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Sacca L, Lobaina D, Burgoa S, Rao M, Jhumkhawala V, Zapata SM, Issac M, Medina S. Using Patient-Centered Dissemination and Implementation Frameworks and Strategies in Palliative Care Settings for Improved Quality of Life and Health Outcomes: A Scoping Review. Am J Hosp Palliat Care 2024; 41:1195-1237. [PMID: 37956239 DOI: 10.1177/10499091231214241] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND There is a need for patient-provider dissemination and implementation frameworks, strategies, and protocols in palliative care settings for a holistic approach when it comes to addressing pain and other distressing symptoms affecting the quality of life, function, and independence of patients with chronic illnesses. The purpose of this scoping review is to explore patient-centered D&I frameworks and strategies that have been adopted in PC settings to improve behavioral and environmental determinants influencing health outcomes through evidence-based programs and protocols. METHODS The five step Arksey and O'Malley's (2005) York methodology was adopted as a guiding framework: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results. RESULTS Only 6 out of the 38 (16%) included studies applied a D&I theory and/or framework. The RE-AIM framework was the most prominently cited (n = 3), followed by the Diffusion of Innovation Model (n = 2), the CONNECT framework (n = 1), and the Transtheoretical Stages of Change Model (n = 1). The most frequently reported ERIC strategy was strategy #6 "Develop and organize quality monitoring systems", as it identified in all 38 of the included studies. CONCLUSION This scoping review identifies D&I efforts to translate research into practice in U.S. palliative care settings. Results may contribute to enhancing future D&I initiatives for dissemination/adaptation, implementation, and sustainability efforts aiming to improve patient health outcomes and personal satisfaction with care received.
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Affiliation(s)
- Lea Sacca
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Diana Lobaina
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sara Burgoa
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Meera Rao
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Vama Jhumkhawala
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sheena M Zapata
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
| | - Michelle Issac
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
| | - Suleyki Medina
- Symptom Management and Palliative Medicine, Baptist Health of South Florida, Miami Cancer Institute, Miami, FL, USA
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Troxel WM, Klein DJ, Dong L, Mousavi Z, Dickerson DL, Johnson CL, Palimaru AI, Brown RA, Rodriguez A, Parker J, Schweigman K, D’Amico EJ. Sleep Problems and Health Outcomes Among Urban American Indian and Alaska Native Adolescents. JAMA Netw Open 2024; 7:e2414735. [PMID: 38833247 PMCID: PMC11151157 DOI: 10.1001/jamanetworkopen.2024.14735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/02/2024] [Indexed: 06/06/2024] Open
Abstract
Importance Adolescent sleep problems are prevalent, particularly among racial and ethnic minority groups, and can increase morbidity. Despite the numerous strengths of their racial and ethnic group, urban American Indian and Alaska Native adolescents face significant health disparities but are rarely included in health research. Understanding how sleep problems are associated with health outcomes among American Indian and Alaska Native adolescents may elucidate novel targets for interventions to promote health equity. Objective To assess whether baseline sleep problems are associated with changes in behavioral and cardiometabolic health outcomes among urban American Indian and Alaska Native adolescents 2 years later. Design, Setting, and Participants American Indian and Alaska Native adolescents were recruited via flyers and community events for an observational cohort study in California. Baseline assessments were conducted among 142 adolescents from March 1, 2018, to March 31, 2020, and follow-ups were conducted among 114 adolescents from December 1, 2020, to June 30, 2022. Exposures Baseline actigraphy-assessed sleep duration and efficiency and self-reported sleep disturbances and social jet lag (absolute value of the difference in sleep midpoint on weekends vs weekdays; indicator of circadian misalignment). Main Outcomes and Measures Main outcome measures included self-reported depression (measured using the Patient Health Questionnaire), anxiety (measured using the Generalized Anxiety Disorder 7-item scale), past year alcohol and cannabis use, body mass index, systolic blood pressure (SBP) and diastolic blood pressure (DBP), waist circumference, and glycosylated hemoglobin (HbA1c). Analyses examined whether baseline sleep was associated with health outcomes at follow-up, controlling for age, sex, and baseline outcome measures. Results The baseline sample included 142 urban American Indian and Alaska Native adolescents (mean [SD] age, 14.0 [1.4] years; 84 girls [59%]), 80% of whom (n = 114; mean [SD] age, 14.1 [1.3] years; 71 girls [62%]) completed follow-ups. Linear or logistic regressions showed significant negative associations between shorter sleep duration and depression (β = -1.21 [95% CI, -2.19 to -0.24]), anxiety (β = -0.89 [95% CI, -1.76 to -0.03]), DBP (β = -2.03 [95% CI, -3.79 to -0.28]), and HbA1c level (β = -0.15 [95% CI, -0.26 to -0.04]) and likelihood of alcohol (odds ratio [OR], 0.57 [95% CI, 0.36-0.91]) and cannabis use (full week: OR, 0.59 [95% CI, 0.35-0.99]) at follow-up. Greater social jet lag was associated with significantly higher SBP (β = 0.06 [95% CI, 0.01-0.11]) at follow-up. Conclusions and Relevance This cohort study found significant associations between poor sleep and adverse changes in health outcomes. Findings highlight the importance of developing culturally responsive interventions that target sleep as a key modifiable risk factor to improve the health of American Indian and Alaska Native adolescents.
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Affiliation(s)
- Wendy M. Troxel
- Behavioral and Policy Sciences, Division of Social and Economic Wellbeing, RAND Corporation, Pittsburgh, Pennsylvania
| | - David J. Klein
- Behavioral and Policy Sciences, Division of Social and Economic Wellbeing, RAND Corporation, Santa Monica, California
| | - Lu Dong
- Behavioral and Policy Sciences, Division of Social and Economic Wellbeing, RAND Corporation, Santa Monica, California
| | - Zahra Mousavi
- Behavioral and Policy Sciences, Division of Social and Economic Wellbeing, RAND Corporation, Santa Monica, California
| | - Daniel L. Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | | | - Alina I. Palimaru
- Behavioral and Policy Sciences, Division of Social and Economic Wellbeing, RAND Corporation, Santa Monica, California
| | - Ryan A. Brown
- Behavioral and Policy Sciences, Division of Social and Economic Wellbeing, RAND Corporation, Santa Monica, California
| | - Anthony Rodriguez
- Behavioral and Policy Sciences, Division of Social and Economic Wellbeing, RAND Corporation, Boston, Massachusetts
| | - Jennifer Parker
- Behavioral and Policy Sciences, Division of Social and Economic Wellbeing, RAND Corporation, Santa Monica, California
| | | | - Elizabeth J. D’Amico
- Behavioral and Policy Sciences, Division of Social and Economic Wellbeing, RAND Corporation, Santa Monica, California
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Donald C, Rajani K, Singer M, Skye M, Craig Rushing S, Kelley A, Morgan B, Zaback T, Becker T, Lambert W. A Qualitative Review of Barriers and Facilitators Identified While Implementing the Native Students Together Against Negative Decisions Curriculum in a Multisite Dissemination and Implementation Study. HEALTH EDUCATION & BEHAVIOR 2024; 51:425-435. [PMID: 36124442 DOI: 10.1177/10901981221123228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Culturally-adapted evidence-based programs (EBPs) are needed to promote healthy behaviors among Native teens and young adults. Little is known about the facilitators and barriers of implementing and sustaining EBPs in Native communities. This paper aims to identify those factors described by educators who implemented the Native Students Together Against Negative Decisions (STAND) curriculum. METHODS We conducted qualitative, semi-structured interviews with 44 Native STAND educators from 48 sites throughout the United States. We used a modified grounded theory approach to explore barriers, facilitators, and sustainability factors related to implementing Native STAND. RESULTS We learned that disruptions to staffing, coordination, and organizational factors were the most common barriers. Factors that improved implementation success included: tailoring the program to local needs/constraints, having a supportive Project Manager, improved fidelity due to check-in calls, and participation in summer training. Factors that improved sustainability included: access to needed infrastructure, administrative support, community support, and student interest. DISCUSSION The delivery of Native STAND was further improved by person-to-person communication and resource sharing across sites. Sustaining EBPs in AI/AN settings requires culturally-tailored technical assistance, sufficient implementation funds for materials and staffing, and a community of peer educators to inspire forward progress. CONCLUSION EBPs that reflect the needs and experiences of American Indian and Alaska Native (AI/AN) youth are necessary to address systemic inequities in adolescent health outcomes. The Native STAND Dissemination and Implementation study is among the first to assess facilitators and barriers to program delivery in diverse AI/AN settings.
