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2.
BMC Public Health ; 19(1): 1675, 2019 Dec 12.
Artigo em Inglês | MEDLINE | ID: mdl-31830933

RESUMO

BACKGROUND: This study is built on a long-standing research partnership between the Johns Hopkins Center for American Indian Health and the White Mountain Apache Tribe to identify effective interventions to prevent suicide and promote resilience among American Indian (AI) youth. The work is founded on a tribally-mandated, community-based suicide surveillance system with case management by local community mental health specialists (CMHSs) who strive to connect at-risk youth to treatment and brief, adjunctive interventions piloted in past research. METHODS: Our primary aim is to evaluate which brief interventions, alone or in combination, have the greater effect on suicide ideation (primary outcome) and resilience (secondary outcome) among AI youth ages 10-24 ascertained for suicide-related behaviors by the tribal surveillance system. We are using a Sequential Multiple Assignment Randomized Trial with stratified assignment based on age and suicidal-behavior type, and randomizing N = 304 youth. Brief interventions are delivered by AI CMHSs, or by Elders with CMHS support, and include: 1) New Hope, an evidence-based intervention to reduce immediate suicide risk through safety planning, emotion regulation skills, and facilitated care connections; and 2) Elders' Resilience, a culturally-grounded intervention to promote resilience through connectedness, self-esteem and cultural identity/values. The control condition is Optimized Case Management, which all study participants receive. We hypothesize that youth who receive: a) New Hope vs. Optimized Case Management will have significant reductions in suicide ideation; b) Elders' Resilience vs. Optimized Case Management will have significant gains in resilience; c) New Hope followed by Elders' Resilience will have the largest improvements on suicide ideation and resilience; and d) Optimized Case Management will have the weakest effects of all groups. Our secondary aim will examine mediators and moderators of treatment effectiveness and sequencing. DISCUSSION: Due to heterogeneity of suicide risk/protective factors among AI youth, not all youth require the same types of interventions. Generating evidence for what works, when it works, and for whom is paramount to AI youth suicide prevention efforts, where rates are currently high and resources are limited. Employing Native paraprofessionals is a means of task-shifting psychoeducation, culturally competent patient support and continuity of care. TRIAL REGISTRATION: Clinical Trials NCT03543865, June 1, 2018.


Assuntos
Índios Norte-Americanos/psicologia , Suicídio/etnologia , Suicídio/prevenção & controle , Adolescente , Criança , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Avaliação de Programas e Projetos de Saúde , Fatores de Proteção , Projetos de Pesquisa , Resiliência Psicológica , Fatores de Risco , Ideação Suicida , Adulto Jovem
3.
Health Serv Res ; 54 Suppl 2: 1431-1441, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31657013

RESUMO

OBJECTIVE: To examine reported racial discrimination and harassment against Native Americans, which broadly contribute to poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 342 Native American and 902 white US adults, conducted January-April 2017. METHODS: We calculated the percent of Native Americans reporting discrimination in several domains, including health care. We used logistic regression to compare the Native American-white difference in odds of discrimination and conducted exploratory analyses among Native Americans only to examine variation by socioeconomic and geographic/neighborhood characteristics. PRINCIPAL FINDINGS: More than one in five Native Americans (23 percent) reported experiencing discrimination in clinical encounters, while 15 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Native Americans also reported they or family members have experienced violence (38 percent) or have been threatened or harassed (34 percent). In adjusted models, Native Americans had higher odds than whites of reporting discrimination across several domains, including health care and interactions with the police/courts. In exploratory analyses, the association between geographic/neighborhood characteristics and discrimination among Native Americans was mixed. CONCLUSIONS: Discrimination and harassment are widely reported by Native Americans across multiple domains of their lives, regardless of geographic or neighborhood context. Native Americans report major disparities compared to whites in fair treatment by institutions, particularly with health care and police/courts. Results suggest modern forms of discrimination and harassment against Native Americans are systemic and untreated problems.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Índios Norte-Americanos/estatística & dados numéricos , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Índios Norte-Americanos/psicologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Racismo/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone , Estados Unidos
5.
Artigo em Inglês | MEDLINE | ID: mdl-31627325

