Role of social, cultural and symbolic capital for youth and community wellbeing in a rural Alaska Native community.

Health promotion programs by and for Indigenous Peoples increasingly use strength-based Indigenous approaches aimed at reinforcing protective factors rooted in their cultures and traditions. These protective factors can counteract the deleterious effects induced by the rapid social changes related to colonization. Western social scientists defined cultural, social and symbolic capital as assets akin to social strengths that can promote health. It is important to understand Indigenous perspectives on these social and cultural capitals, and the ways their interplay can promote wellness. Using the qualitative methods photovoice and digital storytelling, we elicited the perspectives of Athabascan middle and high school students participating in the Frank Attla Youth and Sled Dog Care-Mushing Program in their home community of Huslia in Interior Alaska. Subsequently, we disseminated the stories and preliminary findings in Huslia, and conducted focus groups with adults to triangulate with the youth perspectives. Deductive and inductive thematic content analysis of youth stories and photos revealed the impacts of the program on them and their community. Youth reported gains in cultural, social and symbolic capital and shared what these forms of capital mean in their cultural context. Cultural capital gains were mostly in its embodied form, e.g. in work ethics, perseverance and the value of cultural traditions; social capital gains revolved around relations with peers, adults and Elders, nature and animals, as well as social cohesion and sense of belonging in Huslia; Symbolic capital was reflected through pride and spirituality. The students' stories also illustrated their perspectives on how the program affected their wellbeing, through physical activity, healing relations with dogs, increased self-esteem and visions of a bright future. Adults corroborated youth perspectives and shared their observations of program impacts on discipline, academic and life skills and resilience. These findings could be used to guide development and assessment of culturally-based wellbeing promoting interventions.

Indigenous Knowledge: Revitalizing Everlasting Relationships between Alaska Natives and Sled Dogs to Promote Holistic Wellbeing.

INTRODUCTION: Indigenous peoples have documented their culture's history in oral stories, revealing lessons about holistic relationships fostering perseverance. Despite vast differences in time, relationships and stories are equally important today. Athabascans retain their values, life skills, and wellness through cultural practices. Creating opportunities for youths to learn through reciprocal relationships increases wellness in Indigenous communities, highlighting the significance of community-developed programs that connect youths to their place and culture. METHOD: Athabascan youths in rural Alaska get hands-on experience and Elder mentorship working with sled dogs in the Frank Attla Youth and Sled Dog Care-Mushing Program (FAYSDP). Through a community-based participatory research partnership with the community of Huslia and Jimmy Huntington School, we examined how FAYSDP affects youths, and how relationships within culture and land promote wellbeing. Fifteen middle and high-school youths shared their perspectives on how FAYSDP impacts them and their community using photovoice and digital storytelling. Nineteen adults contributed their perspectives in focus groups. We used emerging themes (inductive) and Athabascan cultural values and elements of social capital (deductive approaches) to analyze the qualitative data. RESULTS: Findings illustrate how FAYSDP promotes wellbeing by empowering youths to apply what they learn to generate their own knowledge, while centering communities around culturally significant practices such as dog mushing. It connects youths to their home and their cultural values, using dogs as the driving force to bridge generations and foster youth wellness. DISCUSSION: We discuss implications for community-based programs that engage Elders as teachers and the land as their classroom to promote youth holistic wellness.

Cultural values, coping, and hope in Yup'ik communities facing rapid cultural change.

Historical trauma and rapid cultural change contribute to a high burden of stress in Alaska Native communities. The goal of the Yup'ik Experiences of Stress and Coping Project was to better understand stress and coping in Yup'ik communities and the role of cultural values and practices in coping. Sixty Yup'ik adults aged 18-84 years took part in semistructured interviews. They discussed how they coped with salient stressful experiences and shared the things that bought them hope and peace. Interview themes were identified and inter-relationships between themes were explored through social network analysis. Participants discussed the importance of cultural traditions in coping, including subsistence, dancing and drumming, intergenerational transmission of knowledge, and reflective awareness of interconnections with others. Participants found strength in family relationships, spirituality, helping others, and coming together as a community. Three coping clusters emerged: Ilaliurucaraq (be welcoming) involved opening one's frame of mind and building connections; Yuuyaraq (Yup'ik way of life) focused on Yup'ik traditions and values; and Assircaarturluni Yuuyaraq (try to live a better life) involved healing from historical trauma. Findings illustrate the resilience and evolving strengths of rural Yup'ik communities facing a continually changing cultural landscape and provide information for developing community-driven culturally based interventions.

