Adult Caretaker Engagement and School Connectedness and Association with Substance Use, Indicators of Emotional Well-Being and Suicide Risk, and Experiences with Violence Among American Indian or Alaska Native High School Students - Youth Risk Behavior Survey, United States, 2023.

The strength of American Indian and Alaska Native (AI/AN) communities comes from generations of Indigenous traditions, language, culture, and knowledge. These strengths have been challenged by a complex set of systemic, structural, and social factors related to historical and intergenerational trauma that affects the health of AI/AN communities. Furthermore, AI/AN population health data often are inaccurate because of analytic coding practices that do not account for multiracial and ethnic AI/AN identification and inadequate because of statistical suppression. The 2023 national Youth Risk Behavior Survey included a supplemental sample of AI/AN high school students. Coding of race and ethnicity was inclusive of all AI/AN students, even if they also identified as another race or as Hispanic or Latino, providing comprehensive data on health behaviors and experiences among AI/AN high school students nationwide. Adult caretaker engagement and school connectedness and their association with 13 health behaviors and experiences were examined, including five types of current substance use, four indicators of emotional well-being and suicide risk, and four types of violence. Pairwise t-tests and adjusted prevalence ratios from logistic regression models identified significant associations between exposure and outcome variables. Among AI/AN students, having an adult who always tried to meet their basic needs, high parental monitoring, and high school connectedness were associated with lower prevalence of certain measures of substance use, poor emotional well-being and suicide risk, and violence. Compared with non-AI/AN students, the prevalence of current electronic vapor product use, current marijuana use, attempted suicide, and experience of sexual violence was higher among AI/AN students.This report presents the most comprehensive, up-to-date data on substance use, indicators of emotional well-being and suicide risk, and experiences with violence among AI/AN high school students nationwide. The findings suggest the importance of engaged household adults and school connectedness in promoting emotional well-being and preventing substance use, suicide-related behavior, and experiences of violence among AI/AN students. Understanding the historical context and incorporating Indigenous knowledge when developing interventions focused on AI/AN youths are critical to ensure such interventions are successful in improving AI/AN health and well-being.

Performance of Machine Learning Suicide Risk Models in an American Indian Population.

Importance: Few suicide risk identification tools have been developed specifically for American Indian and Alaska Native populations, even though these populations face the starkest suicide-related inequities. Objective: To examine the accuracy of existing machine learning models in a majority American Indian population. Design, Setting, and Participants: This prognostic study used secondary data analysis of electronic health record data collected from January 1, 2017, to December 31, 2021. Existing models from the Mental Health Research Network (MHRN) and Vanderbilt University (VU) were fitted. Models were compared with an augmented screening indicator that included any previous attempt, recent suicidal ideation, or a recent positive suicide risk screen result. The comparison was based on the area under the receiver operating characteristic curve (AUROC). The study was performed in partnership with a tribe and local Indian Health Service (IHS) in the Southwest. All patients were 18 years or older with at least 1 encounter with the IHS unit during the study period. Data were analyzed between October 6, 2022, and July 29, 2024. Exposures: Suicide attempts or deaths within 90 days. Main Outcomes and Measures: Model performance was compared based on the ability to distinguish between those with a suicide attempt or death within 90 days of their last IHS visit with those without this outcome. Results: Of 16 835 patients (mean [SD] age, 40.0 [17.5] years; 8660 [51.4%] female; 14 251 [84.7%] American Indian), 324 patients (1.9%) had at least 1 suicide attempt, and 37 patients (0.2%) died by suicide. The MHRN model had an AUROC value of 0.81 (95% CI, 0.77-0.85) for 90-day suicide attempts, whereas the VU model had an AUROC value of 0.68 (95% CI, 0.64-0.72), and the augmented screening indicator had an AUROC value of 0.66 (95% CI, 0.63-0.70). Calibration was poor for both models but improved after recalibration. Conclusion and Relevance: This prognostic study found that existing risk identification models for suicide prevention held promise when applied to new contexts and performed better than relying on a combined indictor of a positive suicide risk screen result, history of attempt, and recent suicidal ideation.

From trauma to resilience: advancing cultural responsiveness and equity in the Muskowekwan First Nation's healing journey.

