A preliminary needs assessment of American Indians who inject drugs in northeastern Montana.

BACKGROUND: Injection drug use has not been well documented in American Indians living in the USA. American Indian and Alaskan Natives (AI/ANs) show higher rates of substance use compared to the general population, and have historically been subject to a number of risk factors that are known to increase the likelihood of substance use. AI/ANs also experience increased risk for infectious diseases that are transmitted via injection drug use and/or sexual activity. Harm reduction approaches have been shown to be effective for decreasing risk of disease transmission in at-risk populations, and may be well suited for AI/AN injection drug users residing in rural reservation communities. In this study, we aimed to examine the characteristics of American Indians (AI) who use injection drugs (PWUID) in northeastern Montana to identify needs that could be addressed with harm reduction programming. METHODS: For the present study, we used a respondent-driven sampling approach to generate a sample of 51 self-identified male and female injection drug users ≥18 years of age who were American Indians living on the Fort Peck Indian Reservation. Sampling weights were applied to all analyses using Respondent-Driven Sampling Analysis Tool (RDSAT). RESULTS: There were no strong recruitment patterns by age, sex, or ethnic identity status of the recruiter or participant, but there were strong within-group recruitment patterns by location within the reservation. The majority of the sample reported initiating substance use before the age of 18. Participants reported significant risk for HIV, hepatitis, and other infectious diseases through their drug use and/or risky sexual behavior. Sixty-five percent reported having reused syringes, and 53% reported drawing from the same filter. Seventy-five percent reported inconsistent condom use during the 3 months preceding the survey, and 53% reported injecting drugs during sex during the 3 months preceding the survey. Only 66% of participants reported having been tested for HIV in the 12 months preceding the survey. The vast majority (98%) of respondents expressed interest in a harm reduction program. Seventy-six percent reported that it was easy or very easy to obtain new syringes. CONCLUSIONS: We documented several risks for blood-borne pathogens, including elevated levels of syringe reuse. Further, we documented significant interest in harm reduction interventions in the present sample of AI/AN injection drug users. Findings suggest a need for increased access to harm reduction programming for AI/AN injection drug users to reduce the transmission of infectious disease and increase access to compassionate care.

Partnering with American Indian communities in strength-based collaborative health research: Guiding principles from the Fort Peck Ceremony of ResearchProject.

BACKGROUND: The Ceremony of Research Project was implemented to strengthen tribal communities' ability to harmonize Western research processes with Indigenous ways of knowing. METHODS: Focus groups were conducted with tribal members to understand Indigenous processes, beliefs, and practices necessary to promote positive research experiences with tribal communities. RESULTS: Findings address time; relationship building and maintenance; inclusion of diverse tribal members in the research design, as well as American Indian epistemology; respect for tribal values, beliefs, and customs throughout the research process; and the reciprocity of research. CONCLUSIONS: Our study has important implications for how researchers can take a strengthbased approach to conducting research with tribal communities.

Perceived Level of Relationship Commitment, Sexual Risk Taking and Condom Use Among American Indian Men.

This study investigated commitment, sexual risk taking behavior and condom use among heterosexual men. The sample was 120 American Indian men ages 18-24 on the Fort Peck Reservation. Measures included sexual risk taking behaviors, attitude towards the relationship, discordance in perception of attitudes toward the relationship, and condom use. Inconsistent condom users comprised 57 % of the sample. Men with more than one sexual partner as well as men who reported inconsistent condom use reported less favorable attitudes toward their relationship. Discordant attitudes were observed in men who reported that their partner was more committed to the relationship then they were. This influenced having multiple sex partners. Inconsistent condom use decreased as respondents perceived an increasing level of partner's attachment to the relationship in comparison to themselves. Further examination of intimate partner relationship characteristics and how these dynamics influence sexual and reproductive health among American Indians is needed.

Sexual risk behavior and symptoms of historical loss in American Indian men.

Native Americans in the United States are not typically regarded as a most at-risk population for HIV or other sexually transmitted infections (STIs), despite emerging evidence which suggests otherwise. As a result, Native Americans lack access to key prevention services and programs. In planning prevention programs for this unique population, however, it is important to take into account the cultural factors that may be implicated in health risk behaviors. Historical Loss is a type of historical trauma that has been reported in Native Americans, and which may be related to health behaviors. We examined whether Historical Loss was associated with sexual risk behaviors in a sample of 120 American Indian men living in Fort Peck Reservation in northeastern Montana who completed questions regarding Historical Loss and sexual risk behaviors. Symptoms of Historical Loss that reflected Anxiety/Depression and Anger/Avoidance were associated with an increased likelihood of individuals' having sex with multiple concurrent partners. Health interventions that aim to address HIV/STI prevention should take symptoms of Historical Loss into account, as Historical Loss could be a potential factor that will mitigate HIV, STI, and pregnancy prevention efforts in this population.

Pregnancy prevention among American Indian men ages 18 to 24: the role of mental health and intention to use birth control.