Systemic and individual factors in the buprenorphine treatment-seeking process: a qualitative study.

BACKGROUND: Opioid use is a significant problem in Alaska. Medication-assisted treatment for opioid use, including buprenorphine, reduces withdrawal symptoms and the harm associated with opioid abuse. Understanding consumers' treatment-seeking process is important for addressing barriers to treatment, facilitating effective service utilization, and informing policy. METHODS: To understand treatment-seeking behavior, we examined the attitudes, perceptions, and knowledge of those who would benefit from the medication-assisted treatment (MAT) buprenorphine. Qualitative data from 2 focus groups (each including 4 participants) and 3 in-depth interviews with people who have used or considered using buprenorphine in treatment for an opioid use disorder were analyzed using grounded theory and directed content analysis approaches. RESULTS: Key findings suggest that individual (withdrawal process, individual motivation) and systemic (sociocultural, political, societal values) factors frame the treatment seeking process. Participants' progress on the treatment-seeking road was affected by models of addiction and MAT, which related to facilitators and barriers encountered in seeking treatment (e.g. support, resources, treatment structure). These factors shaped the longer-term road to recovery, which was seen as on ongoing process. CONCLUSIONS: The findings of this study suggest it is crucial for interventionists to take a contextual approach that considers individual and systemic factors involved in opioid addiction, treatment, and recovery. This study highlights ways policy makers and treatment providers can address the barriers consumers face in their treatment-seeking process in order to increase treatment access.

Disseminating research in rural Yup'ik communities: challenges and ethical considerations in moving from discovery to intervention development.

BACKGROUND: The native people of Alaska have experienced historical trauma and rapid changes in culture and lifestyle patterns. As a consequence, these populations shoulder a disproportionately high burden of psychological stress. The Yup'ik Experiences of Stress and Coping project originated from rural Yup'ik communities' concerns about stress and its effects on health. It aimed to understand the stressful experiences that affect Yup'ik communities, to identify coping strategies used to deal with these stressors and to inform culturally responsive interventions. OBJECTIVES: Here, we examine the process of moving from research (gaining understanding) to disseminating project findings to translation into intervention priorities. We highlight the importance of community participation and discuss challenges encountered, strategies to address these challenges and ethical considerations for responsible intervention research with indigenous communities that reflect their unique historical and current socio-cultural realities. DESIGN: Community-wide presentations and discussions of research findings on stress and coping were followed by smaller Community Planning Group meetings. During these meetings, community members contextualized project findings and discussed implications for interventions. This process placed priority on community expertise in interpreting findings and translating results and community priorities into grant applications focused on intervention development and evaluation. RESULTS: Challenges included translation between English and Yup'ik, funding limitations and uncertainties, and the long timelines involved in moving from formative research to intervention in the face of urgent and evolving community needs. The lack of congruence between institutional and community worldviews in the intervention research enterprise highlights the need for "principled cultural sensitivity". CONCLUSIONS: Cultural sensitivity requires sharing results that have practical value, communicating openly, planning for sustainability and incorporating indigenous knowledge and expertise through a community-guided process. Our research findings will inform continued work within our partnership as we co-develop culturally based strategies for multilevel community interventions to address stress.

Providers' voices on telebehavioral health: survey of an outpatient counseling agency in Alaska.

