Lessons Learned From a Community-Based Participatory Research Mental Health Promotion Program for American Indian Youth.

Background American Indian (AI) youth have the highest rates of suicide among racial/ethnic minority groups in the United States. Community-based strategies are essential to address this issue, and community-based participatory research (CBPR) offers a model to engage AI communities in mental health promotion programming. Objectives This article describes successes and challenges of a CBPR, mixed-method project, The Lumbee Rite of Passage (LROP), an academic-community partnership to develop and implement a suicide prevention program for Lumbee AI youth in North Carolina. Method LROP was conducted in two phases to (1) understand knowledge and perceptions of existing mental health resources and (2) develop, implement, and evaluate a cultural enrichment program as a means of suicide prevention. Discussion/Results LROP implemented an effective community-academic partnership by (1) identifying and understanding community contexts, (2) maintaining equitable partnerships, and (3) implementing a culturally tailored research design targeting multilevel changes to support mental health. Strategies formed from the partnership alleviated challenges in each of these key CBPR concept areas. Conclusions LROP highlights how a CBPR approach contributes to positive outcomes and identifies opportunities for future collaboration in a tribal community. Using culturally appropriate CBPR strategies is critical to achieving sustainable, effective programs to improve mental health of AI youth.

Emotions are a window into one's heart": a qualitative analysis of parental beliefs about children's emotions across three ethnic groups.

We conducted a qualitative study to explore parental beliefs about emotions in the family across three cultures (African American, European American, and Lumbee American Indian), using the underutilized yet powerful methodology of focus groups. The main goal of this monograph is to understand parents' beliefs about the role of emotions in the family and how cultural or ethnic background may influence those beliefs. Based on philosophical traditions and previous research, three dimensions of parental beliefs were predicted: Value of Emotion, Socialization of Emotion, and Controllability of Emotion. We expected new themes to emerge during the focus groups.Twelve focus groups were conducted with 87 parents from the three cultural groups mentioned above. Groups met for two sessions scheduled 2 weeks apart. Focus group discussions were led by same-ethnicity moderators. Aninductive analysis was conducted; key themes and subthemes were identified.All three theoretically derived dimensions were well represented in each focus group. Cultural similarities in themes within these dimensions included children's appropriate expression of negative emotions, role of emotion in the home, children's capacity for controlling emotions, and parents' role in socialization of emotion. Cultural variations included concern about parents' expression of negative emotion, children's modulation of positive emotion, the role emotions play in behavior, and choice in emotional experience. Two new dimensions also emerged: Relational Nature of Emotions and Changeability of Emotions. Cultural similarities in themes within these dimensions included emphasis on emotional connections with children, emotional contagion in families, developmental change in children's emotions, and intergenerational change in emotion socialization. Cultural variation included discussion of emotions as guides for action and children's emotional privacy. Dimensions and the themes and subthemes within them are presented with supporting evidence and sources. Implications of parental beliefs for emotion socialization theory and future research, as well as limitations, are discussed.

The racial identity and cultural orientation of Lumbee American Indian high school students.

The uncertain and complex lineage of the Lumbee American Indian tribe has made the issue of identity of prime concern. The cultural identification, racial identification, bicultural competence, and perceived school environment for 103 Lumbee Indian high school students were examined in this study. Higher self-ratings on American Indian cultural competence and American Indian cultural identification than on White cultural competence and White cultural identification were found, and t-test comparisons revealed no gender differences on responses to the instruments. Analysis of variance was conducted to assess whether differences in perceived school environment could be attributed to cultural orientation. Rather than appearing assimilated, this generation of Lumbees tends to exhibit J. E. Helms's (1995b) Internalization identity status and an American Indian cultural orientation.

Health differences among Lumbee Indians using public and private sources of care.

