Unveiling an 'invisible population': health, substance use, sexual behavior, culture, and discrimination among urban American Indian/Alaska Native adolescents in California

Detection of hidden populations using illicit substances

BACKGROUND

The prevalence of hidden populations using illicit substances may lead to underestimation of the health and social impacts. This study aimed to precisely estimate the prevalence and characteristics of hidden populations using illicit drugs.

METHODS

We linked national databases in Taiwan, including drug-related autopsy data and police arrest data. This study included individuals who died, underwent autopsy and showed positive drug results during autopsy, covering heroin, methamphetamine, ketamine, ecstasy and new psychoactive substances (NPS), from 2013 to 2019. We subsequently identified individuals who were arrested for illicit drug use (registered individuals) and individuals without arrest records (unregistered individuals) from 2010 to 2019.

RESULTS

A total of 1653 individuals in the autopsy database met the initial inclusion criteria. The ratio of unregistered individuals to registered individuals was 0.7 for heroin, 2.2 for methamphetamine, 14.8 for ecstasy, 4.9 for ketamine and 174.0 for NPS. Unregistered individuals were younger, more likely to be female, employed and had higher alcohol levels in their blood samples. These results remained consistent across the sensitivity analyses, encompassing both registered individuals who did not undergo autopsy and those who remained alive. Approximately 79% of the polydrug use detected at autopsy was among unregistered individuals, and 10% of unregistered individuals had other substance use records that differed from those detected at death.

CONCLUSIONS

Our approach, which incorporates both registered and unregistered individuals who use substances, shows good potential for evaluating hidden populations. Clinicians should be more attentive to potential polydrug use, even when cross-sectional urine drug tests indicate single substance use.

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.

Culture and COVID-19 Related Impacts on Alcohol-Exposed Pregnancy Risk Among Urban American Indian and Alaska Native Young Adults: A Path Analysis

PURPOSE

We investigated the influence of COVID-19 pandemic-related factors and cultural identification on indicators of alcohol-exposed pregnancy (AEP) risk among urban American Indian and Alaska Native (AIAN) youth ages 16-20.

METHODS

Path analysis was used to evaluate associations among measures collected at baseline of the Native WYSE CHOICES, an intervention study to reduce AEP risk among urban AIAN youth. Data were collected nationally from 439 female-at-birth AIAN youth (mean age 18.1 years) residing in urban areas.

RESULTS

Identification with Native American culture and heritage was significantly and positively associated with self-efficacy to abstain from alcohol (β = 0.178; p < .001), and, indirectly, significantly and negatively associated with the risk of AEP (β = -0.046; p = .001). Alternatively, distress about the pandemic's consequences for Native American communities and experiencing economic impacts exacerbated by the COVID-19 pandemic were significantly and negatively associated with self-efficacy to abstain from alcohol (respectively: β = -0.165, p < .01; β = -0.126, p < .01) and, indirectly, significantly and positively associated with risk of AEP (respectively: β = 0.043, p < .01; β = 0.033, p < .05).

DISCUSSION

Results underscore the protective role that connectedness to Native American culture and heritage plays directly and indirectly in AEP risk potential. Conversely, the experience of economic barriers and distress over loss of Native American population and culture are direct and indirect risk factors for potential AEP risk. Development of future AEP interventions for urban AIAN young adults should consider Native American cultural identification, historical trauma, and economic impacts in program design and implementation.

Ecodevelopmental influences on latent classes of substance use among urban American Indian adolescents

The large majority (over 70%) of American Indian adolescents who reside in cities rather than tribal lands or rural areas report relatively earlier onset of substance use and more harmful associated health effects, compared to their non-Native peers.

OBJECTIVE

This study investigated multilevel ecodevelopmental influences on empirically derived patterns of substance use among urban American Indian adolescents.

METHOD

Data came from 8th, 10th, and 12th grade American Indian adolescents (n = 2,407) in metropolitan areas of Arizona. Using latent class analysis, their recent use of various substances fell into four patterns: polysubstance users consuming alcohol, tobacco, marijuana, other illicit drugs, and misusing prescription or OTC drugs; users of only alcohol, tobacco, and marijuana; those using only substances other than alcohol; and nonusers. Measures of positive and negative family, peer, school and neighborhood influences were used to predict latent class assignment, employing the R3STEP command in Mplus, while controlling for student gender, age, grade level, and multiracial identity, as well as family type, parental education, and household size.

