From Ambivalence to Revitalization: Negotiating Cardiovascular Health Behaviors Related to Environmental and Historical Trauma in a Northwest American Indian Community.

Cardiovascular disease is the number one cause of death among American Indians and Alaska Natives (AI/AN). Utilizing narratives from members of a Pacific Northwest tribe, this paper explores perceptions about behaviors affecting cardiovascular health through tribal members' lived experiences related to place-based environmental historical trauma. Findings from narrative analysis indicate that ambivalence is an effect of historical trauma and complicates the adoption of protective cardiovascular health behaviors. Tribal narratives indicate a path to overcome this ambivalence stemming from historical environmental trauma through revitalization, adaptation, and re-integration of traditional cultural practices to contemporary contexts. By creating their own health promotion response, one that is not imposed or colonizing, tribal members are re-generating cultural practices and health behaviors associated with lowered risks of cardiovascular disease.

Self-Concepts, Self-Esteem, and Academic Achievement of Minority and Majority North American Elementary School Children.

Minority and majority elementary school students from a Native American reservation (N = 188; K-fifth grade; 5- to 10-year-olds) completed tests of academic self-concepts and self-esteem. School grades, attendance, and classroom behavior were collected. Both minority and majority students exhibited positive self-esteem. Minority students demonstrated lower academic self-concepts and lower achievement than majority students. Two age-related patterns emerged. First, minority students had lower academic achievement than majority students, and this effect was stronger in older (Grades 3-5) than in younger (Grades K-2) students. Second, children's actual achievement was related to their academic self-concepts for older students but more strongly linked to self-esteem in younger students. The authors offer a developmental account connecting students' developing self-representations to their school achievement.

Relationships Between Smoking Behaviors and Cotinine Levels Among Two American Indian Populations With Distinct Smoking Patterns.

Introduction: Smoking prevalence, cigarettes per day (CPD), and lung cancer incidence differ between Northern Plains (NP) and Southwest (SW) American Indian populations. We used cotinine as a biomarker of tobacco smoke exposure to biochemically characterize NP and SW smokers and nonsmokers and to investigate factors associated with variation in tobacco exposure. Methods: American Indians (N = 636) were recruited from two different tribal populations (NP and SW) as part of a study conducted as part of the Collaborative to Improve Native Cancer Outcomes P50 project. For each participant, a questionnaire assessed smoking status, CPD, second-hand smoke exposure, and traditional ceremonial tobacco use; plasma and/or salivary cotinine was measured. Results: Cotinine levels were (mean ± 95% confidence interval [CI]) 81.6 ± 14.1 and 21.3 ± 7.3 ng/ml among NP smokers and non-mokers, respectively, and 44.8 ± 14.4 and 9.8 ± 5.8 ng/ml among SW smokers and nonsmokers, respectively. Cotinine levels correlated with CPD in both populations (p < .0001). Cotinine ≥15 ng/ml was measured in 73.4% of NP smokers and 47.8% of SW smokers and in 19.0% of NP nonsmokers and 10.9% of SW nonsmokers. Ceremonial traditional tobacco use was associated with higher cotinine among NP smokers only (p = 0.004). Second-hand smoke exposure was associated with higher cotinine among NP non-smokers (P < 0.02). More secondhand smoke exposure was associated with smoking more CPD in both populations (p = 0.03-0.29). Linear regression modeling mirrored these findings. Conclusions: High prevalence of smoking in the Northern Plains and high cotinine levels among nonsmokers in both regions highlights the tribal populations' risk for tobacco-related disease. Implications: There is a high prevalence of smoking in Northern Plains American Indians. Among Northern Plains and Southwest nonsmokers, relatively high cotinine levels, representative of high tobacco exposure, suggest considerable exposure to second-hand smoke. It is critical to highlight the extent of second-hand smoke exposure among the Northern Plains and Southwest American Indians and to enhance efforts to initiate smoke-free policies in tribal communities, which are not subject to state-level polices.

Identifying sexual health protective factors among Northern Plains American Indian youth: An ecological approach utilizing multiple perspectives.

