Federal Food Assistance Accessibility and Acceptability Among Indigenous Peoples in the United States: A Scoping Review.

The purpose of this scoping review was to determine the extent to which accessibility and acceptability of federal food assistance programs in the United States have been evaluated among indigenous peoples and to summarize what is currently known. Twelve publications were found that examine aspects of accessibility or acceptability by indigenous peoples of 1 or more federal food assistance programs, including the supplemental nutrition assistance program (SNAP) and/or the Food Distribution Program on Indian Reservations (n = 8), the Special Supplemental Nutrition Program for Women, infants, and children (WIC) (n = 3), and the national school lunch program (n = 1). No publications were found to include the commodity supplemental food program or the child and adult care food program. Publications ranged in time from 1990-2023, and all reported on findings from rural populations, whereas 3 also included urban settings. Program accessibility varied by program type and geographic location. Road conditions, transportation access, telephone and internet connectivity, and an overall number of food stores were identified as key access barriers to SNAP and WIC benefit redemption in rural areas. Program acceptability was attributed to factors such as being tribally administered, providing culturally sensitive services, and offering foods of cultural significance. For these reasons, Food Distribution Program on Indian Reservations and WIC were more frequently described as acceptable compared to SNAP and national school lunch programs. However, SNAP was occasionally described as more acceptable than other assistance programs because it allows participants autonomy to decide which foods to purchase and when. Overall, little attention has been paid to the accessibility and acceptability of federal food assistance programs among indigenous peoples in the United States. More research is needed to understand and improve the participation experiences and health trajectories of these priority populations.

Socio-cultural integration and holistic health among Indigenous young adults.

BACKGROUND: Research on associations between social integration and wellbeing holds promise to inform policy and practice targets for health promotion. Yet, studies of social connection too frequently rely on overly simplistic measures and give inadequate attention to manifestation and meanings of social integration across diverse groups. We use the term socio-cultural integration to describe expanded assessment of both social and cultural aspects of belonging and connection. METHODS: We examined 7 distinct indicators of socio-cultural integration, identified heterogeneous patterns of responses across these indicators using latent profile analysis, and determined their relevance for wellbeing using survey data from a study with Indigenous communities in the U.S. and Canada. Wellbeing was measured using holistic ratings of self-rated physical, emotional, and spiritual health. RESULTS: Latent profile analysis (LPA) of responses to the 7 socio-cultural integration variables yielded a 3-class model, which we labeled low, moderate, and high integration. Mean scores on self-rated physical, mental and spiritual health were significantly associated with LPA profiles, such that those in the low integration group had the lowest self-rated health scores and those in the high integration group had the highest health scores. With the exception of similar ratings of cultural identification between low and moderate integration profiles, patterns of responses to the diverse socio-cultural integration measures varied significantly across the 3 latent profiles. CONCLUSIONS: Results underscore the importance of expanding our assessment of social integration with attention to the interrelationships of family, community, culture, and our environment. Such concepts align with Indigenous conceptions of wellbeing, and have relevance for health across cultures. More concretely, the indicators of socio-cultural integration used in this study (e.g., cultural identity, having a sense of connectedness to nature or family, giving or receiving social support) represent malleable targets for inclusion in health promotion initiatives.

Cultural efficacy as a novel component of understanding linkages between culture and mental health in Indigenous communities.

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.

Suicide and the opioid overdose crisis among American Indian and Alaska Natives: a storm on two fronts demanding swift action.

The opioid crisis in the United States has received national attention and critical resources in the past decade. However, what has been overlooked is the effect the opioid crisis may be having on a three-decade suicide crisis among American Indian and Alaska Native (AIAN) communities that already have too few resources to address behavioral and mental health issues. This paper describes recent epidemiological trends associated with both opioid overdose and suicide at a national level for AIANs and the rest of the United States. We used data reported by the Centers for Disease Control and Prevention to report historical trends of opioid overdose and suicide for AIAN and non-AIAN populations. We found alarming and potentially correlated trends of opioid use and suicidality among AIAN populations. We highlight both current and future research that will be essential to understanding and addressing the unique intersection between opioid and suicide risk and protective factors to inform dual prevention and intervention efforts among AIAN populations with potential relevance to public health response among other at-risk populations.