The Fort Peck Sexual Health Project: A Contextual Analysis of Native American Men is a community-based participatory research (CBPR) project that explores the extent to which knowledge, attitudes, and beliefs about sex, intimate relationships, and mental health influence sexual and reproductive health. For the purpose of this study, the influence of age, fatherhood, and mental health factors related to historical trauma and loss on young American Indian (AI) men's intention to use birth control was examined. In-depth interviews were conducted with 112 Native American men between the ages of 18 and 24 years. The mean age reported was 21 years. Thirty-eight percent of the young men reported having children. The young men reported experiences of historical trauma during their lifetime as well as emotional responses due to historical losses. Ninety-five percent reported that it was very important that they use some form of birth control to prevent their partner from getting pregnant within the next year. Logistic regression analysis indicated that, as age increased, young men were less likely to use birth control to prevent pregnancy. The young men who reported feelings of loss due to experiences related to historical trauma and loss were more likely to use birth control. Findings from this study suggest that public health efforts to educate AI men about planned pregnancies and the use of birth control may be most effective in adolescence. Public health programs that address mental health concerns such as the emotional responses due to historical losses may assist young AI men in their decision to use birth control.

Young Native American men and their intention to use family planning services.

This study examines the extent to which age, fatherhood, relationship status, self-control of birth control method, and the use of birth control influence young Native American men's intention to use family planning services. Data were collected for this study during in-depth interviews with 112 Native American men between the ages of 18 and 24 years. The mean age reported was 21. Thirty-eight percent of the young men reported having children. Almost 70% of the young men reported being in a steady relationship. Eighty-eight percent reported that it was very important that they have self-control of the type of birth control that they use. In addition, 88% of the young men reported that they would use some type of birth control within the next year to prevent a pregnancy with their partner. Logistic regression analysis indicated that as age increased, young men were less likely to seek family planning services for birth control. The young men who reported being fathers were more likely than the young men who did not report being fathers to seek family planning services for birth control. Findings from this study suggest that public health efforts to educate Native American men about family planning services are most effective in their adolescence, before they transition into young adulthood. Fatherhood may also be considered a protective factor that may increase the likelihood that young Native American men will seek family planning services for birth control. Public health efforts that address reproductive health among young Native American men may be effective with Native American men in adolescence, prior to their transition to young adulthood. Family planning services that provide outreach education and care to Native American fathers may also be effective.

Applying indigenous community-based participatory research principles to partnership development in health disparities research.

This case study of community and university research partnerships utilizes previously developed principles for conducting research in the context of Native American communities to consider how partners understand and apply the principles in developing community-based participatory research partnerships to reduce health disparities. The 7 partnership projects are coordinated through a National Institutes of Health-funded center and involve a variety of tribal members, including both health care professionals and lay persons and native and nonnative university researchers. This article provides detailed examples of how these principles are applied to the projects and discusses the overarching and interrelated emergent themes of sharing power and building trust.

Acanthosis nigricans among Northern Plains American Indian children.

The purpose of this study is to present cross-sectional and prospective data on acanthosis nigricans (AN) prevalence in the context of other risk factors for diabetes including high body mass index (BMI), abnormal blood pressure (BP), physical inactivity and family history of diabetes among Northern Plains American Indian (AI) children. Standardized health measures were collected in 2,520 K-12th-grade AI students for AN, BMI, and BP. Data were also collected on family history of diabetes and physical activity. Approximately, 9.7% of the participants were positive for AN. AN was associated with high BMI, abnormal BP, and diabetes family history. Sports participation was inversely associated with AN. Among children measured the prior year, relative risk (and 95% confidence interval [CI]) for obesity and incident AN was 9.8 (4.2-23.0) compared to normal weight. These findings suggest there is utility in measuring this marker of insulin resistance in this at-risk population.

Variability in childhood asthma and body mass index across Northern Plains American Indian communities.

OBJECTIVE: There are sparse data on the variability in childhood asthma across different Native American communities and the corresponding associations with known risk factors such as high body mass index and family history. The purpose of this study is to evaluate cross-sectional data on childhood asthma prevalence, body mass index, and other descriptive variables among Native Americans in five rural Northern Plains Indian reservation communities. METHODS: A school-based screening program was conducted on four Northern Plains Indian Reservations. The 1852 children (96% Native American, 4th through 12th grades) were screened for asthma status, body mass index (BMI), and family history. RESULTS: Approximately 9.5% of students reported current asthma. Current asthma varied significantly across the four reservation sites, ranging from 5.7% to 12.6%. Current asthma was also positively associated with BMI and family history of asthma. CONCLUSIONS: The intertribal differences in asthma prevalence noted here emphasize the need for further understanding the intertribal environmental, social, and behavioral factors that are associated with childhood asthma and obesity. Such knowledge can help inform disease prevention or disease management strategies that encompass the unique characteristics of tribal communities and culture.