research

This special issue of the American Journal of Community Psychology is the result of a 18-year partnership with Alaska Native communities using collaborative field based research methods. Its goal is to provide a case study fulfilling the spirit of ecological inquiry, offering a detailed and nuanced description of a community intervention. The articles describe the nature of our work, including some of our successes, as well as challenges, dilemmas, and even disappointments we experienced along the way. Our primary aim was to develop and assess the feasibility of a complex, multi-level intervention to increase protective factors hypothesized to reduce suicide and alcohol abuse among rural Yup'ik Alaska Native youth ages 12-18. The articles that follow include descriptions of the cultural context, relevant literature and project history, our methods of community engagement in measurement development strategies, an empirical test of the prevention model that guided the intervention, the development and implementation of the intervention, a feasibility and impact assessment, and an evaluation of community engagement. A final article summarizes what is generalizable from the work in field based intervention research with rural and culturally distinct populations, and future prospects for decolonizing community intervention research methods. These papers raise important issues, including (1) need for deep, contextual ecological descriptions, (2) reconceptualization of time in the research relationship, (3) distinctions between populations and communities, and (4) the conflict between values of communities and intervention science.

Feasibility of a community intervention for the prevention of suicide and alcohol abuse with Yup'ik Alaska Native youth: the Elluam Tungiinun and Yupiucimta Asvairtuumallerkaa studies

The Elluam Tungiinun and Yupiucimta Asvairtuumallerkaa studies evaluated the feasibility of a community intervention to prevent suicide and alcohol abuse among rural Yup'ik Alaska Native youth in two remote communities. The intervention originated in an Indigenous model of protection, and its development used a community based participatory research process. Feasibility assessment aimed to assess the extent to which (1) the intervention could be implemented in rural Alaska Native communities, and (2) the intervention was capable of producing measurable effects. Scales maximally sensitive to change were derived from earlier measurement work, and the study contrasted implementation process and outcomes across the two communities. In one community, medium dose response effects (d = .30-.50), with dose defined as number of intervention activities attended, were observed in the growth of intermediate protective factors and ultimate variables. In the other community, medium dose effects were observed for one intermediate protective factor variable, and small dose effects were observed in ultimate variables. Differences across communities in resources supporting intervention explain these contrasting outcomes. Results suggest implementation in these rural Alaska settings is feasible when sufficient resources are available to sustain high levels of local commitment. In such cases, measureable effects are sufficient to warrant a prevention trial.

Found in translation: Decoding local understandings of genetics and heredity in a Yup'ik Eskimo community

The Center for Alaska Native Health Research is a community-based participatory research center that conducts studies involving genetic research with Yup'ik Eskimo community members in Southwest Alaska, where Yup'ik remains the first language for most residents. Cultural equivalents are needed to communicate results of these studies among all partners and members of the participating communities, since many scientific terms have no direct translation in Yup'ik. To inform that effort, we examined local understandings of genetics and heredity in one community. Here, we report results from back-translated Yup'ik interviews, and identify working genetic concepts shared by participants from interviews and focus groups. We suggest issues involved in, and some potential steps toward, developing a concise, scientifically accurate and culturally relevant term for "genetics" and other health concepts.

Stable nitrogen and carbon isotope ratios indicate traditional and market food intake in an indigenous circumpolar population

The transition of a society from traditional to market-based diets (termed the nutrition transition) has been associated with profound changes in culture and health. We are developing biomarkers to track the nutrition transition in the Yup'ik Eskimo population of Southwest Alaska based on naturally occurring variations in the relative abundances of carbon and nitrogen stable isotopes (δ(15)N and δ(13)C values). Here, we provide three pieces of evidence toward the validation of these biomarkers. First, we analyzed the δ(15)N and δ(13)C values of a comprehensive sample of Yup'ik foods. We found that δ(15)N values were elevated in fish and marine mammals and that δ(13)C values were elevated in market foods containing corn or sugar cane carbon. Second, we evaluated the associations between RBC δ(15)N and δ(13)C values and self-reported measures of traditional and market food intake (n = 230). RBC δ(15)N values were correlated with intake of fish and marine mammals (r = 0.52; P < 0.0001). RBC δ(13)C values were correlated with intake of market foods made from corn and sugar cane (r = 0.46; P < 0.0001) and total market food intake (r = 0.46; P < 0.0001). Finally, we assessed whether stable isotope ratios captured population-level patterns of traditional and market intake (n = 1003). Isotopic biomarkers of traditional and market intake were associated with age, community location, sex, and cultural identity. Self-report methods showed variations by age and cultural identity only. Thus, stable isotopes show potential as biomarkers for monitoring dietary change in indigenous circumpolar populations.

