Pathways of Adaptation: Two Case Studies with One Evidence-Based Substance Use Prevention Program Tailored for Indigenous Youth.

Indigenous communities often face disproportionate challenges across a variety of health domains, and effective prevention strategies are sorely needed. Unfortunately, evidence is scant regarding what approaches are effective for these communities. A common approach is to take an evidence-based practice or program with documented effectiveness in other populations and implement it with Indigenous populations. While a science of intervention adaptation is emerging, there remains little guidance on processes for adaptation that strategically leverage both existing scientific evidence and Indigenous prevention strategies. In this paper, two case studies illustrate promising practices for adaptation, documenting the approaches of two research teams funded under the National Institutes of Health's initiative to support Intervention Research to Improve Native American Health (IRINAH). These teams worked with distinct Indigenous populations in the USA and Canada to culturally adapt the same prevention program, the Iowa Strengthening Families Program for Parents and Youth 10-14. The approaches of these two teams and the programs that resulted are compared and contrasted, and critical elements of adaptation in partnership with Indigenous communities are discussed.

Prevalence and Correlates of Physical Dating Violence among North American Indigenous Adolescents.

This study examined the lifetime prevalence of physical dating violence, including victimization, perpetration, and the overlap between the two (mutual violence) among a population sample of 551 reservation/reserve residing Indigenous (i.e., American Indian and Canadian First Nations) adolescents in the upper-Midwest of the United States and Canada. Potential correlates of four dating violence profiles (i.e., no dating violence, perpetration-only, victimization-only, and mutual violence) relevant to this population also were considered. The clearest pattern to emerge from multinomial logistic regression analyses suggested that adolescents who engage in problem behaviors, exhibit high levels of anger, and perceive high levels of discrimination have increased odds of lifetime mutual dating violence relative to those reporting no dating violence. Furthermore, gender comparisons indicated that females were more likely to report being perpetrators only, while males were more likely to report being victims only. Considerations of dating violence profiles and culturally-relevant prevention strategies are discussed.

Predicting the Onset of Alcohol Use and the Development of Alcohol Use Disorder Among Indigenous Adolescents.

Empirical efforts to identify the predictors of drinking behavior among North American Indigenous adolescents are relatively limited. Using longitudinal data, this study considers perceived discrimination, positive drinker prototypes, and peer drinking behavior as risk factors for the onset of alcohol use and development of an alcohol use disorder among 674 Indigenous adolescents as they progressed from early to late adolescence (M age at baseline = 11.11, SD = 0.83). Results showed that positive drinker prototypes and associations with peers who drink increased the risk for the onset of drinking, while perceived discrimination and associations with peers who drink increased the risk for the development of an alcohol use disorder. The theoretical and practical implications of our results are discussed.

The Historical Loss Scale: Longitudinal measurement equivalence and prospective links to anxiety among North American indigenous adolescents.

OBJECTIVES: Thoughts of historical loss (i.e., the loss of culture, land, and people as a result of colonization) are conceptualized as a contributor to the contemporary distress experienced by North American Indigenous populations. Although discussions of historical loss and related constructs (e.g., historical trauma) are widespread within the Indigenous literature, empirical efforts to understand the consequence of historical loss are limited, partially because of the lack of valid assessments. In this study we evaluated the longitudinal measurement properties of the Historical Loss Scale (HLS)-a standardized measure that was developed to systematically examine the frequency with which Indigenous individuals think about historical loss-among a sample of North American Indigenous adolescents. We also test the hypothesis that thoughts of historical loss can be psychologically distressing. METHODS: Via face-to-face interviews, 636 Indigenous adolescents from a single cultural group completed the HLS and a measure of anxiety at 4 time-points, which were separated by 1- to 2-year intervals (Mage = 12.09 years, SD = .86, 50.0% girls at baseline). RESULTS: Responses to the HLS were explained well by 3-factor (i.e., cultural loss, loss of people, and cultural mistreatment) and second-order factor structures. Both of these factor structures held full longitudinal metric (i.e., factor loadings) and scalar (i.e., intercepts) equivalence. In addition, using the second-order factor structure, more frequent thoughts of historical loss were associated with increased anxiety. CONCLUSIONS: The identified 3-factor and second-order HLS structures held full longitudinal measurement equivalence. Moreover, as predicted, our results suggest that historical loss can be psychologically distressing for Indigenous adolescents.

Homelessness-Related Traumatic Events and PTSD Among Women Experiencing Episodes of Homelessness in Three U.S. Cities.