Introduction: The Muskowekwan First Nation (MFN) in Saskatchewan, Canada, epitomizes the enduring strength and cultural preservation of the Saulteaux people. This community faces the lasting effects of colonial trauma, especially the violence, abuse, and adversity experienced by students at the Muskowequan Indian Residential School (MIRS). Decades of abuse by institutional leaders caused generational trauma, contributing to current mental health and well-being challenges. This study highlights the community's role in sharing experiences and shaping healing processes to develop the MFN Family Healing and Wellness Centre in response to urgent community concerns. It examines the integration of Justice, Diversity, Equity, and Inclusion (J-DEI) principles and cultural responsiveness in fostering community resilience and mental well-being. Methods: Adopting a community-based participatory research framework, this study employs a mixed-methods approach, including community engagement sessions and surveys. Collaborating closely with the MFN leadership, it draws upon the specialized expertise of Author2 and Author1, leaders in Indigenous health and research. The research uses qualitative and quantitative data collection, emphasizing the importance of community input and leadership in shaping the research process and outcomes. Results: Findings emphasize the community's commitment to spiritual and cultural practices as vital healing components. Amidst the heightened awareness of the lingering effects of the MIRS within the MFN community, these insights informed the development of the Centre, ensuring it incorporates the community's desires for culturally relevant healing practices. The grand opening of Phase I of the Centre in February 2023 emerged as a significant step forward, symbolizing a move towards holistic community health that honors resilience, holistic wellness, and cultural continuity. Discussion: This case study contributes to the literature on integrated, culturally responsive healthcare models that address the needs of Indigenous peoples and communities. The study provides insights to guide the Centre's future programs and services, ensuring they are culturally tailored and responsive to the community's needs. By illustrating the potential for traditional wisdom and contemporary health practices to foster well-being, the case study advocates for holistic approaches to healing in Indigenous settings, offering a replicable framework for similar initiatives globally.

Financial hardship screening among Native American patients with cancer: a qualitative analysis.

BACKGROUND: Cancer-related financial hardship is an increasingly recognized concern for patients, families, and caregivers. Many Native American (NA) patients are at increased risk for cancer-related financial hardship due to high prevalence of low income, medical comorbidity, and lack of private health insurance. However, financial hardship screening (FHS) implementation for NA patients with cancer has not been reported. The objective of this study is to explore facilitators and barriers to FHS implementation for NA patients. METHODS: We conducted key informant interviews with NA patients with cancer and with clinical staff at an academic cancer center. Included patients had a confirmed diagnosis of cancer and were referred to the cancer center through the Indian Health Service, Tribal health program, or Urban Indian health program. Interviews included questions regarding current financial hardship, experiences in discussing financial hardship with the cancer care and primary care teams, and acceptability of completing a financial hardship screening tool at the cancer center. Clinical staff included physicians, advanced practice providers, and social workers. Interviews focused on confidence, comfort, and experience in discussing financial hardship with patients. Recorded interviews were transcribed and thematically analyzed using MAXQDA® software. RESULTS: We interviewed seven patients and four clinical staff. Themes from the interviews included: 1) existing resources and support services; 2) challenges, gaps in services, and barriers to care; 3) nuances of NA cancer care; and 4) opportunities for improved care and resources. Patients identified financial challenges to receiving cancer care including transportation, lodging, food insecurity, and utility expenses. Patients were willing to complete a FHS tool, but indicated this tool should be short and not intrusive of the patient's financial information. Clinical staff described discomfort in discussing financial hardship with patients, primarily due to a lack of training and knowledge about resources to support patients. Having designated staff familiar with I/T/U systems was helpful, but perspectives differed regarding who should administer FHS. CONCLUSIONS: We identified facilitators and barriers to implementing FHS for NA patients with cancer at both the patient and clinician levels. Findings suggest clear organizational structures and processes are needed for financial hardship to be addressed effectively.

A construct validation of the perceived Negative Context of Reception Scale with Indian American youth.

