Risk and protective factors of social networks on alcohol, cannabis, and opioid use among urban American Indian/Alaska Native emerging adults

Social Safety and Health Outcomes in Emerging Adults: Interactions of Adverse Childhood Experiences and Discrimination

Social safety theory suggests that individuals from minoritized racial and ethnic groups or sexual and gender diverse (SGD) groups are exposed to multilevel and interacting stressors, which can set the stage for adverse health outcomes. Using a social safety framework, we examine interactions between discrimination and adverse childhood experiences (ACEs) on health outcomes and how these interactions may differ by race and ethnicity or SGD status among young adults. An online survey with 2287 young adults (mean age = 25.8 years; 55.5% female) assessed ACEs and interpersonal discrimination and sleep quality, problematic alcohol or cannabis use, and post-traumatic stress disorder (PTSD) symptoms. Linear regression analyses tested interactions between ACEs and discrimination in relation to the outcomes among the overall sample and stratified by race and ethnicity or SGD status. In the overall sample, there was one significant interaction between ACEs and discrimination, such that those experiencing both greater exposure to ACEs and greater discrimination reported higher PTSD scores. Race-stratified models showed that among people of color experiencing high levels of ACEs, greater discrimination was associated with greater PTSD scores. SGD-stratified models showed that for problematic alcohol use and PTSD there was a significant interaction between ACEs and discrimination only among non-SGD participants. Consistent with social safety theory, findings highlight the potential health consequences of experiencing both discrimination and childhood adverse experiences. Intervention efforts are needed to help young people increase coping skills and other strategies to promote resilience when experiencing major life stressors.

Change in Health Status Among American Indian/Alaska Native Adolescents Living Outside of Tribal Land in California Before and During the COVID-19 Pandemic

PURPOSE

This article describes change in health status by analyzing key health domains at two time points before and during the COVID-19 pandemic among a sample of American Indian/Alaska Native (AI/AN) adolescents living outside of tribal land (n = 114) throughout California.

METHODS

Data were analyzed from a longitudinal study, Native American Youth Sleep Health and Wellness (NAYSHAW). To test changes in health from baseline (March 2018-March 2020) to follow-up (December 2020-June 2022), we ran a series of linear regression models for continuous measures and repeated measures logistic regression models for dichotomous measures for physical health, behavioral health, and cultural contexts of health and well-being.

RESULTS

For physical health, body mass index percentile significantly decreased (p = 0.02), and both systolic and diastolic blood pressure significantly increased (p < 0.001 for both), although both measures remained within the normal range for adolescents. For behavioral health, depression and anxiety significantly increased (p = 0.005 and 0.008, respectively), although they remained within subclinical levels, and no significant changes were observed with alcohol and cannabis use. For cultural contexts of health and well-being, both cultural identity and sense of historical loss significantly increased (p < 0.001 and p = 0.03, respectively).

DISCUSSION

We observed a mix of positive and negative health changes among AI/AN adolescents living outside of tribal land before and during COVID-19. Findings highlight that enhanced cultural identity during adolescence may have helped foster resilience during this difficult period.

"Am I Not Native Enough?" A Qualitative Exploration of Experienced Discrimination Among American Indian/Alaska Native Emerging Adults

Centuries of trauma, displacement, and discrimination have taken a toll on American Indian/Alaska Native (AI/AN) life expectancy and health outcomes. Despite resilience, AI/AN emerging adults (EAs) face mental and behavioral health disparities, including substance use, posttraumatic stress, and suicide. Research has consistently shown that AI/AN EAs are at risk of experiencing discrimination, which can range from linguistic taunts to physical threats and violence, as well as institutional discrimination. Discrimination is a key driver of health, and yet, there has been limited research to understand what types of discrimination events occur in this population, and how these experiences may be perceived and processed by AI/AN EAs. Interviews with a subsample of 20 participants from a larger clinical trial explored dimensions of discrimination, including types of experiences; perceived motivation and impact; and how participants coped. Results highlight nuances in experienced discrimination, including vivid accounts of verbal and physical aggression. Some participants identified teachers or highly educated colleagues who were perceived to contribute to the problem. A surprising finding was the experience of discrimination in social interactions with tribal communities and other minority groups. This complements prior evidence of discrimination in and around AI/AN areas, suggesting that additional mechanisms of discrimination should be studied further. Results also highlight how participants were resilient, for example, by accessing support in the form of tribal workshops or professional mentoring. This study highlights opportunities for additional research, as well as actionable details that could inform programming to help AI/AN EAs cope with discrimination.

