The Culture is Prevention Project: measuring cultural connectedness and providing evidence that culture is a social determinant of health for Native Americans.

BACKGROUND: It is important for non-Native persons to understand that the meaning of culture to Native American/Indigenous Peoples is not about esteem, taste or music but rather is described as a cognitive map on how to be. Native American/Indigenous culture can be thought of as all the things and ways in which Native/Indigenous people understand who they are, where they come from and how they are to interact with others. Hundreds of years across many generations have taught that culture-based activities and interventions improve Native/Indigenous health and wellbeing. We explore if increased Native American culture/cultural connectedness is associated with better mental health/well-being and physical health. METHODS: We analyzed data from a two-phased study (N = 259 and N = 102) of 361 urban Native Americans in California (2018-2021). The 29 items validated Cultural Connectedness Scale-California (CCS-CA) measured Native culture/cultural connectedness. Mental health/well-being and physical health were assessed using the: modified Herth Hope Index (mHHI), Satisfaction with Life (SWL), Center for Epidemiologic Studies Depression Scale-Revised (CESD-R-10), Substance Abuse (CAGE-AID), and Health Related Quality of Life (HRQOL). We conducted Pearson correlations and stepwise regression analyses with CCS-CA as the independent (predictor) variable to explore our main research questions: 1) Is increased Native American/Indigenous culture associated with: 1) better mental health/well-being; and 2) better physical health? RESULTS: Increased Native/Indigenous culture (CCS-CA scores) is significantly associated with better mental health/well-being (mHHI, p < .001) and satisfaction with life (SWL, p < .001) predicts good physical health days (HRQOL, p < .001). Increased connection to Native American/Indigenous culture (CCS-CA scores) is significantly associated with decreased risk for depression (CESD-R-10, p < .0) and substance abuse and (CAGE-AID, p < .07). Significant results for culture as protective against risk for substance abuse (CAGE-AID) was most likely affected (p value approaching significance) due to an error in language on the measure (i.e., created double negative). CONCLUSIONS: Native American/Indigenous culture is a predictor of improved outcomes for mental health/well-being and physical healthy days. Native culture is an important social determinant of health. We add to the evidence that Native/Indigenous culture (i.e., cultural connectedness) be considered an important intervention objective and health-related outcome measure.

The Culture is Prevention Project: Measuring Culture As a Social Determinant of Mental Health for Native/Indigenous Peoples.

This paper reports Phase 4 of the Culture is Prevention Project where we validated the Cultural Connectedness Scale - California (CCS-CA) with a sample of 344 Indigenous adults in the San Francisco Bay Area, California. In Phase 3 of this project, the CCS-CA was modified from the original Canadian Cultural Connectedness Scale (CCS) developed by Dr. Angela Snowshoe and colleagues to be a better fit for the more multi-tribal communities in urban California. Both the CCS-CA and CCS consist of 29 items that measure culture on 3 sub-scales: identity, traditions, and spirituality. The project demonstrated a positive link between cultural connectedness and mental health/well-being using the Herth Hope Index. We report results similar to the original CCS study by Snowshoe et al., where we found the CCS-CA to be a valid and reliable strength-based instrument and to support the conclusion that culture is a social determinant of mental health/well-being for Indigenous/Native peoples.

The Culture is Prevention Project: Adapting the Cultural Connectedness Scale for Multi-Tribal Communities.

The Culture is Prevention Project is a multi-phased communitybased participatory research project that was initiated by six urban American Indian and Alaska Native (AI/AN) health organizations in northern California. Issues driving the project were: i) concerns about the lack of culturally informed or Indigenous methods of evaluating the positive health outcomes of culture-based programs to improve mental health and well-being; and ii) providing an approach that demonstrates the relationship between AI/AN culture and health. Most federal and state funding sources require interventions and subsequent measures focused on risk, harm, disease, and illness reduction, rather than on strength, health, healing, and wellness improvement. This creates significant challenges for AI/AN communities to measure the true impact of local strength and resiliency-based wellness programs. This paper focuses on the methods and results from Phase 3 of the Culture is Prevention Project where we adapted the 29-item Cultual Connectedness Scale (CCS), developed in Canada, to be appropriate for California's multi-tribal communities. The resulting new Cultural Connectivity Scale - California (CCS-CA) was developed by urban AI/AN people for urban AI/AN people. The process, instrument, how to adapt for your community, and implications are reviewed.

pH1N1 - a comparative analysis of public health responses in Ontario to the influenza outbreak, public health and primary care: lessons learned and policy suggestions.