OBJECTIVES: Crucial to the resettlement experiences of immigrants is the degree to which the receiving country accepts them and affords them social support and opportunities. Through the factor structure and incremental validity of scores generated by the Negative Context of Reception (NCR) Scale, in the present study, we examine Indian American youths' perception of their context of reception using a sample of youth residing in the United States. METHOD: Data came from a sample of 223 Indian American youth (aged 12-17) as part of a larger convergent mixed-methods project. Using confirmatory factor analysis, we examined the scale's validity and the relationship between perceived NCR and criterion-related factors such as perceived discrimination and depressive and anxiety symptoms. Interpretive Phenomenological Analysis was then used to analyze qualitative data from 11 of these Indian American youth. Qualitative data provided additional insights about NCR in this population. RESULTS: NCR scores evidenced strong psychometric properties among Indian American youth. Confirmatory factor models demonstrated good model fit. NCR yielded significant associations with perceived discrimination (r = .33, p < .001) and depressive symptoms (r = .25, p < .002). Two major themes (parental/family sacrifices and being treated differently from White peers) emerged from the qualitative data. CONCLUSIONS: Results validate NCR as a construct relevant to Indian American youth and associated with negative mental health symptoms such as anxiety and depression. Furthermore, these results underscore the importance of a welcoming and supportive environment for Indian American youths' well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Pilot study of a heart-healthy food box intervention for Native Americans with uncontrolled hypertension: methods and results from the Chickasaw Healthy Eating Environments Research Study.

We sought to evaluate the acceptability and feasibility of a culturally tailored food box intervention for improving blood pressure (BP), food security and Body Mass Index (BMI) among Chickasaw Nation adults with uncontrolled hypertension. As part of the Chickasaw Healthy Eating Environments Research Study (CHEERS), we administered a group randomized pilot study in four tribal communities (two intervention, two control). Participants in the intervention communities received six heart-healthy food boxes, culturally tailored to traditional Chickasaw diet and current food context. Outcomes were measured over 6 months. We enrolled 262 participants, and 204 with complete data on key variables were included in the analysis. The food boxes were very popular, and we achieved high retention for follow-up data collection. Intervention community participants had 2.6 mmHg lower mean systolic BP and improved diet quality and BMI compared with control participants, although, as expected for a pilot study, the differences were not statistically significant. The culturally tailored diet intervention and randomized trial study design were acceptable and feasible for Chickasaw Nation adults with uncontrolled hypertension. Our findings support the value of tribal-food bank partnerships as a potential approach for reducing food insecurity and hypertension-related disparities in Native American communities.

Mental health intervention development for indigenous youth: Essential elements and guiding principles.

There is a need for intervention studies to address mental health issues with Indigenous youth. The purpose of this work is to: 1) consider calming approaches introduced by Native-American adolescents who described in writing how they manage day-to-day stress; and 2) identify culturally relevant constructs (elements and principles) for development of mental health promotion interventions for use with Indigenous youth. Central ideas shared by Native-American adolescents were merged with existing literature to identify essential elements and guiding principles for intervention development. Three essential elements (talking circles; mindfulness practice; tailored educational content) with associated guiding principles are recommended for intervention development.

Engagement with reservation-based Head Start teachers to explore their stress and coping: A qualitative study.

BACKGROUND: Native Americans residing in remote reservation communities find strength in connection to place, culture, language, and sovereignty; they also face challenges as their communities struggle with historical and contemporary traumas that have resulted in poverty, high crime and suicide rates and drug misuse. The psychological well-being of Head Start teachers who teach and support the needs of Native American children, is overlooked. METHODS: Qualitative interviews (n = 18) and focus groups (n = 9) were conducted with Head Start teachers, supervisors, parents, and ancillary staff to identify risk and protective factors at each level of the socioecological model (individual, relationships, community, society). Using content analysis and F4 analyse software two coders identified recurring themes. RESULTS: Individually teachers are resilient, focused more on the children's well-being than their own. Family was both significant support and stressor. Community struggles with drug and alcohol misuse and homelessness were the most frequent stressors. Workplace support included their supervisors and the mentorship they provided each other. Spirituality in the form traditional cultural practices, prayer and Christen faith were important sources of support and well-being. CONCLUSIONS: This paper provides insight into the stress and coping mechanisms of reservation-based Head Start teachers, identifying ways to protect and promote their health and well-being. It is important to provide support at all levels of the socioecological model to enable these teachers to strengthen their physical and psychological health and wellbeing so that they may support the children and families of Head Start to help strengthen Native American health overall.

