American Indian and Alaska Native Mental Health Research : the Journal of the National Center

This paper presents how a community mobilization program to prevent suicide was adapted to an online format to accommodate the impossibility of in-person delivery in Alaska Native communities during the COVID-19 pandemic. The intervention, Promoting Community Conversations About Research to End Suicide (PC CARES), was created collaboratively by researchers and Alaska Native communities with the goal of bringing community members together to create research-informed and community-led suicide prevention activities in their communities...

Positive Indian Parenting (PIP) is a culturally based training developed by the National Indian Child Welfare Association in the mid-1980s that has been widely used across Indian Country. However, quantitative studies on its efficacy have not been conducted. This manuscript reports on the study design and development of an ongoing pilot study evaluating PIP and related adaptations that occurred within the context of the COVID-19 pandemic. Adaptations to the study were required to accommodate social distancing requirements, including changing to virtual platforms for curriculum delivery, fidelity monitoring, and data collection...

This paper describes the revision of the in-person Strong Men, Strong Communities (SMSC) study to a remote protocol and highlights key successes, challenges, and critical lessons learned applicable to remote trial implementation. The SMSC study is the first randomized controlled trial to exclusively recruit American Indian and Alaska Native men into a diabetes prevention intervention. The five-year randomized controlled trial was in its 42nd month with 99 subjects enrolled when the COVID-19 pandemic ceased all in-person research...

American Indian/Alaska Native (Native) youth face high rates of substance use, teen pregnancy and sexually transmitted infections. In response to the COVID-19 pandemic, Respecting the Circle of Life (RCL), a sexual reproductive health and teen pregnancy prevention program for Native youth and their trusted adult, was adapted and delivered in a virtual format with Native youth in a rural, reservation-based Native community. This manuscript describes the adaptation process, feasibility, and acceptability of virtual program implementation...

The COVID-19 pandemic has disproportionately impacted American Indian and Alaska Native (AI/AN) communities. Tribes, tribal organizations, AI/AN youth and community-serving programs, and tribal health organizations have responded and adapted programs and services in response to the COVID-19 pandemic. This paper explores how COVID-19 impacted Native PRIDE, an American Indian non-profit organization, and the tribal communities involved in the Intergenerational Connections Project (ICP). Native PRIDE utilized a mixed-method Indigenous Evaluation Framework (IEF) to reflect on COVID-19 impacts...

In this manuscript, we present changes in study design and analytical strategy due to the COVID-19 pandemic for Nen ŨnkUmbi/EdaHiYedo ("We Are Here Now," or NE). NE is a community-based participatory research multi-level randomized control trial using a stepped wedge design to address sexual and reproductive health disparities among American Indian youth. Adaptations in NE's research design, data collection, and analysis due to the COVID-19 pandemic were made based on meetings with tribally based research team members and outside non-Indigenous researchers involved in NE, as well as the study's Community Advisory Board and the Data Safety Monitoring Board...

Urban American Indian/Alaska Native peoples experience disproportionate levels of food insecurity when compared to the general US population. Through a collaborative research partnership between Native American Lifelines of Baltimore, an Urban Indian Health Program, and a Johns Hopkins Bloomberg School of Public Health student-led research team, food security was identified as a priority issue. A sequential explanatory mixed methods study was planned to explore food security and food sovereignty in the Baltimore Native community prior to the COVID-19 pandemic...

The COVID-19 pandemic forced health research programs across the world to close or pause, threatening the progress of basic science, clinical and social science research, and research careers. Impacts of the pandemic on research occurring with American Indian and Alaska Native (AI/AN) peoples, which is often conducted using community-based and -engaged approaches, offer an opportunity to understand how community-research partnerships shaped decision-making and facilitated adaptations to study design, recruitment, data collection, program implementation, and analyses...

Despite their recent high-profile removal by a handful of professional sports teams, Native-themed mascots continue to be a mainstay of professional, college, and youth athletics. To determine the extent of the literature on the health impacts on American Indians and Alaska Natives (AI/ANs) as a result of Native-themed mascots, we conducted a scoping review of primary research articles, utilizing the National Institute on Minority Health and Health Disparities (NIMHD) research framework as a guide to define health impacts broadly to include impacts on determinants of health and health disparities...

The purpose of this study is to gain insights of American Indian (AI) communities on the role of social support in type 2 diabetes (T2D) management. Social support is a means of enhancing social and personal resources that can address underlying stressors that contribute to T2D inequities and represents a potential channel of intervention to improve management of T2D in these communities. This community-based participatory research included AI adults from the Bois Forte and Lac Courte Oreilles Bands of Ojibwe and consisted of focus groups that were conducted with people with T2D, social support persons, and service providers...