RESULTS

In bivariate tests, each of the positive influences predicted being drug free rather than engaging in one of three distinctive types of substance use, while negative influences predicted recent use of some substances and, among users, polysubstance use rather than the other two patterns of substance use. In multivariate tests of all the ecodevelopmental influences, the negative influences-in the family and among peers especially-were the strongest and most consistent predictors of substance use and of polysubstance use in particular.

Examining Indigenous Identity as a Protective Factor in Mental Well-Being Research in the United States: A Scoping Review

Due to historical and ongoing structural racism and settler colonialism, Indigenous Peoples and communities in the United States are at a higher risk for a variety of diseases, elevated stress, and negative mental health outcomes. In addition, the United States federal government and the public encourage a view that Indigenous Peoples are primarily a racial group. Federally-, state-, and un-recognized Indigenous Peoples have a collective right to self-determination and sovereignty, and individuals of these Peoples understand this. The goals of this scoping review were to examine what research on identity and mental well-being is currently being conducted with Indigenous populations in the United States, synthesize the results, and determine if researchers are utilizing toolsets and theories that reinforce the sovereignty of Indigenous Peoples, communities, and the individual. The scoping review followed guidelines from the Joanna Briggs Institute guide for Scoping Reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). Four databases and over six thousand articles were searched for this review, with twenty-four that had data extracted and analyzed. Current research on the relationship between Indigenous identity and mental well-being shows mixed results. The findings of this scoping review highlight a need for Indigenous-specific tools for measuring identity in place of tools used for other ethnic and racial groups. More research must be conducted to create tools that specifically examine the phenomena of United States-based Indigenous identity.

Discrimination among American Indian and Alaska Native people: implications for public health communication

Introduction

American Indian and Alaska Native People (AI/AN) have experienced discrimination stemming from sustained attempts to erase AI/AN People and their culture or livelihood. Research identifying the types of discrimination experienced by AI/AN People is needed to help individuals recognize discrimination in daily life. We examine experiences of discrimination among an urban AI/AN population using a mixed methods approach.

Methods

Self-identified AI/AN participants (N = 303, n = 294 with complete data; 63% women, mean age = 43 years) were recruited from the Denver-metro area in Colorado. Stress and coping models of discrimination guided our analysis. Exposure to discrimination was quantitatively assessed via the Brief Perceived Ethnic Questionnaire - Community Version (BPEDQ-CV), a self-report measure including four subscales assessing workplace discrimination, social exclusion, physical threat and harassment, and stigmatization. Participants responded to a laboratory recall task in which they described an episode of discrimination and their affective and coping responses. Content analysis was conducted on transcribed responses to illustrate discrimination exposure as reported in the BPEDQ-CV and in prior theoretical work on coping with discrimination.

Results

Repeated measures analyses revealed participants reported experiencing social exclusion more than other forms of discrimination, followed by reports of workplace discrimination, stigmatization, and physical threat. Consistent with these quantitative findings, participants were more likely to recall experiences of social threat (94%), including episodes of workplace discrimination, social exclusion, and stigmatization than physical threat and harassment. Almost half the participants (47%) reported confronting or directly addressing the discrimination, and 38% reported avoiding a direct approach. For 44% of participants, their predominant emotional response included internalizing emotions such as fear/sadness/embarrassment, and another 44% reported experiencing externalizing emotions, including anger.

Conclusion

Our descriptive findings present the experiences of urban AI/AN People who have experienced many forms of unjust and prejudicial treatment. These data can provide useful information to help the general public and AI/AN individuals more readily recognize and prevent discriminatory behavior, and consequently mitigate deleterious effects of discrimination on health.

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.

Neighborhood determinants of sleep and the moderating role of cultural factors among native adolescents

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).

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.

Discrimination and school outcomes in first nation youth: The role of positive psychological characteristics

INTRODUCTION

Positive psychological characteristics have been found to be associated with discrimination and school outcomes separately; however, no work has examined these associations together or in North American Indigenous (NAI) populations. NAI adolescents experience high rates of racial discrimination. Because discrimination has a detrimental impact on academic outcomes it is critical to identify factors that could buffer this impact. The purpose of this study was to examine the indirect effect of racial discrimination on three distinct school outcomes (i.e., attitudes toward school, grades, and educational attainment goals) through the pathway of three positive psychological characteristics (i.e., satisfaction with life, subjective happiness, and self-compassion).