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Affiliation(s)
| | - Kavita Rajani
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Michelle Singer
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Megan Skye
- Oregon Health & Science University, Portland, OR, USA
| | | | | | - Brittany Morgan
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Tosha Zaback
- Oregon Health & Science University, Portland, OR, USA
| | - Thomas Becker
- Northwest Portland Area Indian Health Board, Portland, OR, USA
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Mousavi Z, Troxel WM, Dickerson DL, Dong L, Brown RA, Palimaru AI, Klein DJ, Johnson CL, D’Amico EJ. Neighborhood determinants of sleep and the moderating role of cultural factors among native adolescents. Health Psychol 2024; 43:101-113. [PMID: 38127509 PMCID: PMC10842707 DOI: 10.1037/hea0001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study examined the association between neighborhood social environment and sleep among urban American Indian and Alaska Native (AI/AN) adolescents as well as the moderating role of cultural factors in this association. METHOD The analytic sample included 133 urban AI/AN adolescents (age 12-16, 57.1% female, Mage = 14.03, SDage = 1.35). Perceived neighborhood social environment included safety and cohesion. Cultural factors included AI/AN cultural identification and historical loss. Sleep duration, efficiency, and wake after sleep onset (WASO) were measured via actigraphy. Sleep disturbance was measured via a questionnaire. RESULTS Greater neighborhood safety was significantly associated with lower sleep disturbance (b = -2.17, SE = 0.8, p = .008), higher sleep efficiency (b = 1.75, SE = 0.64, p = .006), and lower WASO (b = -8.60, SE = 3.34, p = .01). Neighborhood cohesion was not associated with any sleep outcomes. Cultural factors moderated the association between neighborhood social environment and sleep outcomes (p < .05). Specifically, both neighborhood safety and cohesion were associated with lower sleep disturbance, only among individuals reporting higher levels of AI/AN cultural identification. Further, neighborhood safety was associated with greater sleep efficiency and lower WASO (i.e., better sleep) only among adolescents with higher contemplation of historical loss. CONCLUSIONS Findings highlight the importance of considering cultural factors in addressing sleep and health disparities. AI/AN cultural identification and a sense of historical loss may be important targets for identifying adolescents who might benefit the most from policies and interventions focused on improving the social environment in order to improve sleep and other health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Zahra Mousavi
- Department of Psychological Science, University of California, Irvine, California, USA
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
| | - Wendy M. Troxel
- Division of Behavior and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania, USA
| | - Daniel L. Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Lu Dong
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
| | - Ryan A. Brown
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
| | - Alina I. Palimaru
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
| | - David J. Klein
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
| | - Carrie L. Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, California, USA
| | - Elizabeth J. D’Amico
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
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5
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Rasmus S, D'Amico EJ, Allen J, Nation C, John S, Joseph V, Rodriguez A, Alvarado G, Gittens AD, Palimaru AI, Brown RA, Kennedy DP, Woodward MJ, Parker J, McDonald K. Because We Love You (BeWeL): A protocol for a randomized controlled trial of two brief interventions focused on social and cultural connectedness to reduce risk for suicide and substance misuse in young Alaska Native people. RESEARCH SQUARE 2024:rs.3.rs-3874293. [PMID: 38343833 PMCID: PMC10854297 DOI: 10.21203/rs.3.rs-3874293/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Background Suicide among young people in Alaska Native (AN) communities was nearly unheard of through the establishment of statehood in 1959, but in the 1970s, AN suicide rates began to double every five years, with most of the increase due to suicide among 15 to 25-year-olds. From 1960-1995, the suicide rate increased by approximately 500% during this period of rapid, imposed social transition. For example, families were forced to live in settlements and children were sent to boarding schools. These disruptions increased conditions associated with suicide risk (e.g., substance use disorders, cultural disconnection), and challenged the community-level social safety net of youth protective factors that might have moderated effects of these traumas. The present study addresses the significant gap in culturally appropriate evidence-based programming to address suicide prevention among AN young people as part of aftercare. Our key research questions and methodology have been informed by AN stakeholders, and the intervention approach is Indigenous-led. Methods Our interventions are targeted toward Alaska Native young people ages 14-24 who present with suicide attempt, ideation, or associated risk behaviors, including alcohol-related injury in the Yukon-Kuskokwim region or the Interior. In a randomized controlled trial, 14-24-year-old AN individuals will receive either BeWeL (n = 185), which comprises a 45-minute virtual cultural talk addressing family and ancestral strengths and increasing protective factors, or BeWeL plus motivational interviewing with social networks, which includes an additional 15 minutes focused on discussion of the individual's social networks (n = 185). We will evaluate intervention effects on primary outcomes of suicide-intent risk, depression, anxiety, frequency of alcohol use, and alcohol consequences. Some of our secondary outcomes include individual and community protective factors, social networks, and awareness of connectedness. Discussion This project has the potential to expand the range and effectiveness of suicide prevention services for AN young people and will help meet the need in Alaska to link clinical behavioral health services to AN community-based networks, and to engage local cultural resources in aftercare for individuals at risk for suicide. Findings have potential to provide practical information to advance the field of suicide prevention and enhance protective factors and resiliency among this population. Trial registration ClinicalTrials.gov Identifier: NCT05360888.
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Hirchak KA, Oluwoye O, Nadeau M, Richardson M, Bajet K, Brigman M, Herron JL, Hernandez-Vallant A, Vasquez A, Pham C, Oliver KA, Baukol P, Webb K, Belone L, McDonell MG, Venner KL, Campbell ANC. Coming together for something good: recommendations from a scoping review for dissemination and implementation science to improve indigenous substance use disorder treatment. Front Public Health 2023; 11:1265122. [PMID: 37915816 PMCID: PMC10616787 DOI: 10.3389/fpubh.2023.1265122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 09/29/2023] [Indexed: 11/03/2023] Open
Abstract
Introduction Dissemination and Implementation (D&I) science is growing among Indigenous communities. Indigenous communities are adapting and implementing evidence-based treatments for substance use disorders (SUD) to fit the needs of their communities. D&I science offers frameworks, models, and theories to increase implementation success, but research is needed to center Indigenous knowledge, enhancing D&I so that it is more applicable within Indigenous contexts. In this scoping review, we examined the current state of D&I science for SUD interventions among Indigenous communities and identified best-practice SUD implementation approaches. Methods PubMed and PsycINFO databases were queried for articles written in English, published in the United States, Canada, Australia, and New Zealand. We included key search terms for Indigenous populations and 35 content keywords. We categorized the data using the adapted and extended Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework that emphasizes equity and sustainability. RE-AIM has also been used as a primary model to consistently identify implementation outcomes. Results Twenty articles were identified from the original unduplicated count of over 24,000. Over half the articles discussed processes related to Reach, Adoption, and Implementation. Effectiveness was discussed by 50% of the studies (n = 10), with 25% of the articles discussing Maintenance/sustainability (n = 4). Findings also highlighted the importance of the application of each RE-AIM domain for meaningful, well-defined community-engaged approaches. Conclusion Finding indicated a need to prioritize Indigenous methods to culturally center, re-align and adapt Western treatments and frameworks to increase health equity and improve SUD treatment outcomes. Utility in the use of the modified RE-AIM and the continued modification for Indigenous communities was also noted.
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Affiliation(s)
- Katherine A. Hirchak
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Oladunni Oluwoye
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Melanie Nadeau
- Department of Indigenous Health, University of North Dakota, Grand Forks, ND, United States
| | - Meenakshi Richardson
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
- Department of Human Development, Washington State University, Vancouver, WA, United States
| | - Kelsey Bajet
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Mariah Brigman
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Jalene L. Herron
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Alexandra Hernandez-Vallant
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Angel Vasquez
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
| | - Cuong Pham
- Department of Medicine, University of Minnesota, Minneapolis, MN, United States
| | | | - Paulette Baukol
- NorthStar Node, Hennepin Healthcare Research Institute, Minneapolis, MN, United States
| | - Kellie Webb
- Eastern Shoshone Recovery Center, Fort Washakie, WY, United States
| | - Lorenda Belone
- Population Health, University of New Mexico, Albuquerque, NM, United States
| | - Michael G. McDonell
- Department of Community and Behavioral Health, Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, United States
| | - Kamilla L. Venner
- Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, NM, United States
- Department of Psychology, University of New Mexico, Albuquerque, NM, United States
| | - Aimee N. C. Campbell
- Department of Psychiatry, Columbia University Irving Medical Center and New York State Psychiatric Institute, New York, NY, United States
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Cance JD, Adams ET, D'Amico EJ, Palimaru A, Fernandes CSF, Fiellin LE, Bonar EE, Walton MA, Komro KA, Knight D, Knight K, Rao V, Youn S, Saavedra L, Ridenour TA, Deeds B. Leveraging the Full Continuum of Care to Prevent Opioid Use Disorder. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:30-39. [PMID: 37261635 PMCID: PMC10689575 DOI: 10.1007/s11121-023-01545-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 06/02/2023]
Abstract
Substance use disorder prevention programs are most effective when matched appropriately to the baseline risk of the population. Individuals who misuse opioids often have unique risk profiles different from those who use other substances such as alcohol or cannabis. However, most substance use prevention programs are geared toward universal audiences, neglecting key inflection points along the continuum of care. The HEAL Prevention Cooperative (HPC) is a unique cohort of research projects that represents a continuum of care, from community-level universal prevention to indicated prevention among older adolescents and young adults who are currently misusing opioids or other substances. This paper describes the theoretical basis for addressing opioid misuse and opioid use disorder across the prevention continuum, using examples from research projects in the HPC.
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Affiliation(s)
- J D Cance
- RTI International, Research Triangle Park, Durham, NC, USA.
| | - E T Adams
- RTI International, Research Triangle Park, Durham, NC, USA
| | | | | | | | - L E Fiellin
- Yale University School of Medicine, New Haven, CT, USA
| | - E E Bonar
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - M A Walton
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - K A Komro
- Rollins School of Public Health, Emory University, Atlanta, USA
| | - D Knight
- Texas Christian University, Fort Worth, TX, USA
| | - K Knight
- Texas Christian University, Fort Worth, TX, USA
| | - V Rao
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S Youn
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - L Saavedra
- RTI International, Research Triangle Park, Durham, NC, USA
| | - T A Ridenour
- RTI International, Research Triangle Park, Durham, NC, USA
| | - B Deeds
- National Institute on Drug Abuse, MD, Bethesda, USA
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Lee J, Schroth R, Lawrence H. Nishtam Niwiipitan (My First Teeth): Oral Health Digital Stories from Urban Indigenous Parents. JDR Clin Trans Res 2023; 8:326-336. [PMID: 35945821 PMCID: PMC10504818 DOI: 10.1177/23800844221117143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To develop oral health-related digital story videos through interviews with Indigenous parents who shared their experiences in dealing with early childhood caries (ECC) in their children. METHODS Indigenous parents in Winnipeg, Manitoba, Canada, were recruited from community programs from October to December 2019 as part of the Nishtam Niwiipitan (My First Teeth), a community-based participatory research study that builds on an ECC intervention. A twofold qualitative narrative approach to data collection was used: 1) interviewing participants and creating digital stories and 2) taking part in the postfilming feedback interviews. Participants were interviewed via video in a semistructured format sharing their experiences and attitudes about caring for children with ECC and the challenges faced seeking dental care for the disease. The stories were drawn from parents in 3 predetermined groups: those with 1) children who had undergone dental surgery under general anesthesia, 2) children who had received silver diamine fluoride as an alternative to surgery to manage ECC, and 3) caries-free children. Prior to editing, the narrated stories were transcribed verbatim and analyzed thematically. The postfilming interview transcripts were also analyzed and coded for key themes. RESULTS Six parents and 1 grandparent, all of whom self-identified as Indigenous (First Nations or Métis) and cared for children aged <6 y, created the digital stories. Three key themes emerged from the postfilming interviews: ability to share, ability to help, and ability to change. Participants felt important, optimistic, and motivated throughout the process of making their digital stories. CONCLUSION Digital storytelling offered First Nations and Métis parents a unique opportunity to share their experiences caring for children with ECC with the wider public. These videos can be incorporated into oral health promotion and ECC intervention programs as a culturally appropriate method for reaching Indigenous families. KNOWLEDGE TRANSFER STATEMENT The use and development of digital storytelling for oral health promotion have great potential for spreading awareness and sharing knowledge with Indigenous parents/caregivers about their children's oral health and care practices. This health promotion tool is congruent with Indigenous ways of knowing, as Indigenous communities have a long tradition of oral history. The videos produced for this study will assist with oral health promotion efforts to address the high rates of early childhood caries in Indigenous communities in Canada.
