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Skye M, Craig S, Donald C, Kelley A, Morgan B, Rajani K, Singer M, Zaback T, Lambert W. Are American Indian/Alaska Native Adolescent Health Behaviors Different? A Review of AI/AN Youth Involved in Native STAND Curriculum, 2014-2017 United States. Matern Child Health J 2021; 25:1893-1902. [PMID: 34705192 PMCID: PMC8599210 DOI: 10.1007/s10995-021-03256-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore health behavior profiles of AI/AN youth involved in native students together against negative decisions (STAND), a national culture-based curriculum. METHODS We analyzed data from 1236 surveys conducted among AI/AN youth at 40 native STAND implementation sites located in 16 states throughout the US from 2014 to 2017. Health profiles included demographics, sexual orientation, sexual activity, STI testing, cigarette use, and suicide attempts in the past 12-months. We used t-tests and chi square tests of independence to compare risk behavior prevalence among the sample. RESULTS Health behavior profiles of AI/AN youth indicate that 45.6% of youth did not use condoms the last time they had sex, and 82.7% have never been tested for STIs. Differences in cigarette smoking were observed in questioning youth (questioning: 80.3%, straight/heterosexual: 63.8%, LGBTQ2S + : 49.9%, p = 0.03). CONCLUSIONS FOR PRACTICE Health behaviors related to sex, substance, violence and self-harm, are at least as common for AI/AN youth as those observed in other US teens. Future research should consider similarities and differences in health profiles of AI/AN youth when designing interventions that affect them. Further, our findings underscore the need for culturally-relevant curricula like native STAND, not because their health behavior is different, but because their socio-ecologic environment is different.
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Affiliation(s)
- Megan Skye
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA.
| | - Stephanie Craig
- Northwest Portland Area Indian Health Board, Portland, OR, 97201, USA
| | - Caitlin Donald
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA
| | | | - Brittany Morgan
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Kavita Rajani
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR, 97201, USA
| | - Tosha Zaback
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA
| | - William Lambert
- Oregon Health and Science University, 3181 SW Sam Jackson Park Rd., Portland, OR, 97239, USA
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Ehlers CL, Geisler JR, Luna JA, Gilder DA, Calac D, Lee JP, Moore RS. Community Awareness of Outreach Efforts to Reduce Underage Drinking on California Indian Reservations. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2021; 27:21-41. [PMID: 32259273 DOI: 10.5820/aian.2701.2020.21] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We report an evaluation of a combined individual- and community-level treatment and prevention effort to reduce underage drinking by American Indian (AI) youths on rural California Indian reservations. The interventions included: brief motivational interviewing and psychoeducation for Tribal youths, restricting alcohol sales to minors in alcohol sales outlets, and community mobilization and awareness activities. Surveys were collected from 120 adults and 74 teens to evaluate the awareness and effectiveness of the interventions. A high proportion of adult (93%) and youth (96%) respondents endorsed being aware of one or more of the intervention activities, and 88% of adults and 71% of youth felt the program impacted the community in a positive way. Eighty-four percent of adults and 63% of youth agreed that as a result of the activities that they decided to take action to reduce teen drinking in their community. Being aware of more of the intervention activities significantly increased the odds of taking action to change drinking behaviors. This study documents that a significant proportion of the community was aware of the intervention efforts and that awareness caused them to take action to reduce underage drinking. Such efforts may benefit other AI/AN communities seeking to reduce underage drinking.
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Onset, Comorbidity, and Predictors of Nicotine, Alcohol, and Marijuana Use Disorders Among North American Indigenous Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:1025-1038. [PMID: 30515623 DOI: 10.1007/s10802-018-0500-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
North American Indigenous (i.e., American Indian and Canadian First Nations) youth experience inequities in rates of substance abuse and dependence. Despite this, few longitudinal studies examine the developmental course of substance use disorders (SUD) among community-based samples of Indigenous youth. The purpose of the study was to examine onset and predictors of nicotine dependence, alcohol use disorders, marijuana use disorders, any SUD, and multiple SUDs across the entire span of adolescence among a longitudinal sample (N = 744) of reservation/reserve Indigenous youth in the upper-Midwest of the United States and Ontario, Canada. Using discrete time survival analysis, the results show that rates of meeting criteria for SUDs by late adolescence were 22% for nicotine, 43% for alcohol, and 35% for marijuana. Peak periods of risk for new nicotine dependence and marijuana use disorder cases occurred around 14 years of age, whereas peak periods of risk for new alcohol use disorder cases emerged slightly later around 16 years of age. We found high rates of SUD comorbidity, and the cumulative probability of developing two or more SUDs during adolescence was 31%. Internalizing disorders increased the odds of nicotine dependence and multiple SUDs, while externalizing disorders increased the odds of all outcomes except nicotine dependence. Gender, age, and per capita family income were inconsistently associated with SUD onset. The findings are embedded within broader substance use patterns identified among Indigenous youth, and prevention, intervention, and treatment implications are discussed.
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Chambers RS, Rosenstock S, Lee A, Goklish N, Larzelere F, Tingey L. Exploring the Role of Sex and Sexual Experience in Predicting American Indian Adolescent Condom Use Intention Using Protection Motivation Theory. Front Public Health 2018; 6:318. [PMID: 30483489 PMCID: PMC6240587 DOI: 10.3389/fpubh.2018.00318] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 10/19/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: American Indian (AI) youth experience poor sexual health outcomes. Research indicates the Protection Motivation Theory (PMT) is a robust model for understanding how sexual risk and protective behaviors are associated with condom use intention (CUI). Studies indicate the constructs of the PMT which influence CUI vary by sex and sexual experience. This analysis explores associations between PMT constructs and CUI by sex and sexual experience among AI youth who participated in the Respecting the Circle of Life (RCL) trial, a sexual and reproductive health intervention. Methods: We analyzed baseline data from the sample of 267 AIs, ages 13-19, who participated in the evaluation. We examined CUI and PMT construct scores by sex and sexual experience utilizing generalized estimated equations and multiple regression models to test which PMT constructs were associated with CUI across sex and sexual experience. Results: Twenty-two percentage of participants were sexually experienced; 56.8% reported CUI at baseline. We found several differences in scores in PMT constructs by sex and sexual experience including self-efficacy, response efficacy, vulnerability, severity, and extrinsic rewards. We also found constructs varied that were associated with CUI varied across sex and sexual experience. No PMT constructs were associated with CUI among sexually experienced youth. Conclusion: Results provide support for developing, selecting and delivering sexual health programs by sex and sexual experience in American Indian communities. Girls programs should focus on internal satisfaction and self-worth while boys should focus on negative impacts of not using condoms. Programs for youth who are not sexually active should focus on negative impacts of not using condoms. Programs for sexually inactive youth should work to change peer norms around condom use and improve knowledge about the efficacy of condom use.
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Affiliation(s)
- Rachel Strom Chambers
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Summer Rosenstock
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Angie Lee
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Novalene Goklish
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Francene Larzelere
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
| | - Lauren Tingey
- International Health, Bloomberg School of Public Health, Johns Hopkins, Baltimore, MD, United States
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Moore RS, Gilder DA, Grube JW, Lee JP, Geisler JA, Friese B, Calac DJ, Finan LJ, Ehlers CL. Prevention of Underage Drinking on California Indian Reservations Using Individual- and Community-Level Approaches. Am J Public Health 2018; 108:1035-1041. [PMID: 29927644 DOI: 10.2105/ajph.2018.304447] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To evaluate combined individual- and community-level interventions to reduce underage drinking by American Indian/Alaska Native (AI/AN) youths on rural California Indian reservations. METHODS Individual-level interventions included brief motivational interviewing and psychoeducation for Tribal youths. Community-level interventions included community mobilization and awareness activities, as well as restricting alcohol sales to minors. To test effects, we compared 7 waves of California Healthy Kids Survey data (2002-2015) for 9th- and 11th-grade AI/AN and non-AI/AN students in intervention area schools with California AI/AN students outside the intervention area (n = 617, n = 33 469, and n = 976, respectively). RESULTS Pre- to postintervention mean past 30-day drinking frequency declined among current drinkers in the intervention group (8.4-6.3 days) relative to comparison groups. Similarly, heavy episodic drinking frequency among current drinkers declined in the intervention group (7.0-4.8 days) versus the comparison groups. CONCLUSIONS This study documented significant, sustained past 30-day drinking or heavy episodic drinking frequency reductions among AI/AN 9th- and 11th-grade current drinkers in rural California Indian reservation communities exposed to multilevel interventions. Public Health Implications. Multilevel community-partnered interventions can effectively reduce underage alcohol use in this population.