This study examined aspects of the sociocultural context in which American Indian (AI) teen pregnancy occurs, focusing specifically on protective factors for Northern Plains AI youth. Principles of community-based participatory research guided the qualitative data collection from 185 community members (focus groups with AI youth, youth parents, and elders; interviews with health care providers and school personnel) from a reservation and an urban community. Results indicated three protective systems impacted the sexual health and behaviors of AI youth: school, family, and enculturation. These findings provide a better understanding of how specific protective factors within these systems may buffer AI youth from involvement in risky sexual behaviors and work to inform culturally relevant prevention and intervention efforts.

Native Transformations in the Pacific Northwest: A strength-based model of protection against substance use disorder.

This paper presents findings from the Native Transformations Project, an exploratory community-based participatory research study that aims to identify sources of strength and protection against substance use disorder in three tribal communities in the coastal Pacific Northwest. Preliminary results from the study describe the specific settings, acts, and behaviors that build strengths and provide protection at the family, community, individual, and spiritual levels within coastal Pacific Northwest local tribal cultures. Findings from this study give voice to stated community preferences for grassroots Native intervention programs based in local cultural knowledge, worldviews, values, and theories of change, that operate at the local level on their own terms.

The Association of Panic Disorder, Posttraumatic Stress Disorder, and Major Depression With Smoking in American Indians.

INTRODUCTION: Rates of cigarette smoking are disproportionately high among American Indian populations, although regional differences exist in smoking prevalence. Previous research has noted that anxiety and depression are associated with higher rates of cigarette use. We asked whether lifetime panic disorder, posttraumatic stress disorder, and major depression were related to lifetime cigarette smoking in two geographically distinct American Indian tribes. METHODS: Data were collected in 1997-1999 from 1506 Northern Plains and 1268 Southwest tribal members; data were analyzed in 2009. Regression analyses examined the association between lifetime anxiety and depressive disorders and odds of lifetime smoking status after controlling for sociodemographic variables and alcohol use disorders. Institutional and tribal approvals were obtained for all study procedures, and all participants provided informed consent. RESULTS: Odds of smoking were two times higher in Southwest participants with panic disorder and major depression, and 1.7 times higher in those with posttraumatic stress disorder, after controlling for sociodemographic variables. After accounting for alcohol use disorders, only major depression remained significantly associated with smoking. In the Northern Plains, psychiatric disorders were not associated with smoking. Increasing psychiatric comorbidity was significantly linked to increased smoking odds in both tribes, especially in the Southwest. CONCLUSIONS: This study is the first to examine the association between psychiatric conditions and lifetime smoking in two large, geographically diverse community samples of American Indians. While the direction of the relationship between nicotine use and psychiatric disorders cannot be determined, understanding unique social, environmental, and cultural differences that contribute to the tobacco-psychiatric disorder relationship may help guide tribe-specific commercial tobacco control strategies.

The social construction of violence among Northern Plains tribal members with antisocial personality disorder and alcohol use disorder.

Whereas recent reports from national studies have presented extremely high rates for many personality disorders in American Indian communities, persistent concerns about the meaning of these symptoms have left many troubled by these reports. American Indians as a group are known to suffer disproportionately from a number of violent experiences, but the dynamics of this violence have received little attention. This paper examines perspectives on violence in the lives of 15 northern plains tribal members who met criteria for antisocial personality disorder and comorbid alcohol use disorder. It explores how study participants constructed and understood their own violent encounters, as well as the motivations they described (characterized here as reputation, leveling, retaliation, catharsis, and self-defense). Violence was gendered in this study, with men generally presenting as perpetrators and women as victims. Men often described themselves as ready participants in a violent world, while women were quite clear that aggression for them was often simply required as they tried to defend themselves from male violence. While this analysis does not replace clinical analyses of violence in antisocial personality disorder, it does reveal an underlying cultural logic that may play a role in shaping the recourse to violence for that minority of individuals for whom it appears to be the obvious choice.

Central corneal thickness in Northwestern American Indians/Alaskan Natives and comparison with White and African-American persons.