RESUMO

This study explored the lived experiences of suicidality and help-seeking for suicide prevention among Alaska Native and American Indian (AN/AI) people in a tribal health system. An interpretive phenomenological approach was used to analyze semi-structured, in-depth interviews with 15 individuals (ages 15-56) with self-reported histories of suicide ideation and/or attempt. Several factors were found to be central to acquiring resilience to suicide risk among AN/AI people across a wide age range: meaningful and consistent social connection, awareness about how one's suicide would negatively effect loved ones, and knowledge and utilization of available health services. Findings highlight the mutable nature of suicide risk and resilience, as well as the importance of interpersonal factors in suicidality.


Assuntos
Nativos do Alasca/psicologia , Índios Norte-Americanos/psicologia , Resiliência Psicológica , Ideação Suicida , Adolescente , Adulto , Conscientização , Feminino , Acesso aos Serviços de Saúde , Humanos , Relações Interpessoais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Violência , Adulto Jovem
6.
BMC Public Health ; 19(1): 1276, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533671

RESUMO

BACKGROUND: Effective leadership is vital in the struggle to decrease the behavioral health disparities between the US population and American Indian Alaska Native (AIAN) communities. AIAN communities have a pre-colonization history of highly effective leadership, yet some AIAN leadership traditions have been eradicated through decades of trauma and genocidal efforts. There is a paucity of research on AIAN public health leadership, and most existing research relies on samples of individuals holding leadership positions rather than individuals purposely selected because of their effectiveness. The aim of the study was to investigate the experiences of successful AIAN behavioral health leaders and present an emerging AIAN public health leadership model. METHODS: Thirty-eight public health leaders in the Substance Abuse and Mental Health Service Administration (SAMHSA) funded Circles of Care project were observed over the course of their three-year leadership role. Stringent criteria for successful community participatory leadership resulted in the selection of 11 of the 38 leaders for inclusion in the study. Ultimately eight leaders (21% of the population of observed leaders) participated in the study. Semi-structured, one-on-one qualitative interviews were conducted. The methods were informed by phenomenology and the data were analyzed using a thematic content analysis approach. RESULTS: The analysis resulted in ten themes: Hopeful Vision for the People, Cultural Humility, Awareness of Historical Context, Purpose Driven Work Behavior, Cultural and Bi-Cultural Knowledge, Trusting a Broader Process, Caring Orientation, Holistic Supervision, Community Centered, and Influence Through Education. Respondents were strongly motivated by a desire to help future generations. They described their success in terms of the application of traditional AIAN values such as cultural humility and community orientation, but also relied heavily on task orientation. An emerging AIAN leadership model is presented. CONCLUSIONS: It is important to encourage AIAN public health leaders to employ leadership research and models conducted or developed in the context of AIAN communities. The emerging model presented in this study could serve as an initial basis for AIAN leadership training. Given the challenging context of AIAN leadership, the lessons taught by these successful leaders could be adapted for use by leaders in non AIAN settings.


Assuntos
Nativos do Alasca/estatística & dados numéricos , Características Culturais , Índios Norte-Americanos/estatística & dados numéricos , Liderança , Transtornos Relacionados ao Uso de Substâncias/prevenção & controle , Adulto , Nativos do Alasca/psicologia , Participação da Comunidade/estatística & dados numéricos , Feminino , Humanos , Índios Norte-Americanos/psicologia , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
7.
Artigo em Inglês | MEDLINE | ID: mdl-31547171

