Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.033
Filtrar
1.
AMA J Ethics ; 22(10): E898-903, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33103654

RESUMO

The disproportionate negative impact of the COVID-19 pandemic on Native communities is a result of transgenerational traumas-mental and physical-which have been ongoing and developing for centuries. This article considers 19th-century American visual and narrative representations of Native experiences of and responses to transgenerational trauma. This article also suggests ethical implications for Native American health of interpreting those representations and suggests an obligation to look on 19th-century White American artists' romanticizations of Native experiences with humility.


Assuntos
Arte , Infecções por Coronavirus/complicações , Trauma Histórico/complicações , Historiografia , Índios Norte-Americanos/psicologia , Pneumonia Viral/complicações , Saúde da População , Violência , Arte/história , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Características da Família , Trauma Histórico/etnologia , História do Século XIX , Humanos , Narração , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Estados Unidos , Violência/ética , Violência/história , Violência/psicologia
2.
Psychol Assess ; 32(6): 594-607, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32212753

RESUMO

Indigenous people and the courts have emphasized that it is important to examine whether scores from violence risk assessment tools are valid and appropriate for Indigenous youth. However, studies are scarce. Therefore, we examined the predictive validity of youth probation officers' Structured Assessment of Violence Risk in Youth (SAVRY) ratings for 744 Canadian youth, including 299 Indigenous youth (219 male, 80 female), and 445 Caucasian youth (357 male, 88 female) in a prospective field study. The SAVRY summary risk ratings and risk total scores significantly predicted violent and any reoffending for Indigenous female and male youth with medium effect sizes. Relatively few significant differences in the predictive validity emerged for Indigenous and Caucasian youth. However, Historical, Protective, and Risk Total scores predicted any recidivism better for Caucasian males than Indigenous males. Also, Indigenous youth scored significantly higher on all risk domains than Caucasian youth. Opposite to predictions, the rates of false positives were higher for Caucasian youth than for Indigenous youth. Based on the results, the SAVRY appears to be a reasonable tool to use for assessing risk in Indigenous youth. However, assessors should take steps to ensure that they use the SAVRY in a culturally appropriate manner, such as considering cultural factors in case formulations and treatment planning as the SAVRY does not ground assessments in an understanding of factors such as colonialism. In addition, future research should examine culturally salient risk factors (e.g., discrimination) and examine potential causes of higher risk scores in Indigenous youth, particularly the role of both past and present-day colonialism. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
Grupo com Ancestrais do Continente Europeu/psicologia , Índios Norte-Americanos/psicologia , Povos Indígenas/psicologia , Delinquência Juvenil/psicologia , Testes Psicológicos , Reincidência/psicologia , Violência/psicologia , Adolescente , Canadá , Criança , Técnicas de Apoio para a Decisão , Feminino , Seguimentos , Humanos , Delinquência Juvenil/etnologia , Masculino , Valor Preditivo dos Testes , Estudos Prospectivos , Psicometria , Reincidência/etnologia , Reprodutibilidade dos Testes , Medição de Risco/métodos , Fatores de Risco , Violência/etnologia , Adulto Jovem
3.
PLoS One ; 15(3): e0230348, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32182279

RESUMO

Before Europeans arrived to Eastern North America, prehistoric, indigenous peoples experienced a number of changes that culminated in the development of sedentary, maize agricultural lifeways of varying complexity. Inherent to these lifeways were several triggers of social stress including population nucleation and increase, intergroup conflict (warfare), and increased territoriality. Here, we examine whether this period of social stress co-varied with deadlier weaponry, specifically, the design of the most commonly found prehistoric archery component in late pre-contact North America: triangular stone arrow tips (TSAT). The examination of modern metal or carbon projectiles, arrows, and arrowheads has demonstrated that smaller arrow tips penetrate deeper into a target than do larger ones. We first experimentally confirm that this relationship applies to arrow tips made from stone hafted onto shafts made from wood. We then statistically assess a large sample (n = 742) of late pre-contact TSAT and show that these specimens are extraordinarily small. Thus, by miniaturizing their arrow tips, prehistoric people in Eastern North America optimized their projectile weaponry for maximum penetration and killing power in warfare and hunting. Finally, we verify that these functional advantages were selected across environmental and cultural boundaries. Thus, while we cannot and should not rule out stochastic, production economizing, or non-adaptive cultural processes as an explanation for TSAT, overall our results are consistent with the hypothesis that broad, socially stressful demographic changes in late pre-contact Eastern North America resulted in the miniaturization-and augmented lethality-of stone tools across the region.


