Striatal hypoactivation during monetary loss anticipation in individuals with substance use disorders in a heterogenous urban American Indian sample.

Research suggests that disproportionate exposure to risk factors places American Indian (AI) peoples at higher risk for substance use disorders (SUD). Although SUD is linked to striatal prioritization of drug rewards over other appetitive stimuli, there are gaps in the literature related to the investigation of aversive valuation processing, and inclusion of AI samples. To address these gaps, this study compared striatal anticipatory gain and loss processing between AI-identified with SUD (SUD+; n = 52) and without SUD (SUD-; n = 35) groups from the Tulsa 1000 study who completed a monetary incentive delay (MID) task during functional magnetic resonance imaging. Results indicated that striatal activations in the nucleus accumbens (NAcc), caudate, and putamen were greatest for anticipating gains (ps < 0.001) but showed no group differences. In contrast to gains, the SUD+ exhibited lower NAcc (p = .01, d =0.53) and putamen (p = .04, d =0.40) activation to anticipating large losses than the comparison group. Within SUD+ , lower striatal responses during loss anticipations were associated with slower MID reaction times (NAcc: r = -0.43; putamen: r = -0.35) during loss trials. This is among the first imaging studies to examine underlying neural mechanisms associated with SUD within AIs. Attenuated loss processing provides initial evidence of a potential mechanism wherein blunted prediction of aversive consequences may be a defining feature of SUD that can inform future prevention and intervention targets.

Community Engagement and Giving Back Among North American Indigenous Youth.

"Volunteer participation" refers to free engagement in activities that benefit someone or something else. Volunteering can produce many benefits for individuals and communities. However, current research examining volunteer participation often excludes diverse viewpoints on what constitutes volunteering, particularly the perspectives of North American Indigenous youth. This oversight may result from researchers' conceptualization and measurement of volunteering from a Western perspective. Utilizing data from the Healing Pathways (HP) project, a longitudinal, community-based participatory study in partnership with eight Indigenous communities in the United States and Canada, we provide a detailed description of volunteer participation and community and cultural engagement. Overall, we employ a community cultural wealth lens to emphasize the various strengths and sources of resilience that these communities possess. At the same time, we encourage scholars and the wider society to broaden their views of volunteering, community involvement, and giving back.

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.

A longitudinal study of positive mental health and coping among Indigenous adults with type 2 diabetes.

OBJECTIVE: Indigenous Peoples and scholars call for strengths-based approaches to research inclusive of Indigenous resiliency and positive outcomes. The purpose of this study was to examine positive mental health for Indigenous adults with type 2 diabetes and to determine if positive mental health is linked to community connectedness (a coping resource) and active coping (a coping response). METHODS: Participants (N = 194 at baseline) were randomly selected from clinical records, at least 18 years old with a type 2 diabetes diagnosis, and self-identified as American Indian. RESULTS: Latent growth curve models revealed that average positive mental health was predicted to decrease over the four waves of the study, although not for participants with above-average active coping at baseline. Community connectedness at baseline was associated with higher initial levels of positive mental health. Within-person change in active coping and community connectedness were both associated with increases in positive mental health. CONCLUSION: This study aligns with previous research demonstrating that coping can influence health outcomes, and furthers the stress process literature by showing that active coping and community connectedness can impact positive mental health for Indigenous adults with Type 2 Diabetes.

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.

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).

Cultural Sources of Strength and Resilience: A Case Study of Holistic Wellness Boxes for COVID-19 Response in Indigenous Communities.

