Effectiveness of the COVID-19 vaccines on preventing symptomatic SARS-CoV-2 infections and hospitalizations in Southwestern Alaska, January-December 2021.

The population in rural southwest Alaska has been disproportionately affected by COVID-19. To assess the benefit of COVID-19 vaccines, we analyzed data from the regional health system. We estimated vaccine effectiveness (VE) during January 16-December 3, 2021, against symptomatic SARS-CoV-2 infection after a primary series or booster dose, and overall VE against hospitalization. VE of a primary series against symptomatic infection among adult residents was 91.3% (95% CI: 85.7, 95.2) during January 16-May 7, 2021, 50.3% (95% CI, 41.1%-58.8%) during July 17-September 24, and 37.0% (95% CI, 27.8-45.0) during September 25-December 3, 2021; VE of a booster dose during September 25-December 3, 2021, was 92.1% (95% CI: 87.2-95.2). During the overall study period, VE against hospitalization was 91.9% (95% CI: 85.4-95.5). COVID-19 vaccination offered strong protection against hospitalization and a booster dose restored protection against symptomatic infection.

Facebook Intervention to Connect Alaska Native People with Resources and Support to Quit Smoking: CAN Quit Pilot Randomized Controlled Trial.

INTRODUCTION: There is some evidence that social media interventions can promote smoking cessation. This randomized controlled pilot study is the first to evaluate the feasibility and potential efficacy of a Facebook smoking cessation intervention among Alaska Native adults. METHODS: Recruitment and data collection occurred December 2019-March 2021. Participants were recruited statewide in Alaska using Facebook advertisements with a targeted sample of 60 enrolled. Participants were stratified by gender, age, and rural/urban residence and randomly assigned to receive referral resources on evidence-based cessation treatments (EBCTs) (control, n=30) or these resources plus a three-month, closed/private, culturally tailored, Facebook group (intervention, n=31) that connected participants to EBCT resources and was moderated by two Alaska Native Trained Tobacco Specialists. Assessments were conducted online post-randomization at one, three, and six months. Outcomes were feasibility (recruitment, retention, intervention engagement), self-reported use of EBCTs, and biochemically confirmed seven-day point-prevalence smoking abstinence. RESULTS: Of intervention participants, 90% engaged (e.g., posted, commented) more than once. Study retention was 57% at six months (no group differences). The proportion utilizing EBCTs was about double for intervention compared with the control group participants at three and six months. Smoking abstinence was higher for intervention than control participants at three months (6.5% vs. 0%, p=0.16) but comparable at six months (6.4% vs. 6.7%, p=0.97). CONCLUSIONS: While additional research is needed to promote long-term cessation, this pilot trial supports recruitment feasibility during the COVID-19 pandemic, consumer uptake, and a signal for intervention efficacy on the uptake of cessation treatment and short-term smoking abstinence. IMPLICATIONS: This study is the first evaluation of a social media intervention for smoking cessation among Indigenous people. We learned that statewide Facebook recruitment of Alaska Native adults who smoke was feasible and there was a signal for the efficacy of a Facebook intervention on the uptake of evidence-based cessation treatment and short-term (three months) biochemically verified smoking abstinence. Clinically, social media platforms may complement current care models by connecting Alaska Native individuals and others living in hard-to-reach communities to cessation treatment resources.

Risk perception, adaptation, and resilience during the COVID-19 pandemic in Southeast Alaska Natives.

Indigenous communities worldwide are at higher risk of negative pandemic outcomes, and communities Indigenous to the Arctic are disproportionately affected compared to national majorities. Despite this, their experiences have scarcely been investigated qualitatively and from their own perspectives. We collected and analyzed 22 structured interviews in three Southeast Alaska island communities (Sitka, Hoonah, and Kake) to learn about their perceptions of and experiences with the COVID-19 pandemic. Interviews were analyzed with thematic qualitative analysis in Dedoose. Four primary categories were identified within which to discuss risk and resilience in Southeast Alaska: (1) risk perception, (2) socioeconomic impacts, (3) reactions to public health guidelines, and (4) coping. Primary findings indicate that Southeast Alaska Native communities display considerable resilience and adaptive flexibility despite the significant adversity imposed by the COVID-19 pandemic. Southeast Alaska Native people use historical and traditional knowledge to culturally ground adaptive behaviors to cope with the threat of COVID-19. Interviewees expressed that adaptive, community-centered, and non-individualistic behaviors strongly tied to Native culture minimized the negative epidemiological impacts of the pandemic. Future research can more deeply explore the root causes of the need for adaptiveness and resilience, such as histories of colonialism and marginalization, to emergency situations in Indigenous communities.

Exploring the perceived effectiveness and cultural acceptability of COVID-19 relevant social media intervention content among Alaska Native people who Smoke: The CAN Quit study.