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Affiliation(s)
- J. Lee
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - R.J. Schroth
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Department of Preventive Dental Science, Dr Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - H.P. Lawrence
- Discipline of Dental Public Health, Faculty of Dentistry, University of Toronto, Toronto, Canada
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Domingo A, Yessis J, Charles KA, Skinner K, Hanning RM. Integrating knowledge and action: learnings from an implementation program for food security and food sovereignty with First Nations communities within Canada. Implement Sci 2023; 18:34. [PMID: 37573323 PMCID: PMC10422772 DOI: 10.1186/s13012-023-01291-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 07/31/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND Collaborative approaches to knowledge translation (KT) are important for advancing community-engaged research. However, there is a need for examples of participatory approaches that have effectively supported public health research, program development, and implementation with First Nations communities. To strengthen KT with communities, we proposed a set of guiding principles for participatory planning and action for local food system change. Principles emerged from a cross-community analysis of Learning Circles: Local Healthy Food to School (LC:LHF2S) a participatory program (2015-2019) for Indigenous food system action. The objective was to identify guiding principles for participatory planning and action from key learnings and successes on scaling-up of the Learning Circles (LC) model vertically in Haida Nation, British Columbia (BC), and horizontally in three distinct community contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake. The application of these principles is discussed in the context of our ongoing partnership with Williams Treaties First Nations to support community planning to enhance food security and sovereignty. METHODS A cross-community thematic analysis was conducted and guided by an implementation science framework, Foster-Fishman and Watson's (2012) ABLe Change Framework, to identify key learnings and successes from adapting the LC approach. Information gathered from interviews (n = 55) and meeting reports (n = 37) was thematically analyzed to inform the development of guiding principles. Community sense-making of findings informed applicability in a new community context embarking on food systems work. RESULTS Emergent guiding principles for participatory food system planning and action are described within four main areas: (1) create safe and ethical spaces for dialog by establishing trust and commitment from the ground up, (2) understand the context for change through community engagement, (3) foster relationships to strengthen and sustain impact, and (4) reflect and embrace program flexibility to integrate learnings. CONCLUSIONS Emergent principles offer guidance to supporting Indigenous community-led research and mobilization of knowledge into action. Principles are intended to support researchers and health system administrators with taking a collaborative approach that fosters relationships and integration of community leadership, knowledge, and action for food system change. Application of principles with implementation frameworks can strengthen KT in Indigenous contexts by incorporating community protocols and perspectives in support of Indigenous self-determined priorities.
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Affiliation(s)
- Ashleigh Domingo
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
| | - Jennifer Yessis
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | | | - Kelly Skinner
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Rhona M Hanning
- Faculty of Health, School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Pacheco M, Warfield SK, Hatzistavrakis P, Mochida-Meek S, Moskowitz D, Matson M, Mustanski B. "I don't see myself represented:" Strategies and considerations for engaging gay male Native Hawaiian and Other Pacific Islander teens in research and HIV prevention services. AIDS Behav 2023; 27:1055-1067. [PMID: 36097088 PMCID: PMC9466349 DOI: 10.1007/s10461-022-03843-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2022] [Indexed: 12/02/2022]
Abstract
Significant efforts have been applied to the development of sexual health programs for minority young gay males. Given the absence of research with Native Hawaiian and other Pacific Islander (NHOPI) gay teen males, this study was done to assess how to reach them. Interviews were conducted with 20 NHOPI gay males ages 19-24 as near peers that can inform reaching teens. Data was analyzed using the Reflexive Thematic Analysis method. Three themes were identified: (1) Culture is a crucial factor for recruitment and engagement-whether participants realized it or not; (2) Confidentiality is key in recruitment to provide a safe space for NHOPI gay teen male research participation; and (3) NHOPI gay teen males experience multiple identity conflicts that must be considered for recruitment and engagement initiatives. Online recruitment efforts are optimal and should reflect distinct NHOPI cultures. More research is needed when it comes to understanding the cultural acceptance and understanding of homosexuality in NHOPI communities and how to integrate cultural education into recruitment methods and interventions.
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Affiliation(s)
- Misty Pacheco
- Department of Kinesiology and Exercise Sciences, University of Hawai'i at Hilo, 200 W Kawili Street, 96720, Hilo, HI, USA.
| | | | - Patti Hatzistavrakis
- Department of Kinesiology and Exercise Sciences, University of Hawai'i at Hilo, 200 W Kawili Street, 96720, Hilo, HI, USA
| | - Summer Mochida-Meek
- Department of Kinesiology and Exercise Sciences, University of Hawai'i at Hilo, 200 W Kawili Street, 96720, Hilo, HI, USA
| | - David Moskowitz
- Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA
| | - Margaret Matson
- Department of Medical Social Sciences, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
| | - Brian Mustanski
- Department of Medical Social Sciences, Northwestern University Institute for Sexual and Gender Minority Health and Wellbeing, Chicago, IL, USA
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11
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Hill J, Yako Y, George C, Musarurwa H, Jordaan E, Kengne AP. A study protocol for a cluster randomized controlled trial to test the applicability of the South African diabetes prevention program in the Eastern Cape Province of South Africa. BMC Public Health 2023; 23:214. [PMID: 36721261 PMCID: PMC9890849 DOI: 10.1186/s12889-022-14884-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 12/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Convincing evidence supports the effectiveness of lifestyle interventions in preventing the occurrence of diabetes in high-income countries, however little is known about appropriate interventions for use in African countries, where there are higher relative increases in diabetes prevalence. The South African Diabetes Prevention Programme (SA-DPP) was initiated with the aim of preventing or delaying the occurrence of diabetes among South Africans (SAs), through interventions, targeting lifestyle changes related to diet and physical activity. The purpose of the current project is to implement and evaluate the suitability and applicability of the SA-DPP developed and tailored in urban populations in the Western Cape Province, in peri-urban populations in the Eastern Cape Province of SA. METHODS The SA-DPP, which is an cluster randomized control trial, will be implemented in adults aged 30-65 years residing in the OR Tambo district, Eastern Cape, SA. Participants will be recruited using self-selected sampling techniques and 24 clusters across peri-urban communities will be randomly allocated to participate in the lifestyle intervention, facilitated by non-professional health workers (NPHW). The diabetes risk screening will follow a two-staged approach, including the community-based screening, using the African diabetes risk score (ADRS), followed by a clinic-based risk status assessment by an oral glucose tolerance test (OGTT) to exclude unknown diabetes. The lifestyle-change objectives of the current programme relate to, 1) < 30% of total energy intake from fat; 2) < 10% of total energy intake from saturated fat; 3) > 15 g of fibre/1000 kcal; 4) > 4 h/week moderate level of physical activity; and 5) > 2% body mass index (BMI) reduction. DISCUSSION The SA-DPP could represent a successful model for the prevention of diabetes and potentially other lifestyle-related diseases in SA and other countries in the region that are confronted with similar challenges. TRIAL REGISTRATION PACTR202205591282906.
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Affiliation(s)
- Jillian Hill
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Yandiswa Yako
- grid.412870.80000 0001 0447 7939Department Human Biology, Faulty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Cindy George
- grid.415021.30000 0000 9155 0024Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Hannibal Musarurwa
- grid.412870.80000 0001 0447 7939Department Human Biology, Faulty of Health Sciences, Walter Sisulu University, Mthatha, South Africa
| | - Esme Jordaan
- grid.415021.30000 0000 9155 0024Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Andre P. Kengne
- grid.415021.30000 0000 9155 0024Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
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12
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Simpson ML, Ruru S, Oetzel J, Meha P, Nock S, Holmes K, Adams H, Akapita N, Clark M, Ngaia K, Moses R, Reddy R, Hokowhitu B. Adaptation and implementation processes of a culture-centred community-based peer-education programme for older Māori. Implement Sci Commun 2022; 3:123. [DOI: 10.1186/s43058-022-00374-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
Health inequities experienced by kaumātua (older Māori) in Aotearoa, New Zealand, are well documented. Examples of translating and adapting research into practice that identifies ways to help address such inequities are less evident. The study used the He Pikinga Waiora (HPW) implementation framework and the Consolidated Framework for Implementation Research (CFIR) to explore promising co-design and implementation practices in translating an evidence-based peer-education programme for older Māori to new communities.
Methods
The study was grounded in an Indigenous methodology (Kaupapa Māori) and a participatory research approach. Data were collected from research documentation, community meeting and briefing notes, and interviews with community researchers.
Results
The data analysis resulted in several key promising practices: Kaumātua mana motuhake (kaumātua independence and autonomy) where community researchers centred the needs of kaumātua in co-designing the programme with researchers; Whanaungatanga (relationships and connectedness) which illustrated how community researchers’ existing and emerging relationships with kaumātua, research partners, and each other facilitated the implementation process; and Whakaoti Rapanga (problem-solving) which centred on the joint problem-solving undertaken by the community and university researchers, particularly around safety issues. These results illustrate content, process, and relationship issues associated with implementation effectiveness.
Conclusions
This study showed that relational factors are central to the co-design process and also offers an example of a braided river, or He Awa Whiria, approach to implementation. The study offers a valuable case study in how to translate, adapt, and implement a research-based health programme to Indigenous community settings through co-design processes.
Trial registration
The project was registered on 6 March 2020 with the Australia New Zealand Clinical Trial Registry: ACTRN12620000316909. Prospectively registered.