Sustainability of an intervention for the prevention of substance use within Native American communities.

The outcomes of this study revealed the importance of recruiting local Native American tribal community members as participants in an Adult Facilitator Trainee Program for a cultural based intervention, Intertribal Talking Circle (ITC), that addresses prevention of substance use among Native American youth. Survey results indicate that Native-Reliance (cultural identity) and self-efficacy increased among the trainees from base-line to 3-months post the training session. Themes emerged from qualitative interviews conducted with the participants that described their readiness to implement and sustain the Talking Circle intervention program within their tribal communities after the research project was completed.

A commercial tobacco and alcohol use intervention for urban Native American youth.

OBJECTIVE: Westernized alcohol and commercial tobacco use prevention approaches for Native Americans have not been effective, or sustainable. The overall objective of this study examined the effect of the culturally based Urban Talking Circle (UTC) intervention versus standard education (SE) program for the prevention of alcohol and commercial tobacco use among urban Native American youth. DESIGN: The study employed a 2-condition quasi-experimental design and utilized convenience and snowball sampling methods for recruiting 100 urban Native American youth participants in two urban Native American community program locations in Florida. Study participants were randomized by their urban Native American community program location to one of the 2-conditions. These included the standard education (SE) program used within United States school systems (drug abuse resistance education) and the Urban Talking Circle (UTC) intervention, culturally tailored and developed for urban Native American youth from the culturally based Talking Circle Intervention for rural Native American Youth. The Native American Alcohol Measure for Youth (NAAMY) and Native Reliance Questionnaire were utilized to collect participants' data. Participants' data was analyzed using multivariate analysis of variance to determine differences between the scores on all measures at pre/post-intervention for the 2-conditions. RESULTS: Study findings indicate that a culturally based intervention was more effective for the reduction of commercial tobacco and alcohol use than a non-culturally based intervention for urban Native American youth. CONCLUSION: The study findings emphasized that the utilization of the culturally tailored UTC intervention reduced involvement associated with alcohol and commercial tobacco use.

The Associations Between Health-Related Knowledge and Health Beliefs Regarding Risk for Gestational Diabetes in American Indian and Alaska Native Female Adolescents and Young Adults at Risk for Gestational Diabetes and Their Female Caregivers: A Cross-Sectional Dyadic Analysis.

INTRODUCTION: Research on associations between knowledge and health beliefs for women at risk for gestational diabetes mellitus (GDM) has focused on adults at risk for or having GDM. Gaps also exist in examining interpersonal associations with family members or peers. We examined dyadic associations between knowledge and health beliefs about the risk for GDM between and within American Indian and Alaska Native (AIAN) female adolescents and young adults (FAYAs) at risk for GDM and their mothers or adult female caregivers (FCs). METHODS: Grounded in the Expanded Health Belief Model, we employed a cross-sectional design using baseline data from 147 dyads of AIAN FAYAs at risk for GDM and their FCs who participated in the Stopping GDM in Daughters and Mothers trial. FAYAs were 12.0 to 24.5 years of age, and 89.1% were students. FCs had a mean (SD) age of 44.0 (9.3) years, 87.0% were AIAN, 44.9% were college educated, 19.7% had ever had GDM, and 81.0% were the FAYA's mother. FAYAs and FCs completed surveys about knowledge and health beliefs (benefits, barriers, severity, susceptibility) regarding GDM risk and prevention. Bivariate correlational analyses were performed to examine associations between and within dyad members. Dyadic associations were investigated using actor-partner interdependence modeling (APIM) assuming distinguishable dyad members. RESULTS: Compared with their FCs, FAYAs had lower health-related knowledge and perceived benefits of GDM prevention and susceptibility regarding GDM risk. APIM revealed actor and partner effects of health-related knowledge on health beliefs for dyads. In particular, positive actor effects were found for FAYAs and FCs for GDM-related knowledge with perceived benefits (P < .001), and positive partner effects of GDM-related knowledge for FCs were related to perceived susceptibility and severity for FAYAs (P < .05). DISCUSSION: As shown in these AIAN dyads, FAYAs and their FCs, as members of one another's social network, may influence each other's health beliefs regarding GDM risk and prevention.