Social media platforms have potential for reach and effectiveness to motivate smoking cessation and use of evidence-based cessation treatment, even during the worldwide COVID-19 pandemic. This study builds on our prior community participatory approach to developing content postings for the CAN Quit Facebook intervention among Alaska Native (AN) people who smoke. With input from a community advisory committee, we selected new content on COVID-19 preventive practices (e.g., masking) and evaluated them using a validated, six-item perceived effectiveness scale and a single item assessing cultural relevance. We obtained feedback on six content postings (two videos and four text/pictures) from an online survey administered to 41 AN people (14 men, 27 women; age range 22-61 years) who smoke in Alaska statewide with 49 % residing in rural Alaska. Perceived effectiveness scale scores were high across postings, ranging from 3.9 to 4.4 out of a maximum score of 5.0. Cultural relevance item scores ranged from 3.9 to 4.3. We found no appreciable differences by sex, age, or rural/urban location for either score. This study adds new information on the adaptation, acceptability, and perceived effectiveness of content on COVID-19 preventive practices for future inclusion in a social media-based intervention for smoking cessation specifically tailored for AN people.

Two-Spirits' Response to COVID-19: Survey Findings in Atlantic Canada Identify Priorities and Developing Practices

The Wabanaki Two-Spirit Alliance, a regional Two-Spirit organization, administered an online survey in May of 2020 to identify priorities and concerns of Two-Spirit individuals and Indigenous 2SLGBTQQIA+ people in Atlantic Canada during the novel coronavirus (COVID-19) pandemic. The respondents (n = 149) shared health concerns including deterioration(s) of mental health (56.32%). They described mental health supports (68.42%), health supports for Two-Spirit individuals (57.89%), healing gatherings (46.05%) and trans-specific supports (44.74%) as interventions in fostering Two-Spirit health. The Alliance's immediate response was to develop community-led responses to address urgent concerns. Our key promising practice has been hosting Two-Spirit gatherings as community-based health/cultural supports;the gatherings also serve as an opportunity for the Alliance to consult the Two-Spirit community about priorities and concerns. During the COVID-19 pandemic, the Alliance explored ways to keep the TwoSpirit community united by maintaining social support(s). We designed a survey that provided essential feedback, resulting in the Alliance shifting priorities toward developing methods of bringing Two-Spirit people together safely by virtual means;seeking sustainable resources to address emerging health concerns;and increasing the Alliance's capacity development.

Wiingushk Okaadenige (Sweetgrass Braid): A Braided Approach to Indigenous Youth Mental Health Support during COVID-19

This paper introduces an integrative (or braided) approach to Indigenous youth mental health, designed in response to a synthesis of knowledge from three systematic literature reviews and four informant consultations with mental health providers in various disciplines. The braided approach includes core principles of Indigenous Healing models (IH), Child and Youth Care (CYC) approaches, and Dialectical Behaviour Therapy (DBT) practices. The purpose of this approach is to best serve the mental and spiritual health needs of Indigenous youth across Canada during the COVID-19 pandemic. Findings of this research project informed the design and implementation of an online Indigenous youth mental health program, which is discussed in relation to the research.

Indigenous Community Praxis and Programs During COVID- 19: Medicine Keeper Wellness and Creative Corner Programs

The COVID-19 pandemic has substantially affected Indigenous communities. Deterioration of physical and mental health within Indigenous communities has been prevalent, due to unjust social, environmental, and economic factors. These have included preexisting health conditions, unsustainable and overcrowded housing, limited health care and mental health services, and inadequate access to clean drinking water. These factors have resulted in exacerbated mental health and trauma symptoms. Indigenous communities have needed to adapt methods of attaining mental health and medical services in order to maintain personal and communal well-being. We offer a summary of the delivery of two programs: the Medicine Keeper Wellness Program and Creative Corner Program, which were conducted in northern, central interior, and southern Indigenous communities in British Columbia, Canada, by Indigenous social workers to promote individual and community wellness. These programs navigated the barriers presented by COVID-19, and the restrictions prompted by it, to accessing social work and therapeutic services.

Editorial

Existing western health care structures including policy makers, funding, hospital and primary care settings, public health units, and training programs, can often only understand these barriers in evidence-based formats, such as an academic journal, to leverage the change needed to improve Indigenous health care and save lives as we review what we have learned through this recent pandemic experience. Many health care systems across the globe had an opportunity to shift their paradigm away from a fully colonial, patriarchal, biomedical model to one that includes Indigenous worldviews, which allowed Indigenous health professionals, including Elders, Healers, Knowledge Keepers, and community members to create and deliver such services. Respect, self-determination, and freedom are international human rights, according to the United Nations, thus it is time for all countries systems to wake up and pay attention to these, for without granting these to Indigenous populations, all human health emergencies and crises of the natural environment are on the way to high levels, from which there is no recovery.

