Historical and cultural roots of drinking problems among American Indians

Trauma and Substance Use among Indigenous Peoples of the United States and Canada: A Scoping Review

Substance use has been identified by Indigenous populations as contributing to health disparities facing their communities. Rates of trauma exposure and post-traumatic stress disorder are higher in Indigenous, compared to non-Indigenous, populations and have been linked to substance use. Historical trauma is thought to be one mechanism underlying substance use and related disorders. The purpose of the present study is to summarize the current state of the literature focusing on the association between trauma (historical and lived) and substance use among Indigenous populations in the United States and Canada. Databases were systematically searched using the preferred reporting items for systematic reviews and meta-analyses statement. The search strategy initially yielded 4,026 articles. After exclusion of ineligible articles, 63 articles remained for synthesis. Results of the present review provide evidence for a positive link between substance use and both historical trauma (i.e., 86.4% of studies) and lived trauma (i.e., 84.7% of studies). Indigenous participants reported that historical trauma and pain related to loss of cultural identity contributed to substance use in their communities. Indigenous participants also consistently described an association between lived trauma and substance use. Despite heterogeneity among Indigenous communities, findings suggest a significant association between trauma and substance use across many different tribes and settings (e.g., reservation/reserve, rural/urban). Indigenous participants identified healing from trauma and reconnecting with culture as necessary components for reducing substance use and maintaining sobriety. With this, the development and implementation of interventions should partner with Indigenous communities in a manner that promotes and enhances cultural values for healing.

Bridging the commercial determinants of Indigenous health and the legacies of colonization: A critical analysis

To date, there has been scarce effort to consider the intertwining of colonization and the commercial determinants of Indigenous health. This is a vital omission, and one that this paper proposes to address. We propose how four losses of tradition borne out of colonialism are intertwined with four respective commercial determinants of Indigenous health: 1) loss of traditional diets and the ultra-processed food industry; 2) loss of traditional ceremony and the tobacco industry; 3) loss of traditional knowledge and the infant formula industry; and 4) loss of traditional support networks and the alcohol industry. Building on Indigenous efforts to decolonize spaces and assert control over their own lives, we argue that analyzing the mechanisms through which industry activities intersect with colonial legacies will improve broader understandings of Indigenous health disparities.

Social determination of alcohol consumption among Indigenous peoples in Colombia: a qualitative meta-synthesis

BACKGROUND

Alcohol consumption is a social phenomenon that involves society, groups, and individuals from different cultures around the world. Among some Indigenous groups located in Colombia, South America, alcohol consumption has been present in their lives, where contradictory processes occur and generate public health attention. We aimed to analyze qualitative research findings on alcohol consumption among Indigenous peoples in Colombia.

METHODS

This article used the qualitative meta-synthesis methodology, which included: (a) comprehensive search strategy, (b) appraisal of qualitative research reports, (c) findings classification, and (d) synthesis. Databases were searched for papers published from 2004 to 2019 in SCOPUS, LILACS, PROQUEST, and JSTOR, among other sources of information. A total of 2,159 papers were reviewed and finally, 13 studies were included in this meta-synthesis. The synthesis of findings included a constant comparative analysis and also aimed for the articulation of its findings to alternative perspectives in a predefined matrix.

RESULTS

Nine Indigenous ethnic groups of Colombia were represented in the 13 articles analyzed. From the analysis emerged the symbolic approach "Alcohol: a chameleon that unpredictable society colors" as the meta-theme of this research. This reflects four social processes that influence interaction with alcohol: Dynamic Systems Mergers (Indigenous system, influence of non-Indigenous system); Diverse Authority Spheres (parenting, Indigenous authority, school, university, religious and spiritual, traditional medicine); Between Transculturation and Interculturality (cultural crises effects and dynamism); and the Paradoxes of the Normalization of Alcohol (reasons, functions, and types of alcohol consumption). Likewise, these results support the social determination of health and sociocultural epidemiology perspectives, as being an adequate way of explaining a complex phenomenon.

CONCLUSION

Alcohol consumption among Indigenous peoples in Colombia is a social construction. Alcohol acts as an instrument, which is present in the changing relationships and tensions of social processes. This is reflected in harmonies, or disharmonies, in the life of Indigenous Colombians, which take place in a historical, sociocultural, economic, and political context. The results provide a reference point to guide practice and research but also reiterate the need to include the social determination of health perspective in public policies, as a path to the understanding of alcohol consumption.

Measuring Attitudes About Alcohol Misuse and Dependence Among Alaska Native People Within a Tribal Health Care System

OBJECTIVES

Attitudes about alcohol misuse and dependence influence alcohol use and help-seeking behavior. Alaska Native and American Indian (AN/AI) people have higher rates of alcohol-related morbidity and mortality but engage in treatment at lower rates than the general population. No validated instruments exist to assess attitudes of AN/AI people about alcohol misuse and dependence to inform treatment and prevention efforts. This study aimed to develop an instrument to assess public attitudes among AN/AI people of alcohol misuse and dependence.

METHODS

This multiphase, mixed-methods study was conducted at Southcentral Foundation, a tribally owned health system serving 65,000 AN/AI people in Alaska. We conducted focus groups and interviews with health system users, providers, and leaders to adapt the Public Attitudes About Addiction Survey. The adapted instrument was piloted with 200 people. Cognitive interviews and exploratory and confirmatory factor analyses were used to refine the instrument, which were then administered to 777 AN/AI people.

RESULTS

Initial exploratory factor analysis identified 5 factors, including 3 from the original Public Attitudes About Addiction Survey (moral, disease, nature), a combined psychology and sociology factor (psychosocial), and a new factor (environment). A final 4-factor model (psychosocial, moral, disease, nature) with 14 items had good fit with root mean square error of approximation (0.035; comparative fit index = 0.977; Tucker-Lewis index = 0.970; standardized root mean residual = 0.040) and loadings ranging from 0.41 to 0.80.

CONCLUSIONS

This study developed the first instrument to assess AN/AI attitudes about alcohol misuse and dependence. This instrument has potential to inform alcohol-related treatment in AN/AI communities. Future research is warranted to adequately measure place-based contributors salient to AN/AI people.

