Recruitment and retention of American Indian youth and caregivers in a culturally adapted prevention program.

This article seeks to understand to what extent cultural engagement and substance use risk factors influence families' decisions to participate, and ultimately complete, a culturally grounded substance use prevention program. Using data from a 14-week culturally oriented family-based substance use prevention program, we examine predictors of successful recruitment and retention of American Indian youth and their caregivers. Guided by the theoretical model for developing culturally specific preventions, the community-based approach to recruitment resulted in 85.6% of eligible families from two American Indian communities agreeing to participate in the randomized controlled trial. After completion of baseline surveys, 57.3% of the intervention selected families initiated participation in the program sessions and 67.8% of these families completed participation in the program. We used logistic regression to analyze two different models: one that predicted whether invited families chose to participate and whether participating families attended eight or more sessions. Important predictors of participation in the intervention program included single-caregiver households, youth Indigenous language and cultural identity, youth early substance use initiation, and household substance use exposure. Overall, results from this study highlight the importance of fully engaged community research partnerships for multi-session family-based interventions, while identifying potential challenges to program recruitment and participation.

Pathways of Adaptation: Two Case Studies with One Evidence-Based Substance Use Prevention Program Tailored for Indigenous Youth.

Indigenous communities often face disproportionate challenges across a variety of health domains, and effective prevention strategies are sorely needed. Unfortunately, evidence is scant regarding what approaches are effective for these communities. A common approach is to take an evidence-based practice or program with documented effectiveness in other populations and implement it with Indigenous populations. While a science of intervention adaptation is emerging, there remains little guidance on processes for adaptation that strategically leverage both existing scientific evidence and Indigenous prevention strategies. In this paper, two case studies illustrate promising practices for adaptation, documenting the approaches of two research teams funded under the National Institutes of Health's initiative to support Intervention Research to Improve Native American Health (IRINAH). These teams worked with distinct Indigenous populations in the USA and Canada to culturally adapt the same prevention program, the Iowa Strengthening Families Program for Parents and Youth 10-14. The approaches of these two teams and the programs that resulted are compared and contrasted, and critical elements of adaptation in partnership with Indigenous communities are discussed.

Stress Exposure and Physical, Mental, and Behavioral Health among American Indian Adults with Type 2 Diabetes.

American Indian (AI) communities experience disproportionate exposure to stressors and health inequities including type 2 diabetes. Yet, we know little about the role of psychosocial stressors for AI diabetes-related health outcomes. We investigated associations between a range of stressors and psychological, behavioral, and physical health for AIs with diabetes. This community-based participatory research with 5 AI tribes includes 192 AI adult type 2 diabetes patients recruited from clinical records at tribal clinics. Data are from computer-assisted interviews and medical charts. We found consistent bivariate relationships between chronic to discrete stressors and mental and behavioral health outcomes; several remained even after accounting for participant age, gender, and income. Fewer stressors were linked to physical health. We also document a dose-response relationship between stress accumulation and worse health. Findings underscore the importance of considering a broad range of stressors for comprehensive assessment of stress burden and diabetes. Policies and practices aimed at reducing stress exposure and promoting tools for stress management may be mechanisms for optimal health for AI diabetes patients.

Prevalence and Correlates of Physical Dating Violence among North American Indigenous Adolescents.

This study examined the lifetime prevalence of physical dating violence, including victimization, perpetration, and the overlap between the two (mutual violence) among a population sample of 551 reservation/reserve residing Indigenous (i.e., American Indian and Canadian First Nations) adolescents in the upper-Midwest of the United States and Canada. Potential correlates of four dating violence profiles (i.e., no dating violence, perpetration-only, victimization-only, and mutual violence) relevant to this population also were considered. The clearest pattern to emerge from multinomial logistic regression analyses suggested that adolescents who engage in problem behaviors, exhibit high levels of anger, and perceive high levels of discrimination have increased odds of lifetime mutual dating violence relative to those reporting no dating violence. Furthermore, gender comparisons indicated that females were more likely to report being perpetrators only, while males were more likely to report being victims only. Considerations of dating violence profiles and culturally-relevant prevention strategies are discussed.