BACKGROUND: Ontario's 36 Public Health Units (PHUs) were responsible for implementing the H1N1 Pandemic Influenza Plans (PIPs) to address the first pandemic influenza virus in over 40 years. It was the first under conditions which permitted mass immunization. This is therefore the first opportunity to learn and document what worked well, and did not work well, in Ontario's response to pH1N1, and to make recommendations based on experience. METHODS: Our objectives were to: describe the PIP models, obtain perceptions on outcomes, lessons learned and to solicit policy suggestions for improvement. We conducted a 3-phase comparative analysis study comprised of semi-structured key informant interviews with local Medical Officers of Health (n=29 of 36), and Primary Care Physicians (n=20) and in Phase 3 with provincial Chief-Medical Officers of Health (n=6) and a provincial Medical Organization. Phase 2 data came from a Pan-Ontario symposium (n=44) comprised leaders representing: Public Health, Primary Care, Provincial and Federal Government. RESULTS: PIPs varied resulting in diverse experiences and lessons learned. This was in part due to different PHU characteristics that included: degree of planning, PHU and Primary Care capacity, population, geographic and relationships with Primary Care. Main lessons learned were: 1) Planning should be more comprehensive and operationalized at all levels. 2) Improve national and provincial communication strategies and eliminate contradictory messages from different sources. 3) An integrated community-wide response may be the best approach to decrease the impact of a pandemic. 4) The best Mass Immunization models can be quickly implemented and have high immunization rates. They should be flexible and allow for incremental responses that are based upon: i) pandemic severity, ii) local health system, population and geographic characteristics, iii) immunization objectives, and iv) vaccine supply. CONCLUSION: "We were very lucky that pH1N1 was not more severe." Consensus existed for more detailed planning and the inclusion of multiple health system and community stakeholders. PIPs should be flexible, allow for incremental responses and have important decisions (E.g., under which conditions Public Health, Primary Care, Pharmacists or others act as vaccine delivery agents.) made prior to a crisis.

Healthy naturally occurring retirement communities: a low-cost approach to facilitating healthy aging.

Naturally occurring retirement communities (NORCs) are broadly defined as communities where individuals either remain or move when they retire. Using the determinants of health model as a base, we hypothesize that some environmental determinants have a different impact on people at different ages. Health benefits to living within NORCs have been observed and likely vary depending upon where the specific NORC exists on the NORC to healthy-NORC spectrum. Some NORC environments are healthier than others for seniors, because the NORC environment has characteristics associated with better health for seniors. Health benefits within healthy NORCs are higher where physical and social environments facilitate greater activity and promote feelings of well-being. Compared to the provision of additional medical or social services, healthy NORCs are a low-cost community-level approach to facilitating healthy aging. Municipal governments should pursue policies that stimulate and support the development of healthy NORCs.

Collaborative partnerships: managing increased healthcare demand without increasing overall system capacity.

Collaborative partnerships can help improve integration and quality in local healthcare systems. We describe an innovative approach that was implemented following the formation of a tri-provider partnership between homecare and two acute care hospitals. The approach questioned the prevailing thought that the home is always the most appropriate and least costly location to provide services to clients traditionally served by homecare. The goal was to improve the delivery of healthcare by better integrating patient characteristics with services provided by homecare, hospitals and family physicians. The result was the implementation of a pilot project in which both homecare clients and non-urgent hospital patients could be served in a hospital-based ambulatory nursing care clinic.