Alcohol consumption and pregnancy in American Indian and Alaska Native women: A scoping review of the literature

American Indian and Alaska Native communities have diverse cultures, histories, and contemporary experiences. Grouping them together masks the differences in health and lifestyle behaviors, chronic disease rates, and health outcomes among them. This is particularly true for data on drinking during pregnancy among American Indian and Alaska Native women. The goal of this article is to describe how generalizing findings from data gathered from often small, geographically specific samples, combined with inferior research methodologies, has led to misunderstandings about drinking among preconceptual and pregnant American Indian and Alaska Native women. We conducted a scoping review using PubMed and the "PCC mnemonic" (population, concept, and context) as our guide. Our search terms included the population (American Indian and Alaska Native women), concept (alcohol), and context (immediately before or during pregnancy) and focused on PubMed articles in the United States. Using these search terms, we uncovered a total of 38 publications and eliminated 19, leaving 19 for review. Methodologically (i.e. how data were collected), we found most previous research on prenatal or preconceptual alcohol use with American Indian and Alaska Native women used retrospective data collection. We also assessed who data were collected from and noted two groups: studies that sampled higher-risk women and those that focused on American Indian and Alaska Native women in specific geographic areas. Restricting data collection to higher-risk American Indian and Alaska Native women or conducting small studies in specific geographic areas has generated an incomplete and inaccurate picture of American Indian and Alaska Native women as a whole as well as those who consume alcohol. Data from select groups of American Indian and Alaska Native women may overestimate the true prevalence of drinking during pregnancy among this population. Updated and accurate data on drinking during pregnancy are urgently needed to inform the development of interventions and prevention efforts.

Trends in Deaths Fully Attributable to Alcohol in Minnesota, 2000-2018

OBJECTIVE

Overall trends in rates of fully alcohol-attributable mortality may mask disparities among demographic groups. We investigated overall, demographic, and geographic trends in fully alcohol-attributable mortality rates in Minnesota.

METHODS

We obtained mortality data from Minnesota death certificates and defined fully alcohol-attributable deaths as deaths that would not occur in the absence of alcohol. We calculated age-adjusted death rates during 2000-2018 using 5-year moving averages stratified by decedents' characteristics and geographic location.

RESULTS

Chronic conditions accounted for most of the alcohol-attributable deaths in Minnesota (89% during 2014-2018). Alcohol-attributable mortality rates per 100 000 population increased from an average rate of 8.0 during 2000-2004 to 12.6 during 2014-2018. During 2000-2018, alcohol-attributable mortality rates were highest among males (vs females), adults aged 55-64 (vs other ages), and American Indian/Alaska Native people (vs other racial and ethnic groups) and lowest among people aged ≤24 years and Asian or Pacific Islander people. During 2014-2018, the alcohol-attributable mortality rate among American Indian/Alaska Native people was more than 5 times higher than the overall mortality rate in Minnesota.

CONCLUSIONS

Results from this study may increase awareness of racial and ethnic disparities and continuing health inequities and inform public health prevention efforts, such as those recommended by the Community Preventive Services Task Force, including regulating alcohol outlet density and increasing alcohol taxes.

Harm reduction acceptability and feasibility in a North American indigenous reserve community

AIMS

The present study assessed community and culturally specific alcohol-related harm among North American Indigenous (NAI) individuals, as well as the acceptability and feasibility of harm reduction approaches in one reserve-based NAI community.

METHODS

Participants lived on or near a NAI reserve in Canada. Semi-structured focus groups were conducted with health care workers (N = 8, 75% NAI) and community members (N = 9, 100% NAI). Self-report questionnaires were administered that measured acceptability and feasibility of harm reduction strategies.

RESULTS

Conventional content analysis revealed loss of culture as culturally specific alcohol-related harm. Health care workers rated harm reduction approaches to be acceptable and feasible, while community participants were more mixed. Majority of participants felt that some harm reduction strategies could provide opportunities for individuals who use alcohol to connect to Indigenous culture and traditions. However, there were mixed findings on whether harm reduction strategies are consistent with Indigenous cultural traditions and values.

CONCLUSION

Future research is needed to evaluate potential utility of harm-reduction approaches for NAI communities.

Intimate Partner and Sexual Violence, Reproductive Coercion, and Reproductive Health Among American Indian and Alaska Native Women: A Narrative Interview Study

Background: The disproportionately high prevalence of poor reproductive and sexual health outcomes among American Indian and Alaska Native (AI/AN) women is related to histories of colonization, oppression, and structural racism. Intimate partner violence (IPV) and sexual violence (SV) contribute to these health outcomes. Materials and Methods: Narrative interviews were conducted with AI/AN women from four tribal reservation communities. Interviews explored connections among sexual and reproductive health, IPV, SV, reproductive coercion (RC), and pregnancy experiences as well as women's experiences of healing and recovery. Results: Among the 56 women interviewed (aged 17-55 years, 77% were aged 40 years and younger), all described multiple exposures to violence and highlighted lack of disclosure related to sexuality, childhood abuse, SV, and historical trauma. Access to confidential reproductive health services and contraceptive education was limited. Almost half (45%) reported experiencing RC in their lifetime. Use of substances occurred in both the context of SV and for surviving after exposure to violence. Women underscored the extent to which IPV, SV, and RC are embedded in histories of colonization, racism, and ongoing oppression. Interventions that incorporate AI/AN traditions, access to culturally responsive reproductive health and advocacy services, organizations, and services that have AI/AN personnel supporting survivors, public discussion about racism, abuse, sexuality, and more accountable community responses to violence (including law enforcement) are promising pathways to healing and recovery. Conclusions: Findings may advance understanding of AI/AN women's reproductive health in the context of historical trauma and oppression. Intervention strategies that enhance resiliency of AI/AN women may promote reproductive health.

Positive Psychological Characteristics and Substance Use in First Nation Adolescents

BackgroundNorth American Indigenous (NAI) adolescents experience disproportionate harm related to substance use compared to non-Indigenous adolescents. Strengths-based approaches to substance use prevention and treatment are consistent with Indigenous conceptualizations of health, which tend to be holistic and incorporate more spirituality and community than mainstream Western conceptualizations. Despite this, little is known about how positive psychological characteristics that might confer protection relate to substance use among NAI adolescents. Thus, the present study aims to examine the relations among life satisfaction, subjective happiness, self-compassion, and cigarette, marijuana, alcohol, and other drug use. MethodsParticipants were 106 reserve-dwelling First Nation adolescents located in Eastern Canada (M_age= 14.6 years, 50.0% female) who completed a paper-and-pencil survey regarding their substance use and psychological characteristics for a larger community-based participatory research project. ResultsGreater life satisfaction was significantly associated with decreased odds of lifetime (OR = 0.88, 95%CI [0.81, 0.96]) and current cigarette smoking (OR = 0.90, 95%CI [0.82, 0.99]). Greater subjective happiness was significantly associated with decreased odds of current marijuana use (OR = 0.83, 95%CI [0.71, 0.97]). Although significantly correlated with lower lifetime use of other drugs, self-compassion was not significantly associated with lifetime or current odds of substance use after controlling for age, gender, and other positive characteristics. DiscussionThis is one of the first studies to evaluate positive characteristics and substance use in NAI adolescents. Results point to positive characteristics that may be useful in substance use prevention and suggest the need for further research to further elucidate these associations.

