The Impact of Individual and Parental American Indian Boarding School Attendance on Chronic Physical Health of Northern Plains Tribes.

This study investigated the relationship of American Indian boarding school attendance and chronic physical health. We hypothesized boarding school attendance would be associated with an increased number of chronic physical health problems. We also examined the relationship between boarding school attendance and the 15 chronic health problems that formed the count of the chronic health conditions. American Indian attendees had a greater count of chronic physical health problems compared with nonattendees. Father's attendance was independently associated with chronic physical health problems. Attendees were more likely to have tuberculosis, arthritis, diabetes, anemia, high cholesterol, gall bladder disease, and cancer than nonattendees.

Correlates of Motivational Interviewing Use Among Substance Use Treatment Programs Serving American Indians/Alaska Natives.

Motivational interviewing (MI) offers a treatment modality that can help meet the treatment needs of American Indians/Alaska Natives (AI/ANs) with substance use disorders. This report presents results from a national survey of 192 AI/AN substance abuse treatment programs with regard to their use of MI and factors related to its implementation, including program characteristics, workforce issues, clinician perceptions of MI, and how clinicians learned about MI. Sixty-six percent of programs reported having implemented the use of MI in their programs. In the final logistic regression model, the odds of implementing MI were significantly higher when programs were tribally owned (OR = 2.946; CI95 1.014, 8.564), where more than 50% of staff were Certified Alcohol and Drug Counselors (CADCs) (OR = 5.469; CI95 1.330, 22.487), and in programs in which the survey respondent perceived that MI fit well with their staff's expertise and training (OR = 3.321; CI95 1.287, 8.569).

The relationship of five boarding school experiences and physical health status among Northern Plains Tribes.

PURPOSE: American Indian (AI) boarding school attendance is related to poor physical health status; however, little is known about how specific aspects of this experience contribute to poor health. Five experiences (age of first attendance, limited family visits, forced church attendance, prohibition on practicing AI culture and traditions, and punishment for use of AI language) may be independently associated with physical health status in adulthood. We expected the effect to be greater for those who began boarding school at older ages. METHODS: Data on AI boarding school attenders (n = 771) came from the AI-Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project. Multiple linear regression models examined the association of these five experiences with physical health status. Additionally, we conducted a separate set of regressions to test for an interaction effect of age of first attendance. RESULTS: Each of the five experiences noted above were independently associated with poorer physical health status compared to those who did not have these experiences. An interaction effect for those punished for use of AI language and who were aged 8 or older was confirmed. CONCLUSIONS: Findings are consistent with reports that boarding school attendance is related to poor AI adult health. To inform AI health programs, the relationship of specific diseases and boarding school attendance should be considered.

AMERICAN INDIAN AND ALASKA NATIVE BOYS: EARLY CHILDHOOD RISK AND RESILIENCE AMIDST CONTEXT AND CULTURE.

American Indian and Alaska Native (AIAN) adolescent and adult men experience a range of health disparities relative to their non-AIAN counterparts and AIAN women. Given the relatively limited literature on early development in tribal contexts, however, indicators of risk during early childhood specific to AIAN boys are not well-known. The current article reviews sources of strength and challenge within AIAN communities for AIAN children in general, including cultural beliefs and practices that support development, and contextual challenges related to socioeconomic and health disparities and historical trauma affecting the AIAN population as a whole. The research literature on early development is reviewed, highlighting what this literature reveals about early gender differences. The article concludes with calls to action on behalf of AIAN boys that align with each of the five tiers of R. Frieden's (2010) Public Health Pyramid.

A National Study of American Indian and Alaska Native Substance Abuse Treatment: Provider and Program Characteristics.