Assuntos
Índios Norte-Americanos/história , Miniaturização , Fatores Sociológicos , Guerra/história , Armas/história , Arqueologia , História Antiga , Humanos , Índios Norte-Americanos/psicologia , América do Norte , Crescimento Demográfico , Guerra/psicologia
4.
Creat Nurs ; 26(1): 43-47, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32024738

RESUMO

Since the early 1990s, the Institute of Medicine has identified the need to increase the number of ethnic minority nurses to improve access to care and eliminate health disparities in these populations (Institute of Medicine, 1994, 2011). American Indians (AI) and Alaska Natives endure the highest rates of poverty, depression, addiction, suicide, domestic violence, and diabetes in the United States (Sarche & Spicer, 2008). With the disadvantages AIs face, nursing schools have difficulty recruiting, retaining, and graduating AI nursing students. Based on the guidance needed by AI nursing students, a program called Niganawenimaanaanig was specifically designed to provide holistic support for these students to improve their chances of successfully completing the baccalaureate nursing program. This program, funded through a Health Resource Services Administration Nursing Workforce Diversity grant, was begun at Bemidji State University in Minnesota, proximal to three of the largest Ojibwe reservations in the state. Once enrolled in Niganawenimaanaanig, students are provided comprehensive care within a unique cultural, academic, and social support framework. Tuition scholarships and monthly stipends provide crucial financial relief to students once they are accepted into the 4-year prelicensure or RN-to-BS nursing programs. In Niganawenimaanaanig's first 2 years, the number of AI students declaring nursing as a major increased by over 600%, and the program has retained 100% of their prenursing freshmen. At the heart of Niganawenimaanaanig is a grounding in AI culture that empowers and fosters resilience among nursing students, which is a relevant and recreatable concept for schools seeking to recruit and retain ethnic minority nursing students.


Assuntos
Diversidade Cultural , Bacharelado em Enfermagem/organização & administração , Índios Norte-Americanos/educação , Índios Norte-Americanos/psicologia , Motivação , Resiliência Psicológica , Estudantes de Enfermagem/psicologia , Adulto , Feminino , Humanos , Minnesota , Estados Unidos , Adulto Jovem
6.
Can Rev Sociol ; 57(1): 34-52, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32011084

RESUMO

The Truth and Reconciliation Commission of Canada (TRC) final report called attention to the damage induced by government policies and practices and outlined a pathway toward reconciliation in which education and child welfare system reforms play a central role. Drawing from 61 interviews with teachers and parents of Indigenous children in Alberta, this paper addresses the question: what do intersections between schooling and child welfare systems contribute to prospects for meaningful reconciliation between Indigenous and non-Indigenous people in Canada? Findings suggest that, despite formal commitments to acknowledge and address colonial legacies of residential schooling, obligations to fulfill state child welfare and educational objectives continue to situate schools, for many Indigenous families, as "dangerous places."


Assuntos
Bem-Estar da Criança/estatística & dados numéricos , Comportamento Perigoso , Índios Norte-Americanos/psicologia , Pais/psicologia , Professores Escolares/psicologia , Instituições Acadêmicas/estatística & dados numéricos , Adolescente , Alberta , Criança , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Instituições Acadêmicas/normas
7.
BMC Health Serv Res ; 20(1): 24, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31914997