Racial disparities in psychological distress in post-apartheid South Africa: results from the SANHANES-1 survey

PURPOSE

South Africa has long endured a high prevalence of mental disorders at the national level, and its unique social and historical context could be a contributor to an increased risk of mental health problems. Our current understanding is limited regarding the relative importance of various social determinants to mental health challenges in South Africa, and how existing racial inequities may be explained by these determinants.

METHODS

This study attempted to elucidate potential social determinants of mental health in South Africa using data from the nationally representative South African National Health and Nutrition Examination Survey (SANHANES-1). The main outcome of interest was psychological distress, measured with the Kessler-10 scale. Hierarchical linear regression models included covariates for demographic and socioeconomic factors, count of traumatic events, and a series of stress-related constructs. Analyses were conducted on two populations: the entire sample (n = 15,981), and the African subpopulation (n = 10,723).

RESULTS

Regression models on the entire sample indicated racial disparities in psychological distress, with Africans experiencing higher distress than White and Coloured individuals. Results within the African sub-population indicated geo-spatial disparities, with Africans in formal urban settings experiencing higher psychological distress than those living in formal and informal rural locales. Across both samples, results indicated a cumulative association between count of stressors and traumatic events and distress.

CONCLUSION

We found racial disparities across several mental health-related domains. Africans had greater exposure to traumatic events, social stressors, and psychological distress. This research is a necessary foundation for public health interventions and policy change to effectively reduce inequities in psychological distress.

Why the Navajo Nation was hit so hard by coronavirus: Understanding the disproportionate impact of the COVID-19 pandemic

The COVID-19 (SARS-CoV-2) pandemic of 2019-2020 has incurred astonishing social and economic costs in the United States (US) and worldwide. Native American reservations, representing a unique geography, have been hit much harder than other parts of the country. This study seeks to understand the reasons for the disproportionate impact of the pandemic on Native American communities by focusing on the Navajo Nation - the largest Native American reservation in the US. I first reviewed the historical pandemics experienced by Native Americans. Guided by the literature review, an institutional analysis focusing on the Navajo Nation suggests a lack of both institutional resilience and healthcare preparation. The analysis further identified four factors that could help explain the Navajo's slow response to the COVID-19 pandemic: prevalence of underlying chronic health conditions, lack of institutional resilience, the relationship between the federal government and tribal governments, and lack of social trust. Relevant policy implications are discussed. For instance, to better prepare Native American communities for shocking events like the COVID-19 pandemic in the future, policymaking should integrate informal institutions to build efficient formal institutions for self-governance. Promoting public health education and establishing collaborations between Native and non-Native communities are also necessary long-run strategies.

Alcohol testing and alcohol involvement among violent deaths by state, 2014-2016

Blood alcohol concentration (BAC) testing rates vary across states, potentially biasing estimates of alcohol involvement in violent deaths. The National Violent Death Reporting System (NVDRS) collects information on violent deaths, including decedents' BACs. This study assessed characteristics of violent deaths by BAC testing status, and the proportion of decedents with a positive BAC or BAC ≥ 0.08 g/dL. NVDRS data from 2014 to 2016 (2014: 18 states; 2015: 27 states; 2016: 32 states) were analyzed to assess BAC testing (tested, not tested, unknown/missing) by state, decedent characteristics, and death investigation system (e.g., state medical examiner, coroners), in 2019. The proportion of violent deaths with a BAC > 0.0 or ≥ 0.08 g/dL was also assessed. Among 95,390 violent death decedents, 57.1% had a BAC test (range: 9.5% in Georgia to 95.8% in Utah), 2.3% were not tested, and 40.6% had an unknown/missing BAC testing status (range: 1.3% in Alaska to 78.0% in Georgia). Decedents who were 21-44 years, American Indian/Alaska Native or Hispanic, died by poisoning, died by undetermined intent, or were investigated by a state medical examiner were most likely to receive BAC testing. Among the violent deaths with a reported BAC, 41.1% had a positive BAC and 27.7% had a BAC ≥ 0.08 g/dL. About 2 in 5 violent deaths were missing data on alcohol testing. Increased testing and reporting of alcohol among violent deaths could inform the development and use of evidence-based prevention strategies (e.g., increasing alcohol taxes, regulating alcohol outlet density) for reducing violent deaths.

The protective effects of self-compassion on alcohol-related problems among First Nation adolescents

Given the disproportionate alcohol-related consequences experienced by North American Indigenous youth, there is a critical need to identify related risk and protective factors. Self-compassion, which has been found to mitigate the effects of trauma exposure, may serve as one such protective factor given the high-degree of historical trauma and contemporary discrimination identified as contributing to the alcohol-related disparities experienced by Indigenous communities. However, no research has examined how self-compassion (i.e., the ability to be kind and accepting and to extend compassion towards oneself) plays a unique role in Indigenous peoples' experiences with alcohol. First Nation adolescents between the ages of 11 and 18 living on a reserve in Eastern Canada (N=106, M _age =14.6, 50.0% female) completed a pencil-and-paper survey regarding their alcohol use, alcohol-related problems, and self-compassion. Self-compassion was significantly inversely associated with alcohol-related problems (b=-.51, p=.01, 95%CI [-.90, -.12], and significantly interacted with frequency of alcohol use in predicting alcohol-related problems (b=-.42, p=.04, 95%CI [-.82, -.03]). Simple slopes analyses revealed that the association between frequency of alcohol use and frequency of experiencing alcohol-related problems was significant and positive at low (b=4.68, p<.001, 95%CI [2.62, 6.73]), but was not significant at high (b=-.29, p=.89, 95%CI [-4.35, 3.77]) levels of self-compassion. Binary logistic regression revealed that higher scores of self-compassion were associated with a lower odds of being in the high-risk group for AUD (OR=0.90, 95%CI [0.83, 0.98], p=.02). Our results suggest self-compassion may be protective against experiencing alcohol problems in Indigenous youth and thus may be a target for behavioral interventions.

Addiction peer recovery coach training pilot: assessment of confidence levels

BACKGROUND

Peer recovery coaches (PRCs) have become a critical tool in addiction treatment in many areas of the world. Despite this fact, no identified research has examined the process or impact of PRC training. Furthermore, no scales were identified to measure trainee confidence in various PRC techniques. The goal of this article is to analyze the process and immediate impact of PRC training of twelve American Indians (AIs) in a culturally-specific program. We focus most specifically on trainee confidence levels.

METHODS

No written consent was obtained and completion of the assessment was considered consent. Trainees completed self-assessments before and after the training. The self-assessment examined nine areas ranging from understanding the role of PRCs to knowledge of effective PRC techniques. Paired t-tests were used to assess for changes in individual trainee responses between the pre- and post-assessments.

