Centering culture in an mHealth adaptation of an alcohol-exposed pregnancy prevention program for American Indian Youth.

Native WYSE CHOICES adapted an Alcohol Exposed Pregnancy (AEP) prevention curriculum for mobile health delivery for young urban American Indian and Alaska Native (AIAN) women. This qualitative study explored the relevance of culture in adapting a health intervention with a national sample of urban AIAN youth. In total, the team conducted 29 interviews across three iterative rounds. Participants expressed interest in receiving culturally informed health interventions, were open to cultural elements from other AIAN tribes, and highlighted the importance of culture in their lives. The study underscores why community voices are central in tailoring health interventions for this population.

Pre-pregnancy and Prenatal Alcohol use Among American Indian and Alaska Native and Non-Hispanic White Women: Findings from PRAMS in Five States.

INTRODUCTION: Estimates of prenatal alcohol use among American Indian and Alaska Native (AI/AN) women are limited. This study sought to characterize pre-pregnancy and prenatal alcohol use among AI/AN women in the Pregnancy Risk Assessment Monitoring System (PRAMS) dataset, evaluate variation in alcohol use by state and rural/urban residence, and evaluate associations between potential risk factors and prenatal alcohol use among AI/AN and non-Hispanic white (NHW) women. METHODS: We pooled PRAMS data from five states (Alaska, New Mexico, Oklahoma, South Dakota and Washington) from 2015 to 2017. We estimated the prevalence of pre-pregnancy and pregnancy risk factors, and alcohol use by race and examined alcohol use by state and rural/urban residence among AI/AN women. We conducted bivariate and multivariable logistic regression modelling to estimate the association between each risk factor of interest and the odds of prenatal alcohol use for AI/AN and NHW women. RESULTS: AI/AN women were less likely to report pre-pregnancy alcohol use compared to NHW women (56% vs. 76%, p < 0.0001). Among women who reported drinking pre-pregnancy, AI/AN women were more likely than NHW women to report drinking 1 or more drinks during pregnancy (4.3% vs. 2.4, p = 0.0049). For AI/AN women, older age and experiencing homelessness (aOR = 2.76; 95% CI 1.16-6.55) increased odds of prenatal alcohol use. For NHW women, having a college education (aOR = 4.06; 95% CI 1.19-13.88) and urban residence (aOR = 1.88; 95% CI 1.40-2.53) increased odds of prenatal alcohol use. CONCLUSIONS: Factors associated with prenatal alcohol use differ between AI/AN women and NHW women, suggesting the need for tailored interventions.

Prenatal Alcohol Counseling Among American Indian and Alaska Native Women and Non-Hispanic White Women in the Pregnancy Risk Assessment Monitoring System.

OBJECTIVE: Universal screening and counseling are recommended for alcohol use during pregnancy, but no prior study has examined differences in prenatal counseling by race or ethnicity. We used Pregnancy Risk Assessment Monitoring System (PRAMS) data to assess differences in provision of counseling on prenatal alcohol use between American Indian/Alaska Native (AI/AN) and non-Hispanic White (NHW) women during prenatal care. METHODS: We analyzed data from 2014-2015 from the four PRAMS states with the highest number of births to AI/AN women: Alaska, New Mexico, Oklahoma, and Washington. We estimated the prevalence of prenatal alcohol use, associated risk factors, and prenatal alcohol prevention counseling for AI/AN (n = 1,805) and NHW (n = 5,641) women. We then conducted multivariable logistic regression modeling stratified by race to estimate factors associated with receipt of prenatal alcohol prevention counseling. All analyses were weighted and accounted for the complex sampling design of PRAMS. RESULTS: Results showed that AI/AN women were counseled on prenatal alcohol use more often than NHW women (77% vs. 67%, p < .05), although the likelihood of any prenatal alcohol use was the same in both groups. The likelihood of prenatal drinking increased with age, education, and income in both groups. Higher education levels were significantly associated with lower risk of prenatal alcohol counseling receipt among AI/AN women. Compared with those with less than a high school diploma, AI/AN women with a college degree or more had 39% reduced risk of receiving counseling (adjusted risk ratio [aRR] = 0.61; 95% confidence interval [CI]: 0.45-0.83). Among NHW women, living at 100% to 199% of the Federal Poverty Level was associated with lower risk (aRR = 0.88; 95% CI: 0.79-0.98) of counseling receipt compared with women living below the federal poverty line. Higher parity was significantly associated with lower risk of counseling for both groups of women. CONCLUSION: Although race was not associated with prenatal alcohol use, AI/AN women were more likely than NHW women to be counseled about prenatal alcohol exposure. Factors associated with counseling receipt differed between the two groups. These findings suggest that receipt of counseling is associated with sociodemographic characteristics, and that counseling is not universally provided. More efforts to provide universal counseling are warranted.

Conceptualizing Indigenous strengths-based health and wellness research using group concept mapping.

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.

Maternal correlates of 2-year-old American Indian children's social-emotional development in a Northern Plains tribe.

The developmental experiences of very young American Indian children today are not well documented in the current literature. The present study sought to explore the social-emotional development of American Indian toddlers living on a Northern Plains reservation, as a function of maternal variables. Mothers completed self-report questionnaires about their experiences and their children's development. Observer ratings of children's development also were conducted. Maternal stress, substance use/abuse, perceptions of stress in the mother-child relationship, social support, and American Indian cultural identity were significantly related to children's social-emotional development. This study is the first to explore these relationships in a Northern Plains American Indian sample of young children and their mothers. Results suggest possible points of intervention for improving the developmental outcomes of very young American Indian children.