Social Networks and Loneliness in the Blackfeet American Indian Community

BACKGROUND

While characteristics of an individual's social network and reported loneliness may be linked, they can be distinct. Prior work indicates that gender moderates the relationship between social networks and loneliness; however, these relationships have not been investigated in American Indian adults. The current work investigates whether the relationship between characteristics of one's social network (i.e., social network size and social integration) and loneliness is moderated by gender in a sample of Blackfeet American Indian adults.

METHOD

At Wave 1 of a longitudinal research project, we used linear regression to test whether gender moderates the relationship between social network characteristics and loneliness in a sample of 275 Blackfeet American Indian adults living in the Blackfeet nation in Montana. Our analyses controlled for age, education, and symptoms and depression and anxiety.

RESULTS

Gender moderated the relationship between social network size and loneliness (β = - 0.15, t(265) = - 2.71, p = 0.01, r2 change = .04), and the relationship between social integration and loneliness (β = - 0.14, t(265) = - 2.68, p = 0.01, r2 change = .03). Women with small social networks reported significantly greater loneliness compared to men with similarly small social networks, and for women higher social integration (i.e., more social roles) related to lower loneliness, but this was not the case for men.

CONCLUSION

Social network characteristics predict loneliness for Blackfeet women but not Blackfeet men in this sample. Future work should elucidate predictors of loneliness for Blackfeet men and consider whether daily changes in social connectedness predict changes in loneliness and whether changes in social networks predict changes in loneliness.

Sleep Problems and Health Outcomes Among Urban American Indian and Alaska Native Adolescents

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.

The Role of Social Networks on Depression and Anxiety Among a Sample of Urban American Indian/Alaska Native Emerging Adults

PURPOSE

Mental health inequalities continue to persist among American Indian/Alaska Native (AI/AN) people. However, few studies have examined the association of social networks and depression and anxiety among urban emerging AI/AN adults.

METHODS

This study analyzes the association of social network characteristics with depression and anxiety among a sample of urban AI/AN emerging adults. A second set of regression models tested the same associations but controlling for respondent sexual and gender minority (SGM) status. Data were from a sample of 150 AI/AN emerging adults residing in urban areas from 20 different states (86% female; mean age 21.8; 48.0% SGM) who participated in a randomized controlled trial analyzing the effects of culturally grounded interventions on alcohol and other drug use and cultural connectedness.

RESULTS

Participants with a higher proportion of network members who were around the same age reported significantly less anxiety. Those who had a higher proportion of network members who they sometimes/often argue/fight with were more likely to report greater depression and anxiety. Participants with higher proportions of social network members who have ever lived on a reservation/Rancheria/tribal land/tribal village reported significantly less depression. However, participants with higher proportions of social network members who lived 50 miles away or more reported significantly more depression. Controlling for SGM status, results were largely similar.

DISCUSSION

Results highlight the role of social connections on the mental well-being of urban AI/AN emerging adults.

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

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.

Voices of Identity: Exploring Identity Development and Transformation among Urban American Indian/Alaska Native Emerging Adults

Emerging adulthood shapes personal, professional, and overall well-being through identity exploration. This study addresses a gap in the minority identity literature by investigating how urban AI/AN emerging adults think about their identity and discussing challenges and protective factors associated with exploring their identity holistically. This mixed-methods study created a sampling framework based on discrimination experiences, cultural identity, social network support, mental health, and problematic substance use. We recruited 20 urban AI/AN emerging adults for interviews. We sought to gain deeper insights into their experiences and discussions surrounding identity formation and exploration. We provide descriptives for demographic characteristics and conducted a thematic analysis of the qualitative data from the interviews. Four themes emerged: a) being an urban AI/AN emerging adult means recognizing that one's identity is multifaceted; b) a multifaceted identity comes with tension of living in multiple worlds; c) the trajectory of one's identity grows over time to a deeper desire to connect with Native American culture; and d) understanding one's Native American background affects one's professional trajectory. Findings underscore the importance of developing programs to support well-being and identity development through cultural connection for urban AI/AN emerging adults.