RESULTS

Pre-training responses ranged from moderate to high. Questions with the lowest average confidence levels address PRC activities or specific techniques to facilitate recovery. All nine questions showed statistically significant mean improvements in the post-training self-assessments. Questions regarding specific PRC activities and techniques showed the greatest improvement. Questions relating to helping people more generally showed the smallest improvement. Average post-training responses fell within a very narrow range indicating relatively consistent confidence levels across skills. Analysis indicates participants were possibly over-confident in certain areas (i.e., maintaining boundaries). This small pilot represents an initial attempt to measure confidence levels of PRC trainees. The findings may inform future training by identifying certain areas where emphasis might be most helpful for trainees. In addition, it is hoped that this work will encourage more systematic analysis of the impact of PRC training on individuals.

The Validity of the Short Inventory of Problems and Drinking Intensity among Urban American Indian Adults

BACKGROUND

American Indian (AI) adults have both high prevalence rates of alcohol abstinence and alcohol use disorders compared to non-Hispanic White adults. We investigated the applicability and validity of the Short Inventory of Problems (SIP) among AI urban adults and the moderating effect of biological sex.

METHODS

AI adults from three Alcoholics Anonymous samples (n = 124) provided baseline, 3-, 6- and 9-month data. Measures included Form 90 and the SIP, which includes 5 domains of alcohol-related negative consequences including interpersonal, intrapersonal, physical, impulse control and social. Drinking frequency and intensity were assessed by percent days abstinent (PDA) and drinks per drinking day (DPDD).

RESULTS

Cronbach alphas of the SIP were similar between urban AI adults and the mainstream treatment-seeking population reported in the SIP manual. DPDD was a significant and positive predictor of all five SIP scales collected 9-months later. Higher PDA was significantly and negatively associated with later consequences, and all 5 SIP scales. Moderation tests indicated that the association between consequences and drinking intensity was stronger for AI females with fewer drinking days resulting in significantly fewer consequences for AI males relative to AI females.

CONCLUSIONS

Findings highlight the acceptability of SIP as a measure to assess drinking related consequences among AI urban adults, with clinical implications related to alcohol use and sex. Further research is warranted to examine differential drinking related outcomes among AI men and women in addition to adaptations of the SIP that more fully capture the range of negative drinking consequences.

Perceptions of alcohol misuse among Alaska native health care system stakeholders: A qualitative exploration

Although alcohol misuse is a priority for health care systems serving Alaska Native and American Indian (ANAI) people, stakeholders' perceptions of misuse are understudied. Patients (n = 34), providers (n = 20), and leaders (n = 16) at a Tribally owned and operated health care system reported that alcohol misuse results from the interaction of factors, including colonization, structural factors, social alienation, social norms about overdrinking introduced at the time of colonizing contact, coping with emotions, and beliefs about ANAI people and alcohol. Childhood exposure to alcohol misuse leads some ANAI people to avoid alcohol altogether, shedding light on the high levels of abstinence observed in ANAI communities.

Understanding the link between racial trauma and substance use among American Indians

Historians and scholars from various disciplines have documented the pervasive influence of racism on American society and culture, including effects on the health and well-being of American Indian (AI) people. Among the many health problems affected by racial discrimination and oppression, both historical and current, are substance use disorders. Epidemiological studies have documented greater drug and alcohol-related morbidity and mortality among AI/AN Alaska Natives compared to other ethnic groups, and culturally appropriate, effective interventions are sorely needed. We collected, as part of a larger community-based participatory research project to address substance use disparities in rural AI communities, qualitative interview data from 25 AI key informants from a frontier reservation in Montana. Using a semistructured interview guide, we asked participants to discuss their perceptions of the causes of substance use problems and barriers to recovery on the reservation. Although no questions specifically asked about discrimination, key informants identified stress from racism as an important precipitant of substance use and barrier to recovery. As one participant stated: "Oppression is the overarching umbrella for all sickness with drugs and alcohol." Participants also identified historical trauma resulting from colonization as a manifestation of race-based stress that drives behavioral health problems. Findings suggest that interventions for AIs with substance use disorders, and possibly other chronic health problems, may be more effective if they address social determinants of health such as racial discrimination and historical trauma. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Perceived descriptive norms for alcohol use among tribal college students: Relation to self-reported alcohol use, consequences, and risk for alcohol use disorder

This research addressed gaps in the literature by testing relationships between perceived descriptive alcohol use norms and individual's own alcohol use and consequences among tribal college and university (TCU) students. Survey data were collected from 3239 tribal college students in 22 TCUs across the United States in 2015 and 2016, of whom 3174 provided usable data on the variables of interest for the current manuscript. Results indicated students misperceived the descriptive norms for alcohol use at their TCU, on average estimating students at their college drank more frequently, more per occasion, and more total drinks per week relative to the observed averages on these outcomes. Participants' own drinking was significantly related to their perceived norms, with higher perceived norms related to more drinking. In addition, higher perceived norms were associated with greater alcohol-related negative consequences and lower likelihood of being a non-drinker. These findings extend research with students at majority-serving colleges and universities, indicating normative misperceptions exist and have similar relationships to alcohol use and consequences among TCU students nationwide. These findings support adaptation of normative feedback interventions for use with TCU students to emphasize healthy alcohol norms and correct misperceptions that support the stereotype that all students drink to excess.

Perceptions and Prevalence of Alcohol and Cigarette Use Among American Indian Adults With Type 2 Diabetes

IN BRIEF This study examined community perceptions and prevalence of alcohol use and cigarette smoking among American Indian adults with type 2 diabetes. Results revealed normative rates and perceptions of smoking and negative views and low rates of alcohol use. Participants reported high levels of household indoor smoking and comorbid high-risk drinking and smoking. The high smoking rate among the adult American Indians in this study is especially problematic given the increased risk of cardiovascular problems related to both smoking and type 2 diabetes. The results underscore the importance of considering substance use behaviors and beliefs as a component of overall health and well-being for people with diabetes.

Native American adolescent narrative written stories of stress

OBJECTIVE(S)

The purpose of this paper is to report study findings related to themes of stress and coping strategies experienced by non-reservation-based Native American adolescents as expressed by their written stories.

DESIGN

A qualitative descriptive narrative approach was used to capture written stories of stress.

ANALYSIS

Key concepts and themes were identified by using the consensual qualitative research (CQR) approach from the participant's stories of stress.

RESULTS

Written stories of stress were collected and analyzed from a convenience sample of 179 Native American adolescent's ages 13-18-years old. Five major themes related to experiences of stress emerged from the stories including (a) relationships, (b) responsibilities, (c) socioeconomic status, (d) negative coping strategies, and (e) positive coping through Native-Reliance.