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Native Hawaiian wellbeing and transdiagnostic trauma symptoms: The protective role of physical activity in dissociation. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2022. [DOI: 10.1016/j.ejtd.2022.100296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kyoon Achan G, Eni R, Phillips-Beck W, Lavoie JG, Kinew KA, Katz A. Canada First Nations Strengths in Community-Based Primary Healthcare. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13532. [PMID: 36294110 PMCID: PMC9602454 DOI: 10.3390/ijerph192013532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/03/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION First Nation (FN) peoples and communities in Canada are still grappling with the effects of colonization. Health and social inequities result in higher disease burden and significant disparities in healthcare access and responsiveness. For resilience, survival, and self-determination, FN are looking inwards for strengths. This paper reports on the cultural, community, and family strengths that have supported FN communities in developing community-based primary healthcare (CBPHC) strategies to support health and wellbeing. METHODS The study was a partnership between university-based researchers; The First Nations Health and Social Secretariat of Manitoba; and eight First Nation communities in Manitoba. Community-based participatory research methods were used to engage the participating communities. One hundred and eighty-three in-depth, semi-structured key informant interviews were completed between 2014 and 2016 with key members of the First Nation communities, i.e., community-based health providers and users of primary healthcare services, representing all age and genders. Data-collection and analysis were conducted following iterative grounded theory analysis. RESULTS Community-based healthcare models based on local strengths support easier access and shorter wait times for care and compassionate care delivery. Resources such as homecare and medical transportation are helpful. Community cooperation, youth power, responsive leadership, and economic development as well as a strong cultural and spiritual base are key strengths supporting health and social wellbeing. CONCLUSIONS Locally led, self-determined care adds strength in FN communities, and is poised to create long-lasting primary healthcare transformation.
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Affiliation(s)
- Grace Kyoon Achan
- Education Indigenous Institute of Health and Healing, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Rachel Eni
- Independent Researcher, Victoria, BC V9C 0M1, Canada
| | - Wanda Phillips-Beck
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, First Nation Health and Social Secretariat Manitoba, University of Manitoba, Winnipeg, MB R3B 2B3, Canada
| | - Josée G. Lavoie
- Department Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3E 3P5, Canada
| | - Kathi Avery Kinew
- First Nation Health and Social Secretariat Manitoba, Winnipeg, MB R3B 2B3, Canada
| | - Alan Katz
- Department of Family Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB R3B 2B3, Canada
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Pedersen M, Harris KJ, Brown B, Anderson K, Lewis JP. A Systematic Review of Interventions to Increase Physical Activity Among American Indian and Alaska Native Older Adults. THE GERONTOLOGIST 2022; 62:e328-e339. [PMID: 33605417 PMCID: PMC9335984 DOI: 10.1093/geront/gnab020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Physical activity (PA) is a powerful protective factor known to reduce risk for chronic conditions across the life span. PA levels are lower among American Indians and Alaska Natives (AIANs) when compared with other racial/ethnic groups and decrease with age. This evidence justifies a synthesis of current intervention research to increase PA levels among AIANs. This systematic review examines completed interventions to increase PA among AIAN older adults and considers recommended practices for research with Indigenous communities. RESEARCH DESIGN AND METHODS The systematic review was designed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement for systematic review protocols and reporting guidelines. Three electronic databases, PubMed, Web of Science, and PsycINFO, were searched for academic literature. Trials investigating interventions to increase PA among AIAN adults older than 50 years were eligible. The Quality Assessment Tool for Quantitative Studies was used to evaluate the quality of evidence. RESULTS Three published trials were identified, including one group-level, clinic-based and two individual-level, home-based interventions. All were 6 weeks in duration, took place in urban areas, and used self-report PA measures. Findings indicated an overall increase in PA levels, improved PA-related outcomes, and improved psychosocial health among participants. None described community-engaged or culture-centered research strategies. DISCUSSION AND IMPLICATIONS The narrow yet promising evidence represents a need for expanded research and a call to action for using culture-centered strategies. An advanced understanding of cultural and contextual aspects of PA may produce more impactful interventions, supporting health and mobility across the life span.
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Affiliation(s)
- Maja Pedersen
- School of Public and Community Health Sciences, University of
Montana, Missoula, Montana, USA
| | - Kari Jo Harris
- School of Public and Community Health Sciences, University of
Montana, Missoula, Montana, USA
| | - Blakely Brown
- School of Public and Community Health Sciences, University of
Montana, Missoula, Montana, USA
| | - Keith Anderson
- School of Social Work, University of Texas at Arlington,
Arlington, Texas, USA
| | - Jordan P Lewis
- Department of Medicine and Biobehavioral Health, University of
Minnesota, Minnesota, Duluth, USA
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Report From the Field: Public Health Equity Through Innovative Multisector Data Sharing. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2022; 28:S171-S178. [PMID: 35616563 DOI: 10.1097/phh.0000000000001460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Data sharing across sectors for the purpose of driving health equity is a particularly innovative yet emerging concept in public health practice and research, although the extent to which public health entities engage in multisector data sharing and initiatives is currently underexplored. This practice report examines the nature and extent to which public health entities are sharing data across sectors in ways that are innovative and supportive of their organizational missions to promote community health equity and well-being. PROGRAM As a program office of the Robert Wood Johnson Foundation, Data Across Sectors for Health (DASH) seeks to promote and support data sharing systems leveraged toward equitable improvements to health. IMPLEMENTATION We pilot tested, revised, and disseminated the 2021 All In National Inventory, a survey implemented to scan the environment to track progress and challenges in the field of data sharing, and feed lessons learned back into communities to cultivate further public health innovations involving shared data and infrastructure development. EVALUATION Use case development, engaging communities to cocreate shared data systems. DISCUSSION Findings show public health plays a pivotal role in innovation to share data across sectors to serve as a community health improvement foundation. While public health often leads these initiatives to improve health and promote health equity, national data suggest there is much room for improvement in incorporating equitable data sharing practice.
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Sacca L, Shegog R, Hernandez B, Peskin M, Rushing SC, Jessen C, Lane T, Markham C. Barriers, frameworks, and mitigating strategies influencing the dissemination and implementation of health promotion interventions in indigenous communities: a scoping review. Implement Sci 2022; 17:18. [PMID: 35189904 PMCID: PMC8862215 DOI: 10.1186/s13012-022-01190-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 01/18/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Many Indigenous communities across the USA and Canada experience a disproportionate burden of health disparities. Effective programs and interventions are essential to build protective skills for different age groups to improve health outcomes. Understanding the relevant barriers and facilitators to the successful dissemination, implementation, and retention of evidence-based interventions and/or evidence-informed programs in Indigenous communities can help guide their dissemination. PURPOSE To identify common barriers to dissemination and implementation (D&I) and effective mitigating frameworks and strategies used to successfully disseminate and implement evidence-based interventions and/or evidence-informed programs in American Indian/Alaska Native (AI/AN), Native Hawaiian/Pacific Islander (NH/PI), and Canadian Indigenous communities. METHODS A scoping review, informed by the York methodology, comprised five steps: (1) identification of the research questions; (2) searching for relevant studies; (3) selection of studies relevant to the research questions; (4) data charting; and (5) collation, summarization, and reporting of results. The established D&I SISTER strategy taxonomy provided criteria for categorizing reported strategies. RESULTS Candidate studies that met inclusion/exclusion criteria were extracted from PubMed (n = 19), Embase (n = 18), and Scopus (n = 1). Seventeen studies were excluded following full review resulting in 21 included studies. The most frequently cited category of barriers was "Social Determinants of Health in Communities." Forty-three percent of barriers were categorized in this community/society-policy level of the SEM and most studies (n = 12, 57%) cited this category. Sixteen studies (76%) used a D&I framework or model (mainly CBPR) to disseminate and implement health promotion evidence-based programs in Indigenous communities. Most highly ranked strategies (80%) corresponded with those previously identified as "important" and "feasible" for D&I The most commonly reported SISTER strategy was "Build partnerships (i.e., coalitions) to support implementation" (86%). CONCLUSION D&I frameworks and strategies are increasingly cited as informing the adoption, implementation, and sustainability of evidence-based programs within Indigenous communities. This study contributes towards identifying barriers and effective D&I frameworks and strategies critical to improving reach and sustainability of evidence-based programs in Indigenous communities. REGISTRATION NUMBER N/A (scoping review).
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Affiliation(s)
- Lea Sacca
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
| | - Ross Shegog
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
| | - Belinda Hernandez
- grid.267309.90000 0001 0629 5880Center for Health Promotion and Disease Prevention, University of Texas Health Science Center School of Public Health in San Antonio, 7411 John Smith Drive, Suite 1100, San Antonio, TX 78229 USA
| | - Melissa Peskin
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
| | - Stephanie Craig Rushing
- grid.422837.80000 0000 9966 8676Northwest Portland Area Indian Health Board, 2121 SW Broadway Suite 300, Portland, OR 97201 USA
| | - Cornelia Jessen
- grid.413552.40000 0000 9894 0703Alaska Native Tribal Health Consortium, 4000 Ambassador Drive, Anchorage, AK 99508 USA
| | - Travis Lane
- grid.470274.20000 0001 0023 3814Inter Tribal Council of Arizona, Inc., 2214 North Central Avenue, Phoenix, AZ 85004 USA
| | - Christine Markham
- grid.267308.80000 0000 9206 2401Center for Health Promotion and Disease Prevention, University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin, Houston, TX 77030 USA
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Dirks LG, Wanda P. Technology to Support Collaborative Dissemination of Research with Alaska Native Communities. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2022; 2021:398-407. [PMID: 35308978 PMCID: PMC8861747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Marginalized communities often mistrust research due to a history of unethical practice and limited community engagement. Research community engagement is expected with Indigenous communities, but few empirical studies have explored engagement in results dissemination, let alone using technology. Studies on using technology to disseminate results focus on health and research professional audiences. This paper discusses Alaska Native stakeholder values on technology to facilitate collaborative results dissemination. In this formative study, six participants engaged in participatory design activities on collaborative results dissemination. Sketches and interviews were analyzed deductively using a value-based codebook. Study findings highlight the importance of community context and transparency. Contextual awareness includes understanding local culture and power dynamics, acknowledging the diversity of cultural practices within Alaska Native groups. Transparency is tied to clear communication: encouraging active dialogue and providing alternatives to communicate research. Technology that supports such collaborative dissemination could increase trust and improve adoption of research-recommended actions.
