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.

Growth hormone therapy in children with idiopathic short stature - the effect on appetite and appetite-regulating hormones: a pilot study.

AIM: To investigate the effect of growth hormone (GH) therapy on appetite-regulating hormones and to examine the association between these hormones and the response to GH, body composition, and resting energy expenditure (REE). METHODS: Nine pre-pubertal children with idiopathic short stature underwent a standard meal test before and 4 months following initiation of GH treatment. Ghrelin, GLP-1, leptin, and insulin levels were measured; area under the curve (AUC) was calculated. Height, weight, body composition, REE, and insulin-like growth factor levels were recorded at baseline and after 4 and 12 months. RESULTS: Following 4 months of GH therapy, food intake increased, with increased height-standard deviation score (SDS), weight-SDS, and REE (p < .05). Significant changes in appetite-regulating hormones included a decrease in postprandial AUC ghrelin levels (p = .045) and fasting GLP-1 (p = .038), and an increase in fasting insulin (p = .043). Ghrelin levels before GH treatment were positively correlated with the changes in weight-SDS (fasting: r = .667, p = .05; AUC: r = .788, p = .012) and REE (fasting: r = .866, p = .005; AUC: r = .847, p = .008) following 4 months of GH therapy. Ghrelin AUC at 4 months was positively correlated with the changes in height-SDS (r = .741, p = .022) and fat-free-mass (r = .890, p = .001) at 12 months of GH treatment. CONCLUSIONS: The reduction in ghrelin and GLP-1 following GH treatment suggests a role for GH in appetite regulation. Fasting and meal-AUC ghrelin levels may serve as biomarkers for predicting short-term (4 months) changes in weight and longer term (12 months) changes in height following GH treatment. The mechanisms linking GH with changes in appetite-regulating hormones remain to be elucidated. ABBREVIATIONS: SDS: standard deviation score; REE: resting energy expenditure; SMT: standard meal test; AUC: area under the curve; ISS: idiopathic short stature; SGA: small for gestational age; FFM: fat-free-mass; FM: fat mass; EER: estimated energy requirements; DRI: dietary reference intakes; IQR: inter-quartile range.