CONCLUSION

The findings reveal the importance of understanding the types and response to stress experienced by Native American adolescents.

Research with American Indian and Alaska Native populations: Measurement matters

Research is an important tool in addressing myriad American Indian and Alaska Native (AIAN) health disparities; however, tensions exist between common empirical measurement approaches that facilitate cross-cultural comparisons and measurement specificity that may be more valid locally and/or culturally appropriate. The tremendous diversity of AIAN communities, small population sizes of distinct AIAN cultural groups, and varying cultural contexts and worldviews should influence measurement decisions in health research. We provide a framework for guiding measurement in collaboration with AIAN communities using examples from substance abuse research for illustration. Our goal is to build upon ongoing efforts to advance measurement validity for AIAN research by engaging community-researcher partnerships and critical thinking in the selection, adaptation, creation, and implementation of measures.

Correlates of Breath Alcohol Concentration Among Driving Under the Influence Program Clients in Southern California

Understanding factors correlated with breath alcohol concentration (BrAC) at time of arrest for driving under the influence (DUI) may lead to informed rehabilitation programs. This study describes correlations between BrAC at time of arrest and sociodemographic, mental, and physical health, and alcohol-related characteristics among clients in a large California DUI Program. Client reported data ( n = 17,282) were collected at an intake from 2009 to 2014. BrACs ranged from 0.083% to 0.390%, with an average of 0.159% ( SD = 0.051), almost twice the legal limit in the state. Approximately 10.6% of the variance in BrAC was explained by 11 significant correlates. Two sociodemographic factors (age and race/ethnicity) as well as several alcohol-related characteristics were related to higher BrAC levels, whereas comorbid mental and physical health factors played less of a role. Factors associated with BrAC are complex and warrant further investigation to identify causality and inform future interventions.

Identifying risk factors for 30-day readmission events among American Indian patients with diabetes in the Four Corners region of the southwest from 2009 to 2016

Objective

The objective of this study was to identify risk factors for 30-day readmission events for American Indian patients with diabetes in the southwest.

Research design and methods

Data from patients with diabetes admitted to Gallup Indian Medical Center between 2009 and 2016 were analyzed using logistic regression analyses.

Results

Of 2,660 patients, 394 (14.8%) patients had at least one readmission within 30 days of discharge. Older age (OR (95% CI) = 1.26, (1.17, 1.36)), longer length of stay (OR (95% CI) = 1.01, (1.0001, 1.0342)), and a history of substance use disorder (OR (95% CI) = 1.80, (1.25, 2.60)) were risk factors for 30-day readmission. An American Indian language preference was protective against readmission.

Conclusions

Readmission events are complex and may reflect broad and interwoven disparities in community systems. Future research should work to support community-defined interventions to address both in hospital and external factors that impact risk factors for readmission.

Group Psychotherapy in Specialty Clinics for Substance Use Disorder Treatment:The Challenge of Ethnoracially Diverse Clients

Minimal research has explored how clinicians address race and ethnicity considerations in the context of group psychotherapy within substance use disorder (SUD) specialty treatment settings. This article is an exploratory qualitative study in an effort to narrow this gap, using data from semi-structured interviews with 13 group clinicians at three outpatient SUD specialty clinics in the United States. Results are drawn from the portion of coded material pertaining to ethnoracial considerations. A predominant theme from the interviews was the importance of individualized care in terms of "meeting clients where they are at." However, minimal attention appears to have been given to addressing clients' demographic diversity. Overall, ethnoracial considerations were minimally addressed in groups, with clinicians framing such primarily in terms of "cultural" factors relevant to clinics' treatment philosophies. Moreover, limited attention was reportedly given to acknowledgment of social inequities faced by ethnoracial minority clients (e.g., racial discrimination), even though a few clinicians reported concern that minority clients were less engaged in treatment. Clinical implications of these findings and recommendations for future research are discussed.

Impacts of alcohol availability on Tribal lands where alcohol is prohibited: A community-partnered qualitative investigation

On a Northern Plains reservation where alcohol was prohibited, we investigated community members' views on the impacts of alcohol availability. Our methods combined elements of Tribal community participatory research with qualitative inquiry to elicit these perspectives. We used rapid appraisal techniques to conduct confidential interviews with 31 key leaders representing 7 relevant major community systems, and representing a variety of perspectives. Topics included respondents' understandings of the current systems of alcohol availability and use on the reservation, the impacts of these systems on reservation residents, and possible ways to measure these impacts. Respondents reported impacts on individuals, families, and the tribe overall. Alcohol-related problems shaped and were shaped by a constellation of social-ecological conditions: kinship, housing, employment, public/social service capacity, and the supply of alcohol in nearby off-reservation areas, as well as inter-governmental relationships and the spiritual life of reservation residents. A variety of social-structural determinants magnified alcohol impacts, so that the problem drinking of a small number of individuals could have broad effects on their families and the entire community. Our participatory qualitative methods enabled us to directly include the voices as well as the personal experiences and expertise of community members in this presentation. These methods may be broadly applied within policy analysis to identify ways to reduce harms related to alcohol and other drugs for Indigenous communities.

"Please Don't Just Hang a Feather on a Program or Put a Medicine Wheel on Your Logo and Think 'Oh Well, This Will Work'": Theoretical Perspectives of American Indian and Alaska Native Substance Abuse Prevention Programs

Many current theories guiding substance abuse prevention (SAP) programs stem from Western ideologies, leading to a scarcity of research on theories from, and a disconnect with, Indigenous perspectives. This qualitative research study explored perceptions of theory by SAP researchers (N = 22) working with American Indian and Alaska Native communities. In-depth interviews identified components of Indigenous theoretical perspectives, including cultural elements such as balance, social cohesion, and belonging as being particularly significant and currently absent from many SAP programs. Recommendations for conducting metatheory studies and operationalization of Indigenous perspectives into guiding theoretical underpinnings for future SAP programming are provided.

Assessment of Risk and Protection in Native American Youth: Steps Toward Conducting Culturally Relevant, Sustainable Prevention in Indian Country

BACKGROUND

This study constitutes a building block in the cultural adaptation of Communities That Care (CTC), a community-based prevention system that has been found to be effective in reducing youth problem behaviors.

METHODS

Using the data from the CTC normative survey dataset that consists of more than quarter million youth nationwide, this study examines the reliability and validity of scores derived from the Communities That Care Youth Survey (CTC-YS), one of the primary assessment tools for gathering community data on risk and protective factors related to problem behaviors including substance use. The reliability and criterion validity analyses are conducted overall for the nationwide sample of youth as well as for the student subsample of Native American youth.

