Ethnic Racial Identity Development and Self-Esteem among Native American Adolescents: The Mediating Role of Peer Belonging.

While ethnic racial identity (ERI) development is associated with a variety of psychological well-being outcomes, the mechanisms through which this association operates is yet to be fully explained. During adolescence, social belonging is a developmentally salient process that can play a key role in how ERI impacts well-being. We sought to explore the mediating role of belonging to peer networks in the association between ERI and self-esteem among Native American adolescents. In this cross-sectional, mediational study, we used survey data from 317 Native American students attending a reservation high school (46.9% female; M age =16). Students' levels of ERI development were measured by combining items from two scales pertaining to ethnic identity development and racial identity. We employed a structural equation modeling approach to explore the mediating role of peer belonging in the association between ERI and self-esteem. Results suggest that our 4-item index of peer belonging was an acceptable measure of this construct. Further, the significant indirect effect of peer belonging explains a notable portion (ß=.22, p ≤ .05) of the total effects of ERI on self- esteem (ß=.54, p ≤ .05). This finding suggests that higher levels of ERI achievement contribute to higher levels of peer belongingness, which in turn lead to improved self-esteem among students. Implications for research and practice are discussed.

Cultural Connection and Well-being for American Indian Adolescents.

American Indian and Alaska Native (AI/AN) adolescents face health disparities resulting from historical traumas. There is a paucity of research focusing on mental health in AI/AN adolescents or the relationship between cultural connection and health. This project assesses the relationship between cultural identity and markers of mental health and well-being for AI/AN adolescents. Adolescents 12 to 18 years old from the Lumbee Tribe of North Carolina participated in this mixed-methods study. Phase 1, discussed in this manuscript, involved surveys using validated instruments to assess cultural connection and markers of mental health and well-being. Characteristics of the 122 AI/AN youth who completed the survey included: mean age 14.9 years (SD = 2.0); 61% (n = 75) assigned female at birth; 56% (n = 70) identified as female; and 4.1% (n = 5) identified as non-binary. Mean tribal affiliation (TA) and ethnic identity (EI) scores suggest strong cultural connection (TA: M = 3.1/5, SD = 0.6; EI: M = 3.4/5, SD = 0.9). Sleep quality (M = 2.63/5) and positive stress management (M = 2.06/5) were low. Bivariate and logistic regression demonstrated moderate positive correlations between EI and friendship, EI and emotional support, TA and friendship, and TA and emotional support. AI/AN adolescents in this sample have a moderate-strong connection with Native culture, marked by ethnic identity and tribal affiliation, and positive markers of mental health and well-being. Data from this study may be used for policy formulation to promote increased funding and programming addressing mental health for AI/AN youth.

Recommendations for Modernizing a Culturally Grounded Substance Use Prevention Program for American Indian and Alaska Native Youth.

American Indian and Alaska Native (AI/AN) youth use alcohol and drugs at a higher rate with earlier onset than the overall youth population in the United States. Youth interventions are needed to support the prevention and reduction of substance misuse-related issues. Connecting AI/AN children to their heritage through culturally grounded prevention programs has been shown to be more effective than programs designed for the general population. The objective of this formative evaluation was to provide community-informed updates for an existing culturally grounded substance use prevention program, The Beauty Way. This study was conducted in partnership with an AI/AN-serving community organization using key informant interviews and talking circles with community members and parents. Participants revealed the challenges and obstacles AI/AN youth face, the impact of cultural values, and activities which engage youth to prevent problematic substance use. Recommendations include the importance of 1) incorporating current challenges to behavioral health such as social media and vaping, 2) including cultural values and activities including land-based learning, and 3) creating a robust facilitator guide and hiring culturally sensitive program staff. These results generated recommendations to strengthen the cultural focus and application of The Beauty Way for AI/AN youth.

Exploring strengths, psychological functioning and youth victimization among American Indians and Alaska Natives in four southern states.