RESUMO

The Yurok Tribe partnered with the University of California Davis (UC Davis) Superfund Research Program to identify and address contaminants in the Klamath watershed that may be impairing human and ecosystem health. We draw on a community-based participatory research approach that begins with community concerns, includes shared duties across the research process, and collaborative interpretation of results. A primary challenge facing University and Tribal researchers on this project is the complexity of the relationship(s) between the identity and concentrations of contaminants and the diversity of illnesses plaguing community members. The framework of bi-directional learning includes Yurok-led river sampling, Yurok traditional ecological knowledge, University lab analysis, and collaborative interpretation of results. Yurok staff and community members share their unique exposure pathways, their knowledge of the landscape, their past scientific studies, and the history of landscape management, and University researchers use both specific and broad scope chemical screening techniques to attempt to identify contaminants and their sources. Both university and tribal knowledge are crucial to understanding the relationship between human and environmental health. This paper examines University and Tribal researchers' shared learning, progress, and challenges at the end of the second year of a five-year Superfund Research Program (SRP) grant to identify and remediate toxins in the lower Klamath River watershed. Our water quality research is framed within a larger question of how to best build university-Tribal collaboration to address contamination and associated human health impacts.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Monitoramento Ambiental/métodos , Poluentes Ambientais/análise , Índios Norte-Americanos/psicologia , Práticas Interdisciplinares , California , Pesquisa Participativa Baseada na Comunidade/estatística & dados numéricos , Saúde Ambiental , Humanos
8.
BMC Public Health ; 19(1): 1211, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31477072

RESUMO

BACKGROUND: The American Cancer Society discourages the dual use of electronic cigarettes (ECs) and cigarettes because such use has not resulted in reduced exposures to the harmful effects of smoking. American Indian (AI) people have the highest prevalence of smoking and of EC use in the United States, but very little is known about dual EC and cigarette use in AI communities. METHODS: In 2016, 375 adult AI in Oklahoma who smoked cigarettes completed a survey about EC use (vaping). We describe vaping patterns, nicotine dependence, and reasons for EC use among the subset of 44 (12%) current dual EC users. To differentiate habitual EC users from occasional or merely curious users, we defined dual use as using ECs on some days or every day in the past 30 days. RESULTS: About one-third of dual users vaped ten or more times daily. About two-thirds used a tank product. Eleven percent used ECs without nicotine and another 9% were unsure of the nicotine content. A minority (40%) enjoyed vaping more than smoking, and most (76%) would smoke first on days they did both. Thirty-one percent vaped within 5 min of waking and another 24% within 30 min. Although the two-item heaviness of use index did not differ significantly between smoking and vaping, the ten-item Penn State Dependence Index (PSDI) suggested greater dependence on smoking than vaping (11.02 vs. 6.42, respectively; p < .0001). The most common reasons for vaping were to reduce smoking (79%), enjoyment of flavors (78%), and ability to vape where smoking is not allowed (73%). Perceptions of less harm to others (69%) or to self were the next most common (65%). Fewer than half used ECs to reduce stress, for affordability, or because others used them. CONCLUSIONS: Nearly 20% of dual users used ECs either without nicotine or without knowing if the product contained nicotine. The PSDI indicated greater dependence on smoking than vaping. Reasons for vaping were nearly equal between smoking reduction and enjoying flavors. Understanding patterns of dual use will inform future efforts to address nicotine dependence for AI communities with high prevalence of smoking.


Assuntos
Fumar Cigarros/etnologia , Índios Norte-Americanos/psicologia , Tabagismo/etnologia , Vaping/etnologia , Adulto , Feminino , Aromatizantes , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Prevalência , Abandono do Hábito de Fumar/etnologia , Inquéritos e Questionários , Estados Unidos/epidemiologia
9.
J Clin Nurs ; 28(21-22): 3935-3948, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31410925