METHODS

First Nation adolescents living on a rural reserve in Eastern Canada (N = 106, Mage  = 14.6 years, 50.0% female) completed a pencil-and-paper survey in Spring 2017 as part of a larger community-based participatory research study.

RESULTS

In the model examining school attitudes, indirect effects through subjective happiness (b = -0.21, 95% confidence interval (CI): [-0.53, -0.03]) and self-compassion (b = -0.19, 95% CI: [-0.39, -0.04]), but not satisfaction with life, were significant. In the model examining grades, only the specific indirect effect through subjective happiness was significant (b = -0.27, 95% CI: [-0.59 -0.07]). Similarly, in the model examining school goals, only the indirect effect through subjective happiness was significant (b = -0.40, 95% CI: [-0.94, -0.08]). The direct effects of discrimination on school attitudes (b = 0.02, 95% CI: [-0.52, 0.56]), grades (b = 0.16, 95% CI: [-0.39, 0.71]), and school goals (b = -0.03, 95% CI: [-0.90, 0.84]) were not significant after controlling for positive psychological characteristics.

DISCUSSION

Schools should foster positive emotions to enhance academic outcomes, especially for NAI youth who are more likely to experience racial discrimination.

Context of substance initiation among urban Native Americans: an exploratory retrospective case-control study

Background

Addiction is a significant problem among many Native American groups but has rarely been examined in urban populations. In particular, little is known about the context in which urban Native Americans first use substances. This study compares cases (people with a history of addiction) to controls (people without a history of addiction) on demographics, substance use history, context of first substance use, and polysubstance use. In addition, this appears to be the first study to overcome the lack of Native American professionals by employing and training lay community members to identify criteria of substance use disorders in survey participants. Employing community members helped foster trust that enabled the revelation of sensitive and often illegal activity. As a result, the investigators were able to recruit participants who likely would not have engaged with traditional researchers.

Methods

The trained Native American lay research assistants recruited community members and administered surveys. They first asked questions regarding the criteria for substance use disorders. Individuals who were determined to have met criteria for a substance use disorder in the past were classified as cases (n = 38) and those who never met such criteria were classified as controls (n = 42). They then asked demographic, substance use, and polysubstance use questions. Lastly, eight cases and eight controls were randomly selected for a second interview by a licensed drug and alcohol counselor (LDAC) who conducted a blinded assessment regarding the presence or absence of a history of a substance use disorder.

Results

Both groups reported a relatively young age of first substance use (age 16 years for cases and age 15 years for controls). Alcohol was the first substance most commonly used in both groups. Controls reported first benzodiazepine use at a younger age than cases but no other significant differences were found. Both groups reported first obtaining their first drug from family, friends, or at home (rather than a party, bar, or store). Most commonly, the location of their first use of drugs occurred at a friend's home, a party, a bar, or school rather than at their own home. Cases were marginally more likely to report that their first drug use occurred with a friend rather than with a family member when compared with controls. The majority of both groups reported that their first drug use occurred with other Native Americans rather than with non-Native Americans. Polysubstance use was common in both groups (43-45%). There were no significant differences between the groups regarding polysubstance use. The LDAC arrived at the same determination as the trained research assistants on all eight cases and eight controls.

Social Networks, Cultural Pride, and Historical Loss Among Non-Reservation American Indian / Alaska Native Emerging Adults

Health disparities among American Indian/Alaska Native (AI/AN) populations in the United States are the result of historical traumas, such as colonization, forced relocation, and federal policies focused on cultural assimilation. Culturally-tailored health interventions aim to address intergenerational trauma by emphasizing cultural strengths and building positive social connections. In this article, we explore the social network characteristics of participants of the first culturally-tailored health intervention for AI/AN emerging adults (18-25) living outside of tribal lands. Participants (N = 150; 86% female) were recruited across the United States via social media and completed online egocentric network interviews prior to the start of intervention workshops. Participants' networks were diverse in composition and structure. They were primarily composed of family and friends, were people they had regular contact with, were similar age, and provided participants with support. We tested for significant associations between network characteristics, individual characteristics (age, gender, travel to reservations, speaking tribal languages, etc.) and two dependent measures: 1) cultural pride and belongingness and 2) thoughts of historical loss. Multiple regression results show that higher proportions of network members who discussed AI/AN identity with participants and having more network members who engage in traditional practices was associated with stronger cultural pride and belongingness. Higher proportions of network members having discussion of AI/AN identity with participants was also associated with more frequent thoughts of historical loss. Controlling for network factors, no individual characteristics were associated with either dependent variable. We discuss implications for the development of culturally-tailored health interventions.