In this article, we report the prevalence of traumatic events (TEs), lifetime and 12-month posttraumatic stress disorder (PTSD) among 148 women experiencing homelessness in 3 midsized cities in the United States (Omaha, NE, Pittsburgh, PA, and Portland, OR). The women ranged in age from 19 to 54 years with an average age of 38.89 years (SD = 10.18). The sample was 42.6% White/European American. We investigated the mediation of distal TEs (i.e., childhood maltreatment) by more proximal TEs associated with being homeless (i.e., homelessness-related stressors) for meeting diagnostic criteria for 12-month PTSD. Results indicated that 42.6% of the women met criteria for lifetime PTSD and 39.7% met criteria for past-year PTSD. The number of TEs reported ranged from 0 to 16 in order of prevalence with a median of 6 TEs. The correlations between childhood maltreatment and 12-month PTSD ranged from .16 to .20 and the correlations between homelessness-related stressors and 12-month PTSD ranged from .21 to .30. The mediation analysis was consistent with the association between childhood maltreatment and past-year PTSD being fully mediated by homelessness-related trauma.

Characteristics of Mothers Caring for Children During Episodes of Homelessness.

This study provides a description of the physical, psychological, and substance use problems of adult homeless women who are and are not caring for children. We also examined differences in the characteristics of these two groups of women. Interviews were conducted with 148 homeless women from three mid-sized U.S. cities, 24.3 % of whom were caring for at least one child. Our results showed that women caring for children were more likely to be sheltered and have health insurance. Homeless women caring for children and solitary homeless women were generally similar in terms of substance abuse problems. However, rates of Borderline Personality Disorder were higher among women caring for children than among solitary homeless women. Our results are somewhat consistent with previous research, with the exception of substance abuse problems and mental health problems, which were shown to be equally problematic for all women, regardless of current caregiving status.

Substance Use Disorders, Comorbidity, and Arrest among Indigenous Adolescents.

Indigenous adolescents are overrepresented at multiple stages of the justice system, but we know very little about the role that mental health, particularly substance use disorder, plays in Indigenous pathways to arrest. This study examined the association between substance use disorder, its comorbidity with other disorders, and arrest using a longitudinal sample of Indigenous youth from the Northern Midwest and Canada. Of the 16% of youth who reported at least one arrest at Wave 5, half met criteria for substance abuse/dependence, and slightly more for conduct disorder. Substance abuse/dependence and conduct disorder were each associated with an increased risk of arrest, although co-occurring disorders were not. The reciprocal effects of arrest and mental disorder are discussed.

Mental and substance use disorders from early adolescence to young adulthood among indigenous young people: final diagnostic results from an 8-year panel study.

OBJECTIVE: Our objective was to investigate change in prevalence rates for mental and substance abuse disorders between early adolescence and young adulthood in a cohort of indigenous adolescents who participated in an 8-year panel study. METHOD: The data are from a lagged, sequential study of 671 indigenous adolescents (Wave 1) from a single culture in the Northern Midwest USA and Canada. At Wave 1 (mean age 11.3 years, Wave 4 (mean age 14.3 years), Wave 6 (mean age 16.2 years), and at Wave 8 (mean age 18.3 years) the tribally enrolled adolescents completed a computer-assisted personal interview that included DISC-R assessment for 11 diagnoses. Our yearly retention rates by diagnostic wave were: Wave 2, 94.7 %; Wave 4, 87.7 %; Wave 6, 88.0 %; Wave 8, 78.5 %. RESULTS: The findings show a dramatic increase in lifetime prevalence rates for substance use disorders. By young adulthood, over half had met criteria of substance abuse or dependence disorder. Also at young adulthood, 58.2 % had met lifetime criteria of a single substance use or mental disorder and 37.2 % for two or more substance use or mental disorders. The results are compared to other indigenous diagnostic studies and to the general population. CONCLUSIONS: A mental health crisis exists within the indigenous populations that participated in this study. Innovations within current mental health service systems are needed to address the unmet demand of adolescents and families.

Correlates of bullying behaviors among a sample of North American Indigenous adolescents.

The purpose of this study was to examine the relationship between familial, educational, and psychosocial factors and bullying among 702 North American Indigenous adolescents aged 11-14 years. The study used multinomial logistic regression models to differentiate correlates of bully perpetration and victimization versus being neither and between being a perpetrator versus being a victim. Analyses reveal that being a bully victim had different correlates than being a perpetrator. Perceived discrimination was associated with increased odds of being either a victim or a perpetrator, relative to being neither. Several factors differentiated being a bully perpetrator from being a bully victim: adolescent age, parental warmth and support, depressive symptoms, anger, and school adjustment. These findings expand upon the limited understanding of the factors associated with bullying among North American Indigenous youth. Bullying intervention and prevention programs that target Indigenous adolescents should be culturally grounded and begin early within the family.

