Assessing health in an Alaska native cultural context: The Yup'ik Wellness Survey.

OBJECTIVES: The development and validation of a wellness measure among the Yup'ik of the Yukon-Kuskokwim Delta in western Alaska is presented, with the overarching goal of supporting locally relevant health practices in this Alaska Native population. METHOD: A survey containing the wellness measure and several additional psychosocial variables was completed by 493 Yup'ik individuals from 7 different highly rural communities in western Alaska. Participants ranged in age from 14 to 94 (M = 38.55, SD = 17.14), and slightly more than half were female (58.62%). RESULTS: Individuals who scored higher on the wellness measure reported greater happiness, greater overall health, greater communal mastery, a larger and more satisfying social support network, and coping styles that were more likely to be active, accepting, and growth-oriented, and less likely to involve drugs and alcohol. CONCLUSIONS: This project advances research on the health implications of enculturation by specifying particular patterns of culturally sanctioned beliefs and behaviors that appear most beneficial.

Enculturation, perceived stress, and physical activity: implications for metabolic risk among the Yup'ik--the Center for Alaska Native Health Research Study.

OBJECTIVES: American Indians and Alaska Natives (ANs) report among the lowest levels of physical activity in the USA, but there is very little systematic research examining the determinants of physical activity patterns in these populations. This study investigated the relationships between enculturation (or cultural traditionality), psychosocial stress, and physical activity in a community-based sample of Yup'ik women and men living in rural AN communities. Associations between these variables and several metabolic risk factors were also examined. DESIGN: A sample of 488 Yup'ik participants (284 women and 204 men) from six villages in the Yukon-Kuskokwim Delta region completed a wellness survey and an array of physiological assessments [e.g., body mass index (BMI), blood pressure]. A subset of 179 participants also completed a 3-day pedometer assessment of physical activity. RESULTS: Multivariate linear regression models indicated that participants who were more enculturated (i.e., living more of a traditional lifestyle) and who experienced lower levels of psychosocial stress were significantly more physically active. In turn, both lower levels of psychosocial stress and higher levels of physical activity were associated with lower BMI, lower percent body fat, and lower waist circumference. CONCLUSIONS: Findings underscore the importance of gaining a culturally specific understanding of physical activity patterns in indigenous groups in order to inform effective health promotion strategies.

Using strategic planning and organizational development principles for health promotion in an Alaska native community.

Health promotion aims to support people in their efforts to increase control over factors that impact health and well-being. This emphasis on empowerment and contextual influences allows for a more holistic conceptualization of health and approaches to promoting health that are anchored in principles of community development and systems change. Piciryaratgun Calritllerkaq (Healthy Living Through A Healthy Lifestyle) is a collaboration between a Yup'ik village in rural Alaska and researchers from the University of Alaska Fairbanks. The goal was to improve nutrition, increase exercise, and decrease stress. The project utilized elements of organization development and strategic planning to develop a local infrastructure and process and to promote local expertise. The project team developed goals, objectives, action, and evaluation plans that integrated local traditions, Yup'ik culture, and research.

Smoking, chewing, and cultural identity: prevalence and correlates of tobacco use among the Yup'ik-The Center for Alaska Native Health Research (CANHR) study.

Survey data were obtained from a large sample of Yup'ik participants residing in the Yukon-Kuskokwim Delta region of Alaska. Tobacco use, age, sex, and a variety of psychosocial variables were assessed. Over 75% of participants use tobacco; one half (57.4%) reported using smokeless tobacco (SLT) regularly; 28.2% reported smoking cigarettes regularly. Relative to women, men reported using SLT less, smoking cigarettes more, and using the combination of cigarettes and SLT more. Younger participants tended to smoke cigarettes more, and to use the combination of cigarettes and SLT more. SLT users displayed significantly greater enculturation by identifying more with a Yup'ik lifestyle and less with a White lifestyle, speaking their traditional language more frequently, and consuming more traditional food and medicine. In contrast, smokers tended to display significantly greater acculturation and reported using drugs and alcohol more to cope with stress. Discussion focuses on appreciating the influence of cultural factors on health behavior and on implications for intervention.

The Center for Alaska Native Health Research Study: a community-based participatory research study of obesity and chronic disease-related protective and risk factors.

OBJECTIVES: To describe the background, approach and general results of the Center for Alaska Native Health Research (CANHR) study. STUDY DESIGN: This was a cross-sectional Community-Based Participatory Research (CBPR) study with one tribal group to assess risk and protection for obesity and the risk factors related to chronic disease, diabetes and cardiovascular disease. METHODS: A combination of biological, genetic, nutritional and psychosocial measurements were taken on 922 Alaska Native participants in ten communities in Southwestern Alaska. The paper reports on data from 753 adult participants. RESULTS: The prevalence of type 2 diabetes is 3.3% in the sample population. Metabolic syndrome is significantly lower among the males and equal for females when compared with Caucasians in the NHANES III sample. Obesity among adults is now at the national average. Risk factors for chronic disease include a shift to a Westernized diet, stress, obesity and impaired fasting glucose and protective factors include high levels of polyunsaturated fatty acid dietary intake. Articles in this issue present specific results in these areas. CONCLUSIONS: The data strongly indicate that, in general, Yup'ik people in our study are metabolically healthy and that diet and life style provide a delicate combination of protective and risk factors. The results strongly indicate that solution focused research utilizing primary and secondary prevention strategies may provide evidence for how to intervene to prevent further increases of chronic diseases. Research that focuses on relating the intrinsic strengths of indigenous worldviews and practices with basic research may contribute to positive transformations in community health.