Protective factors in the relationship between perceived discrimination and risky drinking among American Indian adolescents

INTRODUCTION

The relationship between perceived discrimination and risky drinking among American Indian (AI) youth is understudied, and the potential protective factors that may buffer this association are unknown. Therefore, the objective of this study was to examine protective factors across individual, family, school, peer, and cultural domains of the social ecology that might attenuate the relationship between perceived discrimination and risky drinking among AI adolescents.

METHOD

Data were from the Substance Use Among American Indian Youth Study (Swaim and Stanley, 2018, 2021). AI youth who have used alcohol in their lifetime (n = 2516 within 62 schools) had an average age of 15.16 years (SD = 1.75) and 55.5% were female. Five sets of linear regressions were conducted. Risky drinking was regressed on demographic variables, alcohol use frequency, perceived discrimination, one protective factor (religiosity, parental monitoring, peer disapproval of alcohol use, school engagement, and ethnic identity), and one two-way interaction between perceived discrimination and the protective factor.

RESULTS

Prevalence of risky drinking among lifetime drinkers was 40.1%. There were positive associations between perceived discrimination and risky drinking in all models (Bs range from.20 to.23; p <.001). Parental monitoring had a negative association with risky drinking (B = -0.255, p <.001). Religiosity was the only statistically significant moderator (B = -0.08, p = 0.01), indicating that religiosity weakened the relation between perceived discrimination and risky drinking.

CONCLUSIONS

Religiosity may represent an important protective factor that could help guide efforts to prevent risky drinking in the face of discrimination among AI adolescents.

Food insecurity, sleep, and cardiometabolic risks in urban American Indian/Alaska Native youth

OBJECTIVES

Food insecurity contributes to racial/ethnic disparities in health. This is the first study to examine associations among food insecurity, sleep, and cardiometabolic outcomes in urban American Indian/Alaska Native (AI/AN) youth.

DESIGN

Participants were 142 urban AI/AN youth (mean age = 14 years, 58% female). Food insecurity and self-reported sleep disturbance were measured using validated surveys. A multi-dimensional sleep health composite was derived using questionnaires (ie, satisfaction, alertness) and actigraphy-derived indices (ie, duration, efficiency, regularity, timing). Cardiometabolic measures included body mass index, blood pressure, glycosylated hemoglobin, waist circumference, cholesterol, and triglycerides. Covariates were sex, age, and single-parent household.

RESULTS

Greater food insecurity was significantly associated with greater body mass index (b = 0.12, p = .015), higher systolic blood pressure (b = 0.93, p = .03), and greater sleep disturbance (b = 1.49, p < .001), and marginally associated with lower sleep health composite scores (b = -0.09, p = .08). There was a significant indirect path from greater food insecurity to greater waist circumference through poorer sleep health (0.11, 95% bootstrapping CI: [0.01, 0.30]).

CONCLUSION

Food insecurity is an important correlate of sleep and cardiometabolic health among urban AI/AN youth and should be addressed to reduce emerging health risks during this important developmental period. Policies to reduce food insecurity and increase access to healthy foods as well as sleep interventions for these youth could help, as preliminary findings suggest that sleep health may mediate the negative impact of food insecurity on cardiometabolic risks.

Perceived racial discrimination and suicidal behaviors among racial and ethnic minority adolescents in the United States: Findings from the 2021 adolescent behaviors and experiences survey

The objectives of this study were to investigate: (1) the prevalence of perceived racial discrimination (PRD) in school, among racial/ethnic minority adolescents, and (2) the association between PRD and suicidal behaviors among racial/ethnic minority adolescents in the United States. Data from a sample of 3241 racial/ethnic minority adolescents (53.7% female) from the 2021 Adolescent Behaviors and Experiences Survey were analyzed using binary logistic regression. Controlling for other factors, racial/ethnic minority adolescents who experienced PRD had 1.57 times higher odds of experiencing suicidal ideation (adjusted odds ratio (AOR) = 1.57, 95% Confidence Intervals (CI) = 1.09-2.25), 1.64 times higher odds of making a suicide plan (AOR = 1.64, 95% CI = 1.09-2.49), and 1.67 times higher odds of attempting suicide (AOR = 1.67, 95% CI = 1.04-2.68) during the past year. Other factors associated with suicidal behaviors included self-identifying as lesbian/gay, bisexual, or other/questioning; experiencing cyberbullying; feeling sad or hopeless; and poor mental health during the pandemic. The findings of this study extend past research and demonstrate that racial/ethnic minority adolescents who experienced PRD were more likely to report suicidal behaviors over and above other well-established risk factors for suicidal behaviors. Future studies that employ longitudinal designs are needed to elucidate mechanisms underlying these associations.