Recruitment and retention of American Indian youth and caregivers in a culturally adapted prevention program.

This article seeks to understand to what extent cultural engagement and substance use risk factors influence families' decisions to participate, and ultimately complete, a culturally grounded substance use prevention program. Using data from a 14-week culturally oriented family-based substance use prevention program, we examine predictors of successful recruitment and retention of American Indian youth and their caregivers. Guided by the theoretical model for developing culturally specific preventions, the community-based approach to recruitment resulted in 85.6% of eligible families from two American Indian communities agreeing to participate in the randomized controlled trial. After completion of baseline surveys, 57.3% of the intervention selected families initiated participation in the program sessions and 67.8% of these families completed participation in the program. We used logistic regression to analyze two different models: one that predicted whether invited families chose to participate and whether participating families attended eight or more sessions. Important predictors of participation in the intervention program included single-caregiver households, youth Indigenous language and cultural identity, youth early substance use initiation, and household substance use exposure. Overall, results from this study highlight the importance of fully engaged community research partnerships for multi-session family-based interventions, while identifying potential challenges to program recruitment and participation.

Advantages of stress process approaches for measuring historical trauma.

Despite growing attention to historical trauma (HT) as a key mechanism for documented Indigenous health disparities like alcohol abuse, the complexities of conceptualizing and measuring HT-related constructs have limited empirical tests of these relationships. In this article, we review the current evidence surrounding one HT measure: the Historical Loss Scale. In addition, we provide examples of the benefits of treating historical cultural losses as stressors within sociological and Indigenous stress process models of health.

Substance abuse prevention in American Indian and Alaska Native communities.

In this article we review three categories of American Indian/Alaska Native (AIAN) substance abuse prevention programs: (1) published empirical trials; (2) promising programs published and unpublished that are in the process of development and that have the potential for empirical trials; and (3) examples of innovative grassroots programs that originate at the local level and may have promise for further development. AIAN communities are taking more and more independent control of substance abuse prevention. We point out that European American prevention scientists are largely unaware of the numerous grassroots prevention work going on in AIAN communities and urge a paradigm shift from adapting European American prevention science "best practices" to creating cultural "best practices" by working from inside AIAN communities.

Correlates of homeless episodes among indigenous people.

This study reports the correlates of homeless episodes among 873 Indigenous adults who are part of an ongoing longitudinal study on four reservations in the Northern Midwest and four Canadian First Nation reserves. Descriptive analyses depict differences between those who have and have not experienced an episode of homelessness in their lifetimes. Multivariate analyses assess factors associated with a history of homeless episodes at the time of their first interview and differentiate correlates of "near homelessness" (i.e., doubling up) and "homeless episodes" (periods of actual homelessness). Results show that individuals with a history of homeless episodes had significantly more individual and family health, mental health, and substance abuse problems. Periods of homelessness also were associated with financial problems. Among the female caretakers who experienced episodes of homelessness over the course of the study, the majority had been homeless at least once prior to the start of the study and approximately one-fifth met criteria for lifetime alcohol dependence, drug abuse, or major depression. Family adversity during childhood was also common for women experiencing homelessness during the study.

The Intergenerational Effects of Relocation Policies on Indigenous Families.

This research utilizes life-course perspective concepts of linked lives and historical time and place to examine the multigenerational effects of relocation experiences on Indigenous families. Data were collected from a longitudinal study currently underway on four American Indian reservations in the Northern Midwest and four Canadian First Nation reserves where residents share a common Indigenous cultural heritage. This paper includes information from 507 10 - 12 year old Indigenous youth and their biological mothers who participated in the study. Results of path analysis revealed significant direct and indirect effects whereby grandparent-generation (G1) participation in government relocation programs negatively impacts not only G1 well being, but also ripples out to affect subsequent generations.

Maturation, Peer Context, and Indigenous Girls' Early-Onset Substance Use.