RESUMO

AIMS AND OBJECTIVES: To develop an understanding of how Indigenous mothers experience selecting and using health services for their infants can assist nurses in improving their access to care. This understanding may ultimately lead to improved health outcomes for Indigenous infants and their families. BACKGROUND: Access to acute care services is important to minimise morbidity and mortality from urgent health issues; however, Indigenous people describe difficulties accessing care. Indigenous infants are known to use the emergency department frequently, yet little is known about the facilitators and barriers their mothers experience when accessing these services. DESIGN: This study undertook a qualitative, interpretive description design. METHODS: This article adheres to the reporting guidelines of COREQ. Data collection methods included interviews and a discussion group with Indigenous mothers (n = 19). Data analysis was collaborative and incorporated both Indigenous and Western ways of knowing, through the application of Two-Eyed Seeing. RESULTS: A thematic summary resulted in six themes: (a) problematic wait times; (b) the hidden costs of acute care; (c) paediatric care; (d) trusting relationships; (e) racism and discrimination; and (f) holistic care. CONCLUSIONS: The experiences of Indigenous mothers using acute care services for their infants suggest a role for culturally safe and trauma and violence-informed care by health providers in the acute care context. RELEVANCE TO CLINICAL PRACTICE: Nurses can improve access to acute care services for Indigenous mothers and infants through the provision of culturally safe and trauma and violence-informed approaches care, by building rapport with families, providing care that is respectful and nonjudgemental, eliminating fees associated with using acute care services and linking families with cultural resources both in hospital and within the community.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Disparidades em Assistência à Saúde , Índios Norte-Americanos/estatística & dados numéricos , Mães/psicologia , Adulto , Instituições de Assistência Ambulatorial/organização & administração , Canadá , Serviços Médicos de Emergência/organização & administração , Feminino , Humanos , Índios Norte-Americanos/psicologia , Lactente , Pesquisa Qualitativa , Telemedicina/organização & administração
10.
Int J Equity Health ; 18(1): 124, 2019 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412891

RESUMO

BACKGROUND: In this paper we examine the relationship between social capital and two mental health outcomes-self-rated mental health (SRMH) and heavy episodic drinking (HED)-among the Indigenous populations of Canada. We operationalize a unique definition of social capital from Indigenous specific sources that allows for an analysis of the importance of access to Indigenous networks and communities. We also examine gender variations in the relationship between social capital and the two outcomes, as there is a noticeable lack of research examining the influence of gender in the recent literature on the mental health of Indigenous populations in Canada. METHODS: Using data from the 2012 cycle of the Aboriginal Peoples Survey, logistic regression models were estimated to assess if gender was a significant predictor of either SRMH or HED among the entire Indigenous sample. The sample was then stratified by gender and the relationship between two social capital variables-one general and one indigenous-specific-and each mental health outcome was assessed separately among male and female respondents. All analyses were also further stratified into specific Indigenous groups-First Nations, Métis, or Inuit-to account for the unique cultures, histories, and socioeconomic positions of the three populations. RESULTS: Female respondents were more likely to report fair or poor SRMH in the total sample as well as the First Nations and Métis subsamples (OR = 1.48, CI = 1.14-1.91; OR = 1.63, CI = 1.12-2.36; OR = 1.44, CI = 1.01-2.05 respectively). However, female respondents were less likely than males to engage in weekly HED in all three of the same populations (OR = 0.43, CI = 0.35-0.54, all respondents; OR = 0.42, CI = 0.31-0.58, First nations; OR = 0.39, CI = 0.27-0.56, Métis). Social capital from sources specific to Indigenous communities was associated with lower odds of weekly HED, but only among Indigenous men. Meanwhile the strength of family ties was associated with lower odds of reporting fair/poor SRMH among both Indigenous men and women. However, these results vary in strength and significance among the different Indigenous populations of Canada. CONCLUSIONS: The results of this paper address a critical gap in the literature on gender differences in SRMH and HED among the Indigenous populations of Canada, and reveal gendered variations in the relationship between social capital and SRMH and HED. These findings support further investigation into the role that social capital and particularly Indigenous-specific forms of social capital may play as a determinant of health. This research could contribute to future mental health initiatives aimed at strengthening the social capital of Indigenous populations and promoting resilient Indigenous communities with strong social connections.


Assuntos
Alcoolismo/epidemiologia , Disparidades nos Níveis de Saúde , Índios Norte-Americanos/psicologia , Saúde do Homem , Saúde Mental , Capital Social , Saúde da Mulher , Adulto , Canadá/epidemiologia , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Modelos Logísticos , Masculino , Razão de Chances , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
11.
Rev Esc Enferm USP ; 53: e03464, 2019 Aug 19.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31433011