Multicultural Mastery Scale for youth: multidimensional assessment of culturally mediated coping strategies

Self-mastery refers to problem-focused coping facilitated through personal agency. Communal mastery describes problem solving through an interwoven social network. This study investigates an adaptation of self- and communal mastery measures for youth. Given the important distinction between family and peers in the lives of youth, these adaptation efforts produced Mastery-Family and Mastery-Friends subscales, along with a Mastery-Self subscale. We tested these measures for psychometric properties and internal structure with 284 predominately Yup'ik Eskimo Alaska Native adolescents (12- to 18-year-olds) from rural, remote communities-a non-Western culturally distinct group hypothesized to display higher levels of collectivism and communal mastery. Results demonstrate a subset of items adapted for youth function satisfactorily, a 3-response alternative format provided meaningful information, and the subscale's underlying structure is best described through 3 distinct first-order factors organized under 1 higher order mastery factor.

"Oh No, We are Just Getting to Know You": The Relationship in Research with Children and Youth in Indigenous Communities

We describe important elements in the process of engagement with tribal communities in research with children and youth and their families. We believe it helpful to understand the research relationship with tribal communities through the lens of kinship relations. This calls for re-examination of the nature of research and researcher, with important implications for the research process, design and organization, recovery from errors, and dissemination of results. Implications include a re-examination of some of our canons of research methods and research ethics, along with a willingness to address new challenges, to share control of the research process, and to be open to new conceptual perspectives, including alternative research strategies. Its repercussions hold promise for a deepening of the research relationship, and the role of researcher in the community.

Navigating International, Interdisciplinary, and Indigenous Collaborative Inquiry: Phase 1 in the Circumpolar Indigenous Pathways to Adulthood Project

This report describes how multiple community constituents came together to work with university researchers on developing a shared agenda for studying young indigenous people in five international circumpolar communities. The paper focuses on the set up and process of an initial face-to-face methodological planning workshop involving youth and adult community members and academics. Members of Yup'ik, Inupiat, Eveny, Inuit and Sámi communities from Siberia to Norway participated in the workshop and engaged in negotiations to arrive at shared research interests. This was essential since the ultimate goal of the research is translational and transformative, spurring social action in communities. Describing the beginning stage of this project and the underlying participatory methodology offers reader insight into the how the approach engaged community members with varying degrees of sustained interest and practical success. It, therefore, articulates a methodological approach for those interested in doing community-based participatory research in international contexts.

Associations of very high intakes of eicosapentaenoic and docosahexaenoic acids with biomarkers of chronic disease risk among Yup'ik Eskimos

BACKGROUND

Few studies have examined the associations of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) with biomarkers of chronic disease risk in populations with high intakes.

OBJECTIVE

We examined the associations of red blood cell (RBC) EPA and DHA, as percentages of total fatty acids, with biomarkers of chronic disease risk across a wide range of EPA and DHA intakes.

DESIGN

In a cross-sectional study of 357 Yup'ik Eskimos, generalized additive models were used to plot covariate-adjusted associations of EPA and DHA with chronic disease biomarkers. Linear regression models were used to test for the statistical significance of these associations.

RESULTS

Means (5th-95th percentiles) for RBC EPA and DHA were 2.8% (0.5-5.9%) and 6.8% (3.3-9.0%), respectively. Associations of EPA and DHA were inverse and linear for triglycerides (beta +/- SE = -0.10 +/- 0.01 and -0.05 +/- 0.01, respectively) and positive and linear for HDL cholesterol (beta +/- SE = 2.0 +/- 0.5 and 0.9 +/- 0.6, respectively) and apolipoprotein A-I (beta +/- SE = 2.6 +/- 0.8 and 1.7 +/- 0.8, respectively). Positive linear associations of DHA with LDL and total cholesterol (beta +/- SE = 7.5 +/- 1.4 and 6.80 +/- 1.57, respectively) were observed; for EPA, these associations were nonlinear and restricted to concentrations approximately <5% of total fatty acids. Associations of EPA and DHA with C-reactive protein were inverse and nonlinear: for EPA, the association appeared stronger at concentrations approximately >3% of total fatty acids; for DHA, it was observed only at concentrations approximately >7% of total fatty acids.

CONCLUSION

Increasing EPA and DHA intakes to amounts well above those consumed by the general US population may have strong beneficial effects on chronic disease risk.