American Indians and Alaska Natives (AIANs) experience major disparities in accessing quality care for mental health and substance use disorders. There are long-standing concerns about access to and quality of care for AIANs in rural and urban areas including the influence of staff and organizational factors, and attitudes toward evidence-based treatment for addiction. We conducted the first national survey of programs serving AIAN communities and examined workforce and programmatic differences between clinics located in urban/suburban (n=50) and rural (n=142) communities. We explored the correlates of openness toward using evidence-based treatments (EBTs). Programs located in rural areas were significantly less likely to have nurses, traditional healing consultants, or ceremonial providers on staff, to consult outside evaluators, to use strategic planning to improve program quality, to offer pharmacotherapies, pipe ceremonies, and cultural activities among their services, and to participate in research or program evaluation studies. They were significantly more likely to employ elders among their traditional healers, offer AA-open group recovery services, and collect data on treatment outcomes. Greater openness toward EBTs was related to a larger clinical staff, having addiction providers, being led by directors who perceived a gap in access to EBTs, and working with key stakeholders to improve access to services. Programs that provided early intervention services (American Society of Addiction Medicine level 0.5) reported less openness. This research provides baseline workforce and program level data that can be used to better understand changes in access and quality for AIAN over time.

Use of evidence-based treatments in substance abuse treatment programs serving American Indian and Alaska Native communities.

BACKGROUND: Research and health surveillance activities continue to document the substantial disparities in the impacts of substance abuse on the health of American Indian and Alaska Native (AI/AN) people. While Evidence-Based Treatments (EBTs) hold substantial promise for improving treatment for AI/ANs with substance use problems (as they do for non-AI/ANs), anecdotal reports suggest that their use is limited. In this study, we examine the awareness of, attitudes toward, and use of EBTs in substance abuse treatment programs serving AI/AN communities. METHODS: Data are drawn from the first national survey of tribal substance abuse treatment programs. Clinicians or clinical administrators from 192 programs completed the survey. Participants were queried about their awareness of, attitudes toward, and use of 9 psychosocial and 3 medication EBTs. RESULTS: Cognitive Behavioral Therapy (82.2%), Motivational Interviewing (68.6%), and Relapse Prevention Therapy (66.8%) were the most commonly implemented psychosocial EBTs; medications for psychiatric comorbidity was the most commonly implemented medication treatment (43.2%). Greater EBT knowledge and use were associated with both program (e.g., funding) and staff (e.g., educational attainment) characteristics. Only two of the commonly implemented psychosocial EBTs (Motivational Interviewing and Relapse Prevention Therapy) were endorsed as culturally appropriate by a majority of programs that had implemented them (55.9% and 58.1%, respectively). CONCLUSIONS: EBT knowledge and use is higher in substance abuse treatment programs serving AI/AN communities than has been previously estimated. However, many users of these EBTs continue to have concerns about their cultural appropriateness, which likely limits their further dissemination.

Toddler socioemotional behavior in a northern plains Indian tribe: associations with maternal psychosocial well-being.

M.C. Sarche, C.D. Croy, C. Big Crow, C. Mitchell, and P. Spicer (2009) provided first-ever information relating the socioemotional development of American Indian toddlers to the immediate context of their mothers' lives. The current study sought to replicate and build on their earlier work by examining the impact of additional maternal risk factors, identified in previous research with non-American Indian populations, on the development of American Indian toddlers: maternal depression, negative social influences, and mother's feelings of isolation. At 27 months, American Indian mothers (N = 110) completed the Parent Demographic Questionnaire, which measured maternal psychosocial characteristics (e.g., depressed affect, social support, drug and alcohol use, isolation) and demographics. Mothers also completed the Infant-Toddler Social Emotional Assessment (A.S. Carter & M.J. Briggs-Gowan, 2006) and the Parent-Child Dysfunctional Interaction subscale of the Parenting Stress Index (R.R. Abidin, 1995, 1997). Some results replicated the original study, but others did not. Reports of a dysfunctional mother-child relationship related to externalizing and internalizing problems, replicating the earlier study. This study also found associations between a dysfunctional mother-child relationship and socioemotional competence as well as dysregulation. The previous finding of a relationship between American Indian identity and socioemotional competence was supported. Adding the effects of maternal depressed affect and isolation significantly increased prediction of toddler behavior problems.