RESUMO

OBJECTIVE: To explore the social construction of obstetric violence developed by Tenek and Nahuatl women in Mexico. METHOD: Qualitative, socio-critical study conducted through focal groups in which were deepened the childbirth experiences lived in the period 2015-2016. RESULTS: Participation of 57 women. Through discourse analysis, it was identified that participants do not have enough information about obstetric violence and/or sexual and reproductive rights. This makes the association of their negative experiences with the legal term "obstetric violence" impossible. Most of their speeches correspond to the legal denomination of "obstetric violence". Experiences like prolonged fasting or the use of technologies for invading their privacy were narrated like situations they perceive as violent, but have not been incorporated within the legal term. CONCLUSION: Multiple actions against women's human rights take place within delivery rooms. Most remain unidentified by users, since they have not socially constructed the image of obstetric violence. However, that fact does not make them less susceptible to feel attacked and denigrated during their childbirth experiences.


Assuntos
Parto Obstétrico/psicologia , Índios Norte-Americanos/psicologia , Gestantes/psicologia , Violência/psicologia , Adolescente , Adulto , Feminino , Grupos Focais , Direitos Humanos/psicologia , Humanos , México , Gravidez , Gestantes/etnologia , Direitos Sexuais e Reprodutivos/psicologia , Terminologia como Assunto , Violência/etnologia , Adulto Jovem
12.
BMC Public Health ; 19(1): 981, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337379

RESUMO

BACKGROUND: The goal of adaptation is to maintain the effectiveness of the original intervention by preserving the core elements that account for its success while delivering an intervention that is tailored to the new community and/or cultural context. The current study describes the process of adapting an evidence-based smoke-free homes (SFH) intervention for use in American Indian/Alaska Native (AI/AN) households. METHODS: We followed a systematic adaptation process. We first assessed the community through focus groups coordinated in collaboration with tribal partners. Because our team included the original developers of the intervention, the steps of understanding the intervention, selecting the intervention and consulting with experts were simplified. Additional steps included consulting with stakeholders through a national work group and collaboratively deciding what needed adaptation. RESULTS: A number of key themes pertinent to the adaptation of the SFH intervention were identified in the focus groups. These included the gravity of messaging about commercial tobacco use; respect, familialism, and intergenerationalism; imagery, including significant symbolism, colors, and representative role models; whether and how to address traditional tobacco; and, barriers to a SFH not adequately addressed in the original materials. CONCLUSIONS: Adaptation of an intervention to create smoke-free homes in AI/AN families necessitated both surface structure changes such as appearance of role models and deep structure changes that addressed core values, and beliefs and traditions.


Assuntos
Nativos do Alasca/psicologia , Família/etnologia , Habitação , Índios Norte-Americanos/psicologia , Política Antifumo , Grupos Focais , Humanos
13.
Health Psychol ; 38(8): 738-747, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31204817

RESUMO

OBJECTIVE: Research provides limited detail on how aspects of home life influence basic health status for ethnic/racial minority adolescents. This study examined 2 aspects of the home environment as they relate to 2 markers of health status for Native American, African American, and Latino adolescents. The study addressed the hypothesis that family companionship and investment is associated with adolescent health in all 3 groups. METHOD: Data collectors made visits to the homes of 53 Native American, 132 African American, and 155 Latino families with an adolescent living in residence. They administered the HOME Inventory along with components of the Child Health and Illness Profile and the American Community Survey to parents and adolescents. RESULTS: Significant correlations were observed between the Companionship and Investment domain of LA-HOME and the 2 markers of health for all 3 racial/ethnic groups. Very few significant correlations were observed for the other LA-HOME domain (Physical Environment). When health outcomes were regressed on the 2 home environment factors and gender, Companionship and Investment was a significant predictor in 4 of the 6 models run, with near significant differences in a 5th. CONCLUSIONS: In households where there was a high level of connectedness between adolescents and other family members, adolescents showed more endurance and had fewer health problems. Because adolescence is a period when children tend to spend less time with other family members and are prone to engage in risky behavior, implementing programs that promote parent-adolescent communication and productive time together would seem helpful. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Nível de Saúde , Índios Norte-Americanos/psicologia , Adolescente , Adulto , Afro-Americanos/psicologia , Criança , Feminino , Hispano-Americanos/psicologia , Humanos , Masculino , Adulto Jovem
14.
BMC Public Health ; 19(1): 768, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208402

