1
|
Herman KA, Hautala DS, Aulandez KMW, Walls ML. The resounding influence of benevolent childhood experiences. Transcult Psychiatry 2024:13634615231192006. [PMID: 38419503 DOI: 10.1177/13634615231192006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Research with Indigenous communities has demonstrated the detrimental impacts of intergenerational trauma and disproportionate adverse childhood experiences (ACEs) on health and behavioral outcomes in adulthood. A more balanced narrative that includes positive childhood experiences is needed. The construct of benevolent childhood experiences (BCEs) facilitates assessment of positive early life experiences and their impact on well-being for Indigenous peoples. We consider associations between BCEs and well-being when taking into account ACEs and adult positive experiences. Participants are from Healing Pathways, a longitudinal, community-based panel study with Indigenous families in the Midwestern United States and Canada. Data for the current analyses are derived from 453 participants interviewed at wave 9 of the study. Participants reported high levels of positive childhood experiences in the form of BCEs, with 86.5% of the wave 9 participants reporting experiencing at least six of seven positive indicators. BCEs were positively associated with young adult well-being. This relationship persisted even when accounting for ACEs and adult positive experiences. While ACEs were negatively correlated with young adult well-being, they were not significantly associated with well-being when considering family satisfaction and receiving emotional support. Evidence of high levels of BCEs reflects realities of strong Indigenous families and an abundance of positive childhood experiences.
Collapse
Affiliation(s)
- Kaley A Herman
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, Duluth, MN, USA
| | - Dane S Hautala
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, Duluth, MN, USA
| | - Kevalin M W Aulandez
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, Duluth, MN, USA
| | - Melissa L Walls
- Johns Hopkins Bloomberg School of Public Health, Center for Indigenous Health, Duluth, MN, USA
| |
Collapse
|
2
|
Sittner KJ, Herman KA, Gonzalez MB, Walls ML. A longitudinal study of positive mental health and coping among Indigenous adults with type 2 diabetes. Anxiety Stress Coping 2023; 36:339-352. [PMID: 35587950 PMCID: PMC9674796 DOI: 10.1080/10615806.2022.2076082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 04/13/2022] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Indigenous Peoples and scholars call for strengths-based approaches to research inclusive of Indigenous resiliency and positive outcomes. The purpose of this study was to examine positive mental health for Indigenous adults with type 2 diabetes and to determine if positive mental health is linked to community connectedness (a coping resource) and active coping (a coping response). METHODS Participants (N = 194 at baseline) were randomly selected from clinical records, at least 18 years old with a type 2 diabetes diagnosis, and self-identified as American Indian. RESULTS Latent growth curve models revealed that average positive mental health was predicted to decrease over the four waves of the study, although not for participants with above-average active coping at baseline. Community connectedness at baseline was associated with higher initial levels of positive mental health. Within-person change in active coping and community connectedness were both associated with increases in positive mental health. CONCLUSION This study aligns with previous research demonstrating that coping can influence health outcomes, and furthers the stress process literature by showing that active coping and community connectedness can impact positive mental health for Indigenous adults with Type 2 Diabetes.
Collapse
Affiliation(s)
| | - Kaley A. Herman
- Johns Hopkins Bloomberg School of Public Health, Department of International Health; Center for American Indian Health; Duluth, MN
| | - Miigis B. Gonzalez
- Johns Hopkins Bloomberg School of Public Health, Department of International Health; Center for American Indian Health; Duluth, MN
| | - Melissa L. Walls
- Johns Hopkins Bloomberg School of Public Health, Department of International Health; Center for American Indian Health; Duluth, MN
| |
Collapse
|
3
|
O'Keefe VM, Maudrie TL, Cole AB, Ullrich JS, Fish J, Hill KX, White LA, Redvers N, Jernigan VBB, Lewis JP, West AE, Apok CA, White EJ, Ivanich JD, Schultz K, Lewis ME, Sarche MC, Gonzalez MB, Parker M, Neuner Weinstein SE, McCray CJ, Warne D, Black JC, Richards JR, Walls ML. Conceptualizing Indigenous strengths-based health and wellness research using group concept mapping. Arch Public Health 2023; 81:71. [PMID: 37101194 PMCID: PMC10134608 DOI: 10.1186/s13690-023-01066-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/20/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND In recent years public health research has shifted to more strengths or asset-based approaches to health research but there is little understanding of what this concept means to Indigenous researchers. Therefore our purpose was to define an Indigenous strengths-based approach to health and well-being research. METHODS Using Group Concept Mapping, Indigenous health researchers (N = 27) participated in three-phases. Phase 1: Participants provided 218 unique responses to the focus prompt "Indigenous Strengths-Based Health and Wellness Research…" Redundancies and irrelevant statements were removed using content analysis, resulting in a final set of 94 statements. Phase 2: Participants sorted statements into groupings and named these groupings. Participants rated each statement based on importance using a 4-point scale. Hierarchical cluster analysis was used to create clusters based on how statements were grouped by participants. Phase 3: Two virtual meetings were held to share and invite researchers to collaboratively interpret results. RESULTS A six-cluster map representing the meaning of Indigenous strengths-based health and wellness research was created. Results of mean rating analysis showed all six clusters were rated on average as moderately important. CONCLUSIONS The definition of Indigenous strengths-based health research, created through collaboration with leading AI/AN health researchers, centers Indigenous knowledges and cultures while shifting the research narrative from one of illness to one of flourishing and relationality. This framework offers actionable steps to researchers, public health practitioners, funders, and institutions to promote relational, strengths-based research that has the potential to promote Indigenous health and wellness at individual, family, community, and population levels.
Collapse
Affiliation(s)
- Victoria M O'Keefe
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Tara L Maudrie
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ashley B Cole
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | | | - Jillian Fish
- Minneapolis VA Health Care System, Center for Care Delivery and Outcomes Research, Minneapolis, MN, USA
| | - Kyle X Hill
- Department of Indigenous Health, University of North Dakota School of Medicine & Health Sciences, Grand Forks, ND, USA
| | - Lauren A White
- Joint Program for Social Work and Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Nicole Redvers
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada
| | | | - Jordan P Lewis
- Memory Keepers Medical Discovery Team, University of Minnesota Medical School, Duluth, MN, USA
| | - Amy E West
- Keck School of Medicine, Children's Hospital Los Angeles, Department of Pediatrics, University of Southern California, Los Angeles, CA, USA
| | | | - Evan J White
- Laureate Institute for Brain Research, Tulsa, OK, USA
| | - Jerreed D Ivanich
- University of Colorado Anschutz Medical Campus, Centers for American Indian and Alaska Native Health, Aurora, CO, USA
| | - Katie Schultz
- University of Michigan School of Social Work, Ann Arbor, MI, USA
| | - Melissa E Lewis
- Department of Family and Community Medicine, University of Missouri School of Medicine, Columbia, MO, USA
| | - Michelle C Sarche
- School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Miigis B Gonzalez
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Myra Parker
- School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Sophie E Neuner Weinstein
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Obstetrics and Gynecology, Oregon Health and Sciences University, Portland, OR, USA
| | - Celena J McCray
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Donald Warne
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jessica C Black
- Department of Alaska Native Studies and Rural Development, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Jennifer R Richards
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa L Walls
- Center for Indigenous Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Center for Indigenous Health--Great Lakes Hub, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, USA
| |
Collapse
|
4
|
Maudrie TL, Aulandez KMW, O'Keefe VM, Whitfield FR, Walls ML, Hautala DS. Food Stress and Diabetes-Related Psychosocial Outcomes in American Indian Communities: A Mixed Methods Approach. J Nutr Educ Behav 2022; 54:1051-1065. [PMID: 36244877 PMCID: PMC9742178 DOI: 10.1016/j.jneb.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 06/08/2022] [Accepted: 06/12/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Explore the relationship between diabetes-related psychosocial outcomes and food stress in American Indian communities. DESIGN Convergence model of a mixed methods triangulation study. SETTING Five American Indian reservation communities in the Midwest. PARTICIPANTS One-hundred ninety-two participants were randomly selected from tribal health centers using clinic patient records and were surveyed about diabetes distress, empowerment, and food stress across 4 different time points. Seventeen focus group discussions were conducted and transcribed, and a mix of purposive and convenience sampling was used. PHENOMENON OF INTEREST Psychosocial outcomes associated with (or related to) diabetes and food stress. ANALYSIS Quantitative: Multiple linear regression was performed to explore relationships between food stress and diabetes distress and empowerment. Qualitative: Open coding of data identified portions of the transcripts related to food followed by a deductive approach on the basis of the components of quantitative food stress. RESULTS Food stress in the forms of (1) not having enough money for food and not having enough time for cooking or shopping (P = 0.08) and (2) inadequate food access and being on a special diet (P = 0.032) were associated with increased diabetes distress. Lower diabetes empowerment was associated with not having enough money for food and being on a special diet (P = 0.030). Our qualitative data mirrored quantitative findings that experiencing multiple forms of food stress negatively impacted diabetes psychosocial outcomes and illuminated the cyclical role mental health can play in relationships to food. CONCLUSIONS AND IMPLICATIONS Our findings highlight that experiencing food stress negatively affects diabetes empowerment and diabetes distress. These findings emphasize the importance of improving community food environments and addressing individual food access for diabetes management and prevention initiatives in American Indian communities.