RESUMO

BACKGROUND: Community Health Representatives (CHRs) overcome health disparities in Native communities by delivering home care, health education, and community health promotion. The Navajo CHR Program partners with the non-profit Community Outreach and Patient Empowerment (COPE), to provide home-based outreach to Navajo clients living with diabetes. COPE has created an intervention (COPE intervention) focusing on multiple levels of improved care including trainings for CHRs on Motivational Interviewing and providing CHRs with culturally-appropriate education materials. The objective of this research is to understand the participant perspective of the CHR-COPE collaborative outreach through exploring patient-reported outcomes (PROs) of clients who consent to receiving the COPE intervention (COPE clients) using a qualitative methods evaluation. METHODS: Seven COPE clients were selected to participate in semi-structured interviews one year after finishing COPE to explore their perspective and experiences. Qualitative interviews were recorded, transcribed, and coded to identify themes. RESULTS: Clients revealed that health education delivered by CHRs facilitated lifestyle changes by helping them understand key health indicators and setting achievable goals through the use of accessible material and encouragement. Clients felt comfortable with CHRs who respected traditional practices and made regular visits. Clients also appreciated when CHRs educated their family members, who in turn were better able to support the client in their health management. Finally, CHRs who implemented the COPE intervention helped patients who were unable to regularly see a primary care doctor for critical care and support in their disease management. CONCLUSION: The COPE-CHR collaboration facilitated trusting client-CHR relationships and allowed clients to better understand their diagnoses. Further investment in materials that respect traditional practices and aim to educate clients' families may foster these relationships and improve health outcomes. TRIAL REGISTRATION: clinicaltrials.gov: NCT03326206. Registered 9/26/2017 (retrospectively registered).


Assuntos
/psicologia , Atitude Frente a Saúde/etnologia , Serviços de Saúde Comunitária/organização & administração , Diabetes Mellitus/etnologia , Índios Norte-Americanos/psicologia , /estatística & dados numéricos , Agentes Comunitários de Saúde/psicologia , Relações Comunidade-Instituição , Comportamento Cooperativo , Diabetes Mellitus/terapia , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Organizações sem Fins Lucrativos/organização & administração , Participação do Paciente , Relações Profissional-Paciente , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estados Unidos
8.
BMC Public Health ; 20(1): 40, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31924188

RESUMO

BACKGROUND: Heart disease and stroke are among the leading causes of death in Native Americans. Knowledge of heart attack and stroke symptomology are essential for prompt identification of symptoms and for appropriate action in seeking care. Knowledge of heart attack and stroke symptoms among US Native American adults was this study's focus. METHODS: Multivariate techniques were used to analyze national surveillance data. Native American adults comprised the study population. Low heart attack and stroke knowledge score was the dependent variable. RESULTS: Logistic regression analysis yielded that Native American adults with low heart attack and stroke composite knowledge scores were more likely to be: older, less educated, poorer, uninsured, a rural resident, male, without a primary health care provider, and lacking a recent medical checkup. CONCLUSIONS: The identified characteristics of Native American adults with heart attack and stroke knowledge deficits or disparities should guide educational initiatives by health care providers focusing on improving such knowledge.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Índios Norte-Americanos/psicologia , Infarto do Miocárdio/etnologia , Acidente Vascular Cerebral/etnologia , Adolescente , Adulto , Idoso , Sistema de Vigilância de Fator de Risco Comportamental , Estudos Transversais , Bases de Dados Factuais , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Fatores Socioeconômicos , Acidente Vascular Cerebral/diagnóstico , Estados Unidos , Adulto Jovem
10.
BMC Health Serv Res ; 20(1): 34, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931791

RESUMO

BACKGROUND: The purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients. METHODS: Collaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience. RESULTS: The clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic. CONCLUSIONS: This project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.


Assuntos
/psicologia , Comportamento Cooperativo , Depressão/etnologia , Índios Norte-Americanos/psicologia , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , População Rural , Adolescente , Adulto , Idoso , Depressão/prevenção & controle , Feminino , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
11.
Artigo em Inglês | MEDLINE | ID: mdl-31936256