RESUMO

BACKGROUND: In Canada, there is a growing need to develop community-based, culturally appropriate palliative care for Indigenous people living in First Nations communities. The public health approach to palliative care, which emphasizes community-based initiatives, is especially relevant in First Nations communities because care is grounded in their distinct social and cultural context. Central to the public health approach are educational strategies that strengthen communities' capacity to care for their vulnerable members as they die. This paper presents community-based research conducted with First Nations communities in Canada that aimed to assess and address local palliative care educational needs to improve community capacity in palliative care. METHODS: Participatory action research (PAR) was conducted with four First Nations communities in Canada over a six-year period (2010-2016). The research occurred in three phases. Phase 1: focus groups, interviews and surveys were employed to assess community specific needs and resources. Phase 2: recommendations were developed to guide the PAR process. Phase 3: educational resources were created to address the identified educational needs. These resources were implemented incrementally over 4 years. Ongoing process evaluation was employed, and revisions were made as required. RESULTS: Educational needs were identified for patients, families, community members and internal and external health care providers. A wide and comprehensive range of educational resources were created to address those needs. Those culturally appropriate educational resources are available in a very accessible and useable workbook format and are available for use by other Indigenous people and communities. CONCLUSIONS: This research provides an example of the public health approach and offers implementation strategies around palliative care education. This paper contributes to the international literature on the public health approach to palliative care by presenting a case study from Canada that includes: conducting a culturally appropriate assessment of educational needs, creating recommendations, facilitating development and implementation of educational resources in the community to improve community capacity in palliative care.


Assuntos
Adaptação Psicológica , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Índios Norte-Americanos/psicologia , Cuidados Paliativos/psicologia , Adulto , Canadá , Fortalecimento Institucional/métodos , Feminino , Educação em Saúde , Pesquisa sobre Serviços de Saúde , Serviços de Saúde do Indígena/organização & administração , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Saúde Pública
15.
PLoS One ; 14(6): e0218445, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31206559

RESUMO

American Indian and Alaska Native (AI/AN) youth are more likely to ever have had sex, and to have engaged in sexual activity prior to age 13 compared to all other race groups. It is essential to understand the development of skills to refuse sexual experience in early adolescence in order to reduce disparities associated with early sexual debut among AI/AN youth. Familial, social, and individual factors can act as protective influences on adolescent sexual experience; however, in other settings, research has shown that frequent residential mobility disrupts these protective influences and may increase the likelihood of adolescent sexual activity. AI/AN youth are highly mobile, and, as a result, may be especially vulnerable to increased sexual risk. To date, no prior study has considered the impact of residential mobility on AI/AN youth sexual experience, nor the influence on precursors that reduce initiation of sex. We used data from a longitudinal study of AI/AN youth attending all middle schools from a Northern Plains reservation from 2006-2009 to estimate a structural equation model based on a cultural and age adapted theoretical framework. The tested model included frequent residential mobility as the independent variable and sex refusal self-efficacy as the dependent variable. Mediating variables included factors related to individual risks, psychological well-being, and social supports. Results indicate a direct association between residential mobility and sex refusal self-efficacy (-.29, p = 0.05) and an indirect association mediated by deviant peers (-.08, p = .05). Other mediating variables did not provide insight on the mechanism by which residential mobility influences skills to refuse sexual intercourse among AI/AN youth in early adolescence. Findings provide evidence for an association between residential mobility and precursors to sexual experience suggesting augmenting sexual health interventions for highly mobile youth.