Factors Associated with Sterile Syringe Acquisition among People Who Inject Drugs in West Virginia.

BACKGROUND: Syringe services programs (SSPs) are evidence-based interventions that provide essential overdose and infectious disease prevention resources to people who inject drugs (PWID). Little research has examined factors associated with sterile syringe acquisition at SSPs among rural PWID populations. OBJECTIVES: We aim to identify factors associated with PWID in a rural county in West Virginia having recently acquired sterile syringes at an SSP. METHODS: PWID (n = 420) completed a survey that included measures related to sociodemographics, structural vulnerabilities, and substance use. We used multivariable Poisson regression with robust variance estimation to examine independent associations with sterile syringe acquisition at an SSP. RESULTS: Sixty-five percent of our sample reported having recently acquired sterile syringes at an SSP. Factors associated with recent sterile syringes acquisition at an SSP included: being older (aPR [adjusted prevalence ratio]: 1.011, 95% CI: 1.003-1.019), single (aPR: 0.862, 95% CI: 0.755-0.984), experiencing food insecurity (aPR: 1.233, 95% CI: 1.062-1.431), recently injecting fentanyl (aPR: 1.178, 95% CI: 1.010-1.375) and prescription opioid pain relievers (aPR: 0.681, 95% CI: 0.551-0.842), and recent naloxone acquisition (aPR: 1.360; 95% CI: 1.178-1.569). Receptive syringe sharing was inversely associated with acquiring sterile syringes at an SSP (aPR: 0.852; 95% CI: 0.741-0.979). CONCLUSION: PWID accessing sterile syringes at an SSP was associated with several sociodemographic, structural, and substance use factors. Ensuring rural SSP operations are tailored to local PWID population-level needs is paramount to the prevention of infectious disease outbreaks and overdose fatalities.

Spiritual connectedness through prayer as a mediator of the relationship between Indigenous language use and positive mental health.

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).

Assessment of feasibility and outcomes of a salivary cortisol collection protocol in five American Indian communities.

We evaluated the feasibility and outcomes of administering a naturalistic saliva collection procedure and assessment in American Indian (Indigenous) communities. We focus on Indigenous adults living with type 2 diabetes given the "epidemic" of the disease disproportionately impacting many tribal groups. Data are from community-based participatory research (CBPR) involving 5 tribal communities. Participants were randomly selected from tribal clinic records. The sample includes 188 adults living with type 2 diabetes (56% female; age range = 18-77 years; M age = 46.3 years). Participants provided a total of 748 saliva samples, representing 4 samples/participant on a single day with instructions for collection at 4 time points: upon waking, 1 h after waking, 2 h after waking, and at 8 PM. Saliva sample times were recorded by participants on paper and electronically via placement in a Medication Event Monitoring System (MEMS®) bottle. Overall, 67% of samples were completed within 10 min of protocol instructions and 91% of participants provided at least one useable sample (79% provided four useable samples). Noncompliance, behavioral and environmental factors were not robustly associated with deviations in observed cortisol indices. Results suggest that home-based, community interviewer-involved protocols yields valid data with high compliance. The success of this study was facilitated by exemplary efforts of tribal community-based interviewers and our overall CBPR approach.Lay summaryAuthentic efforts for tribal community partnerships in research are critical to successfully implementing biological assessments with American Indians given legacies of research misconduct and mistrustOur Community-Based Participatory Research with 5 tribes yielded high participant compliance to a home-based salivary cortisol collection protocolLack of compliance to salivary cortisol protocol and medication usage were not consistently associated with observed cortisol indices.

Latent Trajectories and Profiles of Commercial Cigarette Smoking Frequency From Adolescence to Young Adulthood Among North American Indigenous People.