The social and emotional wellbeing of Indigenous LGBTQA+ young people: a global perspective

There has been scant exploration of the social and emotional wellbeing (SEWB) of young Indigenous populations that identify as LGBTQA+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Asexual +). Given the vulnerability of this cohort living in Western settler colonial societies, wider investigation is called for to respond to their needs, experiences and aspirations. This paper summarizes existing research on the topic highlighting the lack of scholarship on the intersection of youth, Indigeneity, LGBTQA+ and SEWB. The paper takes a holistic approach to provide a global perspective that draws on an emerging body of literature and research driven by Indigenous scholars in settler colonial societies. The paper points to the importance of understanding converging colonial influences and ongoing contemporary elements, such as racism and marginalization that impact on young Indigenous LGBTQA+ wellbeing.

Changes in Sleep-Wake Patterns and Disturbances Before and During COVID-19 in Urban American Indian/ Alaska Native Adolescents

BACKGROUND

COVID-19 has profoundly affected sleep, although little research has focused on high-risk populations for poor sleep health, including American Indian/Alaska Native (AI/AN) adolescents.

METHODS

This is the first longitudinal study to examine changes in sleep with surveys completed before the pandemic and during the early months of COVID-19 in a sample of urban AI/AN adolescents (N = 118; mean age = 14 years at baseline; 63% female). We use a mixed-methods approach to explore how COVID-19 affected urban AI/AN adolescents' sleep, daily routines, and interactions with family and culture. Quantitative analysis examined whether pandemic-related sleep changes were significant and potential moderators of COVID-19's effect on sleep, including family and community cohesion and engagement in traditional practices.

RESULTS

: Findings demonstrate changes in sleep, including increases in sleep duration, delays in bedtimes and waketimes, and increases in sleep-wake disturbances (p's <.001). Higher levels of family cohesion and higher levels of engagement in traditional practices moderated pandemic-related increases in weekday sleep duration. Qualitative analyses revealed changes in adolescents' sleep and daily behaviors, as well as strategies adolescents used to cope with pandemic-related disruptions in sleep and routines.

CONCLUSION

Findings demonstrate positive and negative changes in sleep during COVID-19 stay-at-home orders, including simultaneous increases in sleep duration and sleep-wake disturbances. Results highlight the importance of considering multi-level influences on adolescent sleep, such as early school start times, family dynamics, and cultural factors. A multi-level approach may help guide prevention and intervention efforts to improve adolescent sleep health.

Integrating traditional practices and social network visualization to prevent substance use: study protocol for a randomized controlled trial among urban Native American emerging adults

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 .

Mental Health, Physical Health, and Cultural Characteristics Among American Indians/Alaska Natives Seeking Substance Use Treatment in an Urban Setting: A Descriptive Study

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.

Risk and Resilience Factors in Urban American Indian and Alaska Native Youth during the Coronavirus Pandemic

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.

Variations in risk and promotive factors on substance use among urban American Indian youth

Although roughly 70% of the American Indian and Alaska Native (AI) population live in urban areas, research is scarce regarding this population. As a consequence, there is limited understanding about the salient socioenvironmental factors that aid in preventing substance use among urban AI communities. This study utilized a statewide, cross-sectional, school-based survey of urban AI adolescents (N = 2,375) to (a) examine the associations between substance use and risk and promotive factors within the family and peer group, and (b) explore how these associations vary by subgroups (gender, racial/ethnic background, and grade level). Results suggest that risk factors-familial substance use and antisocial peer affiliation-were associated with higher alcohol, cigarette, and marijuana use. However, these findings varied by subgroup. For males, involvement with antisocial peers was associated with greater marijuana use. Involvement with antisocial peers was also positively associated with alcohol and marijuana use for multiracial/multiethnic AI adolescents and those adolescents in 10th and 12th grades. The promotive factors-supportive family environment and prosocial peer affiliation-were not universally associated with lowered substance use by subgroup. This study advances understandings of the risk and promotive factors important in reducing and preventing substance use among urban AI adolescents. Experiencing familial substance use and affiliating with antisocial peers were the salient factors associated with increased substance use, particularly for urban AI adolescents who are older, male, and with multiracial/multiethnic AI backgrounds.