Hope Counseling Center sought to expand behavioral health services to underserved populations in Alaska by offering telebehavioral health services. Providers completed a questionnaire addressing their experiences, opinions, and training needs as they relate to telebehavioral health. Open conversations about the training needs, limitations, and benefits of telebehavioral health supported program development and led to training on new equipment, rapport building, and telebehavioral health outcome studies.

Value of Community Partnership for Understanding Stress and Coping in Rural Yup'ik Communities: The CANHR Study.

Stress and trauma can compromise physical and mental health. Rural Alaska Native communities have voiced concern about stressful and traumatic events and their effects on health. The goal of the Yup'ik Experiences of Stress and Coping Project is to develop an in-depth understanding of experiences of stress and ways of coping in Yup'ik communities. The long-range goal is to use project findings to develop and implement a community-informed and culturally grounded intervention to reduce stress and promote physical and mental health in rural Alaska Native communities. This paper introduces a long-standing partnership between the Yukon-Kuskokwim Regional Health Corporation, rural communities it serves, and the Center for Alaska Native Health Research at the University of Alaska Fairbanks. Within the context of the Stress and Coping project, we then discuss the value and challenges of taking a CBPR approach to advance science and address a priority community concern, and share strategies to respond to challenges. Focus groups were conducted to culturally adapt an existing structured interview and daily diary protocol to better fit Yup'ik ways of knowing. As modified, these interviews increased understanding of stress and coping particular to two Yup'ik communities. Challenges included the geographical nature of Yup'ik communities, communication barriers, competing priorities, and confidentiality issues. Community participation was central in the development of the study protocol, helped ensure that the research was culturally appropriate and relevant to the community, and facilitated access to participant knowledge and rich data to inform intervention development.

Risk reduction for HIV-positive African American and Latino men with histories of childhood sexual abuse.

While the HIV epidemic has disproportionately affected African American and Latino men who have sex with men (MSM), few HIV prevention interventions have focused on African American and Latino men who have sex with both men and women (MSMW). Even fewer interventions target HIV-positive African American and Latino MSM and MSMW with histories of childhood sexual abuse (CSA), a population that may be vulnerable to high-risk sexual behaviors, having multiple sexual partners, and depression. The Men's Health Project, a small randomized clinical trial, compared the effects of two 6-session interventions, the Sexual Health Intervention for Men (S-HIM), guided by social learning theory and aimed at decreasing high-risk sexual behaviors, number of sexual partners, and depressive symptoms, and a standard health promotion control (SHP). A community sample of 137 HIV-positive gay and non-gay identifying African American and Latino MSM and MSMW with histories of CSA was recruited. Results were based on an "intent to treat" analyses of baseline to post, 3 and 6 month follow-ups. The sample as a whole reported reductions in sexual risk behaviors and number of sexual partners from baseline to post-test, and from the 3 to 6 month follow-ups, although the decrease in sexual risk behavior from baseline to post-test was significant only for S-HIM participants. No significant differences between conditions were reported for depressive symptoms, but the total sample reported a significant decrease at 6 months. These findings highlight the importance of addressing sexual decision-making and psychological adjustment for ethnic men, while being sensitive to CSA histories and sexual minority status, and suggest the need to develop additional strategies to heighten HIV risk reduction over time.

Severity of child sexual abuse, post- traumatic stress and risky sexual behaviors among HIV-positive women.

Child sexual abuse (CSA) has been shown to enhance risk for HIV infection and other adverse outcomes. However, most studies examine the effects of a single incident of CSA rather than the full burden of abuse over the life span in predicting these adverse outcomes. A multi-dimensional approach was used in this study to examine the severity of abuse as a predictor of post-traumatic stress, depression, sexual symptoms, and risky sexual behaviors in a multi-ethnic sample of 147 HIV-positive women. Multivariate models indicated that experiencing both intrafamilial and extrafamilial CSA, adult sexual abuse (ASA) and Latina ethnicity predicted PTSD symptoms. ASA also predicted sexual trauma symptoms. Also, CSA and adult re-victimization contributed independently to risk for PTSD and sexual trauma symptoms, but not for risky sexual behaviors. The results support the need for interventions for HIV-positive women that address the full burden of abuse experienced and its sequelae.