Collapse
Affiliation(s)
- Tara L Maudrie
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD.
| | - Kevalin M W Aulandez
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Victoria M O'Keefe
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | | | - Melissa L Walls
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| | - Dane S Hautala
- Center for American Indian Health, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
| |
Collapse
|
5
|
Gonzalez MB, Sittner KJ, Walls ML. Cultural efficacy as a novel component of understanding linkages between culture and mental health in Indigenous communities. Am J Community Psychol 2022; 70:191-201. [PMID: 35285956 PMCID: PMC9452443 DOI: 10.1002/ajcp.12594] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 01/31/2022] [Accepted: 02/02/2022] [Indexed: 05/22/2023]
Abstract
We used a novel measure of cultural efficacy to examine empirical pathways between enculturation, efficacy, and two wellbeing outcomes. Cultural factors are not consistently linked to better wellbeing in the academic literature despite widespread understanding of these processes in Indigenous communities. Healing pathways is a community-based participatory study with eight reservations/reserves in the upper Midwest and Canada. This study uses data collected in 2017-2018 (n = 453, 58.1% women, mean age = 26.3 years) and structural equation modeling to test the relationships between enculturation, cultural efficacy, and mental health. The direct effect of enculturation on anxiety was positive. The indirect effect of enculturation via cultural efficacy was negatively associated with anxiety and positively associated with positive mental health. Cultural efficacy is an important linking variable through which the protective effects of culture manifest. The complex nature of culture must be met with innovative measures and deep understanding of Indigenous peoples to fully capture the protective role of culture.
Collapse
Affiliation(s)
- Miigis B. Gonzalez
- Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Great Lakes HubDuluthMinnesotaUSA
| | - Kelley J. Sittner
- Department of SociologyOklahoma State UniversityStillwaterOklahomaUSA
| | - Melissa L. Walls
- Johns Hopkins Bloomberg School of Public Health, Center for American Indian Health, Great Lakes HubDuluthMinnesotaUSA
| |
Collapse
|
6
|
Lewis ME, Smith J, Wildcat S, Anderson A, Walls ML. The Health Effects of a Cherokee Grounded Culture and Leadership Program. IJERPH 2022; 19:ijerph19138018. [PMID: 35805678 PMCID: PMC9266134 DOI: 10.3390/ijerph19138018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 06/24/2022] [Accepted: 06/25/2022] [Indexed: 11/16/2022]
Abstract
Introduction: Indigenous youth and young adults endure some of the highest rates of physical and mental health problems in the United States compared to their non-Indigenous counterparts. Colonization, oppression, and discrimination play a substantial role in these inequitable disease rates. However, culture (e.g., identity, participation, and connection) relates to the prevention of and recovery from illness in Indigenous populations. The Remember the Removal program aims to teach Indigenous youth and young adults tribally specific culture, history, and language to put them on a trajectory to become informed and culturally connected community leaders. We examined the program’s effects on health. Method: Thirty Remember the Removal program participants, mainly young adults, completed surveys four times: before the program’s start, at the end of the training period, at the program’s end, and at a six-month follow-up. Various indicators of physical, mental, spiritual, and cultural health and well-being were measured at each time period. Paired t-tests were completed to compare baseline scores to each subsequent time interval. Results: At program completion, and as indicated with an asterisk at the six month follow-up, participants had statistically significantly improved diet and exercise measures (e.g., reduced sugary, salty, and fatty foods, reduced soda consumption, increased fruit consumption, and improved self-efficacy for exercise), improved mental health indicators (e.g., reduced stress, anxiety, depression*, anger*, post-traumatic stress disorder, and microaggressions*, and improved positive mental health) and improved social and cultural connection (e.g., social support, Cherokee identity*, Cherokee values). Discussion: This is one of the first quantitative studies to demonstrate the profound effects that cultural learning and connection have on the health and well-being of Indigenous people and practices. It also demonstrates the specificity and effectiveness of a program created by and for tribal citizens. Future programs with Indigenous populations should work to center cultural connection and ensure that programs are created and directed by tribal community members.
Collapse
Affiliation(s)
- Melissa E. Lewis
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO 65212, USA;
- Correspondence:
| | - Jamie Smith
- Department of Family and Community Medicine, School of Medicine, University of Missouri, Columbia, MO 65212, USA;
| | - Sky Wildcat
- Department of Rehabilitation, Human Resources, & Communication Disorders, University of Arkansas, Fayetteville, AR 72701, USA;
| | - Amber Anderson
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Melissa L. Walls
- Center for American Indian Health, Bloomberg School of Public Health, Johns Hopkins University, Duluth, MN 55812, USA;
| |
Collapse
|
7
|
Ishak IA, Walls ML, Aronson BD. The Role of Social Support in the Management of Type 2 Diabetes Mellitus among American Indians: A Qualitative Study. Am Indian Alsk Native Ment Health Res 2022; 29:59-91. [PMID: 35255150 DOI: 10.5820/aian.2901.2022.59] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The purpose of this study is to gain insights of American Indian (AI) communities on the role of social support in type 2 diabetes (T2D) management. Social support is a means of enhancing social and personal resources that can address underlying stressors that contribute to T2D inequities and represents a potential channel of intervention to improve management of T2D in these communities. This community-based participatory research included AI adults from the Bois Forte and Lac Courte Oreilles Bands of Ojibwe and consisted of focus groups that were conducted with people with T2D, social support persons, and service providers. Overall findings underscore the importance of social support in T2D management, especially in providing emotional support, fulfilling an appraisal function, and enabling positive health behaviors. It is also important for policies and practices to consider the social and cultural contexts, particularly the socio-historical context of life within AI communities that has inevitably shaped certain mindsets that may present barriers to care-seeking and optimal T2D management. These findings can inform interventions related to T2D management, especially in incorporating social support and complementing community strengths in achieving a broader goal of reducing diabetes inequities in AI communities.
Collapse
|
8
|
Gonzalez MB, Sittner KJ, Saniguq Ullrich J, Walls ML. Spiritual connectedness through prayer as a mediator of the relationship between Indigenous language use and positive mental health. Cultur Divers Ethnic Minor Psychol 2021; 27:746-757. [PMID: 34291975 PMCID: PMC8497410 DOI: 10.1037/cdp0000466] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
OBJECTIVE The objective of this study is to understand how Indigenous language and spirituality revitalization efforts may affect mental health within Indigenous communities. Although Indigenous communities experience disproportionate rates of mental health problems, research supporting language and spirituality's role in improving mental health is under-researched and poorly understood. METHOD Data for this study are from a Community-based Participatory Research Project involving five Anishinaabe tribes in Minnesota and Wisconsin. Participants were sampled from clinic records of adults with a diagnosis of type 2 diabetes, living on or near the reservation, and self-identifying as American Indian (mean age = 46.3; n = 191). RESULT Structural equation modeling illustrates that language use in the home is associated with positive mental health through spiritual connectedness. CONCLUSION Results support tribal community expressions of the positive effects of cultural involvement for Indigenous wellbeing, and improve what is known about the interconnectedness of language and spirituality. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
Collapse
|
9
|
Marengo CM, Aronson BD, Sittner KJ, Walls ML. A longitudinal study of the stress of poor glucose control and diabetes distress. J Health Psychol 2021; 26:1966-1975. [PMID: 31814451 PMCID: PMC7280073 DOI: 10.1177/1359105319893004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Poor glucose control can be viewed as a stressor, possibly promulgating diabetes distress. We examined the relationship between perceived blood glucose control and diabetes distress over time using a partially controlled cross-lagged path analysis model. After controlling for demographics, control at 6 months was directly related to change in distress at 12 months. Subsequently, distress at 12 months was directly related to change in control at 18 months. Both 6-month control and distress had significant indirect effects on 18-month control and distress. This demonstrates the nuanced bi-directional relationship between the stress of poor perceived control and diabetes distress.
Collapse
Affiliation(s)
| | | | | | - Melissa L Walls
- Department of International Health, Johns Hopkins Center for American Indian Health, Great Lakes Hub, Duluth, MN, USA
| |
Collapse
|
10
|
Sittner KJ, Hautala DS, Walls ML. Conjoint adolescent developmental trajectories of alcohol and marijuana use and early adult outcomes among North American Indigenous people. Addict Behav 2021; 114:106758. [PMID: 33316589 PMCID: PMC7785682 DOI: 10.1016/j.addbeh.2020.106758] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The current study examined the developmental interrelationships between alcohol and marijuana use trajectories from ages 10 to 18 years in a sample of North American Indigenous adolescents. Distinct co-use groups were formed to create profiles of young adult outcomes. METHOD Dual group-based trajectory models of marijuana and alcohol frequency were estimated using data from a longitudinal community-based participatory study of Indigenous adolescents from the upper Midwest and Canada. Joint probabilities were used to create co-use groups, and profiles were created using early adult (Mean Age - 26.28 years) outcomes. RESULTS Four joint trajectory groups were identified: 1) no marijuana and no/low alcohol use (34.4%), 2) mid-onset alcohol only (14%), 3) mid-onset co-use starting at age 13 (24%), and 4) early-onset co-use starting at age 11 (22%). High probabilities existed that adolescents would use marijuana early if they began drinking alcohol at the youngest ages, and that adolescents would not use marijuana if they drank infrequently or delayed drinking until mid-adolescence. Adult outcomes were poorer for the early- and mid-onset co-use groups, but there were few differences between the no/low use and alcohol-only groups. CONCLUSION Co-use of marijuana and alcohol was associated with poorer outcomes in early adulthood, particularly for the group with an earlier age of onset. Abstaining from either substance in adolescence was associated with better outcomes.