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Affiliation(s)
- Roland S Moore
- Roland S. Moore, Joel W. Grube, Juliet P. Lee, Bettina Friese, and Laura J. Finan are with Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA. David A. Gilder and Cindy L. Ehlers are with the Scripps Research Institute, La Jolla, CA. Jennifer A. Geisler was with and Daniel J. Calac is with the Southern California Tribal Health Center
| | - David A Gilder
- Roland S. Moore, Joel W. Grube, Juliet P. Lee, Bettina Friese, and Laura J. Finan are with Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA. David A. Gilder and Cindy L. Ehlers are with the Scripps Research Institute, La Jolla, CA. Jennifer A. Geisler was with and Daniel J. Calac is with the Southern California Tribal Health Center
| | - Joel W Grube
- Roland S. Moore, Joel W. Grube, Juliet P. Lee, Bettina Friese, and Laura J. Finan are with Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA. David A. Gilder and Cindy L. Ehlers are with the Scripps Research Institute, La Jolla, CA. Jennifer A. Geisler was with and Daniel J. Calac is with the Southern California Tribal Health Center
| | - Juliet P Lee
- Roland S. Moore, Joel W. Grube, Juliet P. Lee, Bettina Friese, and Laura J. Finan are with Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA. David A. Gilder and Cindy L. Ehlers are with the Scripps Research Institute, La Jolla, CA. Jennifer A. Geisler was with and Daniel J. Calac is with the Southern California Tribal Health Center
| | - Jennifer A Geisler
- Roland S. Moore, Joel W. Grube, Juliet P. Lee, Bettina Friese, and Laura J. Finan are with Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA. David A. Gilder and Cindy L. Ehlers are with the Scripps Research Institute, La Jolla, CA. Jennifer A. Geisler was with and Daniel J. Calac is with the Southern California Tribal Health Center
| | - Bettina Friese
- Roland S. Moore, Joel W. Grube, Juliet P. Lee, Bettina Friese, and Laura J. Finan are with Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA. David A. Gilder and Cindy L. Ehlers are with the Scripps Research Institute, La Jolla, CA. Jennifer A. Geisler was with and Daniel J. Calac is with the Southern California Tribal Health Center
| | - Daniel J Calac
- Roland S. Moore, Joel W. Grube, Juliet P. Lee, Bettina Friese, and Laura J. Finan are with Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA. David A. Gilder and Cindy L. Ehlers are with the Scripps Research Institute, La Jolla, CA. Jennifer A. Geisler was with and Daniel J. Calac is with the Southern California Tribal Health Center
| | - Laura J Finan
- Roland S. Moore, Joel W. Grube, Juliet P. Lee, Bettina Friese, and Laura J. Finan are with Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA. David A. Gilder and Cindy L. Ehlers are with the Scripps Research Institute, La Jolla, CA. Jennifer A. Geisler was with and Daniel J. Calac is with the Southern California Tribal Health Center
| | - Cindy L Ehlers
- Roland S. Moore, Joel W. Grube, Juliet P. Lee, Bettina Friese, and Laura J. Finan are with Prevention Research Center, Pacific Institute for Research and Evaluation, Berkeley, CA. David A. Gilder and Cindy L. Ehlers are with the Scripps Research Institute, La Jolla, CA. Jennifer A. Geisler was with and Daniel J. Calac is with the Southern California Tribal Health Center
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Blum K, Siwicki D, Baron D, Modestino EJ, Badgaiyan RD. The benefits of genetic addiction risk score (GARS™) and pro-dopamine regulation in combating suicide in the American Indian population. ACTA ACUST UNITED AC 2018; 4. [PMID: 31660252 DOI: 10.15761/jsin.1000195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
It is well-known that Native Americans (NA) clinically present with a very high rate of alcoholism and other drugs of abuse. It is also known that NA also display a very high rate of suicide compared to other ethnic groups. Furthermore, individuals with various psychiatric disorders (e.g., depression) also have higher rates of suicide that are frequently alcohol related. Males are as much as four times more likely to die from suicide than females. Studies comparing Native to other populations within the same geographic regions in North America divulged, almost universally, that alcohol involvement is higher among Native suicides than among the local, non-Native people. Unfortunately, suicide is the eighth leading cause of death in the U.S. and is the third cause of death in those ages 15-24. With these disappointing statistics, we are hereby proposing that because of such a high genetic risk as supported by the work of Barr and Kidd showing that NA carriers the DRD2 A1 allele at the rate of 86%, compared to a highly screened reward deficiency free control of only 3%. It seems reasonable that early identification, especially in children, be tested with the Genetic Addiction Risk Score (GARS) and concomitantly be offered the precision pro-dopamine regulator (KB220PAM), one that matches their unique brain polymorphisms involving serotonergic, endorphinergic, glutaminergic, gabaergic and dopaminergic pathways among others. We believe that using the Precision Addiction Management (PAM) platform at an early age may be prophylactic, while in adults PAM may reduce substance craving affecting tertiary treatment and even relapse and mortality prevention.
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Affiliation(s)
- Kenneth Blum
- Western University Health Sciences Graduate School of Biomedical Sciences, Pomona, CA, USA.,Department of Precision Behavioral Management, Geneus Health, San Antonio, Texas, USA.,Institute of Psychology, ELTE Eotvos Loránd University, Budapest, Hungary.,Department of Psychiatry, Wright University, Boonshoft School of Medicine, Dayton, OH, USA.,Division of Neurogenetic Research & Addiction Therapy, The Florida House Experience, Deerfield Beach, Fl., USA.,Division of Addiction Services, Dominion Diagnostics, North Kingston, RI, USA
| | - David Siwicki
- Department of Precision Behavioral Management, Geneus Health, San Antonio, Texas, USA
| | - David Baron
- Western University Health Sciences Graduate School of Biomedical Sciences, Pomona, CA, USA.,Department of Precision Behavioral Management, Geneus Health, San Antonio, Texas, USA
| | - Edward J Modestino
- Department of Precision Behavioral Management, Geneus Health, San Antonio, Texas, USA.,Division of Addiction Services, Dominion Diagnostics, North Kingston, RI, USA
| | - Rajendra D Badgaiyan
- Department of Precision Behavioral Management, Geneus Health, San Antonio, Texas, USA.,Department of Psychology, Curry College, Milton, MA, USA.,Department of Psychiatry, Ichan School of Medicine at Mount Sinai, New York, NY, USA
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Spillane NS, Weyandt L, Oster D, Treloar H. Social contextual risk factors for stimulant use among adolescent American Indians. Drug Alcohol Depend 2017; 179:167-173. [PMID: 28787693 PMCID: PMC5772949 DOI: 10.1016/j.drugalcdep.2017.06.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 06/16/2017] [Accepted: 06/16/2017] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Stimulants are the most common and efficacious treatment for Attention-Deficit Hyperactivity Disorder (ADHD). We examined the relationship between stimulant misuse and social factors that could be malleable to prevention among American Indian (AI) adolescents. METHOD Participants were AI students (N=3498) sampled from 33 schools in 11 states. Participants completed the American Drug and Alcohol Survey. A multilevel analytic approach was used to evaluate the effects of participant-level (level 1) variables (i.e., gender, grade, peer, school, family, stimulant prescribed by doctor) on lifetime and current simulant use to 'get high.' RESULTS Nearly 7% of our sample had been prescribed stimulants and nearly 6% of the sample reported using stimulants to get high. Age [OR=1.22; 95% CI=1.09, 1.36, p<0.001], perception of peer substance use [OR=1.19; 95% CI=1.14, 1.23, p<0.001], parental monitoring [OR=0.96; 95% CI=0.92, 1.99, p=0.04], and stimulants prescribed by a doctor [OR=8.79, 95% CI=5.86, 13.18, p<0.001] were associated with ever using stimulants to get high. Perception of peer substance use, [b=0.09, SE=0.02, p<0.001, 95%CI [0.05, 0.13], and having stimulants prescribed by a doctor, [b=0.58, SE=0.21, p=0.006, 95%CI [0.17, 0.99], were associated with frequency of past month use to get high. There was also a significant quadratic effect for parental monitoring, suggesting that low and high levels were associated with increased stimulant use. CONCLUSIONS Our results suggest a need for prevention efforts to be directed to AI youth who are prescribed stimulants.
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Affiliation(s)
| | - Lisa Weyandt
- Psychology Department, University of Rhode Island, Kingston, RI 02881
| | - Danielle Oster
- Psychology Department, University of Rhode Island, Kingston, RI 02881
| | - Hayley Treloar
- Center for Alcohol and Addiction Studies, Brown University, Providence, RI, USA
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Gilder DA, Geisler JR, Luna JA, Calac D, Monti PM, Spillane NS, Lee JP, Moore RS, Ehlers CL. A pilot randomized trial of Motivational Interviewing compared to Psycho-Education for reducing and preventing underage drinking in American Indian adolescents. J Subst Abuse Treat 2017; 82:74-81. [PMID: 29021119 DOI: 10.1016/j.jsat.2017.09.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 01/18/2023]
Abstract
Underage drinking is an important public health issue for American Indian and Alaska Native (AI/AN) adolescents, as it is for U. S. teens of all ethnicities. One of the demonstrated risk factors for the development of alcohol use disorders in AI/AN is early age of initiation of drinking. To address this issue a randomized trial to assess the efficacy of Motivational Interviewing (MI) compared to Psycho-Education (PE) to reduce and prevent underage drinking in AI/AN youth was developed and implemented. Sixty-nine youth received MI or PE and 87% were assessed at follow-up. For teens who were already drinking, participating in the intervention (MI or PE) was associated, at follow-up, with lower quantity×frequency (q×f) of drinking (p=0.011), fewer maximum drinks per drinking occasion (p=0.004), and fewer problem behaviors (p=0.009). The MI intervention resulted in male drinkers reporting a lower q×f of drinking (p=0.048) and female drinkers reporting less depression (p=0.011). In teens who had not started drinking prior to the intervention, 17% had initiated drinking at follow-up. As a group they reported increased quantity×frequency of drinking (p=0.008) and maximum drinks (p=0.047), but no change in problem behaviors. These results suggest that intervening against underage drinking using either MI or PE in AI/AN youth can result in reduced drinking, prevention of initiation of drinking, and other positive behavioral outcomes. Brief interventions that enhance motivation to change as well as Psycho-Education may provide a successful approach to reducing the potential morbidity of underage drinking in this high-risk group.
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Affiliation(s)
- David A Gilder
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, SP30-1501, La Jolla, CA 92037, USA.
| | | | - Juan A Luna
- Southern California Tribal Health Center, CA, USA.
| | - Daniel Calac
- Southern California Tribal Health Center, CA, USA.
| | - Peter M Monti
- Center for Alcohol and Addiction Studies, Brown University, Box G-S121-5, Providence, RI 02912, USA.
| | - Nichea S Spillane
- Department of Psychology, Rhode Island University, 306 Chafee Hall, 142 Flagg Road, Kingston, RI 02881, USA.
| | - Juliet P Lee
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Ave., Ste. 1200, Oakland, CA 94612, USA.
| | - Roland S Moore
- Prevention Research Center, Pacific Institute for Research and Evaluation, 180 Grand Ave., Ste. 1200, Oakland, CA 94612, USA.
| | - Cindy L Ehlers
- Department of Neuroscience, The Scripps Research Institute, 10550 North Torrey Pines Road, SP30-1501, La Jolla, CA 92037, USA.