Conduct Disorder and Alcohol Use Disorder Trajectories, Predictors, and Outcomes for Indigenous Youth.

OBJECTIVE: The aim of this study was to identify separate and joint trajectories of conduct disorder (CD) and alcohol use disorder (AUD) DSM-IV diagnostic symptoms among American Indian and First Nation (Indigenous) youth aged 10 to 18 years, and to characterize baseline profiles and later outcomes associated with joint trajectory group membership. METHOD: Data were collected between 2002 and 2010 on three indigenous reservations in the northern Midwest and four Canadian reserves (N = 673). CD and substance use disorder (SUD) were measured using the DSM-IV Diagnostic Interview Schedule for Children-Revised (DISC-R), administered at four time points. RESULTS: Using group-based trajectory modeling, three CD and four AUD trajectories were found. Both had a small group with high symptoms, but the largest groups for both had no symptoms (55% and 73%, respectively). CD symptom trajectories began at age 10 years and peaked at age 14; AUD trajectories began at age 12 years and were highest from age 16 on. Eight joint trajectories were identified. Of the sample, 53% fell into the group with no CD or AUD symptoms. Compared to symptomatic groups, this group had greater caretaker warmth, positive school adjustment, less discrimination, and fewer deviant peers, and were less likely to have a caretaker with major depression at baseline. Symptomatic groups had higher odds of high school dropout, sex under the influence, and arrest at age 17 to 20 years. CONCLUSION: Despite significant risk factors, a large proportion of Indigenous youth had no CD-SUD symptoms over time. CD-SUD symptoms have multiple development trajectories and are related to early developmental risk and later psychosocial outcomes.

Prospective Childhood Risk Factors for Gang Involvement among North American Indigenous Adolescents.

The purpose of the study was to examine prospective childhood risk factors for gang involvement across the course of adolescence among a large eight-year longitudinal sample of 646 Indigenous (i.e., American Indian and Canadian First Nations) youth residing on reservation/reserve land in the Midwest of the United States and Canada. Risk factors at the first wave of the study (ages 10-12) were used to predict gang involvement (i.e., gang membership and initiation) in subsequent waves (ages 11-18). A total of 6.7% of the participants reported gang membership and 9.1% reported gang initiation during the study. Risk factors were distributed across developmental domains (e.g., family, school, peer, and individual) with those in the early delinquency domain having the strongest and most consistent effects. Moreover, the results indicate that the cumulative number of risk factors in childhood increases the probability of subsequent gang involvement. Culturally relevant implications and prevention/intervention strategies are discussed.

Predicting the Onset of Alcohol Use and the Development of Alcohol Use Disorder Among Indigenous Adolescents.

Empirical efforts to identify the predictors of drinking behavior among North American Indigenous adolescents are relatively limited. Using longitudinal data, this study considers perceived discrimination, positive drinker prototypes, and peer drinking behavior as risk factors for the onset of alcohol use and development of an alcohol use disorder among 674 Indigenous adolescents as they progressed from early to late adolescence (M age at baseline = 11.11, SD = 0.83). Results showed that positive drinker prototypes and associations with peers who drink increased the risk for the onset of drinking, while perceived discrimination and associations with peers who drink increased the risk for the development of an alcohol use disorder. The theoretical and practical implications of our results are discussed.

Interactive effects within the prototype willingness model: Predicting the drinking behavior of indigenous early adolescents.

Drawing on the Prototype/Willingness Model of Adolescent Risk Behavior, we used longitudinal data collected from North American Indigenous early adolescents (ages 10-12 years) to examine the interactive effects of favorable drinker prototypes, perceived drinking norms, and past-year drinking behavior on subsequent drinking behavior (i.e., drinking behavior 1 year later and growth in drinking behavior from 1-5 years later). We found that the positive association between favorable drinker prototypes and drinking 1 year later was strongest for adolescents who were high in past-year drinking and perceived low drinking norms. The interaction pattern for growth in drinking was more complex and suggested an important pattern; specifically, favorable drinker prototypes were positively associated with drinking 5 years later, but only for adolescents who reported no past-year drinking and perceived low drinking norms. The theoretical and practical implications of these results are discussed.