Collapse
Affiliation(s)
- Kelley J Sittner
- Department of Sociology, Oklahoma State University, 431 Murray Hall Stillwater, OK 74078, United States.
| | - Dane S Hautala
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 1915 South Street Duluth, MN 55812, United States.
| | - Melissa L Walls
- Johns Hopkins University Bloomberg School of Public Health, Department of International Health, Center for American Indian Health, 1915 South Street Duluth, MN 55812, United States.
| |
Collapse
|
11
|
Aulandez KMW, Walls ML, Weiss NM, Sittner KJ, Gillson SL, Tennessen EN, Maudrie TL, Leppi AM, Rothwell EJ, Bolton-Steiner AR, Gonzalez MB. Cultural Sources of Strength and Resilience: A Case Study of Holistic Wellness Boxes for COVID-19 Response in Indigenous Communities. Front Sociol 2021; 6:612637. [PMID: 33869563 PMCID: PMC8022692 DOI: 10.3389/fsoc.2021.612637] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/19/2021] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has had disproportionately severe impacts on Indigenous peoples in the United States compared to non-Indigenous populations. In addition to the threat of viral infection, COVID-19 poses increased risk for psychosocial stress that may widen already existing physical, mental, and behavioral health inequities experienced by Indigenous communities. In recognition of the impact of COVID-19 related psychosocial stressors on our tribal community partners, the Johns Hopkins Center for American Indian Health Great Lakes Hub began sending holistic wellness boxes to our community partners in 11 tribal communities in the Midwestern United States and Canada in summer of 2020. Designed specifically to draw on culturally relevant sources of strength and resilience, these boxes contained a variety of items to support mental, emotional, cultural, and physical wellbeing. Feedback from recipients suggest that these wellness boxes provided a unique form of COVID-19 relief. Additional Johns Hopkins Center for American Indian Health offices have begun to adapt wellness boxes for the cultural context of their regions. This case study describes the conceptualization, creation, and contents of these wellness boxes and orients this intervention within a reflection on foundations of community-based participatory research, holistic relief, and drawing on cultural strengths in responding to COVID-19.
Collapse
Affiliation(s)
- Kevalin M. W. Aulandez
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Melissa L. Walls
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Nicole M. Weiss
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Kelley J. Sittner
- Department of Sociology, Oklahoma State University, Stillwater, OK, United States
| | - Stefanie L. Gillson
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Elizabeth N. Tennessen
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Tara L. Maudrie
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Ailee M. Leppi
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Emma J. Rothwell
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Athena R. Bolton-Steiner
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| | - Miigis B. Gonzalez
- Johns Hopkins Center for American Indian Health, International Health Department, Johns Hopkins Bloomberg School of Public Health, Duluth, MN, United States
| |
Collapse
|
12
|
Abstract
OBJECTIVE | Type 2 diabetes represents a major health disparity for many American Indian/Alaska Native (AIAN) communities, in which prevalence rates are more than double that of the general U.S. population. Diabetes is a major indicator for other comorbidities, including the leading cause of death for AIANs (i.e., cardiovascular disease). This study investigated associations between protective factors (social support and cultural factors) and self-reported empowerment to manage illness. DESIGN AND METHODS | Participants were drawn from a random sample of tribal clinic records. Data included results from computer-assisted personal interviews with 192 American Indian adults with a diagnosis of type 2 diabetes living on or near a reservation. Community Research Councils, developed at each of the five partnering Anishinaabe reservations, oversaw protocols and procedures in this community-based participatory research collaboration. RESULTS | Multiple ordinary least squares regression models determined that general social support and diabetes-specific social support are positively related to diabetes empowerment. These associations persisted when both social support measures were added to the model, indicating independent effects of different types of social support. Cultural identity and cultural practices were positively related to diabetes empowerment in bivariate analyses; however, both measures dropped from statistical significance after accounting for all other covariates. An interaction term revealed a moderation effect through which cultural identity amplified the positive relationship between social support and diabetes empowerment. CONCLUSION | Results moderately support policy and risk-reduction efforts aiming at expanding social support networks into multiple domains and reinforcing cultural identity and cultural practices.
Collapse
Affiliation(s)
| | - Kaley A Herman
- Johns Hopkins Bloomberg School of Public Health, Duluth, MN
| | | |
Collapse
|
13
|
Abstract
Despite alarming health disparities among American Indians (AIs) and acknowledgement that stressors negatively influence health, conceptualization of the full spectrum of stressors that impact Indigenous communities is underdeveloped. To address this gap, we analyze focus group transcripts of AI adults with type 2 diabetes from five tribal communities and classify stressors using an inductive/deductive analytical approach. A Continuum of American Indian Stressor Model was constructed from categorization of nineteen stressor categories within four domains. We further identified poverty, genocide, and colonization as fundamental causes of contemporary stress and health outcomes for AIs and conclude that stressors are generally experienced as chronic, regardless of the duration of the stressor. This work on AI-specific stressors informs future health research on the stress burden in AI communities and identifies target points for intervention and health promotion.
Collapse
|
14
|
Aronson BD, Sittner KJ, Walls ML. The Mediating Role of Diabetes Distress and Depressive Symptoms in Type 2 Diabetes Medication Adherence Gender Differences. Health Educ Behav 2019; 47:474-482. [PMID: 31665927 DOI: 10.1177/1090198119885416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background. Medication adherence is negatively related to both diabetes distress (DD) and depressive symptoms (DS). Past research suggests gender differences in adherence, DD, and DS. A gap exists in determining if gender differences in adherence are mediated by DD and DS, or if gender moderates differences in adherence by DD/DS. Aims. This study investigated the relationship between gender, DD, DS, and medication adherence and tested for mediating and moderating effects on medication adherence among American Indian adults with type 2 diabetes. Method. The Maawaji idi-oog mino-ayaawin (Gathering for Health) study was a community-based participatory research collaboration with five American Indian tribes. Participants, randomly recruited from clinic records, shared information during computer-assisted personal interviews. This study includes the 166 participants who reported using medications to treat their diabetes. The relationship between gender, DD, DS, and medication adherence are explored. Possible mediating and moderating effects on medication were tested using regression and path analysis. Results. Females had higher levels of DD and DS and lower levels of medication adherence. Higher levels of DD and DS were both associated with lower medication adherence. No evidence was found that gender moderates the relationship between DD or DS and medication adherence. Instead, DD and DS mediated the relationship between gender and medication adherence. Conclusions. Medication adherence differences in male and female patients may be attributable to DD and DS. The present research highlights both DD and DS as targets for clinicians and researchers alike.
Collapse
Affiliation(s)
| | | | - Melissa L Walls
- Department of International Health, Johns Hopkins Center for American Indian Health, Great Lakes Hub, Duluth, MN, USA
| |
Collapse
|
15
|
Aronson BD, Gregoire ARF, Kading ML, RedBrook SM, Wilson R, Walls ML. Self-reported eye diseases among American Indian individuals with type 2 diabetes from the northern Midwest. Eye Rep 2019; 5:9-14. [PMID: 31559003 DOI: 10.16964/er.v5i1.66] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To determine the prevalence of eye diseases and utilization of dilated eye exams among a sample of American Indian (AI) individuals with type 2 diabetes. Methods AI adults with type 2 diabetes utilizing health care at two reservation clinics were randomly sampled and recruited for interviewer-assisted paper surveys. The prevalence of eye diseases was compared across gender, age, income, and educational attainment. Results The prevalence of retinopathy, cataracts, macular degeneration, and glaucoma were 9.4%, 26.7%, 5.2%, and 10.6% respectively, and 59.2% reported past year dilated eye exams. Older participants were more likely to report cataracts (p < 0.001) and glaucoma (p = .003). Those with lower income were more likely to report cataracts (p = 0.001). Conclusions Rates of self-reported eye diseases in this sample were higher, and dilated eye exams lower than other samples of the general United States population with diabetes, suggesting improvement can be made to improve the provision of care for AI individuals with type 2 diabetes.
Collapse
Affiliation(s)
- Benjamin D Aronson
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, Duluth, Minnesota, USA
| | - Anna R F Gregoire
- University of Minnesota Medical School-Duluth, Duluth, Minnesota, USA
| | - Margarette L Kading
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, Duluth, Minnesota, USA
| | - Shannon M RedBrook
- Department of Biomedical Science, University of Minnesota Medical School-Duluth, Duluth, Minnesota, USA
| | - Ryan Wilson
- University of Minnesota Medical School-Duluth, Duluth, Minnesota, USA
| | - Melissa L Walls
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School-Duluth, Duluth, Minnesota, USA
| |
Collapse
|
16
|
Kading ML, Gonzalez MB, Herman KA, Gonzalez J, Walls ML. Living a Good Way of Life: Perspectives from American Indian and First Nation Young Adults. Am J Community Psychol 2019; 64:21-33. [PMID: 31486101 PMCID: PMC6800209 DOI: 10.1002/ajcp.12372] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
In this study, we respond to calls for strengths-based Indigenous research by highlighting American Indian and First Nations (Anishinaabe) perspectives on wellness. We engaged with Anishinaabe community members by using an iterative, collaborative Group Concept Mapping methodology to define strengths from a within-culture lens. Participants (n = 13) shared what it means to live a good way of life/have wellness for Anishinaabe young adults, ranked/sorted their ideas, and shared their understanding of the map. Results were represented by nine clusters of wellness, which addressed aspects of self-care, self-determination, actualization, community connectedness, traditional knowledge, responsibility to family, compassionate respect toward others, enculturation, and connectedness with earth/ancestors. The clusters were interrelated, primarily in the relationship between self-care and focus on others. The results are interpreted by the authors and Anishinaabe community members though the use of the Seven Grandfather Teachings, which provide a framework for understanding Anishinaabe wellness. The Seven Grandfather Teachings include Honesty (Gwayakwaadiziwin), Respect (Manaadendamowin), Humility (Dabaadendiziwin), Love (Zaagi'idiwin), Wisdom (Nibwaakaawin), Bravery/Courage (Aakode'ewin), and Truth (Debwewin).