Assuntos
Comportamentos de Risco à Saúde/fisiologia , Índios Norte-Americanos/psicologia , Dinâmica Populacional , Comportamento Sexual/psicologia , Adolescente , Comportamento do Adolescente/psicologia , Nativos do Alasca/psicologia , Feminino , Humanos , Masculino , Grupo Associado , Autoeficácia
16.
Int J Circumpolar Health ; 78(1): 1630233, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31199204

RESUMO

Historically, heart health was approached holistically by First Nations (FN) peoples, which was integrated into daily living. Caring for the physical, emotional and spiritual needs of individuals, community, family, and the living environment was integral. The Truth and Reconciliation Commission of Canada demonstrates the decimation of health practices through governmental policy to destroy the cultural foundations of FN peoples. Relational systems and ways of living were outlawed, and the health of FN people suffered. A digital storytelling study collaborated with Manitoba FN women with lived experience of caring for a biomedical-diagnosed heart condition. The objective was to identify concepts, language, and experiences of heart health among FN women. Six women created five digital stories; four are available publically online. Themes addressed by the storytellers include: changes to diet and lifestyle, related health conditions, experiences with healthcare system, residential schools, and relationships with children and grandchildren. The intersection of Western and FN knowledges heard in the women's stories suggests heart health knowledge and care is embedded within historical and social contexts. Insights into the non-dichotomous relationship between FN and biomedical knowledge of heart health, along with their conceptualisations of heart, suggests historical and social roots underlying heart health issues First Nations women face.


Assuntos
Assistência à Saúde/etnologia , Conhecimentos, Atitudes e Prática em Saúde , Cardiopatias/etnologia , Índios Norte-Americanos/psicologia , Regiões Árticas , Dieta/etnologia , Relações Familiares/etnologia , Feminino , Humanos , Estilo de Vida/etnologia , Manitoba , Narração
17.
Sleep Health ; 5(4): 352-358, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31153800

RESUMO

OBJECTIVES: In a sample of 90 American Indian (AI) college students (Age M(SD) = 21.47(3.02), 61.1% female), we investigated relationships between stress (perceived psychological stress and recent negative life events), sense of belonging to the university community and tribal community and sleep. We hypothesized that belonging and stress would associate with sleep. METHODS: Participants wore a wrist accelerometer for 7 nights and answered surveys during an in-lab visit. RESULTS: Sense of belonging to the university community associated with actigraphy-measured wake after sleep onset (WASO) (ß = -.45, t(80) = -3.98, P < .001, R2 change = 0.16), total sleep time (ß = .30, t(80) = 2.49, P = .02, R2 change = .07), sleep efficiency (ß = .38, t(80) = 3.29, P = .001, R2 change = .11) and subjective global sleep quality (ß = -.44, t(75) = -4.82, P < .001, R2 change = .15). Sense of belonging to the tribal community predicted average wake after sleep onset (ß = -.29, t(80) = -2.64, P = .01, R2 change = 0.08). Total negative life events in the preceding year associated with WASO (ß = .24, t(80) = 2.19, P = .03, R2 change = 0.05), while perceived psychological stress associated with actigraphy-measured sleep efficiency (ß = -.28, t(80) = -2.25, P = .03, R2 change = 0.06) and subjective global sleep quality (ß = .40, t(78) = 3.94, P < .001, R2 change = 0.16). CONCLUSIONS: Stress and sense of belonging associate with sleep in AI college students. Future research should investigate whether life stress and belonging may affect health in this population by affecting patterns of sleep and investigate psychosocial resources that may moderate the relationships between stress, belonging and sleep.


Assuntos
Índios Norte-Americanos/psicologia , Sono , Identificação Social , Estresse Psicológico/etnologia , Estudantes/psicologia , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Estudantes/estatística & dados numéricos , Universidades , Adulto Jovem
18.
Psychol Addict Behav ; 33(4): 392-400, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31081646