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Tingey L, Chambers R, Goklish N, Larzelere F, Lee A, Suttle R, Rosenstock S, Lake K, Barlow A. Rigorous evaluation of a pregnancy prevention program for American Indian youth and adolescents: study protocol for a randomized controlled trial. Trials 2017; 18:89. [PMID: 28241775 PMCID: PMC5330144 DOI: 10.1186/s13063-017-1842-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 02/15/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND American Indian adolescents have one of the highest rates of teen pregnancy and repeat teen births in the US. Substance use is a significant risk factor for unprotected sex, and American Indian adolescents have the highest substance use-related morbidity and mortality of any US racial group. Despite these disparities, there are no existing, evidence-based programs for pregnancy prevention that have been rigorously evaluated among American Indian teens. METHODS The proposed study is a randomized controlled trial to test the efficacy of a comprehensive sexual and reproductive health program developed in partnership with an American Indian community. Participants will be American Indians ages 11-19 and their parent or trusted adult, randomized to receive the control condition or intervention called Respecting the Circle of Life: Mind, Body and Spirit. The intervention includes eight lessons delivered to self-selected peer groups during a summer basketball camp and one lesson delivered to the youth and parent/trusted adult together within 3 months after camp. All lessons are administered by trained community health workers from the participating American Indian community. Youth and parent/trusted adult participants will complete assessments at baseline, 3, 9, 12, 24 and 36 months post-intervention completion. The primary outcome variables are sexual/reproductive health knowledge, sexual initiation, condom use self-efficacy and intent to use a condom at next sex as changed from baseline to post-intervention between intervention and control participants. Selected primary outcomes are applicable to all study participants. DISCUSSION Currently there are no sexual and reproductive health programs designed specifically for American Indian youth that have been rigorously evaluated and found to have an evidence base. Respecting the Circle of Life is highly innovative by incorporating lesson delivery into a summer basketball camp and involving parents or other trusted adults in curriculum administration. If found successful, it will be the first evidence-based program for teen pregnancy prevention for American Indian youth and adolescents. TRIAL REGISTRATION Clinicaltrials.gov, NCT02904629 . Retrospectively registered on 23 September 2016.
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Affiliation(s)
- Lauren Tingey
- Johns Hopkins Center for American Indian Health, 415 N. Washington St, Baltimore, MD 21231 USA
| | - Rachel Chambers
- Johns Hopkins Center for American Indian Health, 415 N. Washington St, Baltimore, MD 21231 USA
| | - Novalene Goklish
- Johns Hopkins Center for American Indian Health, 415 N. Washington St, Baltimore, MD 21231 USA
- Johns Hopkins Center for American Indian Health, 308 Kuper St, Whiteriver, AZ 85941 USA
| | - Francene Larzelere
- Johns Hopkins Center for American Indian Health, 415 N. Washington St, Baltimore, MD 21231 USA
- Johns Hopkins Center for American Indian Health, 308 Kuper St, Whiteriver, AZ 85941 USA
| | - Angelita Lee
- Johns Hopkins Center for American Indian Health, 415 N. Washington St, Baltimore, MD 21231 USA
- Johns Hopkins Center for American Indian Health, 308 Kuper St, Whiteriver, AZ 85941 USA
| | - Rosemarie Suttle
- Johns Hopkins Center for American Indian Health, 415 N. Washington St, Baltimore, MD 21231 USA
- Johns Hopkins Center for American Indian Health, 308 Kuper St, Whiteriver, AZ 85941 USA
| | - Summer Rosenstock
- Johns Hopkins Center for American Indian Health, 415 N. Washington St, Baltimore, MD 21231 USA
| | - Kristin Lake
- Johns Hopkins Center for American Indian Health, 415 N. Washington St, Baltimore, MD 21231 USA
| | - Allison Barlow
- Johns Hopkins Center for American Indian Health, 415 N. Washington St, Baltimore, MD 21231 USA
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Sittner KJ, Hautala D. Aggressive delinquency among north American indigenous adolescents: Trajectories and predictors. Aggress Behav 2016; 42:274-86. [PMID: 26350331 PMCID: PMC4823165 DOI: 10.1002/ab.21622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 07/08/2015] [Accepted: 07/14/2015] [Indexed: 11/12/2022]
Abstract
Aggressive delinquency is a salient social problem for many North American Indigenous (American Indian, Canadian First Nations) communities, and can have deleterious consequences later in life. Yet there is a paucity of research on Indigenous delinquency. Group-based trajectory modeling is used to prospectively examine trajectories of aggressive delinquency over the course of adolescence using data from 646 Indigenous adolescents from a single culture, spanning the ages of 10-19. Five aggression trajectory groups were identified, characterized by different levels and ages of onset and desistence: non-offenders (22.1%), moderate desistors (19.9%), adolescent-limited offenders (22.2%), high desistors (16.7%), and chronic offenders (19.2%). Using the social development model of antisocial behavior, we selected relevant risk and protective factors predicted to discriminate among those most and least likely to engage in more aggressive behavior. Higher levels of risk (i.e., parent rejection, delinquent peers, substance use, and early dating) in early adolescence were associated with being in the two groups with the highest levels of aggressive delinquency. Positive school adjustment, the only significant protective factor, was associated with being in the lowest aggression trajectory groups. The results provide important information that could be used in developing prevention and intervention programs, particularly regarding vulnerable ages as well as malleable risk factors. Identifying those youth most at risk of engaging in higher levels of aggression may be key to preventing delinquency and reducing the over-representation of Indigenous youth in the justice system.
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Affiliation(s)
- Kelley J Sittner
- Department of Sociology, Oklahoma State University, Stillwater, Oklahoma
| | - Dane Hautala
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, Nebraska
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Chambers R, Tingey L, Mullany B, Parker S, Lee A, Barlow A. Exploring sexual risk taking among American Indian adolescents through protection motivation theory. AIDS Care 2016; 28:1089-96. [PMID: 27064364 DOI: 10.1080/09540121.2016.1164289] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This paper examines decision-making around sexual behavior among reservation-based American Indian youth. Focus group discussions were conducted with youth ages 13-19 years old. Through these discussions, we explored youth's knowledge, attitudes and behaviors related to sexual risk taking through the lens of the protection motivation theory to inform the adaptation of an evidence-based HIV prevention intervention. Findings suggest that condom use self-efficacy and HIV prevention knowledge is low, vulnerability to sexually transmitted infections is lacking and alcohol plays a significant role in sexual risk taking in this population. In addition, parental monitoring and peer influence may contribute to or protect against sexual risk taking. Results suggest that future HIV prevention interventions should be delivered to gender-specific peer groups, include a parental component, teach sexual health education and communication skills, integrate substance-use prevention, and work to remove stigma around obtaining and using condoms.
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Affiliation(s)
- Rachel Chambers
- a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Lauren Tingey
- a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Britta Mullany
- a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Sean Parker
- a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Angelita Lee
- a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - Allison Barlow
- a Johns Hopkins Center for American Indian Health, Department of International Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
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Suicide Among American Indian, Alaskan Native, and Canadian Aboriginal Youth: Advancing the Research Agenda. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2015. [DOI: 10.1080/00207411.1996.11449375] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Whitbeck LB, Armenta BE. Patterns of substance use initiation among Indigenous adolescents. Addict Behav 2015; 45:172-9. [PMID: 25679365 PMCID: PMC6014601 DOI: 10.1016/j.addbeh.2015.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 11/25/2014] [Accepted: 01/12/2015] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Les B Whitbeck
- Department of Sociology, University of Nebraska-Lincoln, United States.
| | - Brian E Armenta
- Department of Sociology, University of Nebraska-Lincoln, United States
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Manzo K, Tiesman H, Stewart J, Hobbs GR, Knox SS. A comparison of risk factors associated with suicide ideation/attempts in American Indian and White youth in Montana. Arch Suicide Res 2015; 19:89-102. [PMID: 25010183 DOI: 10.1080/13811118.2013.840254] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We examined racial/ethnic and gender-specific associations between suicide ideation/attempts and risky behaviors, sadness/hopelessness, and victimization in Montana American Indian and White youth using 1999-2011 Youth Risk Behavior Survey data. Logistic regression was used to calculate odds ratios and 95% confidence intervals in stratified racial/ethnic-gender groups. The primary results of this study show that although the American Indian youth had more statistically significant suicidal thoughts and attempts than the White youth, they had fewer statistically significant predictors compared to the White youth. Sadness/hopelessness was the strongest, and the only statistically significant, predictor of suicide ideation/attempts common across all four groups. The unhealthy weight control cluster was a significant predictor for the White youth and the American Indian/Alaska Native girls; the alcohol/tobacco/marijuana cluster was a significant predictor for the American Indian boys only. Results show important differences across the groups and indicate directions for future research targeting prevention and intervention.
