Historical Oppression, Resilience, and Transcendence: Can a Holistic Framework Help Explain Violence Experienced by Indigenous People?

The Weaving Healthy Families program: Promoting parenting practices, family resilience, and communal mastery

Parenting quality, family resilience, and community resilience and support have been found to be primary protective factors for the disproportionate burden of anxiety, posttraumatic stress disorder (PTSD), substance use disorder (SUD), depression, and suicide that US Indigenous youth and adults tend to experience. The purpose of this research study was to examine pilot results for outcomes related to relational factors for Indigenous family members who participated in the Weaving Healthy Families (WHF) program (translated to Chukka Auchaffi' Natana, in the Choctaw tribal language), a culturally grounded and empirically informed program geared toward promoting wellness, family resilience, parenting practices, and community resilience while also preventing SUD and violence. This nonrandomized pre-experimental pilot intervention followed a longitudinal design, which included pre-test, a post-test, and a 6-, 9-, and 12-month post-intervention follow-up surveys. Repeated-measures regressions were utilized with generalized estimating equations (GEE) to examine changes in parenting, family resilience, and communal mastery before and after the intervention for 24 adults and adolescents (12-17) across eight tribal families. Results indicate that the overall quality of parenting improved, as measured by improved parental monitoring and reductions in inconsistent discipline and corporal punishment. We identified sex differences in positive parenting, poor monitoring, and corporal punishment, with greater decreases in these measures among males over time. Family resilience and communal mastery improved for adolescent and adult participants after the WHF program. Our results indicate promising improvements across relational, familial, and community ecological, which provide clear clinical implications.

"'We'd Just Patch Ourselves up': Preference for Holistic Approaches to Healthcare and Traditional Medicine among Members of a State-Recognized Tribe"

Background:Health disparities between Native Americans and white Americans persist due to a variety of factors, including colonization, poverty, and racism. Racist interpersonal interactions between nurses and other healthcare providers and tribal members may also contribute to reluctance among Native Americans to engage with Western healthcare systems. Purpose: The purpose of this study was to better understand the healthcare experiences of members of a state-recognized Gulf Coast tribe. Methods: In partnership with a community advisory board, 31 semistructured interviews were conducted, transcribed, and analyzed utilizing a qualitative description approach. Results: All participants mentioned their preferences, views about, or experiences of using natural or traditional medicine approaches (referenced 65 times). Emergent themes include (a) preference for and use of traditional medicine; (b) resistance to western healthcare systems; (c) preference for holistic approaches to health; and (d) negative provider interpersonal interactions contributing to reluctance in seeking care. Conclusion: These findings suggest that integrating a holistic conceptualization of health and traditional medicine practices into Western healthcare settings would benefit Native Americans.

"Never Give Up. The Creator Has Good Things in Store for You": Risk Factors, Protective Factors, and Evidence of Resilience for Canadian Indigenous Women Abused by Intimate Partners

Canadian Indigenous women often experience severe partner violence and child abuse, but few studies holistically examine risk and protective factors and evidence of resilience that affect their well-being. This mixed-methods secondary analysis explored the experiences of 40 Canadian Indigenous abused women. Risk factors included intimate partner violence (IPV), childhood abuse, poverty, colonization, and disability. Protective factors included formal and informal support, community support, spirituality, and childhood residence. Evidence of resilience is from interview quotes and none of the measures of depression, mental distress, and posttraumatic stress disorder was in the clinical range. Despite significant IPV and childhood abuse, the women's resilience is highlighted.

"We have to … work for wholeness no matter what": Family and culture promoting wellness, resilience, and transcendence

Sociocultural, mental, behavioral, and physical factors are interrelated associates of chronic health conditions-such as diabetes, obesity, and cardiovascular disease-all of which are disproportionally high and drive much of the mortality and morbidity for Indigenous peoples. Indigenous worldviews conceptualize health holistically, with inseparability across social, spiritual, cultural, familial, mental, behavioral, physical, and social dimensions of wellness. Food, family, and culture are fundamental to Indigenous wellness. The purpose of this article is to use the Framework of Historical Oppression, Resilience, and Transcendence (FHORT) conceptualization of relational wellness to honor urban and rural U.S. Indigenous perspectives that highlight the intersections of family, culture, physical health, spiritual, and mental health to promote resilience and wellness. This research focused on interconnections between wellness, culture, health, and family. Thirty-one critical ethnographic interviews used a life-history approach with methodology following an Indigenous toolkit for ethical and culturally sensitive research strategies, such as building upon cultural strengths, engaging in long-term, relational commitments with communities, incorporating storytelling and oral history traditions, centering Indigenous methodologies and preferences, working with cultural insiders, and prioritizing the perspectives of Indigenous peoples. Emergent themes included: (a) roots of Indigenous wellness: cultural values promoting balance and connection; (b) practicing resilience: family transmission of health information; and (c) wholistic mental wellness and resilience, with the subtheme culture and wellness. Interventions can be developed in collaboration with tribes for optimum efficacy and cultural relevancy and can approach wellness holistically in culturally relevant ways that center foodways, culture, family, and spirituality.