Maternal correlates of 2-year-old American Indian children's social-emotional development in a Northern Plains tribe.

The developmental experiences of very young American Indian children today are not well documented in the current literature. The present study sought to explore the social-emotional development of American Indian toddlers living on a Northern Plains reservation, as a function of maternal variables. Mothers completed self-report questionnaires about their experiences and their children's development. Observer ratings of children's development also were conducted. Maternal stress, substance use/abuse, perceptions of stress in the mother-child relationship, social support, and American Indian cultural identity were significantly related to children's social-emotional development. This study is the first to explore these relationships in a Northern Plains American Indian sample of young children and their mothers. Results suggest possible points of intervention for improving the developmental outcomes of very young American Indian children.

Young Adult Migration from a Northern Plains Indian Reservation: Who Stays and Who Leaves.

We evaluated how ambitions, community ties, monetary sufficiency, employment, and alcohol consumption related to whether young American Indian adults had moved from their Northern Plains reservation. Of 518 Northern Plains reservation residents in 1993, we located 472 in 2003-2005 and found that 89 lived more than a four-hour drive from the reservation. Coding the 472 as to whether they had stayed on/near the reservation or moved away, we ran logistic regressions on data they reported in 1996 to determine which demographic and attitudinal variables were associated with having moved. We found ambitions and goals were more associated with moving away than were ties to the community, which in turn were more related than monetary and personal characteristics that promote independence and prosperity. The more importance they placed on getting a good education or carrying on the tribe's traditions, the more likely they were to have moved away. We found too that the odds of moving away decreased with greater alcohol consumption. Tribal council members and college administrators therefore may wish to promote policies that increase opportunities for young adults to achieve higher education goals while remaining on reservation to carry on tribal traditions. Benefits may also come from encouraging and assisting reservation members studying off-reservation to return after completing their education. These findings would argue too for greater investment in alcohol services for reservation-dwelling populations.

The use of telemedicine to evaluate competency to stand trial: a preliminary randomized controlled study.

To investigate whether forensic evaluations can be performed reliably using telemedicine, we compared the results on a standard competency assessment instrument using telemedicine (TM) and live interviews (LI). Two board-certified forensic psychiatrists used the Georgia Court Competency Test (GCCT) to evaluate 21 forensic psychiatric inpatients. Half of the patients were randomly assigned to a telemedicine interview and half were assigned to a live interview. Total scores on the GCCT were similar for both raters, indicating high levels of agreement between telemedicine and live interviews. Patient and provider satisfaction were measured and indicated that, although patients did not express a preference for a particular interview modality, providers reported greater satisfaction with live interviews. Findings suggest that one aspect of competency to stand trial can be reliably evaluated using telemedicine and that patients perceive telemedicine as an acceptable alternative to a standard live interview. The limited sample size precludes definite conclusions and further studies involving a larger forensic study population are warranted.

Childhood characteristics associated with stage of substance use of American Indians: Family background, traumatic experiences, and childhood behaviors.

The purpose of this analysis is to examine childhood characteristics associated with stage of substance use in adulthood in two American Indian (AI) populations. Data were drawn from an epidemiologic study of two AI reservation populations for persons age 18-44 years (n=2070). We used descriptive and multivariate analysis to examine correlates of four mutually exclusive stages of substance use: lifetime abstinence (Stage 0), use of alcohol only (Stage 1A), use of marijuana/inhalants with or without alcohol (Stage 1B), and use of other illicit drugs with or without the previously listed substances (Stage 2). Problematic substance use by parents, younger age of first substance use, initiating substance use with a drug (with or without alcohol), and adolescent conduct problems were associated with higher stage substance use. Persons who experienced sexual abuse, witnessed family violence, or experienced other traumatic events before the age of 18 were more likely to be at Stage 1B than Stage 1A. These findings underscore the importance of providing effective interventions during childhood and adolescence to reduce the risk of substance use progression.