American Indian and Alaska Native (AI/AN) youth face a history of adversity and trauma that are linked to academic and health concerns. Culturally grounded art-based interventions hold promise to address challenges faced by AI youth. AI culture and wisdom can evoke a sense of capability in youth that strengthens their resilience. This study sought to evaluate a culturally oriented art therapy curriculum on its impact on resilience, stress, and mood for AI youth (n = 36). A paired-samples t-test was conducted to compare the perceived stress scores of the participants before and after a 12-week art intervention...

The objective of this study was to examine the longitudinal relationship between perceived racial/ethnic discrimination and depressive symptoms among adolescents living in the Cherokee Nation, as well as the potential moderating roles of race and social support. Self-reported survey data were analyzed from a sample of high school students (n = 1,622) who identified as American Indian only, American Indian and White, and White only. Compared to students who reported no discrimination on the basis of race, those who reported ever having experienced discrimination scored, on average, 1...

Culturally grounded after-school programs (ASPs) aim to promote health and well-being among Indigenous youth. Native Spirit is a 10-session ASP that focuses on local cultural values and activities facilitated by local cultural practitioners. This pilot study used a single group, pretest-posttest design (N = 18) with Indigenous adolescents in grades 7-12 and conducted participant interviews (N = 11) to assess the impact of the program on cultural identity, self-esteem, and resilience. There were immediate post-program increases in mean strength in cultural identity (p = 0...

This paper examines the ethical issues underlying research with urban American Indians and Alaska Natives (AI/ANs) through the lens of tribal sovereignty. There are 574 federally recognized tribes within the United States. Each of those tribes is recognized by the federal government as having sovereign status, an important political designation that ensures that decisions impacting tribal peoples must be made after consultation with those nations. Most AI/AN people live away from their designated tribal lands, yet their sovereign rights are frequently only recognized when living on tribal lands...

Inequities in access to health care create barriers to physical and mental health treatment for the rapidly aging American Indian population in the United States. This study uses concept mapping-a participatory, mixed-methods approach to understanding complex phenomena-to examine the perceived impacts of multilevel factors influencing Elders' ability to access and use health care and how these perceptions vary according to gender and age, with the aim of identifying tailored strategies to address inequities...

This article discusses a community-based participatory research project with university researchers, an urban inter-tribal center, and other community partners to develop, administer, and deliver a community needs assessment of an urban American Indian (AI) community. In the development process, community focus groups identified major domains of inquiry for a needs assessment survey: mental health and substance abuse, medical care, and social services, including cultural programming. Results are presented and discussed in each domain...

Positive youth development approaches with American Indian/Alaska Native (AI/AN) youth have been particularly successful and promising. Utilizing a survey with 3,736 AI/AN students, we investigated the associations between risk and protective factors and significant mental distress of AI/AN youth. The protective factors were studied within the positive youth development framework, which includes positive developmental assets reflecting aspects of the Circle of Courage, a prior framework embodying core indigenous values for youth development and education to support youth at risk...

In this study, positive aspects of self-compassion (i.e., self-kindness, common humanity, and mindfulness of one's thoughts and feelings) were explored in relation with suicide risk factors (i.e., perceived burdensomeness and thwarted belongingness) in a community sample of 242 self-identified American Indian/Alaska Native (AI/AN) adults. Participants completed a survey packet including a demographic form, the Interpersonal Needs Questionnaire, and the Self-Compassion Scale at several Indian Health Service clinics and tribal centers in the Great Plains of the United States...

American Indian and Alaska Native (AI/AN) young adults are strong and resilient. Interventions designed to improve their mental health and help-seeking skills are especially needed, particularly those that include culturally relevant resources and relatable role models. This paper presents formative research from the BRAVE study, a five-year community based participatory research project led by the Northwest Portland Area Indian Health Board. Formative research included three phases and more than 38 AI/AN young adults and content experts from across the United States...

Historical trauma has contributed to the reality that addiction disproportionately affects tribal communities, including American Indian youth. We sought to understand American Indian youths' own experiences and perceptions of the environments to which they return after completing residential treatment for substance use disorder. We recruited three cohorts of American Indian residents of a substance use disorder treatment facility (N = 40). These residents completed a survey that measured risk and protective factors, as well as actual risk behaviors, including drug use, gambling, and violence...