A qualitative exploration of facilitators and barriers to adopting a healthy lifestyle among Black, Hispanic, and American Indian males with diabetes or at risk for type 2 diabetes.

OBJECTIVES: Higher prevalence of several chronic diseases occurs in men in the United States, including diabetes and prediabetes. Of the 34 million adults with diabetes and 88 million with prediabetes there is a higher prevalence of both conditions in men compared to women. Black, Hispanic, and American Indian men have some of the highest rates of diabetes and diabetes complications. Adopting a healthy lifestyle including healthy eating and physical activity, is important in preventing type 2 diabetes and diabetes complications. DESIGN: This study included six focus groups that explored facilitators and barriers to adopting a healthy lifestyle in Black, Hispanic, and American Indian men with diabetes or at risk for type 2 diabetes. Thematic analysis was used to identify facilitators and barriers to adopting a healthy lifestyle. RESULTS: Participants included males 18 years of age and older identifying as Black, Hispanic, or American Indian and diagnosed with prediabetes, diabetes, hypertension, or otherwise at risk for type 2 diabetes. Thirty-seven men participated, 19 diagnosed with diabetes and 18 at risk for type 2 diabetes. Fourteen Black, 14 Hispanic, and 9 American Indian men participated. The themes of facilitators to a healthy lifestyle included: family and the social network; psychosocial factors; health status, health priorities and beliefs about aging; knowledge about health and healthy behavior; and healthy community resources. Themes of barriers to a healthy lifestyle also included: mistrust of the health care system, cost, and low socioeconomic status. CONCLUSIONS: This study underscores the complexity of factors involved in adopting a healthy lifestyle for some racial and ethnic minority men with diabetes or at risk for type 2 diabetes.

Baseline Sociodemographic Characteristics and Mental Health Status of Primary Caregivers and Children Attending Schools on the Navajo Nation During COVID-19.

BACKGROUND: Despite historical and contemporary trauma, American Indian and Alaska Native (AIAN; Indigenous) communities responded with resilience to the COVID-19 pandemic. However, AIANs experienced disproportionate rates of infection, hospitalization, death, and reduced life expectancy. School closures exacerbated disparities, leading to learning loss, economic instability, and mental health challenges among AIAN youth. METHODS: The Project SafeSchools cohort study employed a comprehensive longitudinal convergent mixed-methods approach, integrating community-based participatory research principles. The study enrolled Navajo Nation caregivers whose children were eligible to attend local reservation-based schools. We conducted an analysis of caregiver self-report baseline data collected between August 2021 and May 2022. RESULTS: A total of 242 caregivers completed at least part of the baseline assessment and were included in data analysis. Caregivers were primarily female (88.7%), non-Hispanic (97%), and Indigenous (97%). Most caregivers were in their late 30s (mean age 38), with varying educational backgrounds and employment statuses. Children were evenly split between males and females and distributed across different age groups. Most children attended school at baseline in various formats, including in-person, hybrid, and online-only settings. Caregivers reported a range of psychosocial and behavioral risks, including general mental distress, depressive symptoms, and anxiety for themselves and their children. Furthermore, caregivers and children exhibited various protective factors, such as strong cultural identity, resilience, and academic self-efficacy. CONCLUSIONS: This study highlights the higher rates of mental health distress among participating caregivers and children compared to national averages. Despite these challenges, cultural protective factors remained strong and should guide future crisis response efforts.

Promoting Slhánay̓ Skwálwen (Indigenous Women's Heart Health): Findings From Sharing Circles With Squamish Nation.