RESUMO

OBJECTIVES: To validate questionnaire items assessing American Indian (AI) parental beliefs regarding control over their children's oral health within the context of psychosocial measures and children's oral health status. METHODS: Baseline questionnaire data were collected as part of a randomized controlled trial (n = 1016) addressing early childhood caries. Participants were AI parents with preschool-age children in the Navajo Nation Head Start program. Questionnaire items assessed parental oral health locus of control (OHLOC) and agreement with beliefs indicating that they were in control of their children's oral health (internal), the dentist was in control (external powerful others), or children's oral health was a matter of chance (external chance). Exploratory factor analysis was conducted, and convergent validity was assessed using linear regression. RESULTS: Parents with more education (p < 0.0001) and income (p = 0.001) had higher scores for internal OHLOC. Higher internal OHLOC scores were associated with higher scores on knowledge (p < 0.0001), perceived seriousness and benefits (p < 0.0001), higher self-efficacy, importance, sense of coherence (p < 0.0001 for all), and lower scores for perceived barriers (p < 0.0001) and distress (p = 0.01). Higher scores for both types of external OHLOC were associated with lower scores on knowledge (p < 0.0001), perceived seriousness (p < 0.0001), and higher scores on perceived susceptibility (p = 0.01 external chance; <0.0001 powerful others) and barriers (<0.0001). Higher scores for external powerful others were associated with lower scores for importance (p = 0.04) and sense of coherence (p = 0.03). Significant associations were not found for OHLOC beliefs and children's oral health status. CONCLUSIONS: Questionnaire items addressing OHLOC functioned in accordance with the theoretical framework in AI participants.


Assuntos
Índios Norte-Americanos/psicologia , Saúde Bucal , Inquéritos e Questionários/normas , Criança , Pré-Escolar , Análise Fatorial , Feminino , Humanos , Conhecimento , Modelos Lineares , Masculino , Pais/psicologia , Probabilidade , Reprodutibilidade dos Testes , Autoeficácia
12.
AIDS Care ; 32(3): 379-385, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31775515

RESUMO

The Respecting the Circle of Life (RCL) intervention is a comprehensive, skills-based sexual/reproductive health program shown to be effective for reducing sexual risk among American Indian (AI) adolescents (13-19 years of age). This paper seeks to identify critical program components of the RCL intervention for replication of impacts on condom use intention (CUI) when scaling to additional communities. RCL was tested among AI adolescents through a cluster randomized controlled trial (N = 267) embedded in an 8-day basketball camp. Data were collected at baseline, immediately post-camp, at 6 and 12 months post-camp. Previously established predictors of CUI that were statistically significantly impacted by RCL at the post-camp time point were tested as mediators of RCL impact on CUI. Condom use self-efficacy and response efficacy fully mediated the effect of RCL on CUI. The indirect path through condom use self-efficacy had the greatest effect on CUI, explaining 79% of the direct effect. When stratified by gender, there was only evidence of mediation among girls. Results indicate condom use self-efficacy and response efficacy are critical components of the RCL intervention for AI girls, and sexual/reproductive health programs should include practical skills training to improve these constructs to maximize intervention impact on CUI.


Assuntos
Preservativos/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Índios Norte-Americanos/psicologia , Intenção , Saúde Reprodutiva/etnologia , Autoeficácia , Saúde Sexual/etnologia , Adolescente , Feminino , Infecções por HIV/prevenção & controle , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Comportamento de Redução do Risco , Comportamento Sexual , Adulto Jovem
13.
Diabetes Educ ; 46(1): 108-117, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31868100

RESUMO

PURPOSE: The purpose of this qualitative descriptive study was to examine the National Standards for Diabetes Self-Management Education and Support (DSMES) defined diabetes self-care behaviors (healthy eating, being active, taking medication, monitoring, problem solving, reducing risk, and healthy coping) in the context of older community-dwelling American Indians (AIs). METHODS: Secondary theme analysis of transcribed semistructured qualitative interview data from 28 participants in the Native Elder Care Study aged >60 years identified factors that influence the DSMES self-care behaviors in the context of community-dwelling AIs. RESULTS: Four themes that characterized barriers, facilitators, and opportunities for DSMES to support self-care behaviors included community food security, care partners in self-care, community opportunities for diabetes support, and blending of both health worlds. CONCLUSION: Tribal communities have contemporary strengths and cultural traditions that can be activated to enhance diabetes self-management education and support. Diabetes educators can work in tandem with community health representatives to strengthen the social and community support within which individual AIs with type 2 diabetes mellitus live. Community-based participatory research with AI caregivers, dyads, families, youth, and Indian Health Service clinicians may help to improve tribal food policy and school health initiatives, as well as develop intergenerational interventions for modeling effective diabetes self-management.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Comportamentos Relacionados com a Saúde/etnologia , Vida Independente/psicologia , Índios Norte-Americanos/psicologia , Autogestão/psicologia , Idoso , Feminino , Abastecimento de Alimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Apoio Social
14.
J Relig Health ; 59(2): 743-757, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29730808