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Affiliation(s)
- Lisa G Dirks
- University of Washington Information School, Seattle, WA, USA
| | - Pratt Wanda
- University of Washington Information School, Seattle, WA, USA
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Pedersen M, Harris KJ, Brown B, Grant M, Kleinmeyer C, Glass A, Graham N, King DK. Physical Activity Intervention Adaptation: Recommendations from Rural American Indian Older Adults. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2022; 23:1067-1077. [PMID: 35092521 DOI: 10.1007/s11121-022-01342-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 12/11/2022]
Abstract
Preventive interventions are critical to improving health equity among American Indian (AI) populations, yet interventions that promote physical activity (PA) among AI populations are scarce. This research addresses the research-to-practice gap by informing the adaption and implementation process of evidence-based interventions (EBIs) among rural AI older adults. We used a community-based approach and an Indigenous-focused adaptation theoretical framework. Qualitative, semi-structured interviews elicited detailed information on preferences for PA intervention among rural AI older adults. We applied a collaborative directed content analysis strategy, and established trustworthiness and relevance using an inter-rater reliability process and member checking. We conducted 21 interviews, all participants identified as AI, the mean age was 66 years (SD = 7.6), and 57% were female. Themes characterized contextual and cultural intervention considerations for adapting and implementing evidence-based PA interventions in rural AI older adults. Key findings included an emphasis on social and community interaction, strategies for targeted engagement, preference for group format, pairing PA sessions with shared meals, and inclusiveness in the PA intervention across ability levels and age groups. This study identified opportunities for adaptation of PA-focused EBIs among rural AI older adults. Findings can be applied to support the adaptation and implementation of effective and relevant PA-focused preventive interventions among this population which is at high risk for chronic disease and health disparities.
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Affiliation(s)
- Maja Pedersen
- Stanford Prevention Research Center, Stanford School of Medicine, Stanford University, Stanford, USA.
| | - Kari Jo Harris
- School of Public and Community Health Sciences, University of Montana, Missoula, USA
| | - Blakely Brown
- School of Public and Community Health Sciences, University of Montana, Missoula, USA
| | - Mattea Grant
- School of Public and Community Health Sciences, University of Montana, Missoula, USA
| | - Chelsea Kleinmeyer
- Community Health Division, Confederated Salish and Kootenai Tribal Health Department, Saint Ignatius, Montana, USA
| | - Ashley Glass
- Community Health Division, Confederated Salish and Kootenai Tribal Health Department, Saint Ignatius, Montana, USA
| | - Niki Graham
- School of Public and Community Health Sciences, University of Montana, Missoula, USA
| | - Diane K King
- Center for Behavioral Health Research and Services, Institute of Social and Economic Research, University of Alaska Anchorage, Anchorage, USA
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Steinberg RI, Begay JA, Begay PM, Goldtooth DL, Nelson ST, Yazzie DA, Delamater AM, Hockett CW, Phimphasone-Brady P, Powell JC, Sinha M, Dabelea D, Sauder KA. Lessons on Resilient Research: Adapting the Tribal Turning Point Study to COVID-19. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2022; 29:155-182. [PMID: 35881986 PMCID: PMC9837807 DOI: 10.5820/aian.2902.2022.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Tribal Turning Point (TTP) is a community-based randomized controlled trial of a lifestyle intervention to reduce risk factors for type 2 diabetes in Native youth. TTP began in 2018 and was interrupted by the COVID-19 pandemic in 2020. In this paper we aimed to understand 1) how the pandemic impacted TTP's operations, and how the TTP team successfully adapted to these impacts; 2) how the effects of COVID-19 and our adaptations to them were similar or different across TTP's research sites; and 3) lessons learned from this experience that may help other Native health research teams be resilient in this and future crises. Using a collaborative mixed methods approach, this report explored five a priori domains of adaptation: intervention delivery, participant engagement, data collection, analytic strategies, and team operations. We derived three lessons learned: 1) ensure that support offered is flexible to differing needs and responsive to changes over time; 2) adapt collaboratively and iteratively while remaining rooted in community; and 3) recognize that relationships are the foundation of successful research.
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Affiliation(s)
- Rachel I. Steinberg
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Joel A. Begay
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Paula M. Begay
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Deidra L. Goldtooth
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Shawna T.M. Nelson
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Debra A. Yazzie
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | | | | | | | | | - Madhumita Sinha
- Diabetes Epidemiology and Clinical Research Section at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) and the University of Arizona College of Medicine
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
| | - Katherine A. Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center at the University of Colorado Anschutz Medical Campus
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Haozous EA, Jaramillo ET, Willging CE. Getting to Know: American Indian Elder Health Seeking in an Under-funded Healthcare System. SSM. QUALITATIVE RESEARCH IN HEALTH 2021; 1:100009. [PMID: 34988544 PMCID: PMC8725791 DOI: 10.1016/j.ssmqr.2021.100009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
American Indian (AI) Elders are the heart of the community. Existing research explores links between specific health behaviors and social determinants of health, but there is little theory explaining patient behaviors in the context of the Indian Health Service (IHS) system of care. We drew from a multiyear mixed-methods participatory study of Elder healthcare experiences to identify the systemic, interpersonal, and historic factors in the IHS that impact their health-seeking behaviors. We conducted an interpretive grounded theory analysis guided by Indigenous methodologies to analyze interviews with 96 AI Elders from two Southwestern states. Our resulting theory, Getting to Know, explains how Elders knew, owned, accessed, and were denied information and resources in their efforts to receive care. Findings highlight how Elders' health-seeking behaviors reflect longstanding inequities, the many ways Elder knowledge was incongruent with Western knowledge embedded in the IHS system, and how this conflict contributed to Elder discomfort in clinical settings. Future work will test the applicability of Getting to Know in other AI communities and design culturally safe care to meet Elder needs. By applying an Indigenous-centered analysis to the voices of Elders, we identified key influences on health outcomes not previously observed in the literature. By illuminating these influences, we show how culturally safe care can be better formulated to meet the needs of Elders, ultimately improving health for AI communities.
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Affiliation(s)
- Emily A Haozous
- Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque NM 87106-4341, USA
| | - Elise Trott Jaramillo
- Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque NM 87106-4341, USA
| | - Cathleen E Willging
- Pacific Institute for Research and Evaluation, 851 University Blvd SE, Suite 101, Albuquerque NM 87106-4341, USA
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D'Amico EJ, Dickerson DL, Rodriguez A, Brown RA, Kennedy DP, Palimaru AI, Johnson C, Smart R, Klein DJ, Parker J, McDonald K, Woodward MJ, Gudgell N. Integrating traditional practices and social network visualization to prevent substance use: study protocol for a randomized controlled trial among urban Native American emerging adults. Addict Sci Clin Pract 2021; 16:56. [PMID: 34565444 PMCID: PMC8474938 DOI: 10.1186/s13722-021-00265-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nonmedical use of prescription opioids (defined as taking opioid medications for hedonic effects or in a manner other than prescribed) and the use of heroin have emerged in recent years as major public health concerns in the United States. Of particular concern is the prevalence of opioid use among emerging adults (ages 18-25), as this is a developmental period of heightened vulnerability and critical social, neurological, and psychological development. Data from 2015 show that American Indian/Alaska Native (AI/AN) people have the highest rates of diagnosis for opioid use disorders (OUDs). One recent study found that the overdose death rate among urban-dwelling AI/AN individuals was 1.4 times higher compared to those living in rural areas. To date, there are no evidence-based prevention programs addressing opioid use among urban AI/AN emerging adults that integrate culturally-appropriate strategies with evidence-based treatment. Traditions and Connections for Urban Native Americans (TACUNA) builds on our prior work with AI/AN communities across California to develop and evaluate culturally appropriate programming to address opioid, alcohol, and cannabis use among urban AI/AN emerging adults. METHODS/DESIGN In a randomized controlled trial, 18-25 year old urban AI/AN emerging adults will receive either TACUNA (n = 185), which comprises three virtual workshops utilizing motivational interviewing, social network visualization, and integrating traditional practices and a wellness circle, or one virtual culturally sensitive opioid education workshop (n = 185). We will evaluate intervention effects on primary outcomes of frequency of opioid, alcohol, and cannabis use, as well as secondary outcomes of social network characteristics and cultural connectedness, over a 12-month period. DISCUSSION This project has the potential to expand the range and effectiveness of opioid, alcohol, and cannabis services for urban AI/AN emerging adults by addressing the opioid epidemic and use of other substances at both the community and individual level. In addition, it provides important culturally grounded conceptual and practical information to advance the field of substance use interventions and enhance resiliency among this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020 https://clinicaltrials.gov/ct2/show/record/NCT04617938 .
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Affiliation(s)
- Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA.
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, 1640 Sepulveda Blvd., Suite 200, Los Angeles, CA, 90025, USA
| | | | - Ryan A Brown
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - David P Kennedy
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Alina I Palimaru
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Carrie Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
| | - Rosanna Smart
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Jennifer Parker
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Keisha McDonald
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Michael J Woodward
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Ninna Gudgell
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
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Blue Bird Jernigan V, Maudrie TL, Nikolaus CJ, Benally T, Johnson S, Teague T, Mayes M, Jacob T, Taniguchi T. Food Sovereignty Indicators for Indigenous Community Capacity Building and Health. FRONTIERS IN SUSTAINABLE FOOD SYSTEMS 2021. [DOI: 10.3389/fsufs.2021.704750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Food insecurity, defined as a lack of stable access to sufficient and nutritious food, is a global public health priority due to its relationships with diminished mental and physical human health. Indigenous communities experience disproportionality high rates of food insecurity as a byproduct of settler-colonial activities, which included forced relocation to rural reservation lands and degradation of traditional subsistence patterns. Many Indigenous communities have worked to revitalize their local food systems by pursuing food sovereignty, regularly expressed as the right and responsibility of people to have access to healthy and culturally appropriate foods, while defining their own food systems. Food sovereignty is a promising approach for improving health. However, limited literature is available that identifies the diverse practices of food sovereignty or strategies communities can implement to strengthen their food sovereignty efforts. This article reviews the scientific literature and highlights key indicators that may support community capacity building for food sovereignty and health. The seven indicators are: (1) access to resources, (2) production, (3) trade, (4) food consumption, (5) policy, (6) community involvement, and (7) culture. A total of 25 sub-indicators are outlined to allow communities to understand how an indicator is operationalized as well as explore their own community's progress within each indicator. It is not expected that every indicator and their subcategories will apply fully to any given Indigenous community, and the application of these indicators must be adapted for each community's local context, however the indicators may provide support for building and assessing efforts to create more sustainable Indigenous food systems.