Collapse
Affiliation(s)
- Margarette L. Kading
- The College of St. Scholastica, Physician Assistant Studies, 940 Woodland Ave, Duluth, MN 55812
| | - Miigis B. Gonzalez
- Johns Hopkins Center for American Indian Health, 1915 South Street, Duluth, MN 55812
| | - Kaley A. Herman
- Johns Hopkins Center for American Indian Health, 1915 South Street, Duluth, MN 55812
| | - John Gonzalez
- Bemidji State University, 1500 Birchmont Drive NE, Bemidji, MN, 56601
| | - Melissa L. Walls
- Johns Hopkins Center for American Indian Health, 1915 South Street, Duluth, MN 55812
| |
Collapse
|
17
|
Wendt DC, Hartmann WE, Allen J, Burack JA, Charles B, D'Amico EJ, Dell CA, Dickerson DL, Donovan DM, Gone JP, O'Connor RM, Radin SM, Rasmus SM, Venner KL, Walls ML. Substance Use Research with Indigenous Communities: Exploring and Extending Foundational Principles of Community Psychology. Am J Community Psychol 2019; 64:146-158. [PMID: 31365138 PMCID: PMC6777961 DOI: 10.1002/ajcp.12363] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Many Indigenous communities are concerned with substance use (SU) problems and eager to advance effective solutions for their prevention and treatment. Yet these communities also are concerned about the perpetuation of colonizing, disorder-focused, stigmatizing approaches to mental health, and social narratives related to SU problems. Foundational principles of community psychology-ecological perspectives, empowerment, sociocultural competence, community inclusion and partnership, and reflective practice-provide useful frameworks for informing ethical community-based research pertaining to SU problems conducted with and by Indigenous communities. These principles are explored and extended for Indigenous community contexts through themes generated from seven collaborative studies focused on understanding, preventing, and treating SU problems. These studies are generated from research teams working with Indigenous communities across the United States and Canada-inclusive of urban, rural, and reservation/reserve populations as well as adult and youth participants. Shared themes indicate that Indigenous SU research reflects community psychology principles, as an outgrowth of research agendas and processes that are increasingly guided by Indigenous communities. At the same time, this research challenges these principles in important ways pertaining to Indigenous-settler relations and Indigenous-specific considerations. We discuss these challenges and recommend greater synergy between community psychology and Indigenous research.
Collapse
Affiliation(s)
- Dennis C Wendt
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - William E Hartmann
- School of Interdisciplinary Arts and Sciences, University of Washington-Bothell, Bothell, WA, USA
| | - James Allen
- Memory Keepers Medical Discovery Team - American and Rural Health Equity, Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| | - Jacob A Burack
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Billy Charles
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | | | - Colleen A Dell
- Department of Sociology, School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Daniel L Dickerson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dennis M Donovan
- Department of Psychiatry and Behavioral Sciences, Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
| | - Joseph P Gone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anthropology, Harvard University, Cambridge, MA, USA
| | - Roisin M O'Connor
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Sandra M Radin
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
| | - Stacy M Rasmus
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Kamilla L Venner
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Melissa L Walls
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| |
Collapse
|
18
|
Walls ML, Hautala D, Gonzalez M, Greenfield B, Aronson BD, Onello E. Perceptions and Prevalence of Alcohol and Cigarette Use Among American Indian Adults With Type 2 Diabetes. Clin Diabetes 2019; 37:260-268. [PMID: 31371857 PMCID: PMC6640875 DOI: 10.2337/cd18-0078] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IN BRIEF This study examined community perceptions and prevalence of alcohol use and cigarette smoking among American Indian adults with type 2 diabetes. Results revealed normative rates and perceptions of smoking and negative views and low rates of alcohol use. Participants reported high levels of household indoor smoking and comorbid high-risk drinking and smoking. The high smoking rate among the adult American Indians in this study is especially problematic given the increased risk of cardiovascular problems related to both smoking and type 2 diabetes. The results underscore the importance of considering substance use behaviors and beliefs as a component of overall health and well-being for people with diabetes.
Collapse
Affiliation(s)
- Melissa L. Walls
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Dane Hautala
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Miigis Gonzalez
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Brenna Greenfield
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| | - Benjamin D. Aronson
- Department of Pharmacy Practice, Ohio Northern University Raabe College of Pharmacy, Ada, OH
| | - Emily Onello
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, MN
| |
Collapse
|
19
|
Abstract
Research is an important tool in addressing myriad American Indian and Alaska Native (AIAN) health disparities; however, tensions exist between common empirical measurement approaches that facilitate cross-cultural comparisons and measurement specificity that may be more valid locally and/or culturally appropriate. The tremendous diversity of AIAN communities, small population sizes of distinct AIAN cultural groups, and varying cultural contexts and worldviews should influence measurement decisions in health research. We provide a framework for guiding measurement in collaboration with AIAN communities using examples from substance abuse research for illustration. Our goal is to build upon ongoing efforts to advance measurement validity for AIAN research by engaging community-researcher partnerships and critical thinking in the selection, adaptation, creation, and implementation of measures.
Collapse
Affiliation(s)
- Melissa L Walls
- a University of Minnesota Medical School , Duluth , Minnesota
| | - Nancy Rumbaugh Whitesell
- b Colorado School of Public Health , University of Colorado Anschutz Medical Campus , Aurora , Colorado
| | - Allison Barlow
- c Johns Hopkins Bloomberg School of Public Health , Baltimore , Maryland
| | - Michelle Sarche
- b Colorado School of Public Health , University of Colorado Anschutz Medical Campus , Aurora , Colorado
| |
Collapse
|
20
|
Coser A, Sittner KJ, Walls ML, Handeland T. Caregiving Stress Among American Indians With Type 2 Diabetes: The Importance of Awareness of Connectedness and Family Support. J Fam Nurs 2018; 24:621-639. [PMID: 30497320 PMCID: PMC6510027 DOI: 10.1177/1074840718810550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
American Indian (AI) communities experience a disproportionate rate of Type 2 diabetes (T2D) and cumulative exposure to stress. Although this link is well researched among various populations, it has not been examined among AI communities. Path analysis was used to examine a multiple-mediator model to explain how caregiver stress influences self-reported mental and physical health among 100 AI participants with T2D. Caregiver stress was negatively associated with physical and mental health. Physical health was positively associated with family/community connectedness and mental health was positively associated with both family support and connectedness. The relationship between caregiver stress and mental health was partially mediated by family/community connectedness; caregiver stress had no indirect effects on physical health via either hypothesized mediator. Findings demonstrate the importance of integrating individuals' connection to family and community and its influence on caregiver stress and mental health in intervention programs targeting diabetes management and care among AI communities.
Collapse
|
21
|
Brockie TN, Elm JHL, Walls ML. Examining protective and buffering associations between sociocultural factors and adverse childhood experiences among American Indian adults with type 2 diabetes: a quantitative, community-based participatory research approach. BMJ Open 2018; 8:e022265. [PMID: 30232110 PMCID: PMC6150153 DOI: 10.1136/bmjopen-2018-022265] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The purpose of this study was to determine the frequency of select adverse childhood experiences (ACEs) among a sample of American Indian (AI) adults living with type 2 diabetes (T2D) and the associations between ACEs and self-rated physical and mental health. We also examined associations between sociocultural factors and health, including possible buffering processes. DESIGN Survey data for this observational study were collected using computer-assisted survey interviewing techniques between 2013 and 2015. SETTING Participants were randomly selected from AI tribal clinic facilities on five reservations in the upper Midwestern USA. PARTICIPANTS Inclusion criteria were a diagnosis of T2D, age 18 years or older and self-identified as AI. The sample includes n=192 adults (55.7% female; mean age=46.3 years). PRIMARY MEASURES We assessed nine ACEs related to household dysfunction and child maltreatment. Independent variables included social support, diabetes support and two cultural factors: spiritual activities and connectedness. Primary outcomes were self-rated physical and mental health. RESULTS An average of 3.05 ACEs were reported by participants and 81.9% (n=149) said they had experienced at least one ACE. Controlling for gender, age and income, ACEs were negatively associated with self-rated physical and mental health (p<0.05). Connectedness and social support were positively and significantly associated with physical and mental health. Involvement in spiritual activities was positively associated with mental health and diabetes-specific support was positively associated with physical health. Social support and diabetes-specific social support moderated associations between ACEs and physical health. CONCLUSIONS This research demonstrates inverse associations between ACEs and well-being of adult AI patients with diabetes. The findings further demonstrate the promise of social and cultural integration as a critical component of wellness, a point of relevance for all cultures. Health professionals can use findings from this study to augment their assessment of patients and guide them to health-promoting social support services and resources for cultural involvement.