A Cautionary Tale: Examining the Interplay of Culturally Specific Risk and Resilience Factors in Indigenous Communities.

Efforts to build empirical evidence for the protective effects of Indigenous cultural factors on psychological health have yielded mixed findings. We examine the interplay of previously hypothesized culturally relevant risk (discrimination, historical loss) and protective (spiritual activities) factors among Indigenous people. The sample includes 569 Indigenous adolescents (M age = 17.23, SD = 0.88; 51.0% girls) and 563 Indigenous adult caregivers (M age = 44.66, SD = 9.18; 77.4% women). Our central finding was that indigenous spirituality was associated with poorer psychological outcomes across several domains (depressive symptoms, anger, anxiety, somatization and interpersonal difficulties), but observed effects were attenuated once perceived discrimination and historical losses were added to statistical models. Thus, consideration of relevant stressors drastically changed our conclusions, underscoring the uncertain dynamics through which specific Indigenous cultural factors impact mental health. Researchers should work in collaboration with Indigenous communities to improve measurement and empirical investigation of these complex constructs.

The Historical Loss Scale: Longitudinal measurement equivalence and prospective links to anxiety among North American indigenous adolescents.

OBJECTIVES: Thoughts of historical loss (i.e., the loss of culture, land, and people as a result of colonization) are conceptualized as a contributor to the contemporary distress experienced by North American Indigenous populations. Although discussions of historical loss and related constructs (e.g., historical trauma) are widespread within the Indigenous literature, empirical efforts to understand the consequence of historical loss are limited, partially because of the lack of valid assessments. In this study we evaluated the longitudinal measurement properties of the Historical Loss Scale (HLS)-a standardized measure that was developed to systematically examine the frequency with which Indigenous individuals think about historical loss-among a sample of North American Indigenous adolescents. We also test the hypothesis that thoughts of historical loss can be psychologically distressing. METHODS: Via face-to-face interviews, 636 Indigenous adolescents from a single cultural group completed the HLS and a measure of anxiety at 4 time-points, which were separated by 1- to 2-year intervals (Mage = 12.09 years, SD = .86, 50.0% girls at baseline). RESULTS: Responses to the HLS were explained well by 3-factor (i.e., cultural loss, loss of people, and cultural mistreatment) and second-order factor structures. Both of these factor structures held full longitudinal metric (i.e., factor loadings) and scalar (i.e., intercepts) equivalence. In addition, using the second-order factor structure, more frequent thoughts of historical loss were associated with increased anxiety. CONCLUSIONS: The identified 3-factor and second-order HLS structures held full longitudinal measurement equivalence. Moreover, as predicted, our results suggest that historical loss can be psychologically distressing for Indigenous adolescents.

Homelessness-Related Traumatic Events and PTSD Among Women Experiencing Episodes of Homelessness in Three U.S. Cities.

In this article, we report the prevalence of traumatic events (TEs), lifetime and 12-month posttraumatic stress disorder (PTSD) among 148 women experiencing homelessness in 3 midsized cities in the United States (Omaha, NE, Pittsburgh, PA, and Portland, OR). The women ranged in age from 19 to 54 years with an average age of 38.89 years (SD = 10.18). The sample was 42.6% White/European American. We investigated the mediation of distal TEs (i.e., childhood maltreatment) by more proximal TEs associated with being homeless (i.e., homelessness-related stressors) for meeting diagnostic criteria for 12-month PTSD. Results indicated that 42.6% of the women met criteria for lifetime PTSD and 39.7% met criteria for past-year PTSD. The number of TEs reported ranged from 0 to 16 in order of prevalence with a median of 6 TEs. The correlations between childhood maltreatment and 12-month PTSD ranged from .16 to .20 and the correlations between homelessness-related stressors and 12-month PTSD ranged from .21 to .30. The mediation analysis was consistent with the association between childhood maltreatment and past-year PTSD being fully mediated by homelessness-related trauma.