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Pedersen M, Harris KJ, Lewis J, Grant M, Kleinmeyer C, Glass A, Graham N, Brown B, King D. Uplifting the voices of rural American Indian older adults to improve understanding of physical activity behavior. Transl Behav Med 2021; 11:1655-1664. [PMID: 34347863 DOI: 10.1093/tbm/ibab107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
American Indian (AI) older adults experience pronounced health disparities and demonstrate one of the lowest levels of physical activity (PA) among racial and ethnic groups. Nearly half of AI older adults live in rural areas, indicating distinct challenges to participation in PA. Research to identify factors influencing PA in this population is missing from the literature, yet is critical to informing culturally relevant PA intervention development and implementation. The purpose was to identify barriers to and facilitators of PA among rural AI older adults using the ecological model and qualitative methods. A community-based approach was used to conduct semi-structured interviews with rural AI older adults. Interview questions were based on a multi-level ecological model. Content analysis was performed, using an iterative coding process to identify findings. The mean age of participants (n = 21) was 66 years. Barriers to and facilitators of PA were identified across ecological model levels. Barriers included factors such as caregiving and community responsibilities, lack of acceptable areas for walking, and overall lack of community-level support for older adult health. Facilitators included a personal connection to the land and ancestors through PA, multigenerational participation, and supportive tribal policies. This study addressed a gap in the literature by identifying barriers to and facilitators of PA among rural AI older adults, which can inform PA intervention development. With barriers and facilitators identified by AI older adults themselves, the voices of those directly affected are uplifted to shape efforts toward addressing longstanding health disparities through relevant public health interventions.
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Affiliation(s)
- Maja Pedersen
- Stanford Prevention Research Center, Stanford University, Stanford, CA 94305, USA
| | - Kari Jo Harris
- School of Public and Community Health Sciences, University of Montana, Missoula, MT 59812, USA
| | - Jordan Lewis
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Duluth, MN, USA
| | - Mattea Grant
- School of Public and Community Health Sciences, University of Montana, Missoula, MT 59812, USA
| | | | - Ashley Glass
- Confederated Salish and Kootenai Tribal Health Department, MT, USA
| | - Niki Graham
- School of Public and Community Health Sciences, University of Montana, Missoula, MT 59812, USA
| | - Blakely Brown
- School of Public and Community Health Sciences, University of Montana, Missoula, MT 59812, USA
| | - Diane King
- Center for Behavioral Health Research and Services, University of Alaska Anchorage, AK, USA
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D'Amico EJ, Dickerson DL, Brown RA, Klein DJ, Agniel D, Johnson C. Unveiling an 'invisible population': health, substance use, sexual behavior, culture, and discrimination among urban American Indian/Alaska Native adolescents in California. ETHNICITY & HEALTH 2021; 26:845-862. [PMID: 30626198 PMCID: PMC7510334 DOI: 10.1080/13557858.2018.1562054] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/17/2018] [Indexed: 06/09/2023]
Abstract
Objectives: There are limited public health data on urban American Indian/Alaska Native (AI/AN) populations, particularly adolescents. The current study attempted to address gaps by providing descriptive information on experiences of urban AI/AN adolescents across northern, central, and southern California.Design: We describe demographics and several behavioral health and cultural domains, including: alcohol and other drug (AOD) use, risky sexual behavior, mental and physical health, discrimination experiences, involvement in traditional practices, and cultural pride and belonging. We recruited 185 urban AI/AN adolescents across northern, central, and southern California from 2014 to 2017 who completed a baseline survey as part of a randomized controlled intervention trial.Results: Average age was 15.6 years; 51% female; 59% of adolescents that indicated AI/AN descent also endorsed another race or ethnicity. Rates of AOD use in this urban AI/AN sample were similar to rates for Monitoring the Future. About one-third of adolescents reported ever having sexual intercourse, with 15% reporting using alcohol or drugs before sex. Most reported good mental and physical health. Most urban AI/AN adolescents participated in traditional practices, such as attending Pow Wows and learning their tribal history. Adolescents also reported discrimination experiences, including being a victim of racial slurs and discrimination by law enforcement.Conclusions: This study describes a select sample of California urban AI/AN adolescents across several behavioral health and cultural domains. Although these adolescents reported numerous discrimination experiences and other stressors, findings suggest that this sample of urban AI/AN teens may be particularly resilient with regard to behavioral health.
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Affiliation(s)
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | | | | - Carrie Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, USA
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Dickerson DL, D'Amico EJ, Klein DJ, Johnson CL, Hale B, Ye F, Dominguez BX. Drum-Assisted Recovery Therapy for Native Americans (DARTNA): Results from a feasibility randomized controlled trial. J Subst Abuse Treat 2021; 126:108439. [PMID: 33966952 DOI: 10.1016/j.jsat.2021.108439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/23/2020] [Accepted: 04/21/2021] [Indexed: 12/30/2022]
Abstract
Alcohol and other drug (AOD) use among American Indians and Alaska Natives (AI/ANs) is a significant health issue in the United States. However, few evidence-based substance use interventions that utilize AI/AN traditional practices, such as drumming, exist. The current study is a feasibility randomized controlled trial (RCT) analyzing the potential benefits of DARTNA (Drum-Assisted Recovery Therapy for Native Americans) among 63 AI/AN adults seeking substance use treatment within an urban area in southern California. We compared DARTNA participants to usual care plus, which involved an integrated multimedia health educational program and usual care from providers for AOD use. At end of treatment, DARTNA participants reported significantly lower cognitive impairment and lower counts of physical ailments. Given that this was a feasibility trial, we also used Cohen's d = 0.20 or odds ratio = 2 or 0.5 to determine clinical significance. At end of treatment, we found promising benefits for DARTNA participants related to better physical health, fewer drinks per day, and lower odds of marijuana use in the past 30 days compared to the control group. Using these criteria, at 3-month follow-up, DARTNA participants reported less adoption of 12-step principles, less cognitive impairment, and lower anxiety with relationships. However, DARTNA participants reported more drinks per day and more cigarettes compared to the control group. Overall, this study demonstrates feasibility of conducting an RCT with AI/AN people in urban settings and highlights how a substance use treatment intervention utilizing drumming may help to meet the diverse needs of AI/AN people seeking substance use treatment.
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Affiliation(s)
- Daniel L Dickerson
- Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA.
| | | | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
| | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, 981 West Arrow Highway, #412, San Dimas, CA 91773, USA
| | - Benjamin Hale
- Sacred Path Indigenous Wellness Center, 981 West Arrow Highway, #412, San Dimas, CA 91773, USA
| | - Feifei Ye
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA
| | - Blanca X Dominguez
- Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA
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Dickerson DL, D'Amico EJ, Klein DJ, Johnson CL, Hale B, Ye F. Mental Health, Physical Health, and Cultural Characteristics Among American Indians/Alaska Natives Seeking Substance Use Treatment in an Urban Setting: A Descriptive Study. Community Ment Health J 2021; 57:937-947. [PMID: 32720004 PMCID: PMC7855095 DOI: 10.1007/s10597-020-00688-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/18/2020] [Indexed: 01/14/2023]
Abstract
Although approximately 70% of American Indians/Alaska Natives (AI/ANs) reside in urban areas, our knowledge of risk and protective factors among AI/ANs seeking substance use treatment within urban areas is limited. We analyze substance and commercialized cigarette use, AI/AN cultural identity and involvement, physical health and cognitive functioning, and mental health symptoms among 63 AI/AN adults seeking substance use treatment within an urban area in California. Alcohol (37%), marijuana (27%), and methamphetamine (22%) were the most commonly reported substances. Sixty-two percent used commercialized tobacco use. The majority of AI/AN adults (78%) engaged in at least one traditional practice during the past month and endorsed high levels of spiritual connectedness. Those who engaged in traditional practices demonstrated significantly less depression (p = 0.007) and anxiety (p = 0.04). Medical and mental health issues were not prominent, although participants revealed high levels of cognitive impairment. Results highlight the importance of utilizing AI/AN traditional practices for AI/AN adults seeking substance use treatment within urban areas. Clinical Trials Registry Number NCT01356667.
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Affiliation(s)
- Daniel L Dickerson
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, 90025, USA.
| | | | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
| | - Benjamin Hale
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
| | - Feifei Ye
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA
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D'Amico EJ, Palimaru AI, Dickerson DL, Dong L, Brown RA, Johnson CL, Klein DJ, Troxel WM. Risk and Resilience Factors in Urban American Indian and Alaska Native Youth during the Coronavirus Pandemic. AMERICAN INDIAN CULTURE AND RESEARCH JOURNAL 2021; 44:21-48. [PMID: 35719739 PMCID: PMC9205322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
American Indians and Alaska Natives suffer disproportionately from poverty and other inequities and are vulnerable to adverse health and socioeconomic effects of COVID-19. Using surveys and interviews (May - July 2020), we examined urban American Indian/Alaska Native adolescents' (N=50) health and behaviors, family dynamics, community cohesion, and traditional practice participation during COVID-19. About 20% of teens reported clinically significant anxiety and depression, 25% reported food insecurity, and 40% reported poor sleep. Teens also reported high family and community cohesion, and many engaged in traditional practices during this time. Although many teens reported problems, they also emphasized resilience strategies.
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Affiliation(s)
| | | | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs; Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine; 1640 Sepulveda Blvd., Suite 200; Los Angeles, CA
| | - Lu Dong
- RAND Corporation; 1776 Main St., Santa Monica, CA 90401
| | - Ryan A Brown
- RAND Corporation; 1776 Main St., Santa Monica, CA 90401
| | | | - David J Klein
- RAND Corporation; 1776 Main St., Santa Monica, CA 90401
| | - Wendy M Troxel
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, Pennsylvania 15213
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Trimble JE. "Being Grounded in the Ancestors and Looking Forward..."-Blending Culturally Competent Research with Indigenous Leadership Styles 1. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 21:98-104. [PMID: 31641923 DOI: 10.1007/s11121-019-01063-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The themes and topics found in this Prevention Science supplemental issue on Promoting Health Equity through Rigorous, Culturally Informed Intervention Science: Innovations with Indigenous Populations in the United States represent a comprehensive array of essential considerations for the ethical and principled conduct of health-related research with indigenous communities. The topics are inclusive of what must be considered when researchers realize "culture matters" in the conduct of ethnocultural field-based research. The reader is introduced to profound insights, engaging observations, important research results, and cutting-edge commentary on the future of health-centered research and practice with indigenous populations. In reflecting on the general intent of the issue, two additional themes are considered. Attention is given to the research relationship and requirements for a significant degree and depth in the cultural competence and sensitivity of field-based research teams. Consideration also is given culture and leadership style at the local community level in research programs. These twin considerations have bearing on two important questions facing future research in Indigenous health. In effect, who will guide the community's policies, practices, and experiences of the research teams? Who will lead the funding and policy sources and the next generation of researchers?
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Affiliation(s)
- Joseph E Trimble
- Department of Psychology, Western Washington University, 516 High Street, Bellingham, WA, 98225, USA.