RESUMO

Research exploring American Indian (AI) youth drinking motives and their relation to negative outcomes is critical due to higher rates of alcohol use and early exposure to intoxication in the population. The purpose of this study is to explore classes of drinking motives as they relate to heavy episodic drinking, perceived discrimination, religious importance, ethnic identity, and ethnic pride. This study is part of an ongoing epidemiologic and etiologic investigation of substance use among AI youth drinkers living on or near reservations (n = 1,934, Mage = 15.31). A latent class analysis (LCA) was conducted to discern latent classes of drinking motives. Once latent classes were identified, differences in perceived discrimination, ethnic pride, ethnic identity, religious importance, and heavy episodic drinking were tested. A 2-class solution provided the best overall model fit to the data. The higher coping and enhancement motive class was associated with significantly greater heavy episodic drinking, perceived discrimination, and ethnic identity compared with the low motive class. Further, the class structure did not differ between 7th and 8th graders and 9th-12th graders. Results indicate that among AI youth, the class with strong motives to drink for coping or enhancement had higher ethnic identity, greater risk of heavy episodic drinking, and greater perceived discrimination compared with the class with low motives. Future research should examine additional factors and stressors that may be associated with these classes of drinking motives and are unique to the AI population. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Índios Norte-Americanos/psicologia , Motivação , Consumo de Álcool por Menores/psicologia , Adaptação Psicológica , Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Feminino , Humanos , Masculino
19.
Prev Chronic Dis ; 16: E53, 2019 04 25.
Artigo em Inglês | MEDLINE | ID: mdl-31022368

RESUMO

INTRODUCTION: We examined diet quality and intake of pregnancy-specific micronutrients among pregnant American Indian women in the Northern Plains. METHODS: We conducted an analysis of nutrition data from the Prenatal Alcohol and SIDS and Stillbirth (PASS) Network Safe Passage Study and the PASS Diet Screener study (N = 170). Diet intake, including dietary supplementation, was assessed by using three 24-hour recalls conducted on randomly selected, nonconsecutive days. Diet intake data were averaged across the participant's recalls and scored for 2 dietary indices: the Healthy Eating Index 2010 (HEI-2010) and the Alternate Healthy Eating Index for Pregnancy (AHEI-P). We also assessed nutrient adequacy with Dietary Reference Intakes for pregnancy. RESULTS: On average, participants were aged 26.9 (standard deviation [SD], 5.5) years with a pre-pregnancy body mass index of 29.8 (SD, 7.5) kg/m2. Mean AHEI-P and HEI-2010 scores (52.0 [SD, 9.0] and 49.2 [SD, 11.1], respectively) indicated inadequate adherence to dietary recommendations. Micronutrient intake for vitamins D and K, choline, calcium, and potassium were lower than recommended, and sodium intake was higher than recommended. CONCLUSION: Our findings that pregnant American Indian women are not adhering to dietary recommendations is consistent with studies in other US populations. Identifying opportunities to partner with American Indian communities is necessary to ensure effective and sustainable interventions to promote access to and consumption of foods and beverages that support the adherence to recommended dietary guidelines during pregnancy.


Assuntos
Dieta/etnologia , Ingestão de Energia/etnologia , Comportamento Alimentar/psicologia , Índios Norte-Americanos/etnologia , Índios Norte-Americanos/estatística & dados numéricos , Estado Nutricional/etnologia , Gestantes/psicologia , Adulto , Dieta/estatística & dados numéricos , Feminino , Humanos , Índios Norte-Americanos/psicologia , Gravidez , Estados Unidos/etnologia , Adulto Jovem
20.
Am J Psychother ; 72(2): 38-46, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30945559

RESUMO

As a complement to multicultural competence, the multicultural orientation (MCO) perspective has been proposed as a pragmatic way to enhance cultural understandings about psychotherapeutic dynamics, processes, and outcomes. Consisting of three core components-cultural humility, cultural comfort, and cultural opportunities-the MCO is considered relevant for both individual and group treatment. However, the MCO perspective has yet to be specifically applied to psychotherapy supervision. Because supervision often provides multicultural oversight for individual and group psychotherapy services, considering the ramifications of MCO for psychotherapy supervision (MCO-S) is important. In this article, the implications of MCO-S are reviewed, with attention given to the impacts of cultural humility, cultural comfort, and cultural opportunities on the supervisor-supervisee relationship. Case examples are provided to illustrate the ways in which MCO can affect the psychotherapy supervision process and outcome. Supervision research possibilities are also proposed.


Assuntos
Competência Cultural , Psicoterapia/métodos , Diversidade Cultural , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Índios Norte-Americanos/psicologia , Masculino , Processos Psicoterapêuticos , Psicoterapia de Grupo/métodos , Adulto Jovem
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