RESUMO

This article is based on a longitudinal study of Indian Americans devoted to a guru tradition, aiming to explore how faith contributes to their mental well-being. Respondent sample size at phase 1 (2003-2004) was 1872 and at phase 2 (2013-2014) was 1764. Two scales were used to measure faith maturity and well-being. Results showed that phase 2 well-being scores of the devotees were higher, influenced by faith maturity and engagement regularity, thereby corroborating the faith-religiosity-well-being link, further reinforced by the structural equation model. Faith emerges as critical variable in working with this cohort and planning interventions towards promoting their well-being.


Assuntos
Índios Norte-Americanos/psicologia , Religião , Espiritualidade , Adulto , Idoso , Humanos , Estudos Longitudinais , Saúde Mental , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados Unidos
15.
Drug Alcohol Depend ; 206: 107736, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31765857

RESUMO

BACKGROUND: American Indian (AI) youth have disproportionately high rates of both heroin and other opioid misuse and recently have seen a large increase in negative outcomes due to opioid misuse. To address the dearth of research on within-group risk factors for heroin and other opioid misuse in AI adolescents, the goal of the present study is to explore the influence of peer, family, and school factors on opioid use among AI youth. METHODS: Participants (n = 3498, 49.5 % female, Mage = 14.8) were drawn from a large school-based sample of AI youth living on or near reservations, across six geographic regions, between 2009 and 2013. Participants completed a self-report questionnaire regarding substance use and related factors. Multilevel logistic regression was utilized to examine the role of peer, family, and school-related factors on past-month and lifetime heroin and other opioid misuse. RESULTS: Greater peer substance use (OR = 1.14, p<0.001), lower family disapproval of use (OR = .98, p = 0.01), and lower school performance (OR = .90, p = 0.01) were associated with greater likelihood of lifetime opioid misuse. Greater peer substance use (OR = 1.05, p<0.001) and lower family disapproval of use (OR = .99, p = 0.04) were associated with greater likelihood of past month opioid misuse. Greater peer substance use was the only variable significantly related to greater likelihood of lifetime (OR = 1.15, p<0.001) or past month heroin use (OR = 1.02, p = 0.047). CONCLUSIONS: Findings highlight the need for interventions and offer potential factors to consider in developing interventions for heroin and/or other opioid misuse among AI adolescents.


Assuntos
Comportamento do Adolescente/etnologia , Comportamento do Adolescente/psicologia , Índios Norte-Americanos/etnologia , Índios Norte-Americanos/psicologia , Transtornos Relacionados ao Uso de Opioides/etnologia , Transtornos Relacionados ao Uso de Opioides/psicologia , Adolescente , Analgésicos Opioides/efeitos adversos , Criança , Feminino , Humanos , Masculino , Transtornos Relacionados ao Uso de Opioides/terapia , Grupo Associado , Fatores de Proteção , Fatores de Risco , Autorrelato , Inquéritos e Questionários , Adulto Jovem
16.
Am J Addict ; 29(1): 27-34, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31041821