INTRODUCTION: North American Indigenous people (ie, American Indian/Alaska Native and Canadian First Nations) have the highest rates of commercial cigarette smoking, yet little is known about long-term trajectories of use among this population. The purpose of this study is to examine heterogeneous trajectories and profiles of Indigenous cigarette use frequency from early adolescence (mean age: 11.1 years) to young adulthood (mean age: 26.3 years). AIMS AND METHODS: Data come from a nine-wave prospective longitudinal study spanning early adolescence through young adulthood among Indigenous people in the Upper Midwest of the United States and Canada (N = 706). Smoking frequency was examined at each wave, and latent class growth analysis was used to examine heterogeneous patterns. Early adolescent and young adult demographics and smoking-related characteristics were examined across these latent trajectory groups. RESULTS: In young adulthood, 52% of participants smoked daily/near-daily, and an additional 10% smoked weekly or monthly. Four latent trajectory groups emerged: low/non-smokers (35.2%) who had low probabilities of smoking across the study; occasional smokers (17.2%) who had moderate probabilities of smoking throughout adolescence and declining probabilities of smoking into young adulthood; mid-adolescent onset smokers (21.6%) who showed patterns of smoking onset around mid-adolescence and escalated to daily use in young adulthood; and early-adolescent onset smokers (25.9%) who showed patterns of onset in early adolescence and escalated to stable daily use by late adolescence. CONCLUSIONS: The findings suggest multiple critical periods of smoking risk, as well as a general profile of diverse smoking frequency patterns, which can inform targeted intervention and treatment programming. IMPLICATIONS: Nearly two-thirds (62%) of this sample of Indigenous people were current smokers by early adulthood (mean age = 26.3 years), which is substantially higher than national rates in the United States and Canada. Moreover, in all but one trajectory group, smoking prevalence consistently increased over time, suggesting these rates may continue to rise into adulthood. The longitudinal mixture modeling approach used in this study shows that smoking patterns are heterogeneous, and implications for public health policy likely vary across these diverse patterns characterized by timing of onset of use, escalation in frequency of use, and stability/change over time.

Culture, Social Support, and Diabetes Empowerment Among American Indian Adults Living With Type 2 Diabetes.

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.

Pathways of Adaptation: Two Case Studies with One Evidence-Based Substance Use Prevention Program Tailored for Indigenous Youth.

Indigenous communities often face disproportionate challenges across a variety of health domains, and effective prevention strategies are sorely needed. Unfortunately, evidence is scant regarding what approaches are effective for these communities. A common approach is to take an evidence-based practice or program with documented effectiveness in other populations and implement it with Indigenous populations. While a science of intervention adaptation is emerging, there remains little guidance on processes for adaptation that strategically leverage both existing scientific evidence and Indigenous prevention strategies. In this paper, two case studies illustrate promising practices for adaptation, documenting the approaches of two research teams funded under the National Institutes of Health's initiative to support Intervention Research to Improve Native American Health (IRINAH). These teams worked with distinct Indigenous populations in the USA and Canada to culturally adapt the same prevention program, the Iowa Strengthening Families Program for Parents and Youth 10-14. The approaches of these two teams and the programs that resulted are compared and contrasted, and critical elements of adaptation in partnership with Indigenous communities are discussed.

Perceptions and Prevalence of Alcohol and Cigarette Use Among American Indian Adults With Type 2 Diabetes.

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.

Living a Good Way of Life: Perspectives from American Indian and First Nation Young Adults.

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).

Substance Use Research with Indigenous Communities: Exploring and Extending Foundational Principles of Community Psychology.

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.

Research with American Indian and Alaska Native populations: Measurement matters.

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.

Microaggressions, diabetes distress, and self-care behaviors in a sample of American Indian adults with type 2 diabetes.

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.

Engaging Native American Caregivers in Youth-Focused Diabetes Prevention and Management.

Native American youth aged 10 to 19 years are disproportionately affected by type 2 diabetes. Intergenerational programs may improve health in tribal communities. We evaluated Together on Diabetes, a diabetes prevention and management program, among 257 participating Native American youths with or at risk for type 2 diabetes and their adult caregivers. Feasibility, acceptability, and demographic data were collected from 226 adult caregivers. Data on physical measurements (weight, height, waist circumference) were collected from 37 of the caregivers. Results indicated that engaging adult caregivers was feasible, acceptable, and effective. Furthermore, a subset of adult caregivers reduced their body mass index (weight in kilograms divided by height in m2) significantly from the start to the end of the program, a 12 month period (P = .02). Findings suggest the feasibility of engaging adult caregivers in youth diabetes prevention programs.

Caregiving Stress Among American Indians With Type 2 Diabetes: The Importance of Awareness of Connectedness and Family Support.

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.

Patient-Centered Care, Diabetes Empowerment, and Type 2 Diabetes Medication Adherence Among American Indian Patients.

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.

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

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