BACKGROUND: Identifying factors that support healthy psychological functioning after experiencing violence or other adversities in youth can lead to better prevention and intervention efforts. This is particularly important among communities with disproportionately high rates of adversity resulting from legacies of social and political injustices, such as American Indian and Alaska Native populations. METHODS: Data were pooled from four studies in the southern U.S. to examine a subsample of American Indian/Alaska Native participants (N = 147; mean age 28.54 years, SD = 16.3). Using the resilience portfolio model, we investigate the impact of three categories of psychosocial strengths (regulatory, meaning making, and interpersonal) on psychological functioning (subjective well-being and trauma symptoms), controlling for youth victimization, lifetime adversities, age, and gender. RESULTS: In examining subjective well-being, the full model accounted for 52 % of the variance, with strengths explaining more variance than adversities (45 % vs 6 %). For trauma symptoms, the full model accounted for 28 % of the variance, with strengths and adversities accounting nearly equally for the variance (14 % and 13 %). DISCUSSION: Psychological endurance and sense of purpose showed the most promise for bolstering subjective well-being while poly-strengths (having a diversity of multiple strengths) was most predictive of fewer trauma symptoms. Building psychosocial strengths offers promising strategies for prevention and intervention in Native nations and communities.

Intersecting sex and American Indian identity moderates school and individual correlates of binge drinking among reservation-area adolescents.

Reservation-area American Indian (AI) youth demonstrate higher rates of binge drinking (BD) than their non-AI peers. However, individual and school-level differences in BD disparities between reservation-area AI/non-AI female and male adolescents remain unexamined. This study applies an Intersectional framework to examine risk and protective factors of BD among reservation-area youth at the intersection of their sex and AI identities. A nationally representative sample of adolescents (N = 14,769; Mage = 14.6, 49% female; 61% AI) attending 103 reservation-serving schools completed a survey between 2015 and 2019. Multilevel modeling was used to examine differences in risk and protective factors of BD between AI and non-AI male and female adolescents. Our findings indicate that the effects of student and school-level risk and protective factors on adolescents' BD are driven primarily by sex within AI and non-AI groups. Implications for future confirmatory research and tailoring school-based prevention programs are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Is ethnicity an appropriate measure of health care marginalization? A systematic review and meta-analysis of the outcomes of diabetic foot ulceration in Aboriginal populations.

BACKGROUND: Aboriginal people have higher prevalence rates of diabetes than non-Aboriginal people in the same geographic locations, and diabetic foot ulcer (DFU) complication rates are also presumed to be higher. The aim of this systematic review and meta-analysis was to compare DFU outcomes in Aboriginal and non-Aboriginal populations. METHODS: We searched PubMed, Embase, CINAHL and the Cochrane Library from inception to October 2018. Inclusion criteria were all types of studies comparing the outcomes of Aboriginal and non-Aboriginal patients with DFU, and studies from Canada, the United States, Australia and New Zealand. Exclusion criteria were patient age younger than 18 years, and studies in any language other than English. The primary outcome was the major amputation rate. We assessed the risk of bias using the ROBINS-I (Risk Of Bias In Non-randomized Studies - of Interventions) tool. Effect measures were reported as odds ratio (OR) with 95% confidence interval (CI). RESULTS: Six cohort studies with a total of 244 792 patients (2609 Aboriginal, 242 183 non-Aboriginal) with DFUs were included. The Aboriginal population was found to have a higher rate of major amputation than the non-Aboriginal population (OR 1.85, 95% CI 1.04-3.31). Four studies were deemed to have moderate risk of bias, and 2 were deemed to have serious risk of bias. CONCLUSION: Our analysis of the available studies supports the conclusion that DFU outcomes, particularly the major amputation rate, are worse in Aboriginal populations than in non-Aboriginal populations in the same geographic locations. Rurality was not uniformly accounted for in all included studies, which may affect how these outcome differences are interpreted. The effect of rurality may be closely intertwined with ethnicity, resulting in worse outcomes.

Issues postopératoires chez les Autochtones au Canada: revue systématique.