Collapse
Affiliation(s)
- Teresa N Brockie
- Community Public Health Nursing, Johns Hopkins School of Nursing, Baltimore, Maryland, USA
| | - Jessica H L Elm
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth, Minnesota, USA
| | - Melissa L Walls
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth, Minnesota, USA
| |
Collapse
|
22
|
Ratner NL, Davis EB, Lhotka LL, Wille SM, Walls ML. Patient-Centered Care, Diabetes Empowerment, and Type 2 Diabetes Medication Adherence Among American Indian Patients. Clin Diabetes 2017; 35:281-285. [PMID: 29263570 PMCID: PMC5734175 DOI: 10.2337/cd17-0008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
IN BRIEF Type 2 diabetes has been labeled an epidemic in many American Indian communities. Thus, identifying factors that improve medication adherence for American Indian patients is crucial. We found significant and positive relationships among patient-centered care, medication adherence, and diabetes empowerment. In addition, diabetes empowerment partially mediated the relationship between patient-centered care and medication adherence.
Collapse
|
23
|
Sittner KJ, Greenfield BL, Walls ML. Microaggressions, diabetes distress, and self-care behaviors in a sample of American Indian adults with type 2 diabetes. J Behav Med 2017; 41:122-129. [PMID: 29116568 DOI: 10.1007/s10865-017-9898-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 10/30/2017] [Indexed: 12/29/2022]
Abstract
American Indian/Alaska Native people experience the highest age-adjusted prevalence of type 2 diabetes of any racial group in the United States, as well as high rates of related health problems. Chronic stressors such as perceived discrimination are important contributors to these persistent health disparities. The current study used structural equation modeling to examine the relationships between racial microaggressions, diabetes distress, and self-care behaviors (diet and exercise) in a sample of 192 American Indians with type 2 diabetes from the northern United States. We found that microaggressions was positively associated with diabetes distress and that microaggressions had an indirect link to self-care via diabetes distress. Diabetes distress is an important mechanism linking microaggressions to self-care behaviors, which are critical to successful disease management and the reduction of complications. The amelioration of diabetes distress could improve self-care even in the presence of pervasive, chronic social stressors such as microaggressions.
Collapse
Affiliation(s)
- Kelley J Sittner
- Department of Sociology, Oklahoma State University, 431 Murray Hall, Stillwater, OK, 74078, USA.
| | - Brenna L Greenfield
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth Campus, 1035 University Drive, Duluth, MN, 55812, USA
| | - Melissa L Walls
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth Campus, 1035 University Drive, Duluth, MN, 55812, USA
| |
Collapse
|
24
|
Walls ML, Sittner KJ, Aronson BD, Forsberg AK, Whitbeck LB, al'Absi M. Stress Exposure and Physical, Mental, and Behavioral Health among American Indian Adults with Type 2 Diabetes. Int J Environ Res Public Health 2017; 14:ijerph14091074. [PMID: 28926940 PMCID: PMC5615611 DOI: 10.3390/ijerph14091074] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 09/09/2017] [Accepted: 09/13/2017] [Indexed: 02/08/2023]
Abstract
American Indian (AI) communities experience disproportionate exposure to stressors and health inequities including type 2 diabetes. Yet, we know little about the role of psychosocial stressors for AI diabetes-related health outcomes. We investigated associations between a range of stressors and psychological, behavioral, and physical health for AIs with diabetes. This community-based participatory research with 5 AI tribes includes 192 AI adult type 2 diabetes patients recruited from clinical records at tribal clinics. Data are from computer-assisted interviews and medical charts. We found consistent bivariate relationships between chronic to discrete stressors and mental and behavioral health outcomes; several remained even after accounting for participant age, gender, and income. Fewer stressors were linked to physical health. We also document a dose-response relationship between stress accumulation and worse health. Findings underscore the importance of considering a broad range of stressors for comprehensive assessment of stress burden and diabetes. Policies and practices aimed at reducing stress exposure and promoting tools for stress management may be mechanisms for optimal health for AI diabetes patients.
Collapse
Affiliation(s)
- Melissa L Walls
- Department of Family Medicine and Biobehavioral Health ,University of Minnesota Medical School, Duluth campus, 1035 University Drive, 235 SMed, Duluth, MN 55812, USA.
| | - Kelley J Sittner
- Department of Sociology, Oklahoma State University, Stillwater, OK 74078, USA.
| | - Benjamin D Aronson
- Department of of Pharmacy Practice, Ohio Northern University, Ada, OH 45810, USA.
| | - Angie K Forsberg
- Department of Family Medicine and Biobehavioral Health ,University of Minnesota Medical School, Duluth campus, 1035 University Drive, 235 SMed, Duluth, MN 55812, USA.
| | - Les B Whitbeck
- Department of Sociology University of Nebraska, Lincoln, NE 68588, USA.
| | - Mustafa al'Absi
- Department of Family Medicine and Biobehavioral Health ,University of Minnesota Medical School, Duluth campus, 1035 University Drive, 235 SMed, Duluth, MN 55812, USA.
| |
Collapse
|
25
|
Greenfield BL, Sittner KJ, Forbes MK, Walls ML, Whitbeck LB. Conduct Disorder and Alcohol Use Disorder Trajectories, Predictors, and Outcomes for Indigenous Youth. J Am Acad Child Adolesc Psychiatry 2017; 56:133-139.e1. [PMID: 28117059 PMCID: PMC5314209 DOI: 10.1016/j.jaac.2016.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 09/29/2016] [Accepted: 11/22/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The aim of this study was to identify separate and joint trajectories of conduct disorder (CD) and alcohol use disorder (AUD) DSM-IV diagnostic symptoms among American Indian and First Nation (Indigenous) youth aged 10 to 18 years, and to characterize baseline profiles and later outcomes associated with joint trajectory group membership. METHOD Data were collected between 2002 and 2010 on three indigenous reservations in the northern Midwest and four Canadian reserves (N = 673). CD and substance use disorder (SUD) were measured using the DSM-IV Diagnostic Interview Schedule for Children-Revised (DISC-R), administered at four time points. RESULTS Using group-based trajectory modeling, three CD and four AUD trajectories were found. Both had a small group with high symptoms, but the largest groups for both had no symptoms (55% and 73%, respectively). CD symptom trajectories began at age 10 years and peaked at age 14; AUD trajectories began at age 12 years and were highest from age 16 on. Eight joint trajectories were identified. Of the sample, 53% fell into the group with no CD or AUD symptoms. Compared to symptomatic groups, this group had greater caretaker warmth, positive school adjustment, less discrimination, and fewer deviant peers, and were less likely to have a caretaker with major depression at baseline. Symptomatic groups had higher odds of high school dropout, sex under the influence, and arrest at age 17 to 20 years. CONCLUSION Despite significant risk factors, a large proportion of Indigenous youth had no CD-SUD symptoms over time. CD-SUD symptoms have multiple development trajectories and are related to early developmental risk and later psychosocial outcomes.
Collapse
|
26
|
Abstract
Members of American Indian (AI) communities face many barriers to receiving both mental and physical healthcare. These barriers can have a negative effect on overall health. Barriers are compounded for AIs who are also experiencing homelessness, and AI make up a disproportionate percentage of the homeless population nationwide. In-depth semi-structured interviews were conducted with 12 service providers and 16 homeless participants in a mid-size Midwestern city to identify barriers to care for homeless participants. Key barriers identified in this study for homeless participants were: transportation, phone accessibility, discrimination, and cold and bureaucratic cultures of healthcare systems. Major barriers identified by service providers were: access to care, discrimination and mistrust, and restrictive policies. Given generally higher disease prevalence within the homeless population and health disparities within the AI community, steps should be taken to reduce barriers to healthcare.
Collapse
Affiliation(s)
- Stephanie M Wille
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School, Duluth campus
| | - Katherine A Kemp
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School, Duluth campus
| | - Brenna L Greenfield
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School, Duluth campus
| | - Melissa L Walls
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School, Duluth campus
| |
Collapse
|
27
|
Abstract
Understanding culture as a means of preventing or treating health concerns is growing in popularity among social behavioral health scientists. Language is one component of culture and therefore may be a means to improve health among Indigenous populations. This study explores language as a unique aspect of culture through its relationship to other demographic and cultural variables. Participants (n = 218) were adults who self-identified as American Indian, had a type 2 diabetes diagnosis, and were drawn from two Ojibwe communities using health clinic records. We used chi-squared tests to compare language proficiency by demographic groups and ANOVA tests to examine relationships between language and culture. A higher proportion of those living on reservation lands could use the Ojibwe language, and fluent speakers were most notably sixty-five years of age and older. Regarding culture, those with greater participation and value belief in cultural activities reported greater language proficiency.
Collapse
|
28
|
Carlson AE, Aronson BD, Unzen M, Lewis M, Benjamin GJ, Walls ML. Apathy and Type 2 Diabetes among American Indians: Exploring the Protective Effects of Traditional Cultural Involvement. J Health Care Poor Underserved 2017; 28:770-783. [PMID: 28529223 PMCID: PMC5614516 DOI: 10.1353/hpu.2017.0073] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this study we examine relationships between traditional cultural factors, apathy, and health-related outcomes among a sample of American Indian adults with type 2 diabetes. Participants completed cross-sectional interviewer-assisted paper and pencil surveys. We tested a proposed model using latent variable path analysis in order to understand the relationships between cultural participation, apathy, frequency of high blood sugar symptoms, and health-related quality of life. The model revealed significant direct effects from cultural participation to apathy, and apathy to both health-related outcomes. No direct effect of cultural participation on either health-related outcome was found; however, cultural participation had a negative indirect effect through apathy on high blood sugar and positive indirect effects on health-related quality of life. This study highlights a potential pathway of cultural involvement to positive diabetes outcomes.