The utility of the prototype/willingness model in predicting alcohol use among North American Indigenous adolescents.

In the present study, we considered the utility of the prototype/willingness model in predicting alcohol use among North-American Indigenous adolescents. Specifically, using longitudinal data, we examined the associations among subjective drinking norms, positive drinker prototypes, drinking expectations (as a proxy of drinking willingness), and drinking behavior among a sample of Indigenous adolescents from ages 12 to 14 years. Using an autoregressive cross-lagged analysis, our results showed that subjective drinking norms and positive drinker prototypes at 12 years of age were associated with increased drinking expectations at 13 years of age, and that greater drinking expectations at 13 years of age were associated with increased drinking behavior at 14 years of age. Our results provide initial evidence that the prototype/willingness model may generalize to Indigenous adolescents, a population that has received little attention within the psychological sciences. Our results also highlight some potential ways in which existing prevention efforts aimed at reducing substance use among Indigenous adolescents may be enhanced.

Patterns of substance use initiation among Indigenous adolescents.

BACKGROUND: The data for this study come from an eight-wave panel study of Indigenous (Canadian First Nations and American Indian) adolescents from three U.S. reservations and four Canadian reserves. OBJECTIVES: Our objective was to investigate variations in patterns of substance use initiation from early adolescence through early adulthood using data collected annually for 8 years. METHOD: At baseline the sample included 675 Indigenous adolescents (M age=11.10, SD=.83; 50.3% girls). First, we calculated cumulative rates of substance use initiation by age. We then examined whether the cumulative initiation rates were moderated by gender using logistic regression analyses. Second, we calculated hazard rates for substance use initiation by age. Third, we focused on the ordering of two substances, paired two substances, and three substance initiation sequences. RESULTS: If one looks only at the cumulative rates of substance use initiation there appears to be support for a sequential progression of substance use during early adolescence. In contrast to the cumulative rates of substance use initiation, the hazard analyses showed a much more mixed, less progressive sequence. Among two substance pairings a nicotine to marijuana initiation sequence was most likely, followed by a nicotine to alcohol sequence. An alcohol to marijuana sequence was nearly twice as likely as a marijuana to alcohol sequence. Refined analyses to conform to those of many of the traditional gateway studies by introducing paired two substance orderings indicated that nicotine and/or alcohol prior to marijuana use was by far the most likely sequence. In two of the three most likely three substance sequences (nicotine to alcohol to marijuana and nicotine to marijuana to alcohol) nicotine was the first substance initiated. CONCLUSION: This study refines the gateway hypothesis for Indigenous adolescents by providing an in-depth analysis of substance use initiation. The only evidence for a "gateway" substance that emerged in our analyses was for nicotine use which was likely to precede alcohol and marijuana use in both two-substance pairings and to a lesser extent in three-substance initiation sequences.

Substance Use Disorders, Comorbidity, and Arrest among Indigenous Adolescents.

Indigenous adolescents are overrepresented at multiple stages of the justice system, but we know very little about the role that mental health, particularly substance use disorder, plays in Indigenous pathways to arrest. This study examined the association between substance use disorder, its comorbidity with other disorders, and arrest using a longitudinal sample of Indigenous youth from the Northern Midwest and Canada. Of the 16% of youth who reported at least one arrest at Wave 5, half met criteria for substance abuse/dependence, and slightly more for conduct disorder. Substance abuse/dependence and conduct disorder were each associated with an increased risk of arrest, although co-occurring disorders were not. The reciprocal effects of arrest and mental disorder are discussed.

Characteristics of Mothers Caring for Children During Episodes of Homelessness.