OBJECTIVE: To gather knowledge and experiences from Squamish Nation citizens to codevelop a model of foraging walks for Indigenous women's heart health. DESIGN: Qualitative study (sharing circles). SETTING: Vancouver, Canada (virtual). PARTICIPANTS: Squamish Nation community members (n = 9), Elders or Knowledge Keepers (n = 5), and researchers (n = 2). INTERVENTION: Community-led foraging walks as a culturally safe nutrition education strategy. MAIN OUTCOME MEASURE(S): Perspectives and experiences. ANALYSIS: Content analysis and narrative synthesis. RESULTS: Personal experiences of foraging walks or knowledge of traditional plants were limited for most participants, and all desired to learn more about traditional foods using land-based activities. Participants identified a lack of nutrition education surrounding heart health and common mistreatment and judgment from health professionals. Participants identified important elements of a future Squamish program, including who should be involved, how to implement it, and the most effective temporal and physical setting. All agreed foraging walks help promote 5 dimensions of heart health (physical, emotional, spiritual, mental, and social) through physical activity, purposeful nutrition, and connection to community and culture. Findings from the sharing circles were used in the creation of a template for future foraging sessions and contributed to plant identification cards for the whole community. CONCLUSIONS AND IMPLICATIONS: Community-based pilot studies to test foraging walks as a culturally safe and environmental approach to nutrition education and cardiovascular health awareness for Indigenous communities are warranted. Research to examine the similarities and differences across Indigenous groups related to understanding heart health and land-based practices for nutrition education and heart health awareness is needed.

Collaboration With Tribal Stakeholders to Explore Care for Postpartum Depression in the Chickasaw Nation.

OBJECTIVE: To describe and interpret Indigenous women's experiences of postpartum depression (PPD) from the perspectives of community advisory board members. DESIGN: Qualitative, descriptive design with a community-engagement approach. SETTING: Virtual group interviews. PARTICIPANTS: Community advisory board members (N = 8) who were tribal employees, citizens of the tribe, and/or family members of citizens who had detailed knowledge of PPD among Indigenous women and issues surrounding their care. METHODS: In video- and audio-recorded virtual group interviews, we asked participants questions using a semistructured interview guide. We used qualitative content analysis to generate results. RESULTS: Major themes included The "Who, What, and Where" of PPD in Indigenous Women; Meanings Attributed to PPD in Indigenous Women; Realities of PPD Care in the Chickasaw Nation; and Feasibility, Acceptability, Perceived Barriers, and Facilitators of a Future Collaboration. CONCLUSION: The participants identified next steps for addressing PPD in the Chickasaw Nation: raise awareness of PPD among providers, patients, and families; improve messaging about PPD to decrease stigma and normalize mental health care; and develop or adapt a culturally appropriate and relevant tool to screen for PPD in Indigenous women.

Childhood trauma exposure, age and self-compassion as predictors of later-life symptoms of depression and anxiety in American Indian adults.

BACKGROUND: Although previous research has established a relationship between childhood trauma and later-life anxiety and depression symptoms in American Indian samples, less is known about protective factors that may reduce the strength of this relationship. OBJECTIVE: The purpose of the present study was to investigate in a sample of American Indian adults, whether age moderates the relationship between self-compassion and poor mental health associated with childhood trauma. PARTICIPANTS AND SETTING: Seven hundred and twenty-nine self-identifying American Indian adults (age 18-95) residing in the United States completed an online survey. METHOD: All participants were self-identifying American Indian adults recruited via Qualtrics, which utilized targeted recruiting through managed research panels. Participants self-reported age, gender, income, and completed measures of self-compassion, childhood trauma, and symptoms of anxiety and depression. RESULTS: Lower self-compassion predicted higher levels of both anxiety symptoms (ß = -2.69, R2change = 0.24, t(718) = -15.92, p < .001) and depression symptoms (ß = -2.23, R2change = 0.26, t(718) = -16.30, p < .001). In line with our hypothesis, there was a significant three-way interaction between age, childhood trauma exposure and self-compassion in predicting later-life symptoms of anxiety (ß = -0.68, t(712) = -3.57, p < .001, R2change = 0.01) and depression (ß = -0.54, t(712) = -3.32, p = .001, R2change = 0.01). CONCLUSIONS: The findings indicate that for older American Indian adults, self-compassion may be a particularly promising protective factor for symptoms of depression for those who have experienced high levels of childhood trauma, and for symptoms of anxiety regardless of childhood trauma exposure.

Enhancing sleep health in urban American Indian/Alaska Native adolescents: Implications for culturally tailored interventions.