Keeping busy: a Yup'ik/Cup'ik perspective on health and aging.

OBJECTIVES: Knowledge of cultural beliefs about health and how they influence life choices and intervention is essential in forming health policy and health promotion programs to meet the growing needs of aging minority populations. This study explores cultural beliefs and practices of health and well-being of Yup'ik/Cup'ik women in two rural villages in southwestern Alaska. STUDY DESIGN: Exploratory, descriptive qualitative study. METHODS: Interviews were conducted with 15 mid-life and older women to address two key research questions: 1) How do Yup'ik/Cup'ik women define health and wellbeing; and 2) What environmental, social, and cultural factors contribute to healthy aging? RESULTS: The women in this study define health aging within the framework of subsistence living-keeping busy, walking, eating subsistence foods, and respect for elders. These beliefs and practices promote a strong, active body and mind, vital components to healthy aging. CONCLUSIONS: While many health beliefs and practices appear very different from those current in research on aging, many commonalities and similarities emerge-concern for family, importance of physical activity and healthy diet. A significant finding of this study is that traditional Yup'ik/ Cup'ik ways of living parallel that of current research findings on what constitutes healthy aging in mainstream populations.

Stress, coping, and well-being among the Yup'ik of the Yukon-Kuskokwim Delta: the role of enculturation and acculturation.

OBJECTIVES: To report on the relationships between cultural identity and stress, coping, and psychological well-being in Yup'ik communities. STUDY DESIGN: A quantitative self-administered questionnaire. METHODS: A health and wellness survey was completed by a total of 488 Yup'ik participants (284 women and 204 men) from 6 rural villages in the Yukon-Kuskokwim Delta region. Respondents were fairly equally distributed across an age range of 14 to 94 (mean +/- SD = 38.50 +/- 17.18). RESULTS: Participants who reported living more of a Kass'aq way of life (greater acculturation) reported experiencing greater psychosocial stress, less happiness, and greater use of drugs and alcohol to cope with stress. Participants who reported identifying more with a traditional Yup'ik way of life reported greater happiness, more frequent use of religion and spirituality to cope with stress, and less frequent use of drugs and alcohol to cope with stress. CONCLUSIONS: In conjunction with previous research, the data strongly indicates that in general, Yup'ik people in the Y-K Delta tend to associate stress and negative health outcomes with the process of acculturation, and health and healing with the process of enculturation. Research that focuses on documenting the intrinsic strengths of indigenous worldviews may contribute to positive transformations in community health.

Conceptions of wellness among the Yup'ik of the Yukon-Kuskokwim Delta: the vitality of social and natural connection.

Focus group research was conducted to examine indigenous conceptions of wellness among the Yup'ik Eskimos of southwestern Alaska. The dialogue on wellness emphasized the importance of living a traditional lifestyle, seeking creative solutions to manage drastic cultural change, and fostering connection within the communities and the native landscape. These themes mesh well with existing characterizations of Alaska Native experiences and worldviews, and reflect substantial links between enculturation, acculturation and health. The data underscores the importance of comprehending local conceptions of wellness in order to effectively work toward promoting optimal health. This paper represents part of an ongoing dialogue in which researchers and native communities co-direct the investigation into healthy ways of being in the world.

Building a community-based participatory research center to investigate obesity and diabetes in Alaska Natives.

The Center for Alaska Native Health Research (CANHR) is a community-based participatory research project aimed at understanding current risk factors for obesity, diabetes, and cardiovascular disease in Alaska Natives living in Southwest Alaska. We utilize a multidisciplinary approach that includes assessment of genetic, nutritional and behavioral risk factors and their interrelationships with one another in the overall development of disease. The design of the CANHR project involved community participation in the development, implementation and interpretation of research results. We have developed a participatory research program that is designed to be culturally appropriate, relevant to community needs and interests, and respectful to our participants. This manuscript describes the organizational development of our CANHR study and the procedures employed in its progression to date.

On community leadership: stories about collaboration in action research.

This article provides an account of a 10-year collaborative documentation of community leadership in an African American community on the South side of Chicago. The stories are oriented to several critical incidents in the life course of the collaboration. They are told from the perspectives of one university professor, four graduate students, and one community leader. Together they provide an account of how this research was shaped by the interactions of the research team with members of the community, how research questions emerged, methodologies were developed, ways of gathering data were tried and tested, and interpretations of data unfolded. Special attention is given to the ways in which the process and products of this research contributed to the community's own process of leadership development. The stories also discuss the various roles participants in this collaboration played both in the academic arena and in the community, and how they experienced gender, race, nationality, and social status.