Collapse
|
29
|
Aronson BD, Palombi LC, Walls ML. Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes. J Behav Med 2016; 39:694-703. [PMID: 27001254 PMCID: PMC4945379 DOI: 10.1007/s10865-016-9733-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 03/14/2016] [Indexed: 10/22/2022]
Abstract
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.
Collapse
Affiliation(s)
- Benjamin D Aronson
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN, 55812, USA.
| | - Laura C Palombi
- Department of Pharmacy Practice and Pharmaceutical Sciences, University of Minnesota College of Pharmacy, 232 Life Science, 1110 Kirby Drive, Duluth, MN, 55812, USA
| | - Melissa L Walls
- Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| |
Collapse
|
30
|
Abstract
Efforts to build empirical evidence for the protective effects of Indigenous cultural factors on psychological health have yielded mixed findings. We examine the interplay of previously hypothesized culturally relevant risk (discrimination, historical loss) and protective (spiritual activities) factors among Indigenous people. The sample includes 569 Indigenous adolescents (M age = 17.23, SD = 0.88; 51.0% girls) and 563 Indigenous adult caregivers (M age = 44.66, SD = 9.18; 77.4% women). Our central finding was that indigenous spirituality was associated with poorer psychological outcomes across several domains (depressive symptoms, anger, anxiety, somatization and interpersonal difficulties), but observed effects were attenuated once perceived discrimination and historical losses were added to statistical models. Thus, consideration of relevant stressors drastically changed our conclusions, underscoring the uncertain dynamics through which specific Indigenous cultural factors impact mental health. Researchers should work in collaboration with Indigenous communities to improve measurement and empirical investigation of these complex constructs.
Collapse
Affiliation(s)
- Melissa L Walls
- University of Minnesota Medical School-Duluth 1035 University Drive 235 SMed Duluth, MN 55812 218-726-8367 (telephone) 218-726-7559 (fax)
| | - Les Whitbeck
- University of Nebraska-Lincoln 711 Oldfather Hall Lincoln, NE 68588-0324
| | - Brian Armenta
- Department of Psychological Sciences, 200 S. 7th Street, University of Missouri, Columbia, MO 65211
| |
Collapse
|
31
|
Aronson BD, Johnson-Jennings M, Kading ML, Smith RC, Walls ML. Mental health service and provider preference among American Indians with type 2 diabetes. Am Indian Alsk Native Ment Health Res 2016; 23:1-23. [PMID: 28562840 PMCID: PMC5454776 DOI: 10.5820/aian.2301.2016.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
In this study, we investigated mental health service and provider preferences of American Indian adults with type 2 diabetes from two tribes in the northern Midwest. Preferences were determined and compared by participant characteristics. After controlling for other factors, living on reservation lands was associated with increased odds of Native provider preference, and decreased odds of biomedical service preference. Anxiety also was associated with decreased odds of biomedical service preference. Spiritual activity engagement and past health care discrimination were associated with increased odds of traditional service preference. We discuss implications for the types of mental health services offered and characteristics of providers who are recruited for tribal communities.
Collapse
|
32
|
Abstract
Positive mental health (PMH) is an important construct for understanding the full continuum of mental health. Some socially disadvantaged populations experience a paradoxically high level of PMH despite negative social experiences including discrimination. The purpose of this study is to examine the prevalence and culturally salient correlates of PMH among a cross-sectional sample of 218 American Indian adults living with type 2 diabetes mellitus. Although 17.1 percent of individuals in this sample met Patient Health Questionnaire (PHQ-9) criteria for depression, 51.5 percent were in flourishing PMH. Perceived discrimination was negatively associated with PMH, and participation in traditional cultural activities was positively associated with PMH. Traditional cultural activities did not appear to buffer the impact of discrimination on PMH. This study contributes to strengths-based research with American Indian communities, furthers our understanding of correlates of PMH, and documents comparatively high rates of flourishing mental health in our sample relative to previously published studies with diverse samples.
Collapse
Affiliation(s)
| | | | | | | | - Reid C Smith
- University of Minnesota, College of Pharmacy-Duluth
| | | |
Collapse
|
33
|
Hart RJ, Doherty DA, McLachlan RI, Walls ML, Keelan JA, Dickinson JE, Skakkebaek NE, Norman RJ, Handelsman DJ. Testicular function in a birth cohort of young men. Hum Reprod 2015; 30:2713-24. [PMID: 26409015 DOI: 10.1093/humrep/dev244] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 09/08/2015] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION By investigating a birth cohort with a high ongoing participation rate to derive an unbiased population, what are the parameters and influences upon testicular function for a population not selected with regard to fertility? SUMMARY ANSWER While varicocele, cryptorchidism and obesity may impact on human testicular function, most common drug exposures and the presence of epididymal cysts appear to have no or minimal adverse impact. WHAT IS KNOWN ALREADY The majority of previous attempts to develop valid reference populations for spermatogenesis have relied on potentially biased sources such as recruits from infertility clinics, self-selected volunteer sperm donors for research or artificial insemination or once-fertile men seeking vasectomy. It is well known that studies requiring semen analysis have low recruitment rates which consequently question their validity. However, there has been some concern that a surprisingly high proportion of young men may have semen variables that do not meet all the WHO reference range criteria for fertile men, with some studies reporting that up to one half of participants have not meet the reference range for fertile men. Reported median sperm concentrations have ranged from 40 to 60 million sperm/ml. STUDY DESIGN, SIZE AND DURATION The Western Australian Pregnancy Cohort (Raine) was established in 1989. At 20-22 years of age, members of the cohort were contacted to attend for a general follow-up, with 753 participating out of the 913 contactable men. Of these, 423 men (56% of participants in the 20-22 years cohort study, 46% of contactable men) participated in a testicular function study. Of the 423 men, 404 had a testicular ultrasound, 365 provided at least one semen sample, 287 provided a second semen sample and 384 provided a blood sample. PARTICIPANTS/MATERIALS, SETTING, METHODS Testicular ultrasound examinations were performed at King Edward Memorial Hospital, Subiaco, Perth, for testicular volume and presence of epididymal cysts and varicoceles. Semen samples were provided and analysed by standard semen assessment and a sperm chromatin structural assay (SCSA) at Fertility Specialists of Western Australia, Claremont, Perth. Serum blood samples were provided at the University of Western Australia, Crawley, Perth and were analysed for serum luteinizing hormone (LH), follicular stimulating hormone (FSH), inhibin B, testosterone, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), estradiol, estrone and the primary metabolites of DHT: 5α-androstane-3α,17β-diol (3α-diol) and 5-α androstane-3-β-17-beta-diol (3β-diol). Serum steroids were measured by liquid chromatography, mass spectrometry and LH, FSH and inhibin B were measured by ELISA assays. MAIN RESULTS AND THE ROLE OF CHANCE Cryptorchidism was associated with a significant reduction in testicular (P = 0.047) and semen (P = 0.027) volume, sperm concentration (P = 0.007) and sperm output (P = 0.003). Varicocele was associated with smaller testis volume (P < 0.001), lower sperm concentration (P = 0.012) and total sperm output (P = 0.030) and lower serum inhibin B levels (P = 0.046). Smoking, alcohol intake, herniorrhaphy, an epididymal cyst, medication and illicit drugs were not associated with any significant semen variables, testicular volume or circulating reproductive hormones. BMI had a significantly negative correlation with semen volume (r = -0.12, P = 0.048), sperm output (r = -0.13, P = 0.02), serum LH (r = -0.16, P = 0.002), inhibin B (r = -0.16, P < 0.001), testosterone (r = -0.23, P < 0.001) and DHT (r = -0.22, P < 0.001) and a positive correlation with 3αD (r = 0.13, P = 0.041) and DHEA (r = 0.11, P = 0.03). Second semen samples compared with the first semen samples in the 287 participants who provided two samples, with no significant bias by Bland-Altman analysis. Testis volume was significantly correlated positively with sperm concentration (r = 0.25, P < 0.001) and sperm output (r = 0.29, P < 0.001) and inhibin B (r = 0.42, P < 0.001), and negatively correlated with serum LH (r = -0.24, P < 0.001) and FSH (r = -0.32, P < 0.001). SCSA was inversely correlated with sperm motility (r = -0.20, P < 0.001) and morphology (r = -0.16, P = 0.005). WHO semen reference criteria were all met by only 52 men (14.4%). Some criteria were not met at first analysis in 15-20% of men, including semen volume (<1.5 ml, 14.8%), total sperm output (<39 million, 18.9%), sperm concentration (<15 million/ml, 17.5%), progressive motility (<32%, 14.4%) and morphologically normal sperm (<4%, 26.4%), while all five WHO criteria were not met in four participants (1.1%). LIMITATIONS AND REASONS FOR CAUTION This was a large cohort study; however, potential for recruitment bias still exists. Men who did not participate in the testicular evaluation study (n = 282) did not differ from those who did (n = 423) with regard to age, weight, BMI, smoking or circulating reproductive hormones (LH, FSH, inhibin B, T, DHT, E2, E1, DHEA, 3α-diol, 3β-diol), but were significantly shorter (178 versus 180 cm, P = 0.008) and had lower alcohol consumption (P = 0.019) than those who did participate. WIDER IMPLICATIONS OF THE FINDINGS This study demonstrated the feasibility of establishing a birth cohort to provide a relatively unbiased insight into population-representative sperm output and function and of investigating its determinants from common exposures. While varicocele, cryptorchidism and obesity may impact on human testicular function, most common drug exposures and the presence of epididymal cysts appear to have little adverse impact, and this study suggests that discrepancies from the WHO reference ranges are expected, due to its derivation from non-population-representative fertile populations.