This paper examines a biosocial model of the impact of puberty on Indigenous girls' early-onset substance use by considering the potential mediating role of peer context (i.e. mixed-sex peer groups and substance use prototypes) on the puberty and substance use relationship. Data include responses from 360 girls of a common Indigenous cultural group residing on reservations/reserves in the upper Midwest and Canada. Results of structural equation modeling revealed that the statistically significant relationship between girls' pubertal development and early-onset substance use was mediated by both mixed-sex/romantic peer groups and favorable social definitions of substance use. Implications for substance use prevention work include addressing the multiple and overlapping effects of peer influence from culturally-relevant perspectives.

Propensity for Violence among Homeless and Runaway Adolescents: An Event History Analysis*

Little is known about the prevalence of violent behaviors among homeless and runaway adolescents or the specific behavioral factors that influence violent behaviors across time. In this longitudinal study of 300 homeless and runaway adolescents aged 16-19 years at baseline, we use event history analysis to assess the factors associated with acts of violence over three years, controlling for individual propensities and time-varying behaviors. The results indicate that females, non-minorities, and non-heterosexuals were less likely to engage in violence across time. Those who met criteria for substance abuse disorders (i.e. alcohol abuse, alcohol dependence, drug abuse) were more likely to engage in violence. A history of caretaker abuse was associated with violent behaviors, as were street survival strategies such as selling drugs, participating in gang activity, and associating with deviant peers. Simply having spent time directly on the streets at any specific time point also increased the likelihood for violence.

Gestational risks and psychiatric disorders among indigenous adolescents.

This study reports on the effects maternal prenatal binge drinking, cigarette smoking, drug use, and pregnancy and birth complications on meeting criteria for psychiatric disorders at ages 10-12 and 13-15 years among 546 Indigenous adolescents from a single culture in the northern Midwest and Canada. Adolescent DSM-IV psychiatric disorders were assessed with the Diagnostic Interview Schedule for Children-Revised (DISC-R). Results indicate that maternal behaviors when pregnant have significant effects on adolescent psychiatric disorders even when controlling for age and gender of adolescent, family per capita income, living in a single mother household, and adolescent reports of mother's positive parenting.

A dimensional model of psychopathology among homeless adolescents: suicidality, internalizing, and externalizing disorders.

The present study examined associations among dimensions of suicidality and psychopathology in a sample of 428 homeless adolescents (56.3% female). Confirmatory factor analysis results provided support for a three-factor model in which suicidality (measured with lifetime suicidal ideation and suicide attempts), internalizing disorders (assessed with lifetime diagnoses of major depressive episode and post-traumatic stress disorder), and externalizing disorders (indicated by lifetime diagnoses of conduct disorder, alcohol abuse, and drug abuse) were positively intercorrelated. The findings illustrate the utility of a dimensional approach that integrates suicidality and psychopathology into one model.

Onset of conduct disorder, use of delinquent subsistence strategies, and street victimization among homeless and runaway adolescents in the Midwest.

This study examines the effects of childhood-onset conduct disorder on later antisocial behavior and street victimization among a group of homeless and runaway adolescents. Four hundred twenty-eight homeless and runaway youth were interviewed directly on the streets and in shelters from four Midwestern states. Key findings include the following. First, compared with those who exhibit adolescent-onset conduct disorder, youth with childhood onset are more likely to engage in a series of antisocial behaviors such as use of sexual and nonsexual survival strategies. Second, youth with childhood-onset conduct disorder are more likely to experience violent victimization; this association, however, is mostly through an intervening process such as engagement in deviant survival strategies.

Victimization and posttraumatic stress disorder among runaway and homeless adolescents.

This article presents lifetime and 12-month prevalence rates and comorbidity for posttraumatic stress disorder (PTSD) among a sample of 428 homeless and runaway adolescents. Data are from baseline interviews of a longitudinal diagnostic study of 428 (187 males; 241 females) homeless and runaway adolescents aged 16-19 years (mean age = 17.4 years, SD = 1.05). The data were collected by full-time street interviewers on the streets and in shelters in eight Midwestern cities of various populations. About one-third (35.5%) of the runaways met lifetime criteria for PTSD and 16.1% met 12-month criteria for the disorder. More than 90% of the adolescents who met criteria for PTSD met criteria for at least one of the other four diagnoses. Multivariate analyses indicated that correlates of PTSD were age of adolescent, being female, having experienced serious physical abuse and/or sexual abuse from an adult caretaker, and having been assaulted or injured by weapon when on the street. The multiplicative interaction between sexual abuse by caretaker and sexual assault when the adolescents were on their own was statistically significant, indicating that rape victims were highly likely to meet criteria for PTSD regardless of early sexual abuse. At very high levels of early sexual abuse, the probability of meeting criteria for PTSD converges with that for sexual assault victims.