CONTEXTE: Il existe d'importantes iniquités en matière de santé chez les populations autochtones au Canada. La faible densité de la population canadienne et les populations en région éloignée posent un problème particulier à l'accès et à l'utilisation des soins chirurgicaux. Aucune synthèse des données sur les issues chirurgicales chez les Autochtones au Canada n'avait été publiée jusqu'à maintenant. MÉTHODES: Nous avons interrogé 4 bases de données pour recenser les études comparant les issues chirurgicales et les taux d'utilisation chez les adultes des Premières Nations, inuits et métis et chez les adultes non autochtones au Canada. Des évaluateurs indépendants ont réalisé toutes les étapes en parallèle. L'issue primaire était la mortalité; les issues secondaires comprenaient le taux d'utilisation des chirurgies, les complications et la durée du séjour à l'hôpital. Nous avons effectué une méta-analyse pour l'issue primaire à l'aide d'un modèle à effets aléatoires. Nous avons évalué les risques de biais à l'aide de l'outil ROBINS-I. RÉSULTATS: Vingt-huit études ont été analysées, pour un total de 1 976 258 participants (10,2 % d'Autochtones). Aucune étude ne portait précisément sur les populations inuites et métisses. Quatre études portant sur 7 cohortes ont fourni des données corrigées sur la mortalité pour 7135 participants (5,2 % d'Autochtones); les Autochtones présentaient un risque de décès après une intervention chirurgicale 30 % plus élevé que les patients non autochtones (rapport de risque combiné 1,30; IC à 95 % 1,09­1,54; I 2 = 81 %). Les complications étaient aussi plus fréquentes chez le premier groupe, notamment les infections (RC corrigé 1,63; IC à 95 % 1,13­2,34) et les pneumonies (RC 2,24; IC à 95 % 1,58­3,19). Les taux de différentes interventions chirurgicales étaient plus faibles, notamment pour les transplantations rénales, les arthroplasties, les chirurgies cardiaques et les accouchements par césarienne. INTERPRÉTATION: Les données disponibles sur les issues postopératoires et le taux d'utilisation de la chirurgie chez les Autochtones au Canada sont limitées et de faible qualité. Elles suggèrent que les Autochtones ont de plus hauts taux de décès et d'issues négatives postchirurgicales et qu'ils font face à des obstacles dans l'accès aux interventions chirurgicales. Ces conclusions indiquent qu'il y a un besoin de réévaluer en profondeur les soins chirurgicaux prodigués aux Autochtones au Canada pour leur assurer un accès équitable et améliorer les issues. NUMÉRO D'ENREGISTREMENT DU PROTOCOLE: PROSPERO-CRD42018098757.

Siamit: A Novel Academic-Tribal Health Partnership in Northwest Alaska.

PROBLEM: American Indians and Alaska Natives hold a state-conferred right to health, yet significant health and health care disparities persist. Academic medical centers are resource-rich institutions committed to public service, yet few are engaged in responsive, equitable, and lasting tribal health partnerships to address these challenges. APPROACH: Maniilaq Association, a rural and remote tribal health organization in Northwest Alaska, partnered with Massachusetts General Hospital and Harvard Medical School to address health care needs through physician staffing, training, and quality improvement initiatives. This partnership, called Siamit, falls under tribal governance, focuses on supporting community health leaders, addresses challenges shaped by extreme geographic remoteness, and advances the mission of academic medicine in the context of tribal health priorities. OUTCOMES: Throughout the 2019-2020 academic year, Siamit augmented local physician staffing, mentored health professions trainees, provided continuing medical education courses, implemented quality improvement initiatives, and provided clinical care and operational support during the COVID-19 pandemic. Siamit began with a small budget and limited human resources, demonstrating that relatively small investments in academic-tribal health partnerships can support meaningful and positive outcomes. NEXT STEPS: During the 2020-2021 academic year, the authors plan to expand Siamit's efforts with a broader social medicine curriculum, additional attending staff, more frequent trainee rotations, an increasingly robust mentorship network for Indigenous health professions trainees, and further study of the impact of these efforts. Such partnerships may be replicable in other settings and represent a significant opportunity to advance community health priorities, strengthen tribal health systems, support the next generation of Indigenous health leaders, and carry out the academic medicine mission of teaching, research, and service.