Collapse
Affiliation(s)
- R J Hart
- School of Women's and Infants' Health, University of Western Australia, Perth, WA 6008, Australia Fertility Specialists of Western Australia, Bethesda Hospital, 25 Queenslea Drive, Claremont, WA 6010, Australia
| | - D A Doherty
- School of Women's and Infants' Health, University of Western Australia, Perth, WA 6008, Australia Women and Infants Research Foundation, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, Australia
| | - R I McLachlan
- Hudson Institute of Medical Research, Monash Medical Centre, Melbourne, Australia
| | - M L Walls
- School of Women's and Infants' Health, University of Western Australia, Perth, WA 6008, Australia Fertility Specialists of Western Australia, Bethesda Hospital, 25 Queenslea Drive, Claremont, WA 6010, Australia
| | - J A Keelan
- School of Women's and Infants' Health, University of Western Australia, Perth, WA 6008, Australia Women and Infants Research Foundation, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, Australia
| | - J E Dickinson
- School of Women's and Infants' Health, University of Western Australia, Perth, WA 6008, Australia Women and Infants Research Foundation, King Edward Memorial Hospital, 374 Bagot Road, Subiaco, Perth, WA, Australia
| | - N E Skakkebaek
- Department of Growth and Reproduction, University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark
| | - R J Norman
- Robinson Institute, University of Adelaide, FertilitySA, Adelaide, Australia
| | - D J Handelsman
- ANZAC Research Institute, University of Sydney, Concord Hospital, Sydney, Australia
| |
Collapse
|
34
|
Abstract
PURPOSE This article reports on the prevalence and correlates of microaggressive experiences in health care settings reported by American Indian (AI) adults with type 2 diabetes mellitus (T2DM). METHODS This community-based participatory research project includes two AI reservation communities. Data were collected via in-person article-and-pencil survey interviews with 218 AI adults diagnosed with T2DM. RESULTS Greater than one third of the sample reported experiencing a microaggression in interactions with their health providers. Reports of microaggressions were correlated with self-reported history of heart attack, worse depressive symptoms, and prior-year hospitalization. Depressive symptom ratings seemed to account for some of the association between microaggressions and hospitalization (but not history of heart attack) in multivariate models. CONCLUSIONS Microaggressive experiences undermine the ideals of patient-centered care and in this study were correlated with worse mental and physical health reports for AIs living with a chronic disease. Providers should be cognizant of these subtle, often unconscious forms of discrimination.
Collapse
Affiliation(s)
- Melissa L Walls
- From the Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School-Duluth, Duluth, MN (MLW); Department of Psychology, Bemidji State University, Bemidji, MN (JG); Department of Sociology and Criminal Justice, University of St. Thomas, St. Paul, MN (TG); Department of Family Medicine/Community Health, University of Minnesota Medical School-Duluth, Duluth, MN (EO).
| | - John Gonzalez
- From the Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School-Duluth, Duluth, MN (MLW); Department of Psychology, Bemidji State University, Bemidji, MN (JG); Department of Sociology and Criminal Justice, University of St. Thomas, St. Paul, MN (TG); Department of Family Medicine/Community Health, University of Minnesota Medical School-Duluth, Duluth, MN (EO)
| | - Tanya Gladney
- From the Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School-Duluth, Duluth, MN (MLW); Department of Psychology, Bemidji State University, Bemidji, MN (JG); Department of Sociology and Criminal Justice, University of St. Thomas, St. Paul, MN (TG); Department of Family Medicine/Community Health, University of Minnesota Medical School-Duluth, Duluth, MN (EO)
| | - Emily Onello
- From the Department of Biobehavioral Health and Population Sciences, University of Minnesota Medical School-Duluth, Duluth, MN (MLW); Department of Psychology, Bemidji State University, Bemidji, MN (JG); Department of Sociology and Criminal Justice, University of St. Thomas, St. Paul, MN (TG); Department of Family Medicine/Community Health, University of Minnesota Medical School-Duluth, Duluth, MN (EO)
| |
Collapse
|
35
|
Whitbeck LB, Sittner Hartshorn KJ, Crawford DM, Walls ML, Gentzler KC, Hoyt DR. Mental and substance use disorders from early adolescence to young adulthood among indigenous young people: final diagnostic results from an 8-year panel study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:961-73. [PMID: 24488151 PMCID: PMC4031267 DOI: 10.1007/s00127-014-0825-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 01/17/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Our objective was to investigate change in prevalence rates for mental and substance abuse disorders between early adolescence and young adulthood in a cohort of indigenous adolescents who participated in an 8-year panel study. METHOD The data are from a lagged, sequential study of 671 indigenous adolescents (Wave 1) from a single culture in the Northern Midwest USA and Canada. At Wave 1 (mean age 11.3 years, Wave 4 (mean age 14.3 years), Wave 6 (mean age 16.2 years), and at Wave 8 (mean age 18.3 years) the tribally enrolled adolescents completed a computer-assisted personal interview that included DISC-R assessment for 11 diagnoses. Our yearly retention rates by diagnostic wave were: Wave 2, 94.7 %; Wave 4, 87.7 %; Wave 6, 88.0 %; Wave 8, 78.5 %. RESULTS The findings show a dramatic increase in lifetime prevalence rates for substance use disorders. By young adulthood, over half had met criteria of substance abuse or dependence disorder. Also at young adulthood, 58.2 % had met lifetime criteria of a single substance use or mental disorder and 37.2 % for two or more substance use or mental disorders. The results are compared to other indigenous diagnostic studies and to the general population. CONCLUSIONS A mental health crisis exists within the indigenous populations that participated in this study. Innovations within current mental health service systems are needed to address the unmet demand of adolescents and families.
Collapse
Affiliation(s)
- Les B. Whitbeck
- Department of Sociology, 739 Oldfather Hall, University of Nebraska-Lincoln, Lincoln, NE 68588-0324, USA
| | | | - Devan M. Crawford
- Bureau of Sociological Research, 210 Benton Hall, University of Nebraska-Lincoln, Lincoln, NE 68588-0623, USA
| | - Melissa L. Walls
- Department of Biobehavioral Health and Population Sciences, 235 SMed, University of Minnesota Medical School, Duluth, 1035 University Drive, Duluth, MN 55812-3031, USA
| | - Kari C. Gentzler
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE 68588-0623, USA
| | - Dan R. Hoyt
- College of Arts and Sciences, 1223 Oldfather Hall, University of Nebraska-Lincoln, Lincoln, NE 68588-0312, USA
| |
Collapse
|
36
|
Walls ML, Aronson BD, Soper GV, Johnson-Jennings MD. The Prevalence and Correlates of Mental and Emotional Health Among American Indian Adults With Type 2 Diabetes. Diabetes Educ 2014; 40:319-328. [PMID: 24562607 DOI: 10.1177/0145721714524282] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS The purpose of this study was to examine the prevalence and correlates of mental and emotional health factors among a sample of American Indian (Indigenous) adults diagnosed with type 2 diabetes. METHODS Data are from a community-based participatory research project involving 2 Indigenous reservation communities. Data were collected from 218 Indigenous adults diagnosed with type 2 diabetes via in-person paper-and-pencil survey interviews. RESULTS Reports of greater numbers of mental/emotional health problems were associated with increases in self-reported hyperglycemia, comorbid health problems, and health-impaired physical activities. CONCLUSIONS This study addresses a gap in the literature by demonstrating the associations between various mental/emotional health factors and diabetes-related health problems for Indigenous Americans. Findings underscore the importance of holistic, integrated primary care models for more effective diabetes care.
Collapse
Affiliation(s)
- Melissa L Walls
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School-Duluth, Duluth, Minnesota (Dr Walls, Mr Soper)
| | - Benjamin D Aronson
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, Minnesota (Dr Aronson, Dr Johnson-Jennings)
| | - Garrett V Soper
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School-Duluth, Duluth, Minnesota (Dr Walls, Mr Soper)
| | - Michelle D Johnson-Jennings
- Department of Pharmacy Practice and Pharmaceutical Sciences, College of Pharmacy, University of Minnesota, Duluth, Minnesota (Dr Aronson, Dr Johnson-Jennings)
| |
Collapse
|
37
|
Abstract
This paper brings forth the voices of adult Aboriginal First Nations community members who gathered in focus groups to discuss the problem of youth suicide on their reserves. Our approach emphasizes multilevel (e.g., individual, family, and broader ecological systems) factors viewed by participants as relevant to youth suicide. Wheaton's conceptualization of stressors and Evans-Campbell's multilevel classification of the impacts of historical trauma are used as theoretical and analytic guides. Thematic analysis of qualitative data transcripts revealed a highly complex intersection of stressors, traumas, and social problems seen by community members as underlying mechanisms influencing heightened levels of Aboriginal youth suicidality. Our multilevel coding approach revealed that suicidal behaviors were described by community members largely as a problem with deep historical and contemporary structural roots, as opposed to being viewed as individualized pathology.