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Affiliation(s)
- Karen Manzo
- a Department of Epidemiology , West Virginia University School of Public Health , Morgantown , West Virginia , USA
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15
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Skewes MC, Blume AW. Ethnic identity, drinking motives, and alcohol consequences among Alaska Native and non-Native college students. J Ethn Subst Abuse 2014; 14:12-28. [PMID: 25536236 DOI: 10.1080/15332640.2014.958641] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This research involves the examination of drinking motives, alcohol consequences, and ethnic identity in a sample of Native and non-Native college student drinkers in Alaska. Although more Alaska Native students are abstinent from alcohol compared to any other ethnic group, Native students who do drink experience greater alcohol consequences and dependence symptoms. Therefore, we attempted to examine the influence of ethnic identity on alcohol consequences in a diverse sample of Native and non-Native students in Alaska. Findings showed that drinking motives, as measured by the Drinking Motives Questionnaire (social, coping, enhancement, and conformity), significantly predicted alcohol consequences after controlling for frequency of monthly binge drinking. In addition, after controlling for depression, binge drinking, and drinking motives, one aspect of ethnic identity (Affirmation, Belonging, and Commitment) was significantly negatively related to alcohol consequences, whereas another aspect of ethnic identity (Ethnic Identity Search) was not. Taken together, these findings suggest that interventions for college student alcohol misuse that target Native students should be culturally grounded and focused on enhancing the Affirmation, Belonging, and Commitment to one's ethnic heritage and should address drinking motives, especially drinking to cope, as a way to reduce alcohol related harm.
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Snyder CW, Muensterer OJ, Sacco F, Safford SD. Paediatric trauma on the Last Frontier: an 11-year review of injury mechanisms, high-risk injury patterns and outcomes in Alaskan children. Int J Circumpolar Health 2014; 73:25066. [PMID: 25147771 PMCID: PMC4125707 DOI: 10.3402/ijch.v73.25066] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/07/2014] [Accepted: 07/08/2014] [Indexed: 11/23/2022] Open
Abstract
Background Paediatric trauma system development in Alaska is complicated by a vast geographic coverage area, wide regional variations in environment and culture, and a lack of available published data. Objective To provide a detailed description of paediatric trauma mechanisms, high-risk injury patterns and outcomes in Alaska. Design This retrospective study included all children aged 17 years or younger in the State of Alaska Trauma Registry database admitted with traumatic injury between 2001 and 2011. Each injury record was reviewed individually and assigned a mechanism based on Centers for Disease Control E-codes. Geographic definitions were based on existing Emergency Medical Services regions. Mechanisms were compared by geographic region, patient demographics, injury characteristics and outcome. Subgroup analysis of fatal injuries was performed to identify causes of death. Results Of 5,547 patients meeting inclusion criteria, the most common mechanisms of injury were falls (39%), motor vehicle collisions (10%) and all-terrain vehicle (ATV) accidents (9%). The overall case fatality rate was 2%. Mechanisms with the greatest risk of death were gunshot wounds (21%), pedestrians struck by motorized vehicles (9%) and motor vehicle collisions (5%). These 3 mechanisms accounted for 15% of injuries but 60% of deaths in the overall cohort. Injury patterns involving combined central nervous system (CNS) and torso injuries were unusual but especially lethal, occurring in 3% of patients but carrying a case fatality rate of 18%. Although the distribution of mechanisms was generally similar for each geographic region, ATV and snowmobile injuries were significantly more common in remote areas (23% remote vs. 7% non-remote, p < 0.0001). Conclusions Mechanisms of paediatric trauma in Alaska have widely varying impacts on outcome and show some variation by region. Highest-risk mechanisms include gunshot wounds and motorized vehicle-related accidents. Prevention efforts should give special attention to CNS injury prevention, ATV and snowmobile safety in remote areas, and optimization of management of multisystem trauma. Further studies should investigate predictors of outcome in greater detail.
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Affiliation(s)
- Christopher W Snyder
- Department of Surgery, 6th Medical Group, MacDill Air Force Base, Tampa, FL, USA ; Department of Surgery, The Children's Hospital, Providence Alaska Medical Center, Anchorage, AK, USA ; Division of Acute Care Surgery, University of South Florida, Tampa, FL, USA
| | - Oliver J Muensterer
- Division of Paediatric Surgery, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Frank Sacco
- Department of Surgery, Alaska Native Medical Center, Anchorage, AK, USA
| | - Shawn D Safford
- Division of Paediatric Surgery, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
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A comparison of self-reported physical health and health conditions of American Indian/Alaskan Natives to other college students. J Community Health 2014; 38:1090-7. [PMID: 23800957 DOI: 10.1007/s10900-013-9718-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
American Indian/Alaska Natives comprise a small portion of the general college student population, but often have the poorest health and wellness, as well as the highest dropout rates compared to any other race or ethnicity. Despite the well-documented issues this group faces in higher education, they are often ignored in studies due to their status as the minority within the minority, comprising only 0.8% of all college students in the US. This study examines the differences in college students' overall ratings of health across racial and ethnic groups, focusing specifically on the health and wellness of AI/AN students compared to their counterparts. This paper also investigates the physical health issues students experienced in the past 12 months and the health issues' impact on their academic achievement. Results showed that AI/AN students reported the lowest overall health ratings and the most health issues in the past year.
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Wong CA, Gachupin FC, Holman RC, MacDorman MF, Cheek JE, Holve S, Singleton RJ. American Indian and Alaska Native infant and pediatric mortality, United States, 1999-2009. Am J Public Health 2014; 104 Suppl 3:S320-8. [PMID: 24754619 PMCID: PMC4035880 DOI: 10.2105/ajph.2013.301598] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2013] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We described American Indian/Alaska Native (AI/AN) infant and pediatric death rates and leading causes of death. METHODS We adjusted National Vital Statistics System mortality data for AI/AN racial misclassification by linkage with Indian Health Service (IHS) registration records. We determined average annual death rates and leading causes of death for 1999 to 2009 for AI/AN versus White infants and children. We limited the analysis to IHS Contract Health Service Delivery Area counties. RESULTS The AI/AN infant death rate was 914 (rate ratio [RR] = 1.61; 95% confidence interval [CI] = 1.55, 1.67). Sudden infant death syndrome, unintentional injuries, and influenza or pneumonia were more common in AI/AN versus White infants. The overall AI/AN pediatric death rates were 69.6 for ages 1 to 4 years (RR = 2.56; 95% CI = 2.38, 2.75), 28.9 for ages 5 to 9 years (RR = 2.12; 95% CI = 1.92, 2.34), 37.3 for ages 10 to 14 years (RR = 2.22; 95% CI = 2.04, 2.40), and 158.4 for ages 15 to 19 years (RR = 2.71; 95% CI = 2.60, 2.82). Unintentional injuries and suicide occurred at higher rates among AI/AN youths versus White youths. CONCLUSIONS Death rates for AI/AN infants and children were higher than for Whites, with regional disparities. Several leading causes of death in the AI/AN pediatric population are potentially preventable.
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Affiliation(s)
- Charlene A Wong
- At the time of the study, Charlene A. Wong was with the Department of Pediatrics, Seattle Children's Hospital/University of Washington, Seattle. Francine C. Gachupin is with the Department of Family and Community Medicine, College of Medicine, University of Arizona, Tucson. Robert C. Holman is with the Division of High-Consequence Pathogens and Pathology, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Marian F. MacDorman is with the Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Hyattsville, MD. James E. Cheek is with the Public Health Program, Department of Family and Community Medicine, School of Medicine, University of New Mexico, Albuquerque. Steve Holve is with Indian Health Service (IHS), Tuba City Regional Healthcare Corporation, Tuba City, AZ. Rosalyn J. Singleton is with the Arctic Investigations Program, Division of Preparedness and Emerging Infections, National Center for Emerging and Zoonotic Infectious Diseases, CDC, Anchorage, AK
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Whitbeck LB, Sittner Hartshorn KJ, Crawford DM, Walls ML, Gentzler KC, Hoyt DR. Mental and substance use disorders from early adolescence to young adulthood among indigenous young people: final diagnostic results from an 8-year panel study. Soc Psychiatry Psychiatr Epidemiol 2014; 49:961-73. [PMID: 24488151 PMCID: PMC4031267 DOI: 10.1007/s00127-014-0825-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 01/17/2014] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Les B. Whitbeck
- Department of Sociology, 739 Oldfather Hall, University of Nebraska-Lincoln, Lincoln, NE 68588-0324, USA
| | | | - Devan M. Crawford
- Bureau of Sociological Research, 210 Benton Hall, University of Nebraska-Lincoln, Lincoln, NE 68588-0623, USA
| | - Melissa L. Walls
- Department of Biobehavioral Health and Population Sciences, 235 SMed, University of Minnesota Medical School, Duluth, 1035 University Drive, Duluth, MN 55812-3031, USA
| | - Kari C. Gentzler
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, NE 68588-0623, USA
| | - Dan R. Hoyt
- College of Arts and Sciences, 1223 Oldfather Hall, University of Nebraska-Lincoln, Lincoln, NE 68588-0312, USA
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Extracurricular activity availability and participation and substance use among American Indian adolescents. J Youth Adolesc 2014; 43:454-69. [PMID: 24435768 DOI: 10.1007/s10964-013-0088-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 12/26/2013] [Indexed: 10/25/2022]
Abstract
School-based extracurricular activity involvement has been associated with lower levels of substance use among adolescents from various populations; however, these associations have only been slightly examined among American Indian (AI) adolescents. Building from various theoretical perspectives, it was hypothesized that AI adolescents' perceived access to and the intensity (i.e., frequency) of participation in extracurricular activities would be associated with lower substance use and less engagement in risky substance use behaviors (i.e., being drunk or high at school, riding/driving with an intoxicated driver, and selling drugs). The moderating influences of sex, age, reservation residence, and metropolitan status also were examined. Data from the 2010 Arizona Youth Survey were analyzed for 5,701 8th, 10th, and 12th grade AI adolescents (49.1% female). The expected protective effects of extracurricular participation were demonstrated, such that high levels of perceived availability and intensity of participation consistently predicted low levels of all outcomes. Some of these associations were moderated by one or more demographic factors, with unique patterns emerging for each behavior. Ultimately, the findings suggest that AI adolescents benefit from the availability of extracurricular activities and intensity of participation in them, but the degree of the effect is contingent upon other individual and contextual characteristics.