Recruitment and retention in randomized controlled trials with urban American Indian/Alaska Native adolescents: Challenges and lessons learned

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.

Identifying as American Indian/Alaska Native in Urban Areas: Implications for Adolescent Behavioral Health and Well-Being

American Indian and Alaska Native (AI/AN) youth exhibit multiple health disparities, including high rates of alcohol and other drug (AOD) use, violence and delinquency, and mental health problems. Approximately 70% of AI/AN youth reside in urban areas, where negative outcomes on behavioral health and well-being are often high. Identity development may be particularly complex in urban settings, where youth may face more fragmented and lower density AI/AN communities, as well as mixed racial-ethnic ancestry and decreased familiarity with AI/AN lifeways. This study examines racial-ethnic and cultural identity among AI/AN adolescents and associations with behavioral health and well-being by analyzing quantitative data collected from a baseline assessment of 185 AI/AN urban adolescents from California who were part of a substance use intervention study. Adolescents who identified as AI/AN on their survey reported better mental health, less alcohol and marijuana use, lower rates of delinquency, and increased happiness and spiritual health.

Trends in Non-Medical Prescription Opioid Use among Urban and Rural American Indian and Alaska Native Youth Residing in New Mexico: 2013-2017

Increasing rates of opioid-related deaths over the last twenty years have created a national public health crisis. However, minimal research investigates opioid use among American Indian and Alaska Native (AI/AN) youth. This study examined non-medical prescription opioid prevalence rates and resiliency of urban and rural AI/AN and non-AI/AN students. The sample included eighth, tenth, and twelfth grade students who participated in the New Mexico Youth Risk and Resilience Survey in 2013, 2015, and 2017 (n = 42,098). Logistic regression models showed no significant differences in non-medical prescription opioid use among rural and urban students in 2013, 2015, and 2017. No significant differences in use between AI/AN and non-AI/AN students occurred in 2013, 2015, or 2017. Family and community support were protective of misuse consistent across time points, and included caring adults, community involvement, and clear rules at school. These findings may help to inform the development of strengths-based prevention activities for AI/AN youth.

Understanding sleep facilitators, barriers, and cultural dimensions in Native American urban youth

OBJECTIVES

American Indian/Alaska Native (AI/AN) youth are a high-risk group for sleep problems and associated chronic conditions. Urban AI/AN youth may face certain challenges, including specific psychosocial stressors (e.g., discrimination) and environmental factors (e.g., noise, light) that render them particularly vulnerable to poor sleep health. However, few studies have explored AI/AN adolescent sleep. To our knowledge, this is the first study to use systematic qualitative methods with AI/AN youth to explore their sleep environment and sleep behaviors.

DESIGN

In-depth interviews with 26 youth.

SETTING

Two urban areas in Central and Southern California.

PARTICIPANTS

Urban-dwelling AI/AN youth, age 12-16 years.

INTERVENTION

N/A.

MEASUREMENT

N/A.

RESULTS

We identified five main themes, each with subthemes: sleep patterns and desired sleep, sleep barriers inside the home, environmental factors, sleep facilitators, and cultural dimensions. Key concerns discussed were poor sleep hygiene, excessive use of electronics prior to bedtime, issues with temperature regulation, and noise both within and outside the home. Parents can be an important vehicle for messaging around sleep health and for behavior management. Participating adolescents also indicated differing levels of attachment to Native identity, suggesting that culturally-targeted sleep interventions should build in openness and flexibility to a range of identity starting points. Further, we identified cultural practices, such as sweat lodges and dreamcatchers, that could be incorporated in future sleep interventions for this population.

CONCLUSION

Findings increase our understanding of urban AI/AN youth's sleep environments and behaviors, thus potentially informing program development around sleep health for this vulnerable population.

Motivational interviewing and culture for urban Native American youth (MICUNAY): A randomized controlled trial

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.

Overt Perceived Discrimination and Racial Microaggressions and their Association with Health Risk Behaviors among a Sample of Urban American Indian/Alaska Native Adolescents

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.