RESUMO

BACKGROUND AND OBJECTIVES: Identical latent classes of substance use for 7 to 8 grade and 9 to 12 grade American Indian (AI) youth living on or near reservations suggest that patterns of substance use are established early among these youth. This study examines relationships of substance-related factors to latent class membership and whether these relationships differ by grade group. METHODS: In-school surveys were administered to 1503 7 to 8 grade and 1995 9 to 12 grade students from 46 schools on or near reservations during the 2009/2010 to 2012/2013 school years. Four-class latent class models of substance use were specified and five classes of substance-related factors (peers, substance availability, perceived harm, family, early initiation), plus grade level and gender, were evaluated as predictors. RESULTS: For 7 to 8 grade students, substance-related factors differentiated nonusers from users, while for 9 to 12 graders, these factors also differentiated types of users. Early initiation and peer factors were strongly related to class membership, while other factors were less strongly related. DISCUSSION AND CONCLUSIONS: Early initiation of alcohol or marijuana is strongly related to being in a substance-using class for AI youth. Because these youth tend to initiate use earlier that other US youth, prevention resources should be targeted to reaching them and their families before age 12. SCIENTIFIC SIGNIFICANCE: Predictors of latent classes of substance use were identified for reservation-based AI youth. While the classes were identical for 7 to 8 grade and 9 to 12 grade youth, predictors varied across grade group, which may inform how best to develop prevention efforts unique to middle and high school AI youth.


Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Fumar Cigarros/epidemiologia , Índios Norte-Americanos/psicologia , Índios Norte-Americanos/estatística & dados numéricos , Uso da Maconha/epidemiologia , Adolescente , Fatores Etários , Criança , Usuários de Drogas/psicologia , Etanol , Feminino , Humanos , Análise de Classes Latentes , Masculino , Fatores de Risco , Instituições Acadêmicas , Fatores Sexuais , Estudantes/psicologia , Inquéritos e Questionários , Estados Unidos/epidemiologia
17.
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
18.
BMC Public Health ; 19(1): 1614, 2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791323

RESUMO

BACKGROUND: Disparities in sexually transmitted infections (STI) are an urgent problem among Native American youth and young adults which are not fully explained by different sexual or related behaviors. These sexual health disparities are more likely attributed to social environments and structural determinants such as a shortage of sexual healthcare providers, lower socioeconomic status, and access barriers to STI screening and treatment, including geographic isolation and confidentiality concerns. Innovative, non-clinic based alternatives to promote STI screening and treatment are essential for alleviating these disparities. Self-care, or the care taken by individuals towards their own health and well-being may be such a strategy. This study will assess the efficacy of a self-care intervention, called Protecting Our Future Generation, for increasing uptake of STI screening and impacting sexual risk and protective behaviors among Native American youth and young adults living in a reservation-based community in the Southwestern United States. METHODS: The proposed study is a randomized controlled trial to test the efficacy of a self-care intervention compared to a control condition. Participants will be Native Americans ages 14-26 years old who have had vaginal or anal sex at least once in their lifetime. Participants will be randomized to the intervention which includes: 1) a sexual health self-assessment with embedded clinical prediction tool predicting STI positivity, and 2) personalized messaging with key steps to lower risk for STIs, or the control condition which includes: 1) a self-assessment about water, soda and sugar sweetened beverage consumption, and 2) personalized messaging to meet recommended daily intake. All participants will be offered a self-administered STI test. Participants will complete assessments at baseline, 3- and 6-months follow-up. The primary outcome measure is completion of STI screening. DISCUSSION: Protecting Our Future Generation is among the first self-care interventions uniquely focused on sexual health among a Native American population, who endure significant sexual health disparities and are under-represented in research. If efficacious, the intervention will be a model of sexual health self-care for Native American youth and young adults adaptable for use in healthcare and community-based settings. TRIAL REGISTRATION: Clinical Trials: http://clinicaltrials.gov; NCT03895320; Registered 03/28/2019.


Assuntos
Terapia Comportamental/métodos , Índios Norte-Americanos/psicologia , Autocuidado/métodos , Educação Sexual/métodos , Saúde Sexual/etnologia , Adolescente , Adulto , Feminino , Comportamentos Relacionados com a Saúde , Disparidades nos Níveis de Saúde , Humanos , Masculino , Programas de Rastreamento/psicologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Comportamento Sexual , Doenças Sexualmente Transmissíveis/prevenção & controle , Responsabilidade Social , Sudoeste dos Estados Unidos , Adulto Jovem
20.
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
/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
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...