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Gilder DA, Luna JA, Roberts J, Calac D, Grube JW, Moore RS, Ehlers CL. Usefulness of a survey on underage drinking in a rural American Indian community health clinic. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2013; 20:1-26. [PMID: 23824640 DOI: 10.5820/aian.2002.2013.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This study examined the usefulness of a survey on underage drinking in a rural American Indian community health clinic. One hundred ninety-seven youth (90 male, 107 female; age range 8-20 years) were recruited from clinic waiting rooms and through community outreach. The study revealed that the usefulness of the survey was twofold: Survey results could be used by clinic staff to screen for underage drinking and associated problems in youth served by the clinic, and the process of organizing, evaluating, and implementing the survey results accomplished several important goals of community-based participatory research.
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Affiliation(s)
- David A Gilder
- Department of Molecular and Integrative Neurosciences, The Scripps Research Institute, 10550 North Torrey Pines Road, SP30-1501, La Jolla, CA 92037, USA
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Whitesell NR, Beals J, Crow CB, Mitchell CM, Novins DK. Epidemiology and etiology of substance use among American Indians and Alaska Natives: risk, protection, and implications for prevention. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2013; 38:376-82. [PMID: 22931069 DOI: 10.3109/00952990.2012.694527] [Citation(s) in RCA: 121] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The epidemiology and etiology of substance use and disorder in American Indian and Alaska Native (AI/AN) communities have received increasing attention over the past 25 years and accumulating evidence provides important insights into substance use patterns in these populations. OBJECTIVES AND METHODS We provide a descriptive sketch of the AI/AN population in the United States today, present a brief review of the literature on the epidemiology and etiology of substance use within these populations, and discuss key implications of this literature for prevention efforts. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Patterns of alcohol use and abuse in AI/AN populations are complex and vary across cultural groups, but alcohol clearly impacts both physical health and mental health within these communities. Tobacco use - and associated health consequences - is typically higher in these populations than among other US groups, although significant variation across Native communities is apparent here as with alcohol. Evidence regarding drug use and disorder is less extensive and thus less conclusive, but evidence demonstrates higher rates of use as well. Etiological explanations for substance use and disorder cut across individual characteristics (e.g., genetics) or experiences (e.g., exposure to trauma), to social contexts (e.g., family disruption), and to cultural factors (e.g., historical trauma). Protective factors likely cut across these multiple levels as well and deserve more focused attention for informing prevention efforts. The development of effective prevention strategies, built through collaboration between researchers and Native communities, drawing from the wisdom of both, is a high priority.
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Affiliation(s)
- Nancy Rumbaugh Whitesell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Denver , Aurora, CO 80045, USA.
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Whitbeck LB, Walls ML, Welch ML. Substance abuse prevention in American Indian and Alaska Native communities. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2013; 38:428-35. [PMID: 22931077 DOI: 10.3109/00952990.2012.695416] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In this article we review three categories of American Indian/Alaska Native (AIAN) substance abuse prevention programs: (1) published empirical trials; (2) promising programs published and unpublished that are in the process of development and that have the potential for empirical trials; and (3) examples of innovative grassroots programs that originate at the local level and may have promise for further development. AIAN communities are taking more and more independent control of substance abuse prevention. We point out that European American prevention scientists are largely unaware of the numerous grassroots prevention work going on in AIAN communities and urge a paradigm shift from adapting European American prevention science "best practices" to creating cultural "best practices" by working from inside AIAN communities.
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Affiliation(s)
- Les B Whitbeck
- Department of Sociology, University of Nebraska-Lincoln , Lincoln, NE , USA.
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Ginsburg GS, Barlow A, Goklish N, Hastings R, Baker EV, Mullany B, Tein JY, Walkup J. Postpartum Depression Prevention for Reservation-Based American Indians: Results from a Pilot Randomized Controlled Trial. CHILD & YOUTH CARE FORUM 2012; 41:229-245. [PMID: 22701296 PMCID: PMC3373958 DOI: 10.1007/s10566-011-9161-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND: Postpartum depression is a devastating condition that affects a significant number of women and their offspring. Few preventive interventions have targeted high risk youth, such as American Indians (AIs). OBJECTIVE: To evaluate the feasibility of a depression prevention program for AI adolescents and young adults. METHODS: Expectant AI women (mean age = 18.15; N = 47) were randomized (1:1) to either the Living in Harmony program (LIH, an 8 lesson cognitive-behaviorally based program) or an Educational-Support program (ES, an 8 lesson education program). Both interventions were delivered by AI paraprofessionals. Adolescents were evaluated during their pregnancy at baseline, at post-intervention, and at 4, 12, and 24 weeks postpartum. The primary outcome measure was the Center for Epidemiological Studies-Depression scale (CES-D). Additional measures of depression included the onset of major depressive disorder (MDD; assessed via computerized diagnostic interview) and the Edinburgh Postpartum Depression Scale (EPDS). Secondary outcomes included changes in mothers' global functioning and social support. RESULTS: At all post intervention assessments, mothers in both groups showed similar reductions in depressive symptoms and similar rates of MDD (0 and 6% in LIH and ES respectively). Both groups of participants also showed similar improvements in global functioning. No changes in either group were found on the measure of social support. CONCLUSIONS: Findings suggest that both paraprofessional-delivered interventions may reduce symptoms of depression among AIs. Replication with a larger sample, a usual care control condition, blinded evaluators, and a longer follow-up is needed.
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Affiliation(s)
- Golda S. Ginsburg
- Department of Psychiatry and Behavioral Sciences, Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allison Barlow
- Center for American Indian Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Novalene Goklish
- Center for American Indian Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Ranelda Hastings
- Center for American Indian Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Elena Varipatis Baker
- Center for American Indian Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Britta Mullany
- Center for American Indian Health, Johns Hopkins University School of Public Health, Baltimore, MD, USA
| | - Jenn-Yun Tein
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - John Walkup
- Department of Psychiatry, Weill Cornell Medical College and New York-Presbyterian Hospital, New York, NY, USA
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Bombak AE, Bruce SG. Self-rated health and ethnicity: focus on indigenous populations. Int J Circumpolar Health 2012; 71:18538. [PMID: 22663937 PMCID: PMC3417472 DOI: 10.3402/ijch.v71i0.18538] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 03/21/2012] [Accepted: 03/23/2012] [Indexed: 11/17/2022] Open
Abstract
Objectives Self-rated health (SRH) is a commonly used measure in surveys to assess general health status or health-related quality of life. Differences have been detected in how different ethnic groups and nationalities interpret the SRH measure and assess their health. This review summarizes the research conducted on SRH within and between ethnic groups, with a focus on indigenous groups. Study design and methods A search of published academic literature on SRH and ethnicity, including a comprehensive review of all relevant indigenous research, was conducted using PubMed and summarized. Results A wide variety of research on SRH within ethnic groups has been undertaken. SRH typically serves as an outcome measure. Minority respondents generally rated their health worse than the dominant population. Numerous culturally-specific determinants of SRH have been identified. Cross-national and cross-ethnicity comparisons of the associations of SRH have been conducted to assess the validity of SRH. While SRH is a valid measure within a variety of ethnicities, differences in how SRH is assessed by ethnicities have been detected. Research in indigenous groups remains generally under-represented in the SRH literature. Conclusions These results suggest that different ethnic groups and nationalities vary in SRH evaluations, interpretation of the SRH measure, and referents employed in rating health. To effectively assess and redress health disparities and establish culturally-relevant and effective health interventions, a greater understanding of SRH is required, particularly among indigenous groups, in which little research has been conducted.
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Affiliation(s)
- Andrea E Bombak
- Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
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Mota N, Elias B, Tefft B, Medved M, Munro G, Sareen J. Correlates of suicidality: investigation of a representative sample of Manitoba First Nations adolescents. Am J Public Health 2012; 102:1353-61. [PMID: 22676500 DOI: 10.2105/ajph.2011.300385] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined individual, friend or family, and community or tribe correlates of suicidality in a representative on-reserve sample of First Nations adolescents. METHODS Data came from the 2002-2003 Manitoba First Nations Regional Longitudinal Health Survey of Youth. Interviews were conducted with adolescents aged 12 to 17 years (n=1125) from 23 First Nations communities in Manitoba. We used bivariate logistic regression analyses to examine the relationships between a range of factors and lifetime suicidality. We conducted sex-by-correlate interactions for each significant correlate at the bivariate level. A multivariate logistic regression analysis identified those correlates most strongly related to suicidality. RESULTS We found several variables to be associated with an increased likelihood of suicidality in the multivariate model, including being female, depressed mood, abuse or fear of abuse, a hospital stay, and substance use (adjusted odds ratio range=2.43-11.73). Perceived community caring was protective against suicidality (adjusted odds ratio=0.93; 95% confidence interval=0.88, 0.97) in the same model. CONCLUSIONS Results of this study may be important in informing First Nations and government policy related to the implementation of suicide prevention strategies in First Nations communities.