BACKGROUND: Urban American Indian/Alaska Native (AI/AN) adolescents are vulnerable to sleep and other health-related disparities due to numerous social drivers, including historical trauma and relocation to urban areas. This study aims to identify strategies to increase protective factors and culturally tailor sleep health interventions for this population. METHODS: Using community-based participatory research, the NAYSHAW study conducted in-depth interviews with urban AI/AN adolescents aged 12-19 years to understand critical components needed for developing a culturally sensitive sleep health intervention. Data from two qualitative subsamples (N = 46) and parent surveys (N = 110) were analyzed, focusing on factors that affect sleep health behaviors, including parental involvement, technology, and traditional practices. RESULTS: Key findings include the detrimental impact of electronics use at night and protective effects of traditional practices on sleep. Parental involvement in sleep routines varied by adolescent's age. Adolescents desired sleep health education in interactive formats, whereas parents preferred workshops and digital applications for sleep health strategies. Findings suggest that interventions need to address electronics use and should also be culturally tailored to address the unique experiences of urban AI/AN adolescents. CONCLUSIONS: Results underscore the importance of utilizing community-based strategies to develop culturally tailored sleep interventions for underserved populations, specifically urban AI/AN adolescents. Integrating traditional practices with evidence-based sleep health strategies can provide a holistic approach to improving sleep and overall well-being. Parental education and involvement will be critical to the success of such interventions.

The Relationships of Historical Loss, Acculturation, and Alcohol Expectancies with Alcohol Use Among American Indian and Alaska Native People.

The primary purpose of this study was to 1) explore the relationship among the following variables: thoughts and feelings associated with historical loss, levels of acculturation, alcohol expectancies, and alcohol use among American Indian and Alaska Native (AI/AN) people, as well as to 2) explore predictive relationships among historical loss thoughts and feelings, alcohol expectancies, and alcohol use for AI/AN people within this sample. A convenience (community, non-clinical) sample of 188 AI/AN people completed an online survey, including questions related to alcohol use, alcohol expectancies, thoughts and feelings of historical loss, and acculturation experiences. Results indicated that gender and feelings of historical loss were the significant individual predictors of alcohol use and alcohol expectancies in a sample of AI/AN people. In addition, specific types of alcohol expectancies, when considered together, explained 24% of the variance in alcohol use experiences. Gender differences were noted in that AI/AN men were more likely than AI/AN women to engage in hazardous drinking and expected more feelings of social and physical pleasure as well as power and aggression as a result of drinking alcohol. Areas for further research were highlighted, with an emphasis on further research exploring the correlates and predictors of alcohol use and alcohol expectancies for community, non-clinical samples of AI/AN people, to further understand alcohol use motivation among AI/AN people.

Community-Identified Implementation Strategies for Promoting the Adoption of HIV Self-Testing in a Southern California American Indian community: A Rapid Qualitative Analysis.

HIV incidence increased by 18% between 2015 and 2019 among American Indians (AIs) despite declining rates in other racial/ethnic groups. Culturally-appropriate implementation of prevention programs is needed to address the intersectional conditions contributing to HIV vulnerabilities experienced by AIs. The objectives of this study were to understand factors influencing HIV testing decisions and identify implementation strategies to promote the acceptability of HIV self-testing (HIVST) in a southern California AI community. A total of 15 semi-structured interviews were completed with adult community members of a southern California AI reservation. Analysis used a rapid analytic approach that was guided by the Exploration, Preparation, Implementation, Sustainment (EPIS) framework and expert recommendations for implementing change (ERIC) compilation. Two team members applied a standardized summary template to elucidate implementation determinants and implementation strategies for adopting HIVST. Barriers to HIV testing identified by community members included HIV-related stigma and privacy concerns within their community. Community members expressed positive perceptions of the acceptability of HIVST, with many identifying ease of use and privacy as appealing attributes. Several implementation strategies were suggested for facilitating the adoption of HIVST, including increasing access to tests by mailing kits to community members and increasing demand for kits through media campaigns (e.g., local flyers, social media posts, and booths at tribal events). Community members also recommended discreet packaging of kits and cultural adaptation of accompanying materials (e.g., educational videos featuring community members). The qualitative input from AI community members facilitated identification of implementation strategies that may promote the acceptability and culturally-appropriateness of HIVST.