Methods for addressing missing data in psychiatric and developmental research.

OBJECTIVE: First, to provide information about best practices in handling missing data so that readers can judge the quality of research studies. Second, to provide more detailed information about missing data analysis techniques and software on the Journal's Web site at www.jaacap.com. METHOD: We focus our review of techniques on those that are based on the "Missing at Random" assumption and are either extremely popular because of their convenience or that are harder to employ but yield more precise inferences. RESULTS: The literature regarding missing data indicates that deletion of observations with missing data can yield biased findings. Other popular methods for handling missing data, notably replacing missing values with means, can lead to confidence intervals that are too narrow as well as false identifications of significant differences (type I statistical errors). Methods such as multiple imputation and direct maximum likelihood estimation are often superior to deleting observations and other popular methods for handling missing data problems. CONCLUSIONS: Psychiatric and developmental researchers should consider using multiple imputation and direct maximum likelihood estimation rather than deleting observations with missing values.

Social epidemiology of trauma among 2 American Indian reservation populations.

OBJECTIVES: We examined the prevalence of trauma in 2 large American Indian communities in an attempt to describe demographic correlates and to compare findings with a representative sample of the US population. METHODS: We determined differences in exposure to each of 16 types of trauma among 3084 tribal members aged 15 to 57 years through structured interviews. We compared prevalence rates of trauma, by gender, across the 2 tribes and with a sample of the US general population. We used logistic regression analyses to examine the relationships of demographic correlates to trauma exposure. RESULTS: Lifetime exposure rates to at least 1 trauma (62.4%-67.2% among male participants, 66.2%-69.8% among female participants) fell at the upper limits of the range reported by other researchers. Unlike the US general population, female and male American Indians exhibited equivalent levels of overall trauma exposure. Members of both tribes more often witnessed traumatic events, experienced traumas to loved ones, and were victims of physical attacks than their counterparts in the overall US population. CONCLUSIONS: American Indians live in adverse environments that place them at high risk for exposure to trauma and harmful health sequelae.

The prevalence of DSM-III-R alcohol dependence in two American Indian populations.

BACKGROUND: Evidence suggests that American Indian (AI) populations may be at increased risk for problems with alcohol, but a lack of community-based research using diagnostic criteria has constrained our ability to draw inferences about the extent of severe alcohol problems, such as dependence, in AI populations. METHODS: This article draws on data collected by the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP), which involved interviews with 3084 AI people living on or near their reservations. The AI-SUPERPFP sample was drawn from two culturally distinct tribes, which were designated with geographical descriptions: Northern Plains (NP) and Southwest (SW). Comparisons with data collected by the National Comorbidity Survey (NCS) were explored by using shared measures to situate the findings from AI-SUPERPFP in a national context. RESULTS: Lifetime rates of DSM-III-R alcohol dependence for men in both AI-SUPERPFP samples were 50% higher than those found in the NCS. Rates of lifetime alcohol dependence for women varied by sample, however; NP women had twice the rate of women in the NCS, but SW women had rates quite similar to those of NCS women. Patterns for 12-month alcohol dependence in AI-SUPERPFP were generally more similar to those found in NCS. CONCLUSIONS: The rates of DSM-III-R alcohol dependence found in AI-SUPERPFP were generally higher than US averages and justify continued attention and concern to alcohol problems in AI communities, but they are not nearly as high as those in other reports in the literature that rely on less stringent sampling methods. Furthermore, significant sociocultural influences on the correlates of alcohol dependence in AI communities are evident in these data, underscoring the need to appreciate the complex and varying influences on the patterning of alcohol problems in the diverse cultural contexts of the US.