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Affiliation(s)
- Natalie Mota
- University of Manitoba, Winnipeg, Manitoba, Canada
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Scheel KR, Prieto LR, Biermann J. American Indian college student suicide: risk, beliefs, and help-seeking preferences. COUNSELLING PSYCHOLOGY QUARTERLY 2011. [DOI: 10.1080/09515070.2011.638444] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Broderstad AR, Eliassen BM, Melhus M. Prevalence of self-reported suicidal thoughts in SLiCA. The Survey of Living Condition in the Arctic (SLiCA). Glob Health Action 2011; 4:GHA-4-10226. [PMID: 22114568 PMCID: PMC3222929 DOI: 10.3402/gha.v4i0.10226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 10/29/2011] [Accepted: 10/30/2011] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES The Survey of Living Condition in the Arctic (SLiCA) is an international research project on health and living conditions among Arctic indigenous peoples. The main objective of this article is to examine the prevalence of self-reported suicide thoughts among the study population in Alaska, Greenland, Sweden and Norway. STUDY DESIGN Population-based survey. METHODS Indigenous participants aged 16 years (15 years in Greenland) and older living in traditional settlement regions in Alaska, Sweden and Norway and across the entire Greenland were invited to participate. Data were collected in three periods: in Alaska from January 2002 to February 2003, in Greenland from December 2003 to August 2006, in Sweden from spring 2004 to 2006 and in Norway in 2003 and from June 2006 to June 2008. The principal method in SLiCA was standardised face-to-face interviews using a questionnaire. A questionnaire had among other things, questions about health, education, traditional activities, ethnicity and suicidal thoughts. RESULTS Information about suicidal thoughts, gender and age were available in 2,099 participants between the ages of 16 and 84 from Alaska, Greenland, Sweden and Norway. Greenland had the highest rates of suicidal thoughts when adjusting for age and gender (p=0.003). When stratifying on age and gender, significant differences across countries were only found for females in the two youngest age groups. Differences in suicidal thoughts across countries could partly be explained by educational level. CONCLUSION Swedish respondents had less suicidal thoughts than those in any other countries. In the future, analyses of suicidal thoughts should take socioeconomic status into account as well as self-reported health, depression and anxiety.
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Affiliation(s)
- Ann Ragnhild Broderstad
- Department of Community Medicine, Centre for Sami Health Research, University of Tromsø, Norway.
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Gilder DA, Luna JA, Calac D, Moore RS, Monti PM, Ehlers CL. Acceptability of the use of motivational interviewing to reduce underage drinking in a Native American community. Subst Use Misuse 2011; 46:836-42. [PMID: 21210721 PMCID: PMC3075848 DOI: 10.3109/10826084.2010.541963] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Thirty-six Native American tribal leaders and members living on contiguous rural southwest California reservations were surveyed concerning their view of the acceptability of a motivational interviewing (MI) intervention with youth (aged 8-18 years) who are drinking and their families. The results suggest the following: (1) a substantial proportion of reservation youth would be willing to accept MI for behavior change; (2) relatively few are actually ready to change; (3) most reservation youth are in the precontemplation stage of change; and (4) MI may be well suited as an intervention to prevent underage drinking in that population. The study's limitations are noted.
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Affiliation(s)
- David A Gilder
- Molecular and Integrative Neurosciences Department, The Scripps Research Institue, La Jolla, California 92037, USA
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Effect of exposure to suicidal behavior on suicide attempt in a high-risk sample of offspring of depressed parents. J Am Acad Child Adolesc Psychiatry 2010; 49:114-21. [PMID: 20215933 PMCID: PMC2915586 DOI: 10.1097/00004583-201002000-00005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Exposure to suicidal behavior in peers and relatives is thought to increase risk for suicidal behavior in vulnerable individuals, possibly as a result of imitation or modeling. This study examines exposure to suicidal behavior and likelihood of suicide attempt in a high-risk cohort of offspring of a depressed parent. METHOD A total of 449 offspring of 255 probands with a mood disorder were enrolled in a family study. Probands and offspring were assessed for psychopathology and suicide attempt history, and offspring for suicide exposure. Generalized estimating equations (GEE) and generalized least squares models were used to compare suicide attempt history in exposed and nonexposed offspring as well as characteristics of exposure in exposed offspring suicide attempters and exposed nonattempters. GEE was used to compare exposure occurring before first attempt in attempter offspring and exposure occurring before the same age in matched nonattempter offspring. RESULTS Offspring reporting exposure to suicidal behavior were four times more likely to report a lifetime suicide attempt compared with unexposed offspring, controlling for age. Suicide attempt status was not associated with age at first exposure, total number or degree (attempt or threat) of exposures, or relationship. Analysis of exposure occurring before age at first suicide attempt found no association between exposure and suicide attempt. CONCLUSIONS Offspring exposed to suicidal behavior are more likely to report a lifetime suicide attempt than nonexposed offspring. However, when examining the temporal sequence of exposure and attempt, the association is no longer significant, suggesting that imitation is not sufficient explanation.
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Ehlers CL, Phillips E, Gizer IR, Gilder DA, Wilhelmsen KC. EEG spectral phenotypes: heritability and association with marijuana and alcohol dependence in an American Indian community study. Drug Alcohol Depend 2010; 106:101-10. [PMID: 19748744 PMCID: PMC2815012 DOI: 10.1016/j.drugalcdep.2009.07.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 07/21/2009] [Accepted: 07/22/2009] [Indexed: 11/30/2022]
Abstract
Native Americans have some of the highest rates of marijuana and alcohol use and abuse, yet neurobiological measures associated with dependence on these substances in this population remain unknown. The present investigation evaluated the heritability of spectral characteristics of the electroencephalogram (EEG) and their correlation with marijuana and alcohol dependence in an American Indian community. Participants (n=626) were evaluated for marijuana (MJ) and alcohol (ALC) dependence, as well as other psychiatric disorders. EEGs were collected from six cortical sites and spectral power determined in five frequency bands (delta 1.0-4.0 Hz, theta 4.0-7.5 Hz, alpha 7.5-12.0 Hz, low beta 12.0-20.0 Hz and high beta/gamma 20-50 Hz). The estimated heritability (h(2)) of the EEG phenotypes was calculated using SOLAR, and ranged from 0.16 to 0.67. Stepwise linear regression was used to detect correlations between MJ and ALC dependence and the spectral characteristics of the EEG using a model that took into account: age, gender, Native American Heritage (NAH) and a lifetime diagnosis of antisocial personality and/or conduct disorder (ASPD/CD). Increases in spectral power in the delta frequency range, were significantly correlated with gender (p<0.001) and marijuana dependence (p<0.003). Gender, age, NAH and ASPD/CD were all significantly (p<0.001) correlated with theta, alpha and beta band power, whereas alcohol dependence (p<0.01), gender (p<0.001), and ASPD/CD (p<0.001) were all correlated with high beta/gamma band power. These data suggest that the traits of EEG delta and high beta/gamma activity are correlated with MJ dependence and alcohol dependence, respectively, in this community sample of Native Americans.
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Affiliation(s)
- Cindy L Ehlers
- Department of Molecular and Integrative Neurosciences, The Scripps Research Institute, 10550 North Torrey Pines Road, La Jolla, CA 92037, USA.
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Randomized controlled trial of a paraprofessional-delivered in-home intervention for young reservation-based American Indian mothers. J Am Acad Child Adolesc Psychiatry 2009; 48:591-601. [PMID: 19454915 PMCID: PMC6432645 DOI: 10.1097/chi.0b013e3181a0ab86] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the efficacy of a paraprofessional-delivered, home-visiting intervention among young, reservation-based American Indian (AI) mothers on parenting knowledge, involvement, and maternal and infant outcomes. METHOD From 2002 to 2004, expectant AI women aged 12 to 22 years (n = 167) were randomized (1:1) to one of two paraprofessional-delivered, home-visiting interventions: the 25-visit "Family Spirit" intervention addressing prenatal and newborn care and maternal life skills (treatment) or a 23-visit breast-feeding/nutrition education intervention (active control). The interventions began during pregnancy and continued to 6 months postpartum. Mothers and children were evaluated at baseline and 2, 6, and 12 months postpartum. Primary outcomes included changes in mothers' parenting knowledge and involvement. Secondary outcomes included infants' social and emotional behavior; the home environment; and mothers' stress, social support, depression, and substance use. RESULTS Participants were mostly teenaged, first-time, unmarried mothers living in reservation communities. At 6 and 12 months postpartum, treatment mothers compared with control mothers had greater parenting knowledge gains, 13.5 (p < .0001) and 13.9 (p < .0001) points higher, respectively (100-point scale). At 12 months postpartum, treatment mothers reported their infants to have significantly lower scores on the externalizing domain (beta = -.17, p < .05) and less separation distress in the internalizing domain (beta = -.17, p < .05). No between-group differences were found for maternal involvement, home environment, or mothers' stress, social support, depression, or substance use. CONCLUSIONS This study supports the efficacy of the paraprofessional-delivered Family Spirit home-visiting intervention for young AI mothers on maternal knowledge and infant behavior outcomes. A longer, larger study is needed to replicate results and evaluate the durability of child behavior outcomes.
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Pile Sorts, A Cognitive Anthropological Model of Drug and AIDS Risks for Navajo Teenagers: Assessment of a New Evaluation Tool. ACTA ACUST UNITED AC 2008. [DOI: 10.1300/j023v07n03_03] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Devries KM, Free CJ, Morison L, Saewyc E. Factors associated with the sexual behavior of Canadian Aboriginal young people and their implications for health promotion. Am J Public Health 2008; 99:855-62. [PMID: 18703435 DOI: 10.2105/ajph.2007.132597] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined factors associated with having ever had sex, having more than 1 lifetime sexual partner, and condom nonuse at last incident of sexual intercourse among Canadian Aboriginal young people. METHODS We conducted a secondary analysis of data from the 2003 British Columbia Adolescent Health Survey, a cross-sectional survey of young people in grades 7 through 12. RESULTS Of 1140 young Aboriginal men, 34% had ever had sex; of these, 63% had had more than 1 sexual partner, and 21% had not used a condom at their last incident of sexual intercourse. Of 1336 young Aboriginal women, 35% had ever had sex; of these, 56% had had more than 1 sexual partner, and 41% had not used a condom at their last incident of sexual intercourse. Frequent substance use, having been sexually abused, and having lived on a land reservation were strongly associated with sexual behavior outcomes. Feeling connected to family was strongly associated with increased condom use. CONCLUSIONS Sexual behavior change interventions for Aboriginal young people must move beyond the individual and incorporate interpersonal and structural dimensions. Interventions to reduce substance use and sexual abuse and promote feelings of family connectedness in this population should be explored. Young people living on land reserves need special attention.