PURPOSE: To determine the demographic factors associated with central corneal thickness (CCT) in Northwestern American Indians/Alaskan Natives (AI/ANs) and to compare these CCT measurements with those of White and African-American persons. DESIGN: Cross-sectional comparative, observational study. METHODS: We performed ultrasonic pachymetry (DGH-500 Pachette; DGH Technologies, Exton, Pennsylvania, USA) on a random sample of AI/AN subjects from three randomly selected AI/AN tribes in the Northwest United States (n = 429). Pachymetry also was performed on a convenience sample of White (n = 46) and African-American (n = 33) persons. Our main outcome measure was the average of right and left eye CCT. RESULTS: Average AI/AN CCT was 554.8 +/- 33.9 microm. AI/AN CCT was found to be thicker than that of African Americans (528.5 +/- 33.2 microm) but similar to that of White persons (551.9 +/- 28.3 microm). CCT was greater in AI/AN females than in AI/AN males (557.6 +/- 33.3 microm vs 550.1 +/- 34.5 microm; P = .03). We found no difference in CCT based on percent AI/AN heritage, age, and keratometry readings. We found no significant differences in mean CCT between AI/ANs with glaucoma (556.2 microm) and those who did not have glaucoma (556.6 microm). CONCLUSIONS: CCT measurements for the Northwest AI/AN population are similar to those of White persons but thicker than those of African-American persons. Although glaucoma is common in AI/ANs, we did not find an association with thin CCT. We need future studies to explore the risk factors for glaucoma in AI/ANs.

Drug use among two American Indian populations: prevalence of lifetime use and DSM-IV substance use disorders.

American Indians (AIs) have often reported higher rates of drug use than have other racial/ethnic groups. However, the majority of these studies have focused on drug use among high school adolescents, with little attention to pathological use such as drug abuse or dependence. This study is among the first to report lifetime drug use and disorder (abuse/dependence) information from community samples of two culture groups of AI people-one in the Southwest (SW), one in the Northern Plains (NP)-ranging in age from 15 to 57 years old. Analyses were conducted within four groups: SW men, SW women, NP men, and NP women. Across the four groups, lifetime use rates for marijuana (36.9-57.5%), cocaine (4.3-21.5%), and inhalants (3.6-17.0%) were the highest drug use rates; heroin (0.5-2.1%), the lowest. Lifetime drug disorder rates were highest for marijuana (4.5-14.1%), cocaine (1.1-2.3%), and stimulants (0.7-1.7%). Lifetime polydrug use disorder rates from 1.2 to 4.5%. Women generally had lower prevalence rates than did men in their culture group. The SW women generally had the lowest rates of use and disorder. Lifetime use and disorder rates among the youngest group were often not different from rates of the older groups. Overall, 40-60% had never used any drugs; 85-95% had not developed any drug disorder. Despite widespread concern and rhetoric about drug problems among AIs, many who had used various drugs either were using them without serious consequences or had quit use altogether.

Geographic variation of native people along the Pacific Coast.

Data gathered by Boas in the 1890s from 1749 adult males and 1056 adult females were subjected to anthropometric analyses to investigate possible effects of climatic adaptation. The subjects were native people from California, Oregon, Washington, the panhandle of Alaska, and British Columbia. They were categorized by their tribe's latitude and longitude (the center point of tribal distribution) and by habitat (characterized as coastal, western lowlands, and interior). Multiple R regressions were used to determine complex relationships between age, habitat, latitude, rainfall, mean January temperature, mean July temperature, and blood quantum, all of which affected some anthropometric variables to statistically significant degrees in both the male and the female samples. Body size and proportional differences support other studies of Bergmann's and Allen's rules, and variation in the nasal index supports prior studies of selection of longer, narrower noses in cold and dry climates and broader noses in warmer, moister ones. Recent disruption in the central portion of the study area was detectable in reduced size of subjects in these regions. Other complicating factors, such as ethnicity and the possibility of prior migrations and intermarriage between populations, are discussed.