RESUMEN: Entre 2015 y 2019, la incidencia del VIH entre los indígenas norteamericanos (INs) aumentó un 18%, a pesar de que en otros grupos étnicos y raciales se observaron reducciones. La implementación culturalmente apropiada de programas preventivos es fundamental para abordar las circunstancias interseccionales que contribuyen a la vulnerabilidad al VIH entre INs. Los objetivos de este estudio fueron comprender los factores que influyen en la decisión de hacerse la prueba del VIH e identificar estrategias para fomentar la aceptabilidad de las auto pruebas, en una comunidad de INs en el Sur de California. Se realizaron 15 entrevistas semiestructuradas con los miembros adultos de una reserva situada en el Sur de California. El análisis se realizó utilizando un método cualitativo rápido, basado en el marco Exploration, Preparation, Implementation and Sustainment (EPIS) (español: Exploración, Preparación, Implementación y Sostenimiento) así como una recopilación de sugerencias de expertas en implementación de intervenciones, conocida como ERIC. Dos miembros del equipo de investigación utilizaron una plantilla estandarizada resumida para investigar factores determinantes y estrategias para la adopción de las auto pruebas del VIH. Los miembros de la reserva de INs identificaron el estigma asociado al VIH, así como preocupación por la privacidad entre la comunidad, como barreras para realizarse las pruebas del VIH. Los miembros reaccionaron positivamente a la aceptabilidad de las auto pruebas del VIH, destacándola facilidad del uso y la privacidad asociadas con estas pruebas. También, se sugirieron varias estrategias para facilitar la adopción de las auto pruebas, incluyendo el envío de pruebas a miembros de la comunidad y el aumento de la demanda de pruebas a través de difusión (e.g., folletos, publicaciones en las redes sociales, y puestos en eventos tribales). Los miembros también recomendaron que los empaques de las auto pruebas sean discretos, y que contengan materiales educativos culturalmente apropiados. Las contribuciones cualitativas de la comunidad INs ayudaron identificar estrategias de implementación que pueden fomentar la aceptabilidad de las auto pruebas del VIH en una manera culturalmente apropiada.

Honoring our teachings: children's storybooks as indigenous public health practice.

Introduction: American Indian and Alaska Native (AIAN) communities continue to flourish and innovate in the face of the COVID-19 pandemic. Storytelling is an important tradition for AIAN communities that can function as an intervention modality. To support the needs of AIAN children and caregivers, we (a collaborative workgroup of Indigenous health researchers) developed a culturally grounded storybook that provides pandemic-related public health guidance and mental health coping strategies woven with Inter-Tribal values and teachings. Methods: A collaborative workgroup, representing diverse tribal affiliations, met via four virtual meetings in early 2021 to discuss evolving COVID-19 pandemic public health guidance, community experiences and responses to emerging challenges, and how to ground the story in shared AIAN cultural strengths. We developed and distributed a brief survey for caregivers to evaluate the resulting book. Results: The workgroup iteratively reviewed versions of the storyline until reaching a consensus on the final text. An AI artist from the workgroup created illustrations to accompany the text. The resulting book, titled Our Smallest Warriors, Our Strongest Medicine: Honoring Our Teachings during COVID-19 contains 46 pages of text and full-color illustrations. An online toolkit including coloring pages, traditional language activities, and caregiver resources accompanies the book. We printed and distributed 50,024 physical copies of the book and a free online version remains available. An online survey completed by N = 34 caregivers who read the book with their child(ren) showed strong satisfaction with the book and interest in future books. Discussion: The development of this storybook provides insights for creative dissemination of future public health initiatives, especially those geared toward AIAN communities. The positive reception and widespread interest in the storybook illustrate how braiding AIAN cultural teachings with public health guidance can be an effective way to disseminate health information. This storybook highlights the importance of storytelling as an immersive learning experience through which caregivers and children connect to family, community, culture, and public health guidance. Culturally grounded public health interventions can be effective and powerful in uplifting AIAN cultural values and promoting health and well-being for present and future generations.