Diabetes-by-Proxy: Virtual Embodiment of Disease by Oklahoma Choctaw Parents of Children with Type 1 Diabetes.

Childhood type 1 diabetes is increasing globally and requires meticulous at-home care due to risks for fatal outcomes if glucose levels are not continuously and correctly monitored. Type 1 diabetes research has focused on metabolism and stress measurements confirming high parental worry levels. However, research on caregivers' management strategies has lagged. We show parents' intense, all-encompassing work to preempt a disastrous drop in their child's glucose as a stress-path to the virtual embodiment of their child's condition. That is, parents acquire diabetes-by-proxy. Our findings derive from four and half years of ethnographic research with the same 19 families in the Choctaw Nation of Oklahoma. These parents were exceptionally engaged as caregivers and distressed by the potentially fatal outcome of type 1 diabetes mismanagement. Diabetes-by-proxy names the parents' experience and validates clinical attention to them as they cope with their crucial caregiving commitment.

The relationship between fraternal birth order and childhood sex-atypical behavior among the Istmo Zapotec muxes.

Research on male androphilia (i.e., sexual attraction towards adult males) consistently finds that androphilic males tend to have more older biological brothers than males who are gynephilic (i.e., sexually attracted to adult females). This fraternal birth order effect (FBOE) has been well replicated among androphilic males who present publically in a male-typical (cisgender) and a female-typical (transgender) manner. There is some evidence that the FBOE is more pronounced among transgender androphilic males. However, no studies have directly compared both forms of male androphilia within the same culture. This study tested the FBOE, and its association with childhood sex-atypical behavior (CSAB), among the Istmo Zapotec of Oaxaca, Mexico, where both forms of male androphilia are referred to as a third gender, muxes. Our results indicated that both cisgender muxe nguiiu (n = 124) and transgender muxe gunaa (n = 120) were more likely to be later born among brothers than gynephilic men (n = 194). However, the number of older brothers did not differentiate between transgender and cisgender muxes, nor did it predict CSAB among muxes. These findings replicate the FBOE among both cisgender and transgender muxes but show no evidence that it is more pronounced among transgender androphilic males.

Performing Pimâtisiwin: The Expression of Indigenous Wellness Identities through Community-based Theater.

The performing arts can be a powerful means of wellness, identity exploration, and positive social representation for Indigenous young people. In this article, we outline the results of a year-long collaborative study that explored Indigenous young peoples' relationships between the performing arts, wellness, and resilience. Twenty in-depth interviews were conducted with 10 Cree and Métis youth about their participation in the Circle of Voices theater program at the Gordon Tootoosis Nik̄an̄iw̄in Theatre in Saskatoon, Saskatchewan, Canada. A strength-based analysis focused on performing pimâtisiwin, that is, how young people learn to enact, protest, and play with a wide range of social identities, while also challenging racially stereotyped identities often imposed on them within inner-city environments. This research critically engages performative theory to more readily understand aspects of Indigenous youth identity and wellness and offers new empirical and methodological directions for advancing Indigenous youth wellness in urban settings.

Cultural Connectedness as Obesity Prevention: Indigenous Youth Perspectives on Feast for the Future.

OBJECTIVE: To describe a community-based obesity-prevention initiative that promoted cultural connectedness and traditional food revitalization and gained insight into youth participants' perspectives on the program through a photovoice methodology. METHODS: Photovoice methods were used with fourth- and fifth-grade youths (aged 9-11 years) in the US Southwest who had participated in the Feast for the Future program. A total of 44 youths from 3 communities met for 8-9 sessions; they took photos of current food environments and traditional food systems, and discussed them as well as Feast for the Future and hopes for the future, and then prepared a final presentation. Photovoice sessions were recorded, transcribed verbatim, then open coded using Atlas.ti. RESULTS: Five common themes emerged: traditional food is farmed or gardened, traditional foods are healthy, Feast for the Future supported positive connections to culture, hope for more farming or gardening for future generations, and store or less nutrient-dense food is unhealthy. CONCLUSIONS AND IMPLICATIONS: Photovoice can be an effective way to engage Indigenous youths in conversations about their culture and food environments. The findings suggest that attention to revitalizing traditional food systems and supporting cultural connectedness may be an effective approach to obesity prevention in tribal communities, although future research would be needed to assess the impact of the intervention on obesity rates.