CONTEXT: Of 2.4 million American Indians, approximately 60% are eligible to receive Indian Health Service (IHS) benefits, leaving many to seek care elsewhere. It is unknown if their quality of care, health behaviors, and health status vary by source of care, as demonstrated for other populations. PURPOSE: The purpose of this study was to determine whether preventive services, health behaviors, and number of health conditions vary as a function of having non-IHS public versus private physicians as sources of usual care. METHODS: 1,177 Lumbee Indians, who are ineligible to receive IHS services, completed a telephone interview that included information on receipt of preventive measures, tobacco use, physical activity, breast self-examination, and medical conditions. Frequencies, chi-squares, t tests, odds ratios, and confidence intervals were used to compare variables by source of care. FINDINGS: 939 respondents (80%) had a private and 210 (18%) a public health clinic physician as their usual source of care; 28 (2%) reported having neither. Logistic regression analyses, restricted to the 1,149 participants who reported either a private or public source of care, revealed no differences in receipt of preventive services or health status by usual source of care. Smokeless tobacco use was less common among persons using private than public providers. CONCLUSIONS: Lumbees whose usual source of care was a public clinic physician did not differ in receipt of preventive services or in health status compared to their counterparts who received care from a private physician. More targeted research into health similarities and differences arising from access to public and private sources of care is warranted.

Perceptions and psychosocial correlates of bullying among Lumbee Indian youth.

Although bullying has been linked to suicide among youth, little is known about bullying in American Indians, a population at high risk for suicide. Qualitative data from focus groups with Lumbee Indian youth (N = 31, 16 males, 15 females, 12-17 years of age) and in-depth interviews with gatekeepers in the Lumbee community revealed that bullying is common, and is perceived to contribute to depression and suicide. Youth expressed powerlessness to overcome bullying. Survey data (N = 79, 32 males, 47 females, 11-18 years of age) showed that bullied youth (11.5%) had lower self-esteem and higher levels of depressive symptoms. Interventions are needed to address this behavior that contributes to poor psychosocial health in Lumbee youth.

Sleep Problems, Suicidality and Depression among American Indian Youth.

STUDY BACKGROUND: Mental health and sleep problems are important public health concerns among adolescents yet little is known about the relationship between sleep, depressive symptoms, and suicidality among American Indian youth. METHODS: This study examined the impact of sleep and other factors on depressive symptoms and suicidality among Lumbee American Indian adolescents (N=80) ages 11-18. RESULTS: At the bivariate level, sleepiness, was associated with depression but not with suicidality. Time in bed (TIB) was not associated with depression, but more TIB decreased the likelihood of suicidality. Higher levels of depressive symptoms were associated with increased likelihood of suicidality. At the multivariate level, sleepiness, suicidality, and self-esteem were associated with depression. TIB and depressive symptoms were the only variables associated with suicidality. CONCLUSION: In working with American Indian youth, it may be helpful to consider sleep patterns as part of a comprehensive assessment process for youth who have or are at risk for depression and suicide.

Development and validation of the Parents' Beliefs About Children's Emotions Questionnaire.

Parents' beliefs about children's emotions comprise an important aspect of parental emotion socialization and may relate to children's mental health and well-being. Thus, the goal of this study was to develop the multifaceted Parents' Beliefs About Children's Emotions (PBACE) questionnaire. Central to our work was inclusion of multiple ethnic groups throughout the questionnaire development process, from initial item creation through assessment of measurement invariance and validity. Participants included 1,080 African American, European American, and Lumbee American Indian parents of 4- to 10-year-old children who completed the initial item pool for the PBACE. Exploratory factor analyses were conducted with 720 of these parents to identify factor structure and reduce items. Confirmatory factor analysis was then conducted with a holdout sample of 360 parents to evaluate model fit and assess measurement invariance across ethnicity and across parent gender. Finally, validity of the PBACE scales was assessed via correlations with measures of parental emotional expressivity and reactions to children's emotions. The PBACE is composed of 33 items in 7 scales. All scales generally demonstrated measurement invariance across ethnic groups and parent gender, thereby allowing interpretations of differences across these ethnic groups and between mothers and fathers as true differences rather than by-products of measurement variance. Initial evidence of discriminant and construct validity for the scale interpretations was also obtained. Results suggest that the PBACE will be useful for researchers interested in emotion-related socialization processes in diverse ethnic groups and their impact on children's socioemotional outcomes and well-being. (PsycINFO Database Record (c) 2013 APA, all rights reserved).