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Affiliation(s)
- Karen M Devries
- Health Policy Unit, London School of Hygiene and Tropical Medicine, Keppel St, WC1E 7HT London, UK.
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Abstract
The evidence to date suggests that suicide modeling is a real phenomenon, although of a smaller effect size than other psychiatric and psychosocial risk factors for adolescent suicide. Multiple lines of inquiry provide converging evidence, including studies on suicide clusters, media influence on suicide (particularly coverage of nonfictional suicides), and peer influence on suicidality. Despite variations in study setting and methodology, the body of literature is consistent with a modeling hypothesis. Although advances in documentation of suicide modeling have been made over the past decade, we are still confronted by unresolved issues regarding the underlying mechanisms. Prevention and postvention strategies can be optimized to avert modeling of suicidal behavior only once research addresses the complexities and uncertainties of this phenomenon.
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Affiliation(s)
- Beverly J Insel
- Columbia University, Division of Child & Adolescent Psychiatry (College of Physicians and Surgeons), New York, NY, USA
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Willmon-Haque S, BigFoot SD. Violence and the Effects of Trauma on American Indian and Alaska Native Populations. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/10926790801982410] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ehlers CL, Gilder DA, Phillips E. P3 components of the event-related potential and marijuana dependence in Southwest California Indians. Addict Biol 2008; 13:130-42. [PMID: 18201292 DOI: 10.1111/j.1369-1600.2007.00091.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Native Americans have some of the highest rates of marijuana use and abuse, yet neurobiological measures associated with addiction to marijuana in this population remain unknown. The present investigation evaluated associations between the P350 and P450 components of the event-related potential (ERP) elicited by affective stimuli, and marijuana dependence in a population of Southwest California (SWC) Indian adults. Three hundred and seventeen participants with a mean age of 30 years who were free of major Axis I and psychiatric diagnoses and antisocial personality disorder were categorized as: (1) no marijuana use disorders or other drug dependence diagnoses; (2) marijuana dependence and no other drug dependence diagnoses; and (3) marijuana dependence and other drug dependence diagnoses. ERPs were collected using a facial discrimination task that generated a late positive component with two peaks at approximately P350 and P450 milliseconds. Multivariate analyses of variance was used to detect associations between the two component peaks and the three participant groups taking into consideration age, gender and the presence of a lifetime diagnosis of alcohol dependence. Increases in the latency of both the P350 and P450 component peaks were found to be associated with the diagnosis of marijuana dependence and marijuana dependence co-morbid with other drug dependence. Women appeared to be more impacted than men are. A diagnosis of marijuana dependence was not associated with any changes in late component amplitudes. Taken together these studies suggest that marijuana dependence may be associated with delays in the evaluation and identification of emotional stimuli in SWC Indians.
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Affiliation(s)
- Cindy L Ehlers
- Department of Molecular and Integrative Neurosciences and Molecular and Experimental Medicine, The Scripps Research Institute, La Jolla, CA 92037, USA.
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Regular Tobacco Use Among American Indian and Alaska Native Adolescents. J Ethn Subst Abuse 2008; 6:143-53. [DOI: 10.1300/j233v06n03_06] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Sarche M, Spicer P. Poverty and health disparities for American Indian and Alaska Native children: current knowledge and future prospects. Ann N Y Acad Sci 2008; 1136:126-36. [PMID: 18579879 PMCID: PMC2567901 DOI: 10.1196/annals.1425.017] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This report explores the current state of knowledge regarding inequalities and their effect on American Indian and Alaska Native children, underscoring gaps in our current knowledge and the opportunities for early intervention to begin to address persistent challenges in young American Indian and Alaska Native children's development. This overview documents demographic, social, health, and health care disparities as they affect American Indian and Alaska Native children, the persistent cultural strengths that must form the basis for any conscientious intervention effort, and the exciting possibilities for early childhood interventions.
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Affiliation(s)
- Michelle Sarche
- University of Colorado Denver, American Indian and Alaska Native Programs, mail stop F800, PO Box 6508, Aurora, Co 80045, USA.
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LaFromboise TD, Medoff L, Lee CC, Harris A. Psychosocial and Cultural Correlates of Suicidal Ideation Among American Indian Early Adolescents on a Northern Plains Reservation. RESEARCH IN HUMAN DEVELOPMENT 2007. [DOI: 10.1080/15427600701481020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tam CK, Ng CF, Yu CM, Young BW. Disordered eating attitudes and behaviours among adolescents in Hong Kong: prevalence and correlates. J Paediatr Child Health 2007; 43:811-7. [PMID: 17803673 DOI: 10.1111/j.1440-1754.2007.01195.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To study the prevalence of disordered eating attitudes and behaviours among adolescents in Hong Kong and to examine the socio-demographic and behavioural correlates. METHODS Three secondary schools with different academic performance were selected from the Eastern District of Hong Kong. A total of 2382 students enrolled in Forms 1-7 at the three schools completed a specially designed questionnaire. The questionnaire contained questions on socio-demographic information, body weight satisfaction, exposure to mass media, health behaviours as well as the Eating Attitudes Test - 26 (EAT-26). Data were analysed using Student's t-test, chi2 analysis and multivariate logistic regression models. RESULTS Disordered eating (EAT score > or =20) was present in 52 (3.9%) adolescent boys and 68 (6.5%) adolescent girls. The youngest case was only 11 years old. A high degree of body weight dissatisfaction was shared by our adolescents. Teenage girls, overweight youths and those with poor academic performance were at increased risk of having disordered eating. Strong associations were found between disordered eating and other health-compromising behaviours including smoking, alcohol and soft drug use, delinquent behaviours, suicidal ideation and self-harm behaviours. Exposure to entertainment, beauty and youth magazines was positively related to disordered eating. CONCLUSIONS Disordered eating is prevalent among adolescents in Hong Kong. It remains a significant public health challenge to our community. Prevention programmes targeting youths at the greatest risk should be considered.
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Affiliation(s)
- Carmen Km Tam
- Department of Paediatrics and Adolescent Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong.
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Neumark-Sztainer DR, Wall MM, Haines JI, Story MT, Sherwood NE, van den Berg PA. Shared risk and protective factors for overweight and disordered eating in adolescents. Am J Prev Med 2007; 33:359-369. [PMID: 17950400 DOI: 10.1016/j.amepre.2007.07.031] [Citation(s) in RCA: 367] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2007] [Revised: 04/27/2007] [Accepted: 07/10/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Weight-related problems, including obesity, eating disorders, and disordered eating, are major public health problems in adolescents. The identification of shared risk and protective factors for these problems can guide the development of relevant interventions to a broad spectrum of weight-related problems. This paper examines the prevalence and co-occurrence of overweight, binge eating, and extreme weight-control behaviors (vomiting, diet pills, laxatives, and diuretics) in adolescents and identifies shared risk and protective factors from within the socioenvironmental, personal, and behavioral domains for these three adverse weight-related outcomes. METHODS Data were collected at Time 1 (1998-1999) and Time 2 (2003-2004) on 2516 adolescents participating in Project EAT (Eating Among Teens). Data were analyzed in 2006-2007. RESULTS Weight-related problems were identified in 44% of the female subjects and 29% of the male subjects. About 40% of overweight girls and 20% of overweight boys engaged in at least one of the disordered eating behaviors (binge eating and/or extreme weight control). Weight-teasing by family, personal weight concerns, and dieting/unhealthy weight-control behaviors strongly and consistently predicted overweight status, binge eating, and extreme weight-control behaviors after 5 years. Family meals, regular meal patterns, and media exposure to messages about weight loss were also associated with weight-related outcomes, although the strength and consistency of associations differed across outcomes and gender. CONCLUSIONS Weight-specific socioenvironmental, personal, and behavioral variables are strong and consistent predictors of overweight status, binge eating, and extreme weight-control behaviors later in adolescence. These findings support the need for research to determine if decreasing weight-related social pressures, personal weight concerns, and unhealthy weight-control behaviors can contribute to reductions in obesity in children and adolescents.
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Affiliation(s)
- Dianne R Neumark-Sztainer
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, 1300 South Second Street, Minneapolis, MN 55454, USA.
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Ehlers CL, Slutske WS, Gilder DA, Lau P. Age of first marijuana use and the occurrence of marijuana use disorders in Southwest California Indians. Pharmacol Biochem Behav 2007; 86:290-6. [PMID: 16930685 DOI: 10.1016/j.pbb.2006.07.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2006] [Revised: 07/17/2006] [Accepted: 07/18/2006] [Indexed: 11/27/2022]
Abstract
In several national surveys a younger age of substance usage has been associated with a higher likelihood of the development of dependence. Some studies have suggested that age at first use is primarily an environmentally driven variable, whereas others suggest that it may be partially mediated by a general vulnerability to exhibit problem behaviors. Although Native Americans, overall, have the highest prevalence of substance dependence of any US ethnic group, the relationship of age of first marijuana use on the development of dependence in Native American populations is relatively unknown. Demographic information and DSM-III-R diagnoses were obtained from 525 Southwest California Indian adults residing on contiguous reservations. Multinomial logistic regression was used to investigate the relationship between age of first use and marijuana use disorders. Early marijuana use was found to be strongly associated with abuse and dependence in this population, even in the presence of several other risk factors including externalizing diagnoses. These data suggest that effective environmental prevention efforts at reducing early marijuana use may be an important strategy to lower the prevalence of use disorders in this high risk population.
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Affiliation(s)
- Cindy L Ehlers
- The Scripps Research Institute (TSRI), Department of Neuropharmacology (CVN-14), 10550 N. Torrey Pines Rd, La Jolla, CA 92037, USA.