Past-Year Racial Discrimination and Allostatic Load Among Indigenous Adults in Canada: The Role of Cultural Continuity.

OBJECTIVE: This study aimed to examine the association between racial discrimination and allostatic load (AL) and whether this association was moderated by cultural continuity among Indigenous adults. METHODS: Data were collected from Indigenous adults attending university in a small city in western Canada between 2015 and 2017 (mean age = 27.8 years). The Experience of Discrimination Situation Score and the Vancouver Index Enculturation Subscale were used to assess racial discrimination and cultural continuity, respectively. AL was measured as a composite of seven biomarkers assessing neuroendocrine, cardiovascular, metabolic, and immune system function. Bias-corrected and accelerated bootstrapped linear regression models were used to examine associations adjusting for confounders (n = 104; 72.5% women). RESULTS: Across the full sample, racial discrimination was associated with a linear, dose-response increase in AL score after adjustment for confounders. Among adults with low cultural continuity, past-year discrimination was associated with increased AL and explained 22% (adjusted R) of the variance in AL score. Taken together, the full model including age, sex, and income explained 38% of the variance in AL score in this subgroup. Among adults with high cultural continuity, racial discrimination was not associated with AL, whereas age remained significant and explained 13% of the variance in AL score. CONCLUSIONS: Past-year racial discrimination was associated with early and more pronounced wear and tear on stress response systems among Indigenous adults relative to peers. Indigenous cultural continuity served as an important buffer that promoted biological resilience against the adverse effects of racial discrimination on physiologic regulation among Indigenous adults.

Exploring health and wellness among Native American adults with intellectual and/or developmental disabilities and their family caregivers.

BACKGROUND: Adults with intellectual and/or developmental disabilities (IDD) experience health inequities, and those who also identify as a member of an ethnic minority group face additional health inequities. In the United States, a majority of adults with IDD continue to be supported by family caregivers making their health equity also important. The purpose of this study was to explore how Native American adults with IDD and their family caregivers experience health and wellness. METHOD: This community-engaged research was guided by a Community Advisory Board (CAB) with study participants completing a Photovoice project. RESULTS: Participants identified individual, family and community level influences on health and wellness including the importance of participation in meaningful activities and connection to culture. CONCLUSIONS: In order to address health inequities, more research is needed to understand health and wellness from the unique perspectives of individuals with IDD and those from racial and ethnic minority groups.

Indigenous Identification by Health Professionals in a Mexican Hospital Setting.

In this article, we describe and analyze the identification of people as Indigenous by health-care professionals in a hospital in Mexico City. This socially constructed identification is based on a "contrasting identity" of essentialist and stereotyped categories (language, place of origin, cultural practices, and poverty) that promote the normalization of inequity, marginality, and racism. The ambivalence of the invisibility of the indigenous in the health-care context also marginalizes and generates inequity when it comes to the access to healthcare.

Adverse Childhood Experiences and Immune System Inflammation in Adults Residing on the Blackfeet Reservation: The Moderating Role of Sense of Belonging to the Community.