Collapse
|
38
|
Johnson-Jennings MD, Belcourt A, Town M, Walls ML, Walters KL. Racial Discrimination’s Influence on Smoking Rates among American Indian Alaska Native Two-Spirit Individuals: Does Pain Play a Role? J Health Care Poor Underserved 2014; 25:1667-78. [DOI: 10.1353/hpu.2014.0193] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
39
|
Abstract
In this article we review three categories of American Indian/Alaska Native (AIAN) substance abuse prevention programs: (1) published empirical trials; (2) promising programs published and unpublished that are in the process of development and that have the potential for empirical trials; and (3) examples of innovative grassroots programs that originate at the local level and may have promise for further development. AIAN communities are taking more and more independent control of substance abuse prevention. We point out that European American prevention scientists are largely unaware of the numerous grassroots prevention work going on in AIAN communities and urge a paradigm shift from adapting European American prevention science "best practices" to creating cultural "best practices" by working from inside AIAN communities.
Collapse
Affiliation(s)
- Les B Whitbeck
- Department of Sociology, University of Nebraska-Lincoln , Lincoln, NE , USA.
| | | | | |
Collapse
|
40
|
Abstract
Despite growing attention to historical trauma (HT) as a key mechanism for documented Indigenous health disparities like alcohol abuse, the complexities of conceptualizing and measuring HT-related constructs have limited empirical tests of these relationships. In this article, we review the current evidence surrounding one HT measure: the Historical Loss Scale. In addition, we provide examples of the benefits of treating historical cultural losses as stressors within sociological and Indigenous stress process models of health.
Collapse
Affiliation(s)
- Melissa L Walls
- Department of Biobehavioral Health & Population Sciences, University of Minnesota Medical School-Duluth , Duluth, MN 55812-3031, USA.
| | | |
Collapse
|
41
|
Abstract
This research utilizes life-course perspective concepts of linked lives and historical time and place to examine the multigenerational effects of relocation experiences on Indigenous families. Data were collected from a longitudinal study currently underway on four American Indian reservations in the Northern Midwest and four Canadian First Nation reserves where residents share a common Indigenous cultural heritage. This paper includes information from 507 10 - 12 year old Indigenous youth and their biological mothers who participated in the study. Results of path analysis revealed significant direct and indirect effects whereby grandparent-generation (G1) participation in government relocation programs negatively impacts not only G1 well being, but also ripples out to affect subsequent generations.
Collapse
Affiliation(s)
- Melissa L Walls
- Department of Biobehavioral and Population Science University of Minnesota Medical School - Duluth
| | | |
Collapse
|
42
|
Abstract
Stress process and life-course models of mental distress emphasize socio-cultural and historical processes that influence stress exposure and the impact of stress on mental health outcomes. Drawing from these theoretical orientations as well as concepts from the historical trauma literature, we examine the effects of culturally relevant and more generalized sources of stress on distress among North American Indigenous adults, and tests for the potential cumulative and interactive effects of stress on distress across the life-course via self-reported early childhood and adult/contemporary stressors. Results of OLS regression analyses reveal positive, significant associations between general stressors and distress as well as culturally-meaningful stressors and distress. In addition, we found evidence of the accumulating and interactive impact of stress on psychological distress.
Collapse
Affiliation(s)
- Melissa L Walls
- Department of Behavioral Sciences, University of Minnesota Medical School - Duluth
| | | |
Collapse
|
43
|
Abstract
This paper examines a biosocial model of the impact of puberty on Indigenous girls' early-onset substance use by considering the potential mediating role of peer context (i.e. mixed-sex peer groups and substance use prototypes) on the puberty and substance use relationship. Data include responses from 360 girls of a common Indigenous cultural group residing on reservations/reserves in the upper Midwest and Canada. Results of structural equation modeling revealed that the statistically significant relationship between girls' pubertal development and early-onset substance use was mediated by both mixed-sex/romantic peer groups and favorable social definitions of substance use. Implications for substance use prevention work include addressing the multiple and overlapping effects of peer influence from culturally-relevant perspectives.
Collapse
Affiliation(s)
- Melissa L Walls
- Department of Behavioral Sciences University of Minnesota Medical School - Duluth
| | | |
Collapse
|
44
|
Abstract
This study examines the growth of alcohol and marijuana use during early adolescence among a sample of 746 Indigenous youth (aged 10–12 years at wave 1; 50.3% female) of the upper Midwest and Canada, with a special focus on potential gender differences in these patterns. Research documenting the disproportionately high rates of Indigenous substance use, coupled by our lack of understanding of gender patterns among this group—especially in very early adolescence—highlight the need for this culturally specific work. Results of latent growth curve analyses from three waves of annual data collection indicate that the females in our sample engage in alcohol and marijuana use at rates similar to or greater than their male peers. This finding counters conventional ideas of gender and substance use that place young males at elevated rates of use compared to females, and also adds to our understanding of gendered substance use patterns among Indigenous youth.
Collapse
|
45
|
Walls ML, Johnson KD, Whitbeck LB, Hoyt DR. Mental health and substance abuse services preferences among American Indian people of the northern Midwest. Community Ment Health J 2006; 42:521-35. [PMID: 17143732 PMCID: PMC1705498 DOI: 10.1007/s10597-006-9054-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Accepted: 08/25/2005] [Indexed: 11/26/2022]
Abstract
This study examines factors that influence preferences between traditional cultural and western mental health and substance use associated care among American Indians from the northern Midwest. Personal interviews were conducted with 865 parents/caretakers of tribally enrolled youth concerning their preferences for traditional/cultural and formal healthcare for mental health or substance abuse problems. Adults strongly preferred traditional informal services to formal medical services. In addition, formal services on reservation were preferred to off reservation services. To better serve the mental health and substance abuse treatment needs of American Indians, traditional informal services should be incorporated into the current medical model.
Collapse
Affiliation(s)
- Melissa L Walls
- Department of Sociology, University of Nebraska-Lincoln, 711 Oldfather Hall, Lincoln, NE 68588-0324, USA.
| | | | | | | |
Collapse
|
46
|
Whitbeck LB, Johnson KD, Hoyt DR, Walls ML. Prevalence and comorbidity of mental disorders among American Indian children in the Northern Midwest. J Adolesc Health 2006; 39:427-34. [PMID: 16919807 DOI: 10.1016/j.jadohealth.2006.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2005] [Revised: 11/10/2005] [Accepted: 01/15/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the prevalence of mental disorder and comorbidity among American Indian children aged 10-12 years from four U.S. reservations and five Canadian reserves in the Northern Midwest. METHOD Specially trained Native interviewers administered the Diagnostic Interview for Children-Revised for 11 diagnostic categories to 736 tribally enrolled children (mean age 11 years) and their female caretakers. RESULTS Prevalence rates are reported by child self-report, female caretaker reports, and combined caretaker-child reports. Twenty-three percent (combined caretaker-child reports) of the children met criteria for one of the 11 disorders and 9% met criteria for two or more of the disorders. Externalizing disorders were more prevalent than internalizing disorders or substance abuse disorders. The strongest predictor of child mental disorder was a depressed female caretaker. CONCLUSIONS Nearly one-fourth of Native children met criteria for at least one mental disorder. The presence of early mental disorder is an important risk factor for substance use and mental health problems in later life. We need systematic research to identify risk and protective factors for early mental health problems and to identify barriers to services utilization so that we can develop empirically informed, culturally specific prevention programs that address these needs.
Collapse
Affiliation(s)
- Les B Whitbeck
- Department of Sociology, University of Nebraska at Lincoln, Lincoln, Nebraska 68588-0324, USA.
| | | | | | | |
Collapse
|
47
|
Krieger JW, Castorina JS, Walls ML, Weaver MR, Ciske S. Increasing influenza and pneumococcal immunization rates: a randomized controlled study of a senior center-based intervention. Am J Prev Med 2000; 18:123-31. [PMID: 10698242 DOI: 10.1016/s0749-3797(99)00134-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Immunizations decrease morbidity from influenza and pneumococcal infections. Immunization levels remain below desired levels despite clinic-based and public education efforts. This paper describes a randomized, controlled trial of a senior center-based program, which used peer-to-peer outreach to increase pneumococcal and influenza immunization rates among an urban senior population. METHODS Seniors were randomized to intervention or control groups. The intervention group received educational brochures mailed with reply cards to report immunization status, telephone calls from senior volunteers to unimmunized participants, and computerized immunization tracking. Immunization rates were obtained before and after the intervention by self-report. RESULTS Among participants without prior pneumococcal immunization, the pneumococcal immunization rate among the intervention group (52.0%; 95% CI = 46.6%-57.4%) was significantly higher than that of the control group (30.9%; 95% CI = 26.6%-35.2%) (rate ratio = 1.68; 95% CI = 1.40-2.03). Among those without influenza immunization in the prior year, significantly more (50.0%; 95% CI = 40.0%-60.0%) were immunized against influenza in the intervention group than in the control group (23.0%; 95% CI = 15.2%-33.3%) (rate ratio = 2.17; 95% CI = 1.42-3.31). Among those with influenza immunization in the prior year, the rate ratio was 1.04 (95% CI = 1.01-1.07). CONCLUSIONS The intervention increased both influenza and pneumococcal immunization rates to high levels, suggesting that further progress in increasing adult immunization coverage is possible.
Collapse
Affiliation(s)
- J W Krieger
- Seattle Partners for Healthy Communities/Public Health, Seattle and King County, Washington 98104-4039, USA.
| | | | | | | | | |
Collapse
|