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Dickerson DL, Parker J, Johnson CL, Brown RA, D'Amico EJ. Recruitment and retention in randomized controlled trials with urban American Indian/Alaska Native adolescents: Challenges and lessons learned. Clin Trials 2021; 18:83-91. [PMID: 33231130 PMCID: PMC7878293 DOI: 10.1177/1740774520971774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although the majority of American Indians/Alaska Natives reside in urban areas, there are very few randomized controlled trials analyzing culturally centered substance use prevention interventions for this population. METHODS We describe methods employed to recruit and retain urban American Indian/Alaska Native adolescents into a randomized controlled trial, which was focused on testing the potential benefits of a substance use prevention intervention for this population. We also report challenges encountered in recruitment and retention of participants and strategies employed addressing these challenges. Data collection occurred from August 2014 to October 2017. RESULTS We partnered with two community-based organizations in different cities in California. We utilized American Indian/Alaska Native recruiters from communities, placed flyers in community-based organizations, and asked organizations to post flyers on their web and social media sites. We also offered gift cards for participants. Our initial recruitment and retention model was moderately successful; however, we encountered five main challenges: (1) transportation, (2) increasing trust and interest, (3) adding research sites, (4) getting the word out about the project, and (5) getting youth to complete follow-up surveys. Strategies employed to overcome transportation challenges included shortening the number of sessions, offering sessions on both weekends and weekdays, and increasing bus tokens and transportation options. We hired more staff from American Indian/Alaska Native communities, added more research sites from our previously established relationships, and were more proactive in getting the word out on the project in American Indian/Alaska Native communities. We also utilized more field tracking and emailed and mailed survey invitations to reach more participants for their follow-up surveys. Because of our efforts, we were nearly able to reach our initial recruitment and retention goals. CONCLUSION Although our research team had previously established relationships with various urban American Indian/Alaska Native communities, we encountered various recruitment and retention challenges in our study. However, by identifying challenges and employing culturally appropriate strategies, we were able to collect valuable data on the potential effectiveness of a substance use prevention intervention for urban American Indian/Alaska Native adolescents. Findings from this study assist toward the development of potentially successful strategies to successfully recruit and retain urban American Indian/Alaska Native adolescents in randomized controlled trials.
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Affiliation(s)
- Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs (ISAP), University of California Los Angeles, Los Angeles, CA, USA
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Haozous EA, Lee J, Soto C. Urban American Indian and Alaska Native Data Sovereignty: Ethical Issues. AMERICAN INDIAN AND ALASKA NATIVE MENTAL HEALTH RESEARCH 2021; 28:77-97. [PMID: 34586627 PMCID: PMC8877071 DOI: 10.5820/aian.2802.2021.77] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This paper examines the ethical issues underlying research with urban American Indians and Alaska Natives (AI/ANs) through the lens of tribal sovereignty. There are 574 federally recognized tribes within the United States. Each of those tribes is recognized by the federal government as having sovereign status, an important political designation that ensures that decisions impacting tribal peoples must be made after consultation with those nations. Most AI/AN people live away from their designated tribal lands, yet their sovereign rights are frequently only recognized when living on tribal lands. These urban AI/ANs are still considered citizens of their sovereign nations, yet they lack the protections afforded to those who live on tribal lands, including protections surrounding research with their tribal communities. We explore the Belmont Report and related documents and demonstrate their inadequacy in considering the cultural and ethical concerns specific to protecting urban AI/ANs. We also provide several solutions to help guide future institutional policies regarding research with urban AI/ANs that honors Indigenous data sovereignty, including consultation, partnership with community advisory boards, employment of data use agreements, and ensuring informed consent.
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Knox M, Skan J, Benowitz NL, Schnellbaecher M, Prochaska JJ. Recruitment best practices of a cardiovascular risk reduction randomised control trial in rural Alaska Native communities. Int J Circumpolar Health 2020; 79:1806639. [PMID: 32787541 PMCID: PMC7480599 DOI: 10.1080/22423982.2020.1806639] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 06/30/2020] [Accepted: 07/28/2020] [Indexed: 11/08/2022] Open
Abstract
Though not native to Alaska, tobacco use is common among Alaska Native people in the Norton Sound region, an area consisting of 16 communities with population size 107 to 3,695. We summarise best practices in recruiting Alaska Native adults who smoke for a randomised controlled tobacco treatment trial. Participants were Alaska Native, 19 years and older, smoking daily, with hypertension and/or high cholesterol, residing in the Norton Sound region of Alaska. Study staff travelled to the remote communities to recruit, typically staying 5 days. Screening and enrolment success was examined by day, season, and staffing level. From June 2015 - December 2018, the study team made 122 trips, screening 1089 individuals and enrolling 314 participants. In the field, days 2-3 (51%) were best for screening, while days 3-4 (53%) had the greatest enrolment. Community size correlated with enrolment (r = 0.83, p <.001). Recruitment was optimised in spring and with multiple staff in the field. Despite challenges (e.g., harsh weather, poor internet connectivity), with active outreach (e.g. tabling in busy areas, attending community events, utilising mixed media, collaborating with clinic staff), the project reached its recruitment goal. Study findings can inform community-based tobacco treatment research trials in remote areas. ABBREVIATIONS CVD: Cardiovascular disease; VTC: Video teleconferencing; ANMC: Alaska Native Medical Centre; HEALTHH: Healing and Empowering Alaskan Lives Towards Healthy Hearts; NSHC: Norton Sound Health Corporation; RERB: Research Ethics Review Board.
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Affiliation(s)
- Mariah Knox
- Cardiology Department, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Jordan Skan
- Cardiology Department, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Neal L. Benowitz
- Department of Medicine, Division of Cardiology, University of California, San Francisco, CA, USA
| | | | - Judith J. Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University
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Dissemination of an American Indian Culturally Centered Community-Based Participatory Research Family Listening Program: Implications for Global Indigenous Well-Being. GENEALOGY 2020. [DOI: 10.3390/genealogy4040099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We introduce a culture-centered indigenous program called the Family Listening Program (FLP), which was developed through a long-standing community-based participatory research (CBPR) partnership involving tribal research teams (TRTs) from three American Indian communities (Apache, Navajo, and Pueblo) with the University of New Mexico’s Center for Participatory Research (UNM-CPR). This paper provides background information on the TRT/UNM-CPR multi-generational FLP intervention funded by the National Institute on Drug Abuse and how it is poised to take the next steps of dissemination and implementation (D&I). In preparing for the next steps, the TRT/UNM-CPR team piloted two FLP dissemination activities, first at the state-level and then nationally; this paper describes these activities. Based on the learnings from the pilot dissemination, the TRT/UNM-CPR team developed an innovative D&I model by integrating a community-based participatory research culture-centered science (CBPR-CCS) approach with the Interactive Systems Framework (ISF) to examine the uptake, cultural acceptance, and sustainability of the FLP as an evidence-based indigenous family program.
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Kyoon-Achan G, Schroth RJ, DeMaré D, Sturym M, Edwards J, Lavoie JG, Sanguins J, Campbell R, Chartrand F, Bertone MF, Singh S, Moffatt MEK. Indigenous community members' views on silver diamine fluoride to manage early childhood caries. J Public Health Dent 2020; 80:208-216. [PMID: 32400029 DOI: 10.1111/jphd.12370] [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] [Received: 07/30/2019] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Early childhood caries (ECC) continues to be the leading reason for pediatric dental surgery in Canada and is particularly prevalent among Indigenous children. Silver diamine fluoride (SDF) offers an alternative method to manage non-restoratively caries. It is important to determine Indigenous communities' views on and receptivity toward SDF. AIM To understand Indigenous community members' views on pediatric dental surgery to treat ECC under general anesthesia (GA) and receptivity to SDF as an alternative to restorative surgery. METHODS Focus groups and sharing circles congruent with an Indigenous ways of gathering information were conducted. Three interviewers engaged eight groups of First Nation and Metis communities in three rural Indigenous communities and ne metropolitan urban setting in Manitoba, Canada. Overall, 59 individuals participated. Open coding was guided by grounded theory and further analysis using Nvivo 12 software™. RESULTS Participants mean age was 35.6 years, 88 percent (52 individuals) had a least one child, and 32 percent (19 individuals) were employed. Eight themes emerged, including respondents' fear of dental surgery under GA, fear of pain after dental surgery, parents' need for more information before accepting SDF treatment, and concern about the black staining of treated lesions. CONCLUSIONS Indigenous parents' acceptance of SDF as a treatment option is contingent on having more information and assurance that treatment under GA can be avoided. Understanding Indigenous parents' views may ensure better acceptance of SDF as a minimally invasive treatment option to manage ECC. A cautious and informative approach to SDF implementation in Indigenous communities is recommended.
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Affiliation(s)
- Grace Kyoon-Achan
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Ongomiizwin Research - Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Robert J Schroth
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Winnipeg Regional Health Authority, Section of Pediatric Dentistry, Winnipeg, Canada
| | - Daniella DeMaré
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Melina Sturym
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | | | - Josée G Lavoie
- Ongomiizwin Research - Indigenous Institute of Health and Healing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Julianne Sanguins
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Manitoba Metis Federation, Winnipeg, Canada
| | - Rhonda Campbell
- First Nations Health and Social Secretariat of Manitoba, Winnipeg, Canada
| | | | - Mary F Bertone
- School of Dental Hygiene, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Sarbjeet Singh
- Department of Preventive Dental Science, Dr. Gerald Niznick College of Dentistry, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Canada
| | - Michael E K Moffatt
- Children's Hospital Research Institute of Manitoba, Winnipeg, Canada.,Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.,Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
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D'Amico EJ, Dickerson DL, Brown RA, Johnson CL, Klein DJ, Agniel D. Motivational interviewing and culture for urban Native American youth (MICUNAY): A randomized controlled trial. J Subst Abuse Treat 2020; 111:86-99. [PMID: 32087841 PMCID: PMC7477923 DOI: 10.1016/j.jsat.2019.12.011] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022]
Abstract
To date, few programs that integrate traditional practices with evidence-based practices have been developed, implemented, and evaluated with urban American Indians/Alaska Natives (AI/ANs) using a strong research design. The current study recruited urban AI/AN teens across northern, central, and southern California during 2014-2017 to participate in a randomized controlled trial testing two cultural interventions that addressed alcohol and other drug (AOD) use. Adolescents were 14-18 years old (inclusive), and either verbally self-identified as AI/AN or were identified as AI/AN by a parent or community member. We tested the added benefit of MICUNAY (Motivational Interviewing and Culture for Urban Native American Youth) to a CWG (Community Wellness Gathering). MICUNAY was a group intervention with three workshops that integrated traditional practices with motivational interviewing. CWGs were cultural events held monthly in each city. AI/AN urban adolescents (N = 185) completed a baseline survey, were randomized to MICUNAY + CWG or CWG only, and then completed a three- and six-month follow-up. We compared outcomes on AOD use, spirituality, and cultural identification. Overall, AOD use remained stable over the course of the study, and we did not find significant differences between these two groups over time. It may be that connecting urban AI/AN adolescents to culturally centered activities and resources is protective, which has been shown in other work with this population. Given that little work has been conducted in this area, longer term studies of AOD interventions with urban AI/AN youth throughout the U.S. are suggested to test the potential benefits of culturally centered interventions.