RESULTS

The results of this study indicate that the existing CTC-YS assessments of risk and protective factors in the domains of community, family, school, and peer groups as well as within individuals yield scores that are reliable and valid within the Native American sample of youth.

CONCLUSIONS

This study informs the third step in the CTC prevention planning process, which involves the assessment of risk and protective factors to be targeted in preventive interventions. The question of how the assessment of risk and protective factors among Native American youth might be further improved and a description of efforts related to the cultural adaptation of the CTC program currently underway are also addressed in the discussion.

Unintended impacts of alcohol restrictions on alcohol and other drug use in Indigenous communities in Queensland (Australia)

BACKGROUND

'Alcohol Management Plans' (AMPs) with a focus on alcohol restrictions were implemented in 19 discrete Indigenous communities, in 15 Local Government Areas, by the Queensland Government from 2002. Community residents' perceptions and experiences of the impacts of AMPs on local alcohol and drug use are documented.

METHODS

A cross-sectional study used quantitative and qualitative survey data collected during 2014-2015 in 10 affected communities. Five had some alcohol available. Five had total prohibition. Participant responses were assessed and compared by prohibition status.

RESULTS

Overall, less than 50% of 1098 participants agreed that: i) the restrictions had reduced alcohol availability in their community and ii) that people were drinking less. Nearly three quarters agreed that binge-drinking had increased, attributed to increased availability of illicit alcohol. There were no statistically significant differences between communities with prohibition and those with some access to alcohol. Participants agreed overall that cannabis use had increased but were more equivocal that new drugs were being used. These views were less frequently reported in prohibition communities.

CONCLUSIONS

Contrary to what was intended, Queensland's alcohol restrictions in Indigenous communities were viewed by community residents as not significantly reducing the availability and use of alcohol. Furthermore, this was compounded by perceived increases in binge drinking and cannabis use; also unintended. There is a need to strengthen resolve at all levels to reduce the supply of illicit alcohol in restricted areas.

Substance Use Profiles of Urban American Indian Adolescents: A Latent Class Analysis

A growing majority of American Indian adolescents now live in cities and are at high risk of early and problematic substance use and its negative health effects.

OBJECTIVE

This study used latent class analysis to empirically derive heterogeneous patterns of substance use among urban American Indian adolescents, examined demographic correlates of the resulting latent classes, and tested for differences among the latent classes in other risk behavior and prosocial outcomes.

METHOD

The study employed a representative sample of 8th, 10th, and 12th grade American Indian adolescents (n = 2,407) in public or charter schools in metropolitan areas of Arizona in 2012. Latent class analysis examined eight types of last 30 day substance use.

RESULTS

Four latent classes emerged: a large group of "nonusers" (69%); a substantial minority using alcohol, tobacco, and/or marijuana [ATM] (17%); a smaller group of polysubstance users consuming, alcohol, tobacco, marijuana, other illicit drugs, and prescription or OTC drugs in combination (6%); and a "not alcohol" group reporting combinations of tobacco, marijuana, and prescription drug use, but rarely alcohol use (4%). The latent classes varied by age and grade level, but not by other demographic characteristics, and aligned in highly consistent patterns on other non-substance use outcomes. Polysubstance users reported the most problematic and nonusers the least problematic outcomes, with ATM and "not alcohol" users in the middle.

CONCLUSIONS

Urban AI adolescent substance use occurs in three somewhat distinctive patterns of combinations of recent alcohol and drug consumption, covarying in systematic ways with other problematic risk behaviors and attitudes.

The Politics of Native American Health Care and the Affordable Care Act

This article examines an important but largely overlooked dimension of the Patient Protection and Affordable Care Act (ACA), namely, its significance for Native American health care. The author maintains that reading the ACA against the politics of Native American health care policy shows that, depending on their regional needs and particular contexts, many Native Americans are well-placed to benefit from recent Obama-era reforms. At the same time, the kinds of options made available by the ACA constitute a departure from the service-based (as opposed to insurance-based) Indian Health Service (IHS). Accordingly, the author argues that ACA reforms--private marketplaces, Medicaid expansion, and accommodations for Native Americans--are best read as potential "supplements" to an underfunded IHS. Whether or not Native Americans opt to explore options under the ACA will depend in the long run on the quality of the IHS in the post-ACA era. Beyond understanding the ACA in relation to IHS funding, the author explores how Native American politics interacts with the key tenets of Obama-era health care reform--especially "affordability"--which is critical for understanding what is required from and appropriate to future Native American health care policy making.

Off-premise alcohol outlets on and around tribal land: risks for rural California Indian youth

Investigating the alcohol environment for rural American Indian youth, we conducted 70 interviews with leading members and youth representatives of nine Southern California tribes. We also conducted brief observations in all 13 stores licensed to sell alcohol on and close to the reservation lands of the nine tribes. Underage youth may obtain alcoholic beverages at stores either directly through illegal sales to minors or indirectly through social sources. Stores are also environments within which alcoholic beverages and heavy drinking may become normalized for youth. Limitations and implications for convenience store-based prevention research on alcohol retail environment for youth in rural populations areas are discussed.

Alcohol Screening and Brief Intervention as Standard Practice: Working with the American Indian/Native Alaskan Populations

Alcohol use and the resulting problems associated with high-risk drinking in the American Indian/Native Alaskan (AI/NA) population are well-documented, as alcohol misuse has taken an incredible toll on many AI/NA communities. Presently, both overall health issues and alcohol use occur disproportionately within this population. This article provides an updated overview of the impact of alcohol use in the United States and within AI/NA communities specifically. It also provides recommendations for an alcohol-related screening and brief intervention instrument that social workers can begin using in their practice and can be utilized within the AI/NA community.

The varieties of religious experience and the retention of clients in Taiwanese faith-based residential drug user treatment

This study investigated whether subgroups of faith-based treatment clients displaying similar religious experiences and treatment performance can be theoretically specified and empirically identified. Highlighting the volitional dimension of the change process, four subgroups (i.e., non-Christians, baseline Christians, rededicated Christians, and newly converted Christians) were proposed according to the direction and magnitude of clients' change in religiosity during treatment. Data obtained for 707 subjects who entered a Christian residential therapeutic community program in Taiwan between 2000 and 2009 were analyzed. Results showed that the typology of religious experiences powerfully predicted treatment retention and completion. Issues of therapeutic specificity and relapse prevention are discussed and study's limitations are noted.

North American Indigenous adolescent substance use

OBJECTIVES

To investigate growth in problem drinking and monthly marijuana use among North American Indigenous adolescents from the upper Midwest and Canada.

METHODS

Panel data from a community-based participatory research project includes responses from 619 adolescents residing on or near 7 different reservations/reserves. All respondents were members of the same Indigenous cultural group.