My Parents, My Grandparents Went Through Residential School, and All this Abuse has Come From it: Examining Intimate Partner Violence Against Canadian Indigenous Women in the Context of Colonialism

While the global rates of intimate partner violence (IPV) for Indigenous women have been acknowledged as substantial, few studies have incorporated an analysis of the impacts of colonization in the context of IPV. This secondary mixed-methods analysis explored the experiences of 40 Indigenous women from the Canadian prairie provinces who were abused by their intimate partners. The women discussed the impact of colonization, including the use of residential schools, to break down family life, spiritual beliefs, and languages, at times linking this to IPV. Of the 40 women, 38 described male partners as the abusers and two identified female abusive partners. Consistent with the literature, many of the male partners physically assaulted the respondents so severely that the women were injured and were at risk of death. Almost half of the men (47.4%) used sexually coercive strategies and/or sexually assaulted the women. Implications include the importance of professionals considering the broader historical experiences and possible trauma of Indigenous women who seek assistance for IPV from abusive partners.

"Take care of your families, take care of one another": Indigenist families and foodways

Objective

The purpose of this research was to examine how families and foodways have evolved over time and how they may present promising promotive factors for resilience, health, and wellness.

Background

Because food is central to family, social relationships, and healthy living, Indigenist foodways may promote family resilience and offset inequities.

Method

Pragmatic horizon analysis of data drawn from 31 critical ethnographic interviews on food and family in the Southeast and Northwest, including both urban and rural reservation tribal contexts, resulted in emergent themes related to food and families.

Results

Themes included (a) foodways fostering family connectedness: "The fresh vegetable is how I remember my grandpa"; (b) tight-knit extended families and communities: "The community where I grew up … everybody knew each other, so everybody … pitched in"; (c) family and community celebrations nurturing cohesion: "The family I have, I can always count on. I can trust each one of them"; and (d) families fostering healing: "Sit down and talk to somebody … that you can trust."

Conclusion

Participants explained how foodways promoted family resilience by bringing families and communities together. Indigenist foodways fostered continuity and healing through food preparation and processing and through feasts and gatherings.

Implications

Foodways were described as fundamental to family resilience and community connectedness. Subsistence fostered exercise, eating locally sourced foods, and family resilience. Interventions are needed to promote Indigenist foodway sovereignty while first understanding how culture, history, and food inform wellness and community well-being.

The Role Nurses Can Play in Addressing and Preventing the Prevalence of Missing or Murdered Indigenous Women and Girls (MMIWG)

INTRODUCTION

In 2016, 5,712 American Indian/Alaskan Native (AI/AN) women and girls were reported missing in the United States. In Canada, 4% of the population is Indigenous, yet Indigenous females represent 50% of all sex trafficking victims. This systematic mixed-studies review examined the effects of Missing and Murdered Indigenous Women and Girls (MMIWG) to define a role for nurses.

METHODS

We used five databases with keywords, inclusion criteria, and the Mixed Methods Appraisal Tool.

RESULTS

Findings of 22 papers discuss: (a) demographic data; (b) factors that increase vulnerability of AI/AN women; and (c) how nurses can decrease the prevalence of MMIW.

DISCUSSION

Nurses are the first provider patients see when accessing care. Increasing knowledge about the impact of violence against AI/AN women and girls is the first step in identifying measures needed to address this public health concern.

Developing the Weaving Healthy Families Program to Promote Wellness and Prevent Substance Abuse and Violence: Approach, Adaptation, and Implementation

Family prevention programs that enhance mental health, wellness, and resilience-while simultaneously addressing violence and alcohol and other drug (AOD) abuse-among Indigenous families are scarce. This gap in culturally grounded and community-based programs creates a critical need to develop and evaluate the efficacy of such prevention programs. This article fills this gap, with the purpose of describing the structure and content of the Weaving Healthy Families (WHF) program, a culturally grounded and community-based program aimed at preventing violence and AOD use while promoting mental health, resilience, and wellness in Indigenous families. The focus then turns to how to approach this process of developing and implementing the program in a culturally grounded and community-based way.

Researching Adverse Childhood Experiences in the Youth Justice System: Reflections on Methodology From a Members of a Non-Indigenous Research Team

Understanding the impacts of Adverse Childhood Experiences (ACEs) has rapidly emerged as an important area of research that has implications for those who work in youth justice settings. This paper identifies a series of considerations facing those who work in jurisdictions where Indigenous or First Nations peoples have much higher levels of contact with both child protection and criminal justice systems than other population groups. It presents some reflections from members of a non-Indigenous research team about their efforts to engage with cultural perspectives on ACEs research in a way that facilitates further discussion within the research community about the methodological decisions that are made when investigating issues that are of importance to members of minority culture communities.