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Affiliation(s)
- Elizabeth J D'Amico
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America.
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, United States of America
| | - Ryan A Brown
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America
| | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, LA, CA 90017, United States of America
| | - David J Klein
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America
| | - Denis Agniel
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America
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Rasmus SM, Whitesell NR, Mousseau A, Allen J. An Intervention Science to Advance Underrepresented Perspectives and Indigenous Self-Determination in Health. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:83-92. [PMID: 31152330 PMCID: PMC6885107 DOI: 10.1007/s11121-019-01025-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This concluding article to the Supplemental Issue on Promoting Health Equity through Rigorous, Culturally Informed Intervention Science: Innovations with Indigenous Populations in the United States draws themes and conclusions from the innovative practices implemented by the National Institutes of Health Intervention Research to Improve Native American Health (IRINAH) consortium. The IRINAH work highlights promising practices for advancing the diverse and underrepresented perspectives essential to develop and test culturally appropriate, effective health interventions in American Indian, Alaska Native, and Native Hawaiian settings. Four emergent themes appear through the IRINAH work. First, community-based participatory research (CBPR) has provided projects an intersectional worldview for bridging cultures and informing an ethics of local control. Second, culture is fundamental as a central organizing principle in IRINAH research and intervention implementation. Third, crucial demands for sustainability of interventions in Indigenous intervention science require a rethinking of the intervention development process. Finally, tensions persist in Indigenous health research, even as significant strides are made in the field. These themes collectively inform an ethical and rigorous Indigenous intervention science. Collectively, they suggest a roadmap for advancing Indigenous perspectives and self-determination in health intervention research. IRINAH studies are leading innovation in intervention science by advancing applications of CBPR in intervention science, promoting new directions in small populations health research, and demonstrating value of participatory team science.
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Affiliation(s)
- Stacy M Rasmus
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, 205 Arctic Health Research Building, 2141 Koyukuk Drive, PO Box 757000, Fairbanks, 99775-7000, USA.
| | - Nancy Rumbaugh Whitesell
- Centers for American Indian and Alaska Native Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, MS F800, 13055 E. 17th Avenue, Room 333, Aurora, CO, 80045, USA
| | - Alicia Mousseau
- National Native Children's Trauma Center, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - James Allen
- Department of Family Medicine and Biobehavioral Health & Memory Keepers Medical Discovery Team - American Indian and Rural Health Equity, University of Minnesota Medical School, Duluth Campus, 624 E. 1st St., Suite 201, Duluth, MN, 55805, USA
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Whitesell NR, Mousseau A, Parker M, Rasmus S, Allen J. Promising Practices for Promoting Health Equity Through Rigorous Intervention Science with Indigenous Communities. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 21:5-12. [PMID: 30443847 PMCID: PMC6778005 DOI: 10.1007/s11121-018-0954-x] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Research in indigenous communities is at the forefront of innovation currently influencing several new perspectives in engaged intervention science. This is innovation born of necessity, involving efforts to create health equity complicated by a history of distrust of research. Immense diversity across indigenous cultures, accompanied by variation in associated explanatory models, health beliefs, and health behaviors, along with divergent structural inequities add further complexity to this challenge. The aim of this Supplemental Issue on Promoting Health Equity through Rigorous, Culturally Informed Intervention Science: Innovations with Indigenous Populations in the United States is to highlight the promising new approaches and perspectives implemented by a group of engaged researchers and their community partners, as they seek to move intervention research forward within indigenous communities. Case studies presented are from projects led by members of the National Institutes of Health Intervention Research to Improve Native American Health (IRINAH) consortioum, investigators who conduct health promotion and disease prevention research among American Indians, Alaska Natives, and Native Hawaiians. The promising practices profiled include new strategies in (a) community partnerships, engagement, and capacity building; (b) integration of indigenous and academic perspectives; (c) alignment of interventions with indigenous cultural values and practices; and (d) implementation and evaluation of multilevel interventions responsive to complex cultural contexts. The IRINAH projects illustrate the evolution of an intervention science responsive to the needs, realities, and promise of indigenous communities, with application to health research among other culturally distinct health inequity groups.
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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 Anschutz Medical Campus, MS F800, 13055 E. 17th Avenue, Room 333, Aurora, CO, 80045, USA.
| | - Alicia Mousseau
- National Native Children's Trauma Center, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA
| | - Myra Parker
- Center for the Study of Health and Risk Behaviors, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, 1100 NE 45th Street, Suite 300, Seattle, WA, 98105, USA
| | - Stacy Rasmus
- Center of Alaska Native Health Research, University of Alaska Fairbanks, PO Box 757000, Fairbanks, AK, 99775-7000, USA
| | - James Allen
- Department of Family Medicine and Biobehavioral Health & Memory Keepers Medical Discovery Team - American Indian and Rural Health Equity, University of Minnesota Medical School Duluth Campus, 624 E. 1st St., Suite 201, Duluth, MN, 55805, USA
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Dickerson DL, Brown RA, Klein DJ, Agniel D, Johnson C, D'Amico EJ. Overt Perceived Discrimination and Racial Microaggressions and their Association with Health Risk Behaviors among a Sample of Urban American Indian/Alaska Native Adolescents. J Racial Ethn Health Disparities 2019; 6:733-742. [PMID: 30788812 PMCID: PMC6661006 DOI: 10.1007/s40615-019-00572-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/23/2018] [Accepted: 02/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urban American Indian/Alaska Native (AI/AN) adolescents are an understudied population in the USA who are at risk for a variety of health problems. Perceived discrimination (PD), including both overt PD and racial microaggressions (RMA), is known to adversely affect health. However, studies analyzing associations between overt PD and RMA and various health behaviors are limited. METHODS This study measured past-year alcohol use, heavy drinking, marijuana use, commercialized tobacco use, consequences experienced from alcohol and marijuana use in the past 3 months, mental and physical health status, AI/AN traditional activity participation, and overt PD and RMA among 182 urban AI/AN adolescents in California. To assess the association between overt PD and RMAs and health outcomes, we conducted either logistic regression (for dichotomous outcomes: past-year alcohol use, past-year heavy drinking, past-year marijuana use, consequences of alcohol and marijuana use, commercialized tobacco use) or linear regression (for continuous outcomes: mental and physical health, AI/AN traditional practices). RESULTS In contrast to our hypotheses, overt PD and RMA were not significantly associated with substance use or mental or physical health among this sample of urban AI/AN adolescents. After adjusting for age and gender, overt PD and RMA were only correlated with past-year cigarette use and alcohol-related consequences experienced in the past 3 months. CONCLUSION Potential factors that may play a role in decreasing effects of overt PD and RMA among urban AI/AN adolescents are discussed, including participation in AI/AN traditional practices and community engagement.
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Affiliation(s)
- Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs; Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, 90025, USA.
| | - Ryan A Brown
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - David J Klein
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - Denis Agniel
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - Carrie Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
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Bird Jernigan VB, Salvatore AL, Williams M, Wetherill M, Taniguchi T, Jacob T, Cannady T, Grammar M, Standridge J, Fox J, Tingle Owens J, Spiegel J, Love C, Teague T, Noonan C. A Healthy Retail Intervention in Native American Convenience Stores: The THRIVE Community-Based Participatory Research Study. Am J Public Health 2019; 109:132-139. [PMID: 30495999 PMCID: PMC6301410 DOI: 10.2105/ajph.2018.304749] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2018] [Indexed: 11/04/2022]
Abstract
Objectives. To assess a healthy retail intervention in Tribal convenience stores in Oklahoma.Methods. We adapted healthy retail strategies to the context of 8 Tribally owned stores. We assessed individual- and store-level outcomes in a cluster-controlled intervention trial (April 2016-June 2017). We measured fruit and vegetable intake, store environment perceptions, and purchases before and after the intervention among a cohort of 1637 Native American shoppers. We used mixed-effects linear regression to estimate pre- to postintervention changes in and between groups.Results. We followed 74% of participants (n = 1204) 9 to 12 months. Intervention and control participants perceived healthier stores after intervention. Higher shopping frequency was related to purchases of fruits, vegetables, and healthy items.Conclusions. Intervention exposure was associated with healthy purchasing but not fruit and vegetable intake. Research is needed to further assess impacts of environmental interventions on intake.Public Health Implications. As the first healthy retail intervention in Tribally owned stores, our results contribute evidence for environmental and policy interventions to address obesity in Tribal Nations. Multicomponent interventions, led by Tribal leaders from diverse sectors, are needed to create healthy environments and sustainable improvements in Native American health.
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Affiliation(s)
- Valarie Blue Bird Jernigan
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Alicia L Salvatore
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Mary Williams
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Marianna Wetherill
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Tori Taniguchi
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Tvli Jacob
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Tamela Cannady
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Mandy Grammar
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Joy Standridge
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Jill Fox
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - JoAnna Tingle Owens
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Jennifer Spiegel
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Charlotte Love
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Travis Teague
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Carolyn Noonan
- Valarie Blue Bird Jernigan, Tori Taniguchi, Tvli Jacob, Charlotte Love, and Travis Teague are with the Center for Indigenous Health Research and Action, University of Oklahoma, Tulsa. Alicia L. Salvatore, Mary Williams, and Marianna Wetherill are with the Schusterman Center, University of Oklahoma, Tulsa. Tamela Cannady and Mandy Grammar are with the Choctaw Nation Health Services, Talihina, OK. Joy Standridge, Jill Fox, JoAnna Tingle Owens, and Jennifer Spiegel are with the Chickasaw Nation Nutrition Services Department, OK. Carolyn Noonan is with the Elson S. Floyd College of Medicine, Washington State University, Spokane
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