Substance abuse and medication adherence among HIV-positive women with histories of child sexual abuse.

Substance abuse increases the risks for infections and impairs medication adherence among HIV/AIDS patients. However, little is known about the characteristics of substance abuse and its impact on medication adherence among HIV-positive women with a history of child sexual abuse (CSA). In the present study, 148 HIV-positive women with a history of CSA completed a structured interview assessing CSA severity, psychological status, substance abuse, medication adherence, and sexual decision-making. Severity of CSA was significantly associated with substance use but not with adherence. Participants who had used hard drugs and who had lower self-esteem and adherence self-efficacy reported significantly lower levels of adherence. Additional research on how CSA experiences impact health behaviors is needed to help develop culturally congruent interventions to reduce risk behaviors and facilitate better medication adherence for this vulnerable population.

The effects of expressive writing on adjustment to HIV.

Previous research suggests that writing about stressful experiences results in better health and psychological well-being. In the present study, a multi-ethnic sample of 79 HIV-positive women and men participated in a structured interview, and wrote about either their deepest thoughts and feelings about living with HIV (expressive writing) or their activities in the last 24 hr (control). Sixty-two participants returned for the 2-month follow-up and 50 returned for the 6-month follow-up interview. Oral fluid samples of beta2-microglobulin were taken at the baseline and follow-up assessments to examine the immunological effects of writing. No effects of writing condition were found, but expressive writing participants who included increasing insight/causation and social words in their writing had better immune function and reported more positive changes at follow-up. Results suggest that cognitive processing and changes in social interactions may be critical to the benefits of writing.

The efficacy of an integrated risk reduction intervention for HIV-positive women with child sexual abuse histories.

Child sexual abuse (CSA) is associated with HIV risk behaviors [Bensley, L., Van Eenwyk, J., and Simmons, K. W., 2003.] and more prevalent among women living with HIV than in the general population [Koenig, L. J., and Clark, H., 2004]. This randomized Phase~I clinical trial tested the impact of a culturally congruent psychoeducational intervention designed to reduce sexual risks and increase HIV medication adherence for HIV-positive women with CSA histories. An ethnically diverse sample of 147 women were randomized to two conditions: an 11-session Enhanced Sexual Health Intervention (ESHI) or an attention control. Results based on "intent to treat'' analyses of pre-post changes are reported here. Additional analyses explored whether the observed effects might depend on "intervention dose,'' i.e., number of sessions attended. Women in the ESHI condition reported greater sexual risk reduction than women in the control condition. Although there were no differences between women in the ESHI and control groups on medication adherence, women in the ESHI condition who attended 8 or more sessions reported greater medication adherence at posttest than control women. The findings provide initial support for this culturally and gender-congruent psychoeducational intervention for HIV-positive women with CSA, and highlight the importance of addressing the effects of CSA on sexual risk reduction and medication adherence in preventive interventions for women.

Child sexual abuse: associations with the sexual functioning of adolescents and adults.

As we move into the 21st century, information about sex is widespread and more accessible to the general public than ever before. This interest in sex also increases the focus on symptoms and patterns associated with sexual problems. However, the etiology of sexual dysfunction is multifaceted and poorly understood. One factor that has received growing attention is the role that early sexual abuse plays in sexual development and later sexual functioning, and how these associations differ between males and females. Despite high prevalence rates of child sexual abuse (CSA), which occurs to approximately 1 in 3 females and 1 in 10 males under the age of 18, we do not completely understand the complexities of how and to what extent CSA affects sexual functioning. Nonetheless, the research highlights the need to recognize the potentially powerful influence that abusive childhood experiences contribute to sexual health, performance, and satisfaction. We review research on the relationship between CSA and adolescent and adult sexual functioning. We use a developmental framework to guide our understanding of the effects of CSA, as well as gender and ethnic differences, on the sexual functioning of male and female survivors.