This study provides a description of the physical, psychological, and substance use problems of adult homeless women who are and are not caring for children. We also examined differences in the characteristics of these two groups of women. Interviews were conducted with 148 homeless women from three mid-sized U.S. cities, 24.3 % of whom were caring for at least one child. Our results showed that women caring for children were more likely to be sheltered and have health insurance. Homeless women caring for children and solitary homeless women were generally similar in terms of substance abuse problems. However, rates of Borderline Personality Disorder were higher among women caring for children than among solitary homeless women. Our results are somewhat consistent with previous research, with the exception of substance abuse problems and mental health problems, which were shown to be equally problematic for all women, regardless of current caregiving status.

A longitudinal examination of the measurement properties and predictive utility of the Center for Epidemiologic Studies Depression Scale among North American Indigenous adolescents.

We examined the longitudinal measurement properties and predictive utility of the Center for Epidemiologic Studies Depression Scale (CES-D) from early to late adolescence among a sample of North American Indigenous youths. Participants were 632 North American Indigenous adolescents (n = 632; 50.3% girls; M age at baseline = 11.11 years) participating in an 8-year, 8-wave longitudinal study. Via in-person interviews, participants completed the CES-D at Waves 1, 3, 5, and 7, and the major depressive disorder (MDD) module of the Diagnostic Interview Schedule for Children at Waves 1, 4, 6, and 8. Confirmatory factor analyses indicated that responses to the CES-D were similarly explained by 2-, 3-, and 4-factor models, as well as a 1-factor model with correlations between the error variances for the positively worded items. Longitudinal measurement equivalence analyses indicated full structural (i.e., factor structure), metric (i.e., factor loadings), and scalar (i.e., observed item intercepts) equivalence for each factor structure. Substantive analyses showed that the CES-D was significantly associated with MDD both concurrently and prospectively, although these effects were smaller than might be expected. Finally, the CES-D negative affect and somatic complaints subscales were the strongest and most consistent predictors of MDD. Among our sample of North American Indigenous youths, the measurement properties of the CES-D were stable from early to late adolescence. Moreover, somatic difficulties and depressed affect were the strongest predictors of MDD.

Mental and substance use disorders from early adolescence to young adulthood among indigenous young people: final diagnostic results from an 8-year panel study.

OBJECTIVE: Our objective was to investigate change in prevalence rates for mental and substance abuse disorders between early adolescence and young adulthood in a cohort of indigenous adolescents who participated in an 8-year panel study. METHOD: The data are from a lagged, sequential study of 671 indigenous adolescents (Wave 1) from a single culture in the Northern Midwest USA and Canada. At Wave 1 (mean age 11.3 years, Wave 4 (mean age 14.3 years), Wave 6 (mean age 16.2 years), and at Wave 8 (mean age 18.3 years) the tribally enrolled adolescents completed a computer-assisted personal interview that included DISC-R assessment for 11 diagnoses. Our yearly retention rates by diagnostic wave were: Wave 2, 94.7 %; Wave 4, 87.7 %; Wave 6, 88.0 %; Wave 8, 78.5 %. RESULTS: The findings show a dramatic increase in lifetime prevalence rates for substance use disorders. By young adulthood, over half had met criteria of substance abuse or dependence disorder. Also at young adulthood, 58.2 % had met lifetime criteria of a single substance use or mental disorder and 37.2 % for two or more substance use or mental disorders. The results are compared to other indigenous diagnostic studies and to the general population. CONCLUSIONS: A mental health crisis exists within the indigenous populations that participated in this study. Innovations within current mental health service systems are needed to address the unmet demand of adolescents and families.

Rural Latino adolescent health: preliminary examination of health risks and cultural correlates.

Latino adolescents living in rural settings may be at increased risk of health problems; however, data describing the health status of this population are limited. This study examined 60 rural Latino adolescents and found high rates of health risk, including at-risk/clinical results for hemoglobin A1C (23.3%), high-density lipoprotein cholesterol (55%), systolic blood pressure (21.7%), and overweight/obesity (55%). Time in sedentary behaviors was high and physical activity was limited. Adolescent language use was associated with health risk status, with greater use of English associated with lower risk. Health psychologists could promote improved health by providing health behavior interventions to this underserved population.