BACKGROUND: Previous research documents an association between adverse childhood experiences (ACEs) and immune system inflammation. High chronic inflammation is believed to be one biological pathway through which childhood adversity may affect health into adulthood. The Blackfeet tribal community has high rates of childhood trauma and community members are disproportionately affected by inflammatory diseases. PURPOSE: To investigate whether belonging to the tribal community may moderate the relationship between childhood trauma and immune system inflammation in the Blackfeet tribal community. METHODS: In a sample of 90 adults residing on the Blackfeet reservation, we measured ACEs belonging to the tribal community and two markers of immune system inflammation, interleukin-6 (IL-6) and C-reactive protein (CRP). RESULTS: We found that independent of age, gender, annual income, body mass index, and depressive symptoms, belonging to the tribal community and ACEs interacted to predict levels of both IL-6 and CRP (B= -.37, t[81] = -3.82, p < .001, R2 change = .07 and B = -.29, t[81] = -2.75, p = .01, R2 change = .08, respectively). The association between ACEs and markers of immune system inflammation was statistically significant for community members who reported low levels of belonging to the community. CONCLUSIONS: The findings of this study have important implications for intervention research seeking to reduce risk for inflammatory diseases for at-risk populations. Fostering stronger connections to the larger tribal community may positively affect risk for inflammatory diseases. Future work should examine the behavioral and psychosocial pathways through which stronger connections to community may confer health benefits.

An Approach to Improve Dementia Health Literacy in Indigenous Communities.

This project aims to improve health literacy in Indigenous communities through the development of evidence-based culturally relevant health promotion materials on dementia that bridge the gap between Indigenous and Western perspectives of the illness. The research team worked in partnership with Health Canada's First Nations and Inuit Home and Community Care Program (FNIHCC) and consulted with Indigenous elders to utilize a two-eyed seeing framework that draws upon Indigenous knowledge and Western biomedicine. A consolidated review of materials and research involving Indigenous perspectives of Alzheimer's and age-related dementias led to the development of two culturally appropriate fact sheets. Two Indigenous-specific fact sheets were developed "What is Dementia? Indigenous Perspectives and Cultural Understandings" and "Signs and Symptoms of Dementia: An Indigenous Guide." The fact sheets prioritize Indigenous knowledge and pay particular attention to Indigenous languages, diverse Indigenous cultures, and literacy levels. The content uses phrasing and words from Indigenous people involved in the research to share information. Biomedical concepts and words were included when necessary but language or presentation of these aspects were often modified to reflect Indigenous conceptualizations. This project provides a foundation for evidence-based knowledge translation in relation to cultural safety in dementia care. Specifically, the researchers outline how health care providers can develop culturally appropriate health promotion material, thus increasing Indigenous cultural understandings of dementia and health literacy.

Risk and protective factors for opioid misuse in American Indian adolescents.

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.

Acceptability of an eHealth Intervention to Prevent Alcohol-Exposed Pregnancy Among American Indian/Alaska Native Teens.

BACKGROUND: A tribally led Changing High-Risk Alcohol Use and Increasing Contraception Effectiveness Study (CHOICES) Program has successfully decreased the risk of alcohol-exposed pregnancies (AEPs) among adult American Indian/Alaska Native (AI/AN) women by either reducing risky drinking or increasing contraception use. However, a community needs assessment revealed a need to implement a similar intervention with AI/AN teens. The goal of the project was to develop and establish the acceptability of CHOICES for AI/AN teens. METHODS: Key informant interviews were conducted to review the existing OST CHOICES intervention. After modifications to the existing program, focus groups with AI/AN teens were conducted to ensure validity and to finalize the OST CHAT (CHOICES for American Indian Teens) intervention. RESULTS: Key informant (N = 15) participants suggested that a Web-based intervention may increase teen engagement by making the intervention more interactive and visually stimulating. Based on this formative research, CHAT was developed via Research Electronic Data Capture (REDCap). Feedback on the online CHAT curriculum was given by focus groups comprised of AI/AN adolescents, and participants felt that this type of intervention would be both acceptable and able to implement with a community of reservation-based teens. CONCLUSIONS: This study outlines the development of a Web-based intervention for an AEP intervention for AI/AN teens and will inform future prevention efforts. Implications include an expansion of the evidence-based CHOICES intervention for AI/AN teens and also development of a Web-based intervention for rural, reservation-based AI/AN communities.