Value of Community Partnership for Understanding Stress and Coping in Rural Yup'ik Communities: The CANHR Study

Stress and trauma can compromise physical and mental health. Rural Alaska Native communities have voiced concern about stressful and traumatic events and their effects on health. The goal of the Yup'ik Experiences of Stress and Coping Project is to develop an in-depth understanding of experiences of stress and ways of coping in Yup'ik communities. The long-range goal is to use project findings to develop and implement a community-informed and culturally grounded intervention to reduce stress and promote physical and mental health in rural Alaska Native communities. This paper introduces a long-standing partnership between the Yukon-Kuskokwim Regional Health Corporation, rural communities it serves, and the Center for Alaska Native Health Research at the University of Alaska Fairbanks. Within the context of the Stress and Coping project, we then discuss the value and challenges of taking a CBPR approach to advance science and address a priority community concern, and share strategies to respond to challenges. Focus groups were conducted to culturally adapt an existing structured interview and daily diary protocol to better fit Yup'ik ways of knowing. As modified, these interviews increased understanding of stress and coping particular to two Yup'ik communities. Challenges included the geographical nature of Yup'ik communities, communication barriers, competing priorities, and confidentiality issues. Community participation was central in the development of the study protocol, helped ensure that the research was culturally appropriate and relevant to the community, and facilitated access to participant knowledge and rich data to inform intervention development.

Smoking, chewing, and cultural identity: prevalence and correlates of tobacco use among the Yup'ik-The Center for Alaska Native Health Research (CANHR) study

Survey data were obtained from a large sample of Yup'ik participants residing in the Yukon-Kuskokwim Delta region of Alaska. Tobacco use, age, sex, and a variety of psychosocial variables were assessed. Over 75% of participants use tobacco; one half (57.4%) reported using smokeless tobacco (SLT) regularly; 28.2% reported smoking cigarettes regularly. Relative to women, men reported using SLT less, smoking cigarettes more, and using the combination of cigarettes and SLT more. Younger participants tended to smoke cigarettes more, and to use the combination of cigarettes and SLT more. SLT users displayed significantly greater enculturation by identifying more with a Yup'ik lifestyle and less with a White lifestyle, speaking their traditional language more frequently, and consuming more traditional food and medicine. In contrast, smokers tended to display significantly greater acculturation and reported using drugs and alcohol more to cope with stress. Discussion focuses on appreciating the influence of cultural factors on health behavior and on implications for intervention.

Relationships between plasma adiponectin and body fat distribution, insulin sensitivity, and plasma lipoproteins in Alaskan Yup'ik Eskimos: the Center for Alaska Native Health Research study

Adiponectin, a protein secreted by adipose tissue, has antiatherogenic, anti-inflammatory, and insulin-sensitizing actions. We examined the relationship between plasma adiponectin and adiposity, insulin resistance, plasma lipids, glucose, leptin, and anthropometric measurements in 316 adult men and 353 adult women Yup'ik Eskimos in Southwest Alaska. Adiponectin concentration was negatively associated with body mass index, percentage of body fat, sum of skin folds, waist circumference, triglycerides, insulin resistance (homeostasis model assessment of insulin resistance [HOMA-IR]), fasting insulin, and leptin in both men and women, and also with glucose in women. Adiponectin concentration correlated positively with high-density lipoprotein cholesterol concentration, and also with low-density lipoprotein cholesterol in women. Insulin-sensitive individuals (HOMA-IR <3.52, n = 442) had higher plasma adiponectin concentrations than more insulin-resistant individuals (HOMA-IR >or=3.52, n = 224): 11.02 +/- 0.27 microg/mL vs 8.26 +/- 0.32 microg/mL, P < .001. Adiponectin concentrations did not differ between groups of participants with low and high level of risk for developing coronary heart disease. No difference in plasma adiponectin levels was found among Yup'ik Eskimos and whites matched for sex, age, and body mass index. In conclusion, circulating adiponectin concentrations were most strongly associated with sum of skin folds in Yup'ik men and with high-density lipoprotein cholesterol levels, sum of skin folds, waist circumference, and insulin and triglycerides concentrations in Yup'ik women.

Risk, resilience, and natural recovery: a model of recovery from alcohol abuse for Alaska Natives

AIM

The People Awakening (PA) study explored an Alaska Native (AN) understanding of the recovery process from alcohol abuse and consequent sobriety.

DESIGN

PA utilized a cross-sectional, qualitative research design and community-based participatory research methods.

SETTING AND PARTICIPANTS

The study included a state-wide convenience sample of 57 participants representing all five major AN groups: Aleut/Alutiiq, Athabascan, Inupiaq, Yup'ik/Cup'ik and Tlingit/Haida/Tsimshian. Participants were nominated and self-identified as being alcohol-abstinent at least five years following a period of problem drinking.