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Co-Morbid Alcohol/Other Drug Abuse/Dependence and Psychiatric Disorders in Adolescent American Indian and Alaska Natives. ALCOHOLISM TREATMENT QUARTERLY 2007. [DOI: 10.1300/j020v24n04_02] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Ehlers CL, Phillips E, Finnerman G, Gilder D, Lau P, Criado J. P3 components and adolescent binge drinking in Southwest California Indians. Neurotoxicol Teratol 2007; 29:153-63. [PMID: 17196788 DOI: 10.1016/j.ntt.2006.11.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2006] [Revised: 11/29/2006] [Accepted: 11/29/2006] [Indexed: 11/27/2022]
Abstract
In adolescence, consuming a large number of drinks over a short interval of time (e.g. binging) is not an uncommon occurrence. Since adolescence is an important neurodevelopmental period, the effect of binge drinking on brain and behavior has become a significant health concern. The present study evaluated event-related potentials (ERPs) in young adult Southwest California Indians who had a history of binge drinking during their adolescence. One hundred twenty five participants who were currently 18-25 yrs of age who were free of Axis I psychiatric diagnoses were categorized as: 1) reporting no binge drinking during adolescence (>5 drinks per occasion before age 18) or drug dependence diagnoses 2) reporting binge drinking during adolescence with no drug dependence diagnoses 3) reporting binge drinking during adolescence and drug dependence diagnoses. ERPs were collected using a facial discrimination task. Adolescent alcohol and drug exposure was found to be associated with decreases in the latency of an early P3 component (P350). Decreases in a later component amplitude (P450) were also found in young adults exposed to alcohol, and those exposed to alcohol and drugs. However, that finding appears to be a combined result of predisposing factors such as family history of alcoholism and presence of other externalizing diagnoses. Taken together these preliminary studies suggests that adolescent binge drinking may result in a decreases in P3 component latencies and amplitudes perhaps reflecting a loss or delay in the development of inhibitory brain systems.
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Affiliation(s)
- Cindy L Ehlers
- Department of Molecular and Integrative Neurosciences, The Scripps Research Institute, 10550 N. Torrey Pines Rd., La Jolla, CA 92037, USA.
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Yen CF, Hsu CC, Liu SC, Huang CF, Ko CH, Yen JY, Cheng CP. Relationships among mental health status, social context, and demographic characteristics in Taiwanese aboriginal adolescents: a structural equation model. Psychiatry Clin Neurosci 2006; 60:575-83. [PMID: 16958941 DOI: 10.1111/j.1440-1819.2006.01561.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The purposes of this study were to examine the relationships among mental health status, demographic characteristics, and social contexts, including family conflict and support, connectedness to school, and affiliation with peers who exhibit delinquent behavior and who use substances, among Taiwanese aboriginal adolescents. A total of 251 aboriginal junior high school students in an isolated mountainous area of southern Taiwan were recruited, and the relationships among mental health status, demographic characteristics, and social contexts among them were examined using a structural equation model (SEM). The SEM revealed that family conflict and support had direct influences on mental health status and connectedness to school. Family conflict had a direct relationship with affiliation with peers who use substances, and family conflict and support were both indirectly linked with affiliation with peers who exhibit delinquent behavior and who used substances; these were mediated by a poor mental health status. Female and older age were directly linked with a poor mental health status and were indirectly linked with a greater number of peers who exhibit delinquent behavior and who use substances via the poor mental health status. Disruptive parenting was directly linked with affiliation with peers who use substances. The authors suggest that those who devise strategies to improve aboriginal adolescents' mental health and discourage substance use should take these relationships among mental health, demographic characteristics, and social contexts into account.
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Affiliation(s)
- Cheng-Fang Yen
- Department of Psychiatry, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Spein AR, Sexton H, Kvernmo SE. Longitudinal Drinking Patterns in Indigenous Sami and Non-Indigenous Youth in Northern Norway. J Ethn Subst Abuse 2006; 5:103-17. [PMID: 17135170 DOI: 10.1300/j233v05n03_06] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Drinking patterns among indigenous Sami and non-Sami adolescents in northern Norway were explored. Longitudinal data were collected in 1994/95 among 2,950 high school students (RR: 85%) and in 1997/98 among 1,510 follow-ups (RR: 57%). Longitudinally, Sami had significantly lower drinking rates for all measures. An increase in 30-day drinkers occurred during the follow-up period: 23% in Sami and 19% in non-Sami. Sami reported higher paternal abstinence. Sami drank more often in public places. Sami reported more worries from friends and family about their drinking. The lower drinking rates in Sami relative to majority adolescents contrast with findings among indigenous peers elsewhere, but corresponds with the lower parental drinking rates.
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Affiliation(s)
- Anna R Spein
- Centre for Sami Health Research, Department of Community Medicine, Faculty of Medicine, University of Tromsø, N-9037 Tromsø, Norway,
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48
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Silviken A, Kvernmo S. Suicide attempts among indigenous Sami adolescents and majority peers in Arctic Norway: prevalence and associated risk factors. J Adolesc 2006; 30:613-26. [PMID: 16876860 DOI: 10.1016/j.adolescence.2006.06.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2005] [Revised: 04/06/2006] [Accepted: 06/01/2006] [Indexed: 11/15/2022]
Abstract
The prevalence of suicide attempts and associated risk factors such as sociodemographic conditions, emotional/behavioural problems and parent-child relationships were examined among 591 indigenous Sami and 2100 majority adolescents in Arctic Norway. There were no significant ethnic differences in prevalence of suicide attempts. In both ethnic groups, suicidal ideation, anxious/depressed problems and eating behaviour problems were associated with suicide attempts. Cross-cultural differences in risk factors associated with suicide attempts existed. For Sami adolescents, factors diverging from the traditional cultural norms were associated with suicide attempts, such as alcohol intoxication, single-parent home and paternal overprotection (p</=.05). Vocational studies, not living together with parents, current smoking and experienced sexual intercourse were ethnic specific risk factors associated with suicide attempts among majority peers (p</=.05). Clinicians should take into account that risk factors can differ between ethnic groups and should be sensitive to culturally divergent behaviour.
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Affiliation(s)
- Anne Silviken
- Center for Sami Health Research, Department of Community Medicine, Faculty of Medicine, University of Tromsø, N-9037 Tromsø, Norway.
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Ehlers CL, Hurst S, Phillips E, Gilder DA, Dixon M, Gross A, Lau P, Yehuda R. Electrophysiological Responses to Affective Stimuli in American Indians Experiencing Trauma With and Without PTSD. Ann N Y Acad Sci 2006; 1071:125-36. [PMID: 16891567 DOI: 10.1196/annals.1364.011] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
American Indians are at high risk for exposure to violence and other traumatic events, yet few studies have investigated posttraumatic stress disorder (PTSD) or its neurobiological consequences in Indian communities. In the present study, a sample of American Indians (n = 146) were given a structured diagnostic interview that additionally indexed traumatic life events and symptoms emerging following those events. Electroencephalogram (EEG) spectra and visual event-related potentials (ERPs) to happy, sad, and neutral faces were also recorded from each participant. Ninety-nine percent of the sample had experienced at least one category of trauma with the mean number being 5, 27% had experienced at least 8 categories, and 13% met DSM-IV criteria for PTSD. The PTSD group did not differ on any demographic or diagnostic variables from the larger sample. An electrophysiological signature for PTSD was found that included increases in high-frequency gamma activity (20-40 Hz, F = 8.7, P < 0.004) in frontal leads, higher N1 amplitudes to sad stimuli in frontotemporal leads (F = 12.4, P < 0.001, F = 5.0, P < 0.03), and longer latency P3 components to happy stimuli in midline, central, and right frontal leads (F = 4.7, P < 0.03; F = 4.1, P < 0.04; F = 4.0, P < 0.05). These findings were observed in participants with PTSD, but not in a group with equivalently high trauma counts. These findings suggest that PTSD is associated with EEG hyperarousal, higher attentional levels to sad stimuli, and slower processing of happy stimuli. They also partially confirm ERP data reported in combat victims with PTSD suggesting that PTSD may induce neurobiological consequences that transcend type of eliciting trauma as well as ethnic and cultural factors.
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Affiliation(s)
- Cindy L Ehlers
- The Scripps Research Institute, 10550 N Torrey Pines Road, CVN-14, La Jolla, CA 92037, USA.
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Novins DK, Fickenscher A, Manson SM. American Indian adolescents in substance abuse treatment: Diagnostic status. J Subst Abuse Treat 2006; 30:275-84. [PMID: 16716841 DOI: 10.1016/j.jsat.2005.12.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2005] [Revised: 12/12/2005] [Accepted: 12/18/2005] [Indexed: 11/30/2022]
Abstract
The goal of this study was to describe the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) psychiatric disorders among a sample of American Indian (AI) adolescents in residential substance abuse treatment. Data on 89 AI adolescents admitted to a tribally operated residential substance abuse treatment program were collected. Participants reported using a mean of 5.26 substances; 20% percent met DSM-IV criteria for four or more substance use disorders. Marijuana abuse/dependence was the most common substance use disorder (84.3%). Eighty-two percent met criteria for at least one DSM-IV nonsubstance use disorder, the most common of which was conduct disorder (74.2%). These results suggest strong diagnostic parallels between these AI adolescents and their non-AI counterparts who have participated in similar studies, including the considerable diagnostic complexity that was common among the participants in this study. These diagnostic patterns suggest that emerging practices for treating substance-abusing adolescents that have been developed for use with non-AI adolescents warrant consideration for use with AI youths.
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Affiliation(s)
- Douglas K Novins
- The National Center for American Indian and Alaska Native Mental Health Research, University of Colorado Health Sciences Center, Aurora, CO 80045, USA
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