The COVID-19 pandemic has had disproportionately severe impacts on Indigenous peoples in the United States compared to non-Indigenous populations. In addition to the threat of viral infection, COVID-19 poses increased risk for psychosocial stress that may widen already existing physical, mental, and behavioral health inequities experienced by Indigenous communities. In recognition of the impact of COVID-19 related psychosocial stressors on our tribal community partners, the Johns Hopkins Center for American Indian Health Great Lakes Hub began sending holistic wellness boxes to our community partners in 11 tribal communities in the Midwestern United States and Canada in summer of 2020. Designed specifically to draw on culturally relevant sources of strength and resilience, these boxes contained a variety of items to support mental, emotional, cultural, and physical wellbeing. Feedback from recipients suggest that these wellness boxes provided a unique form of COVID-19 relief. Additional Johns Hopkins Center for American Indian Health offices have begun to adapt wellness boxes for the cultural context of their regions. This case study describes the conceptualization, creation, and contents of these wellness boxes and orients this intervention within a reflection on foundations of community-based participatory research, holistic relief, and drawing on cultural strengths in responding to COVID-19.

Centering the Strengths of American Indian Culture, Families and Communities to Overcome Type 2 Diabetes.

Type 2 diabetes (T2D) is a critical Indigenous health inequity rooted in experiences of colonization and marginalization including disproportionate exposure to stressors, disruption of traditional family and food systems, and attacks on cultural practices that have led to more sedentary lifestyles. Thus, an important step in redressing inequities is building awareness of and interventions attuned to unique Indigenous contexts influencing T2D and Indigenous culture as a pathway to community wellbeing. Using a dynamic, stage-based model of intervention development and evaluation, we detail the creation and evolution of a family-based, culturally centered T2D preventive intervention: Together on Diabetes (later Together Overcoming Diabetes) (TOD). The TOD program was built by and for Indigenous communities via community-based participatory research and has been implemented across diverse cultural contexts. The TOD curriculum approaches health through a holistic lens of spiritual, mental, physical and emotional wellness. Preliminary evidence suggests TOD is effective in reducing diabetes risk factors including lowering BMI and depressive symptoms, and the program is viewed favorably by participants and community members. We discuss lessons learned regarding collaborative intervention development and adaptation across Indigenous cultures, as well as future directions for TOD.

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.

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).

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.

Armed Conflict, Intimate Partner Violence, and Mental Distress of Women in Northeastern Uganda: A Mixed Methods Study.

As global mental health research and programming proliferate, research that prioritizes women's voices and examines marginalized women's mental health outcomes in relation to exposure to violence at community and relational levels of the socioecological model is needed. In a mixed methods, transnational study, we examined armed conflict exposure, intimate partner violence (IPV), and depressive symptoms among 605 women in Northeastern Uganda. We used analysis of variance to test between groups of women who had experienced no IPV or armed conflict, IPV only, armed conflict only, and both; and linear regression to predict depressive symptoms. We used rapid ethnographic methods with a subsample (n = 21) to identify problem prioritization; and, to characterize women's mental health experiences, we conducted follow up in-depth interviews (n = 15), which we analyzed with grounded theory methods. Thirty percent of the sample met the cut-off for probable major depressive disorder; women exposed to both IPV and armed conflict had significantly higher rates of depression than all other groups. While women attributed psychological symptoms primarily to IPV exposure, both past-year IPV and exposure to armed conflict were significantly associated with depressive symptoms. Women identified socioeconomic neglect as having the most impact and described three interrelated mental health experiences that contribute to thoughts of escape, including escape through suicide. Policy efforts should be interprofessional, and specialists should collaborate to advance multi-pronged interventions and gender-informed implementation strategies for women's wellbeing.

Language as a Facilitator of Cultural Connection.

Understanding culture as a means of preventing or treating health concerns is growing in popularity among social behavioral health scientists. Language is one component of culture and therefore may be a means to improve health among Indigenous populations. This study explores language as a unique aspect of culture through its relationship to other demographic and cultural variables. Participants (n = 218) were adults who self-identified as American Indian, had a type 2 diabetes diagnosis, and were drawn from two Ojibwe communities using health clinic records. We used chi-squared tests to compare language proficiency by demographic groups and ANOVA tests to examine relationships between language and culture. A higher proportion of those living on reservation lands could use the Ojibwe language, and fluent speakers were most notably sixty-five years of age and older. Regarding culture, those with greater participation and value belief in cultural activities reported greater language proficiency.