MEASUREMENTS

Open-ended and semistructured interviews gathered extensive personal life histories. A team of university and community co-researchers analyzed narratives using grounded theory and consensual data analysis techniques.

FINDINGS

A heuristic model of AN recovery derived from our participants' experiences describes recovery as a development process understood through five interrelated sequences: (i) the person entered into a reflective process of continually thinking over the consequences of his/her alcohol abuse; (ii) that led to periods of experimenting with sobriety, typically, but not always, followed by repeated cycling through return to drinking, thinking it over, and experimenting with sobriety; culminating in (iii) a turning point, marked by the final decision to become sober. Subsequently, participants engaged in (iv) Stage 1 sobriety, active coping with craving and urges to drink followed for some participants, but not all, by (v) Stage 2 sobriety, moving beyond coping to what one participant characterized as 'living life as it was meant to be lived.

CONCLUSIONS

The PA heuristic model points to important cultural elements in AN conceptualizations of recovery.

Metabolic syndrome in Yup'ik Eskimos: the Center for Alaska Native Health Research (CANHR) Study

OBJECTIVE

This study investigated the prevalence of metabolic syndrome and its defining components among Yup'ik Eskimos.

RESEARCH METHODS AND PROCEDURES

A cross-sectional study design that included 710 adult Yup'ik Eskimos >or=18 years of age residing in 8 communities in Southwest Alaska. The prevalence of metabolic syndrome was determined using the recently updated Adult Treatment Panel III criteria.

RESULTS

The prevalence of metabolic syndrome in this study cohort was 14.7%, and varied by sex with 8.6% of the men and 19.8% of the women having metabolic syndrome. This is lower than the prevalence of 23.9% in the general U.S. adult population. The most common metabolic syndrome components/risk factors were increased waist circumference and elevated blood glucose. High-density lipoprotein (HDL) cholesterol levels in Yup'ik Eskimos were significantly higher, and triglycerides lower than levels reported in National Health and Nutritional Examination III.

DISCUSSION

Compared with other populations, metabolic syndrome is relatively uncommon in Yup'ik Eskimos. The higher prevalence among Yup'ik women is primarily explained by their large waist circumference, suggesting central body fat accumulation. Further increases in metabolic syndrome risk factors among Yup'ik Eskimos could lead to increases in the prevalence of type 2 diabetes and cardiovascular disease, once rare in this population.

The Center for Alaska Native Health Research Study: a community-based participatory research study of obesity and chronic disease-related protective and risk factors

OBJECTIVES

To describe the background, approach and general results of the Center for Alaska Native Health Research (CANHR) study.

STUDY DESIGN

This was a cross-sectional Community-Based Participatory Research (CBPR) study with one tribal group to assess risk and protection for obesity and the risk factors related to chronic disease, diabetes and cardiovascular disease.

METHODS

A combination of biological, genetic, nutritional and psychosocial measurements were taken on 922 Alaska Native participants in ten communities in Southwestern Alaska. The paper reports on data from 753 adult participants.

RESULTS

The prevalence of type 2 diabetes is 3.3% in the sample population. Metabolic syndrome is significantly lower among the males and equal for females when compared with Caucasians in the NHANES III sample. Obesity among adults is now at the national average. Risk factors for chronic disease include a shift to a Westernized diet, stress, obesity and impaired fasting glucose and protective factors include high levels of polyunsaturated fatty acid dietary intake. Articles in this issue present specific results in these areas.

CONCLUSIONS

The data strongly indicate that, in general, Yup'ik people in our study are metabolically healthy and that diet and life style provide a delicate combination of protective and risk factors. The results strongly indicate that solution focused research utilizing primary and secondary prevention strategies may provide evidence for how to intervene to prevent further increases of chronic diseases. Research that focuses on relating the intrinsic strengths of indigenous worldviews and practices with basic research may contribute to positive transformations in community health.

The tools to understand: community as co-researcher on culture-specific protective factors for Alaska Natives

A collaborative research process engaging Alaska Native communities in the study of protective factors in Alaska Native sobriety and the design of a preventative intervention using its findings is described. Study 1 was discovery oriented qualitative research whose objectives were identification of protective factors and development of a heuristic model. Study 2 involved quantitative survey methods to develop and test ameasure of protective factors identified by the qualitative study. Empirical data from these studies is presented, and the role of Alaska Native co-researchers who did not possess specialist research training is described in the design and implementation of the study, interpretation of findings, and design of the intervention model and tools. Benefits that emerged from co-researcher involvement in this process, to the community and to the co-researchers themselves, are described.