RESULTS

Rates of problem drinking and monthly marijuana use increased steadily across the adolescent years, with fastest growth occurring in early adolescence (before age 15). In general, female participants reported higher rates of substance use prior to age 15; however, male reports of use surpassed those of females in later adolescence.

CONCLUSIONS

Results of this study highlight the importance of early adolescent substance use prevention efforts and the possible utility of gender responsive programming.

Racial and ethnic disparities in physical abuse reporting and child protective services interventions in the United States

BACKGROUND

Minorities are more prevalent than the general population in the child protection system; however, racial/ ethnic disparities in physical abuse and child protective services interventions are not understood.

METHODS

Bivariate and multivariate analyses evaluated racial/ethnic differences in reported and substantiated physical abuse, physical abuse deaths, and interventions provided in all reported maltreatment from the 2006 National Child Abuse and Neglect Data System.

RESULTS

In bivariate analyses, African American (25%), Asian/ Pacific Islander (21%), and multiracial children (21%) have a higher prevalence of substantiated physical abuse than whites (20%). Native Americans (0.21%), African Americans (0.15%), Asians/Pacific Islanders (0.12%), and Latinos (0.11%) are more likely to die from physical abuse than whites (0.09%). African Americans have higher odds than whites of reported (odds ratio [OR], 1.13; 95% confidence interval [CI], 1.11-1.14) and substantiated (OR, 1.27; 95% CI, 1.23-1.31) physical abuse. Latinos have higher odds of reported physical abuse (OR, 1.18; 95% CI, 1.16-1.20) and lower odds of substantiated physical abuse (OR, 0.93; 95% CI, 0.90-0.96). Native Americans have lower odds (OR, 0.53; 95% CI, 0.49-0.56) and Asian/Pacific Islanders higher odds (OR, 1.34; 95% CI, 1.26-1.44) of reported physical abuse vs whites. Latinos have significantly lower odds than whites of receiving support services.

CONCLUSIONS

Compared with whites, African Americans are at increased risk. Latino, Asian/Pacific Islander, and multiracial children have greater odds of reports, and Native Americans have lower odds of reports for physical abuse. Significant disparities exist in interventions provided to minority families. Understanding these disparities has the potential to improve reporting, prevention, and interventions.

Preferred drug resistance strategies of urban American Indian youth of the southwest

This study explored the drug resistance strategies that urban American Indian adolescents consider the best and worst ways to respond to offers of alcohol, cigarettes, and marijuana. Focus group data were collected from 11 female and 9 male American Indian adolescents attending urban middle schools in the southwest. The youth were presented with hypothetical substance offer scenarios and alternative ways of responding, based on real-life narratives of similar youth. They were asked to choose a preferred strategy, one that would work every time, and a rejected strategy, one they would never use. Using eco-developmental theory, patterns in the preferred and rejected strategies were analyzed to identify culturally specific and socially competent ways of resisting substance offers. The youth preferred strategies that included passive, non-verbal strategies like pretending to use the substance, as well as assertive strategies like destroying the substance. The strategies they rejected were mostly socially non-competent ones like accepting the substance or responding angrily. Patterns of preferred and rejected strategies varied depending on whether the offer came from a family member or non-relative. These patterns have suggestive implications for designing more effective prevention programs for the growing yet underserved urban American Indian youth population.

Strategies to resist drug offers among urban American Indian youth of the southwest: an enumeration, classification, and analysis by substance and offeror

This study explores the drug resistance strategies of urban American Indian adolescents when they encounter people offering them alcohol, cigarettes, and marijuana. Data were collected in 2005 from 11 female and 9 male adolescents who self-identified as American Indian and attended two urban middle schools in the southwestern United States. In two focus groups-one at each school site-the youth described their reactions to 25 hypothetical substance offer scenarios drawn from real-life narratives of similar youth. Qualitative analysis of their 552 responses to the scenarios generated 14 categories. Half of the responses were strategies reported most often by nonnative youth (refuse, explain, leave, and avoid). Using ecodevelopmental theory, the responses were analyzed for indications of culturally specific ways of resisting substance offers, such as variation by specific substance and relationship to the person offering. Study limitations are noted along with suggestive implications for future research on culturally appropriate prevention approaches for urban American Indian youth.

Indian Student Involvement in Tribal Community-Based Research: Underage Drinking Prevention among Rural Native Californians

The critical need for increased numbers of American Indian/Alaska Native scientists and health professionals motivated the development of the California Native American Research Center for Health (CA-NARCH) initiative. One strategy of the initiative has been to encourage opportunities for applied research experiences for American Indian/Alaska Native students. Placement of CA-NARCH students in funded research assistant positions for a research project "Preventing Underage Drinking by Southwest California Indians: Building Capacity" based at the Southern California Tribal Health Clinic, Inc., in a rural part of Southern California, provides a model in which both American Indian//Alaska Native students and research investigators have benefitted. Six students received training in research ethics, data collection methods and data management and analysis. The students' participation in project activities has resulted in positive experiences for themselves, a productive research staff for the project and positive responses from community members to this sensitive research project.

Characteristics of problem drinking in an urban South American indigenous population

This 2002 Medcen Foundation-funded study explored characteristics of problem drinking among 211 urban Venezuelan Native Americans of Arawak origin. Prevalence of problem drinking using Alcohol Use Disorders Identification Tests was 88.5% among men and 17.3% among women. Periodic binge drinking was marked by loss of control, failure to meet obligations, and alcohol-related trauma. Focus group participants noted that previous occasional binge drinking by men has been replaced by frequent male and female heavy weekend drinking, violence, and death. Limitations and implications are discussed. Awareness of high levels of problem drinking and desire for assistance present compelling mandates for community intervention efforts.

Crystal methamphetamine use among American Indian and White youth in Appalachia: Social context, masculinity, and desistance

Rural areas and American Indian reservations are hotspots for the use of crystal methamphetamine ("meth") in the United States, yet there is little ethnographic data describing meth use in these areas. This study draws upon three years of ethnographic work conducted with American Indian and White youth in Appalachia during the height of the meth epidemic. It describes how historical, cultural, and socioeconomic processes influence vulnerability to meth use in Appalachia, and highlights the role of social relationships and meaning-making in facilitating desistance and recovery from meth use. The first section shows how crystal meth filled a particular functional niche in the lives of many young men, alleviating boredom and anomie linked to recent socioeconomic changes and labor opportunities in the region, and intersecting with local understandings of masculinity and forms of military identity. Here, ethnographic and interview data converge to illustrate how social role expectations, recent socioeconomic change, and meth's pharmacological properties converge to create vulnerability to meth use in Appalachia. The second section draws upon two American Indian narratives of desistance. These youth described recently severed social relationships and acute feelings of social isolation during the initiation of meth use. Both also described dramatic close calls with death that facilitated their eventual desistance from use, involving repaired social relationships and the establishment of new lives and hope. These interviews illustrate how changes in social relationships were linked with both initiation and desistance from meth use, and how religious interpretations of near-death experiences structured narratives of cessation and redemption.