The Health Impacts of Social Distancing Among Indigenous People in Ontario During the First Wave of COVID-19

Among Indigenous Peoples in Canada and around the world, the health impacts of COVID-19 have been measured largely through biological, social, and psychological impacts. Our study draws from a relational concept of health to examine two objectives: (1) how social distancing protocols have shaped Indigenous connections with self, family, wider community, and nature;and (2) what these changing relationships mean for perceptions of Indigenous health. Carried out by an Indigenous team of scholars, community activists, and students, this research draws from a decolonizing methodology and qualitative interviews (n = 16) with Indigenous health and social care providers in urban and reserve settings. Our results illustrate a considerable decline in interpersonal connections-such as with family, community organizations, and larger social networks-as a result of social distancing. Among those already vulnerable, underlying health, social, and economic inequities have been exacerbated. While the health impacts of COVID-19 have been overwhelmingly negative, participants noted the importance of this time for self-reflection and reconnection of human-kind with Mother Earth. This paper offers an alternative perspective to popularized views of Indigenous experiences of COVID-19 as they relate to vulnerability and resilience.

The COVID-19 Pandemic: Challenges and Needs Experienced by Indigenous People in Urban Areas

The world was caught off guard by the swift spread of the COVID19 pandemic at the beginning of 2020. For vulnerable populations such as the urban Indigenous, the first wave of the pandemic was even more challenging, for multiple reasons. Because many of their usual culturally safe services were interrupted, they found themselves struggling on different levels. Our team conducted a needs assessment to shed light on how urban Indigenous people living in the Saugenay-Lac-Saint-Jean region in the province of Quebec, Canada, dealt with this situation, and what holistic health services they most wished they could have relied on. To respect Indigenous culture, data collection was completed through sharing circles in addition to a web-based survey. The results indicated that participants experienced anxiety and psychological distress during the pandemic. They identified unmet needs related to family services, support in homeschooling, access to traditional medicine, and spiritual and cultural practices, among others. Future work should involve the implementation of culturally safe services, adapted to the pandemic era, for Indigenous people living in urban areas.

Community and Public Health Responses to a COVID-19 Outbreak in North-west Saskatchewan: Challenges, Successes, and Lessons Learned

In Spring 2020, Indigenous communities in northwest Saskatchewan, Canada, experienced the first significant outbreak of COVID-19. Through the collective efforts of public health measures by local, provincial, federal, and community partners, COVID-19 impacts were mitigated, and the severity of the outbreak in northwest Saskatchewan was limited. This article outlines the epidemiological profile of COVID-19 in the area during this period and the concomitant narrative of the public health control measures. The narrative connects specific culturally grounded approaches that were taken by community leaders and public health officials to moderate the pandemic's impacts and contain the outbreak. Among the lessons learned from these multi-jurisdictional efforts were the need to customize interventions to individual community characteristics and the benefits of continuous consultation and communication with community leadership. These findings suggest that long-term monetary investment in the strengths, assets, and capacity of communities can contribute toward sustainable solutions for existing structural inequities that have been amplified by the pandemic. The collaboration that resulted from local, provincial, and federal partnerships informed other pandemic response measures for subsequent outbreaks that have affected the region during the evolution of the COVID-19 pandemic.

TE RANGA TUPUA: An Iwi (Tribal) Response to COVID-19 in Aotearoa New Zealand

This whakatau&amarc;ki or proverb, from Dr. Whakaari Te Rangitakuku Metekingi (LLD, CBE) of Whanganui and Ng&amarc;ti Hauiti tribes reminds us that, while we must have a vision to aspire toward, we must also tend to the here and now, to the issues that are up front and close to home. It exhorts us to strengthen what has already been achieved and to find ways of creating benefits for others. This paper presents the collaborative response to COVID19 by Iwi (tribes) within Te Ranga Tupua (TRT), a collective of Iwi from the South Taranaki/Whanganui/Rangit&imarc;kei/Ruapehu regions of Aotearoa New Zealand. The research employs a mixed methods design, based on a Kaupapa M&amarc;ori approach. The quantitative section identifies the population served and quantum of support provided, while the qualitative data presents the processes and associated learnings from the perspective of those tasked with the response. TRT's response to the threat of COVID-19 is shown to have been grounded in Maori tikanga (values), wh&amarc;nau (family) based and holistic, taking into account the mental, emotional, social, cultural, and spiritual elements of safety and wellbeing rather than just the absence or presence of the virus. The extensive relationships and networks that existed between tribes represented in the TRT collective were key to the timely distribution of care and support to Iwi members, to appropriate and relevant information dissemination, and to the overall well-being of the people during the most difficult times of the COVID-19 response.