The tools to understand: community as co-researcher on culture-specific protective factors for Alaska Natives

A collaborative research process engaging Alaska Native communities in the study of protective factors in Alaska Native sobriety and the design of a preventative intervention using its findings is described. Study 1 was discovery oriented qualitative research whose objectives were identification of protective factors and development of a heuristic model. Study 2 involved quantitative survey methods to develop and test ameasure of protective factors identified by the qualitative study. Empirical data from these studies is presented, and the role of Alaska Native co-researchers who did not possess specialist research training is described in the design and implementation of the study, interpretation of findings, and design of the intervention model and tools. Benefits that emerged from co-researcher involvement in this process, to the community and to the co-researchers themselves, are described.

Building a community-based participatory research center to investigate obesity and diabetes in Alaska Natives

The Center for Alaska Native Health Research (CANHR) is a community-based participatory research project aimed at understanding current risk factors for obesity, diabetes, and cardiovascular disease in Alaska Natives living in Southwest Alaska. We utilize a multidisciplinary approach that includes assessment of genetic, nutritional and behavioral risk factors and their interrelationships with one another in the overall development of disease. The design of the CANHR project involved community participation in the development, implementation and interpretation of research results. We have developed a participatory research program that is designed to be culturally appropriate, relevant to community needs and interests, and respectful to our participants. This manuscript describes the organizational development of our CANHR study and the procedures employed in its progression to date.

"Tied together like a woven hat:" Protective pathways to Alaska native sobriety

BACKGROUND: The People Awakening Project (1RO1 AA 11446-03) had two purposes, completed in Phase I and Phase II of the project. The purpose of Phase I was to complete a qualitative study; the research objective was discovery oriented with the specific aim of identification of protective and recovery factors in Alaska Native sobriety. Results were used to develop a heuristic model of protective and recovery factors, and measures based on these factors. The research objective of Phase II was to pilot these measures and provide initial validity data. METHODS: Phase I utilized a life history methodology. People Awakening interviewed a convenience sample of 101 Alaska Natives who had either recovered from alcoholism (n = 58) or never had a drinking problem (n = 43). This later group included both lifetime abstainers (LAs) and non-problem drinkers (NPs). Life histories were transcribed and analyzed using grounded theory and consensual data analytic procedures within a participatory action research framework. Analyses were utilized to generate heuristic models of protection and recovery from alcohol abuse among Alaska Natives. RESULTS: Analyses generated a heuristic model of protective factors from alcohol abuse. The resulting multilevel and multi-factorial model describes interactive and reciprocal influences of (a) individual, family, and community characteristics; (b) trauma and the individual and contextual response to trauma, (c) experimental substance use and the person's social environment; and (d) reflective processes associated with a turning point, or a life decision regarding sobriety. The importance of cultural factors mediating all these protective processes is emphasized. For NPs, the resilience process drew from personal stores of self-confidence, self-efficacy, and self-mastery that derived from ability to successfully maneuver within stressful or potentially traumatizing environments. In contrast, for many LAs, efficacy was instead described in more socially embedded terms better understood as communal mastery. One style of mastery is more associated with individualistic orientations, the other with more collectivistic. Future research is needed regarding the generalizeability of this group difference. CONCLUSIONS: Results suggest that preventative interventions should focus on intervening simultaneously at the community, family, and individual levels to build resilience and protective factors at each level. Of particular importance is the building of reflexivity along with other cognitive processes that allow the individual to think through problems and to reach a life decision to not abuse alcohol.

Unheard Alaska: culturally anchored participatory action research on sobriety with Alaska Natives

Alcohol research in Alaska Native communities has a contentious history. This project has attempted to address a critical need for research to guide alcohol abuse prevention and treatment with Alaska Natives using culturally anchored participatory action research. The process of grounding the research methodology in the culture and community is described, along with its contribution to community psychology's understanding of the importance of cultural factors. Tensions between indigenous values and ways of knowing, and Western research methodologies are delineated, along with how these tensions were resolved. Important issues that arose in doing culturally anchored participatory action research are described. These included the development of a community of inquiry, key methodological decisions, the empowerment of participants as coresearchers, and flexibility in research implementation.

Looking for "a good doctor": a cultural formulation of the treatment of a First Nations woman using western and First Nations method

The following paper utilizes the DSM-IV suggested clinical and cultural formulation to present an example of how First Nations and western treatment methods can work together to treat a First Nation's woman with a serious mental disorder. The formulation provides reflections on cultural elements in the diagnosis and what distinct and common elements are present in the First Nations and western explanatory models for etiology and treatment.