'We've fallen into the cracks': Aboriginal women's experiences with breast cancer through photovoice

Despite some recognition that Aboriginal women who have experienced breast cancer may have unique health needs, little research has documented the experiences of Aboriginal women from their perspective. Our main objective was to explore and to begin to make visible Aboriginal women's experiences with breast cancer using the qualitative research technique, photovoice. The research was based in Saskatchewan, Canada and participants were Aboriginal women who had completed breast cancer treatment. Although Aboriginal women cannot be viewed as a homogeneous group, participants indicated two areas of priority for health-care: (i) Aboriginal identity and traditional beliefs, although expressed in diverse ways, are an important dimension of breast cancer experiences and have relevance for health-care; and (ii) there is a need for multidimensional support which addresses larger issues of racism, power and socioeconomic inequality. We draw upon a critical and feminist conception of visuality to interrogate and disrupt the dominant visual terrain (both real and metaphorical) where Aboriginal women are either invisible or visible in disempowering ways. Aboriginal women who have experienced breast cancer must be made visible within health-care in a way that recognizes their experiences situated within the structural context of marginalization through colonial oppression.

Cherokee self-reliance and word-use in stories of stress

This study examined the relationship between Cherokee self-reliance and related values expressed through word-use in stories of stress written by Cherokee adolescents. The overall aim of this pilot study was to test the feasibility of using cultural appropriate measurements for a larger intervention study of substance abuse prevention in Cherokee adolescents. A sample of 50 Cherokee adolescent senior high school students completed the Cherokee Self-Reliance Questionnaire and wrote their story of stress. The Linguistic Inquiry and Word Count (LIWC) program, a word-based computerized text analysis software, was used to report the percentage of words used in the selected word categories in relation to all the words used by a participant. Word-use from the stories of stress were found to correlate with Cherokee self-reliance.

A cultural approach to conducting HIV/AIDS and hepatitis C virus education among native American adolescents

This pilot study tests the feasibility of using a Talking Circle approach and measures cultural values and beliefs within a HIV/AIDS and hepatitis C virus (HCV) prevention program conducted among a Native American (Cherokee) youth population. A descriptive correlation design was used to examine the relationship between Cherokee self-reliance and HIV/AIDS and HCV knowledge, attitudes, and behaviors. The study used three questionnaires that were administered before and after the prevention program to collect data from a convenience sample of 41 students at a public high school within the boundaries of the Cherokee Nation in Oklahoma. Statistical analysis revealed immediate differences between pretests and posttests related to knowledge, attitudes, and behavioral intentions concerning HIV/AIDS and HCV and the cultural dynamic of Cherokee self-reliance.

Historical and cultural aspects of man's relationship with addictive drugs

Our taste for addictive psychoactive substances is attested to in the earliest human records. Historically, psychoactive substances have been used by (i) priests in religious ceremonies (eg, amanita muscaria); (ii) healers for medicinal purposes (eg, opium); or (iii) the general population in a socially approved way (eg, alcohol, nicotine, and caffeine). Our forebears refined more potent compounds and devised faster routes of administration, which contributed to abuse. Pathological use was described as early as classical Antiquity. The issue of loss of control of the substance, heralding today's concept of addiction, was already being discussed in the 17th century. The complex etiology of addiction is reflected in the frequent pendulum swings between opposing attitudes on issues that are still currently being debated, such as: is addiction a sin or a disease; should treatment be moral or medical; is addiction caused by the substance; the individual's vulnerability and psychology, or social factors; should substances be regulated or freely available.

Risk, resilience, and natural recovery: a model of recovery from alcohol abuse for Alaska Natives

AIM

The People Awakening (PA) study explored an Alaska Native (AN) understanding of the recovery process from alcohol abuse and consequent sobriety.

DESIGN

PA utilized a cross-sectional, qualitative research design and community-based participatory research methods.

SETTING AND PARTICIPANTS

The study included a state-wide convenience sample of 57 participants representing all five major AN groups: Aleut/Alutiiq, Athabascan, Inupiaq, Yup'ik/Cup'ik and Tlingit/Haida/Tsimshian. Participants were nominated and self-identified as being alcohol-abstinent at least five years following a period of problem drinking.

MEASUREMENTS

Open-ended and semistructured interviews gathered extensive personal life histories. A team of university and community co-researchers analyzed narratives using grounded theory and consensual data analysis techniques.

FINDINGS

A heuristic model of AN recovery derived from our participants' experiences describes recovery as a development process understood through five interrelated sequences: (i) the person entered into a reflective process of continually thinking over the consequences of his/her alcohol abuse; (ii) that led to periods of experimenting with sobriety, typically, but not always, followed by repeated cycling through return to drinking, thinking it over, and experimenting with sobriety; culminating in (iii) a turning point, marked by the final decision to become sober. Subsequently, participants engaged in (iv) Stage 1 sobriety, active coping with craving and urges to drink followed for some participants, but not all, by (v) Stage 2 sobriety, moving beyond coping to what one participant characterized as 'living life as it was meant to be lived.

CONCLUSIONS

The PA heuristic model points to important cultural elements in AN conceptualizations of recovery.

The efficacy of a multicultural prevention intervention among urban American Indian youth in the southwest U.S

This study explored how a non-targeted group of ethnic minority youth might or might not benefit from a prevention intervention focused on other cultural groups. The study specifically evaluated the effects of an evidence-based drug prevention curriculum with a sample of urban American Indian youth in the southwest U.S., most of whom self-reported multi-ethnic heritages. Using growth curve modeling, this research examined the developmental trajectory of drug use for these youth, and compared it with the trajectory of youth from other racial/ethnic groups at pre-intervention, post-intervention, and two follow up time periods. Results indicate that alcohol and marijuana use increased from pre-intervention across subsequent time periods for all youth. The drug use of the American Indian youth in the treatment group increased on some measures. Specifically, they reported a steeper trajectory in the amount and frequency of alcohol and marijuana use compared to the youths in the treatment groups with other racial/ethnic identifications. The implications of these findings for the development of culturally grounded prevention programs for multi-ethnic, urban American Indian youth are discussed. EDITORS' STRATEGIC IMPLICATIONS: This research provides a specific example, but also makes a strong global argument, for the need to develop and evaluate prevention programs that are culturally grounded in the worldview of the target group.