"Treat Me like Your Family": Positive Factors that Influence Patient-Provider Relationships for Native American Women

Although extensive documentation of the health disparities experienced by Native American peoples exists, little research explores experiences of members of non-federally recognized tribes who receive health care outside of the Indian Health Services (IHS) system. Additionally, positive factors that influence relationships between health care providers and tribal members are understudied and are needed to promote health care access. A qualitative descriptive methodologic approach was used to conduct semi structured life history interviews with 31 women who identified as members of a state-recognized, Gulf South Native American tribe. Results identified the following important themes: Do Participants Have a Regular Provider, Personal Relationship With Provider, Feel Provider Cares, Provider Addresses Concern, and Respect for Traditional or Holistic Medicine. These findings suggest health care providers play an important role in impacting the health care experiences of Native American tribal members. Implications for trainings for health care providers are discussed.

Risk and Resilience Among Families in Urban AI/AN Communities: the Role of Young Adults

Urban American Indian/Alaska Native (AI/AN) young adults and their families are often geographically or socially distant from tribal networks and traditional social support. Young adults can be especially vulnerable to cultural and social disconnection, so understanding how AI/AN family functioning can augment resilience and protect against risk is important. This research precedes a preventive substance use intervention study and explores urban Native family functioning, emphasizing the role of young adults by analyzing data from 13 focus groups with urban AI/AN young adults (n = 32), parents (n = 25), and health providers (n = 33). We found that young adults can and want to become agents of family resilience, playing active roles in minimizing risks and strengthening family functioning in both practical and traditional ways. Also, extended family and community networks played a vital role in shaping family dynamics to support resilience. These resilience pathways suggest potential targets for intervention.

"It's Always About Sharing, and Caring, and Loving, and Giving": Decolonized and Transcendent Indigenist Foodways Fostering Health and Resilience

Centuries of historical oppression have targeted and undermined Indigenous foodways, which fundamentally disrupts the culture and wellness, yet decolonized, resilient, and transcendent Indigenist practices persist. The purpose of this research was to use the framework of historical oppression, resilience, and transcendence (FHORT) to understand foodway practices among Indigenous Peoples. Given a limited understanding of how foodways may promote health and wellness the focal research questions for this critical ethnographic inquiry were: (a) How do participants describe Indigenist foodways? (b) How do Indigenist foodways reflect decolonized values and practices? and (c) How may Indigenist foodways be promotive for health and wellness? Data were drawn from 31 participants across a rural, reservation-based Southeast (SE) region and an urban Northwest (NW) region. Reconstructive data analysis revealed the following emergent themes: (a) Indigenous Values of Generosity Expressed Through Foodways: "It's Always About Sharing, and Caring, and Loving, and Giving"; (b) Gardening, Subsistence, and Food Sharing: "You Bring Enough for Everybody to Share"; (c) Decolonized Feasts and Foodways: "Everybody Pitch in and Help as Much as They Can." Despite centuries of historical oppression, participants reported decolonized values, worldviews, and foodways that reflected unity, cooperation, sharing, and social cohesion and caring, which were promotive factors for family resilience, health, and cultural identification. This research provides promising pathways about how Indigenist foodways remain salient in daily and cultural life, reflect decolonized values and practices, and may be promotive for health and wellness within the natural world.

Centering Historical Oppression in Prevention Research with Indigenous Peoples: Differentiating Substance Use, Mental Health, Family, and Community Outcomes

The purpose of this pilot study was to understand how historical oppression relates to changes in outcomes for people who participate in the culturally grounded Weaving Healthy Families (WHF) program (i.e., alcohol and drug use, symptoms of anxiety, parenting practices, and communal mastery [CM]). This nonexperimental and longitudinal design used repeated measures regression analysis and generalized estimating equations (GEE) to examine postintervention changes according to reported levels of historical oppression among 24 participants in eight families. How do postintervention changes differ for WHF participants reporting lower and higher levels of historical oppression? Results indicated that participants reporting lower historic oppression reported greater postintervention improvements as indicated by declines in alcohol use, anxiety, and poor parental monitoring. All participants reported increases in CM, regardless of the level of historical oppression. Given historical oppression drives psychosocial conditions, such as substance abuse, mental health, and family challenges, settler colonial oppression must be addressed within social service interventions. Social service providers must work redress historical oppression rather than replicate them. The WHF program holds promise to center structural determinants in social service programs. Future inquiries assessing longitudinal changes in perceptions of historical oppression change and how they are associated with psychosocial outcomes are needed.

"I don't remember any of us … having diabetes or cancer": How historical oppression undermines indigenous foodways, health, and wellness

Past and present structures of settler colonial historical oppression aimed to erase and replace Indigenous peoples have profoundly disrupted U.S. Indigenous foodways. The purpose of this article is to use the Indigenous Framework of Historical Oppression, Resilience, and Transcendence (FHORT) to understand U.S. Indigenous peoples' experiences and perceptions of how (a) foodways have changed within the context of settler colonial historical oppression and (b) these changes have affected wellness and cultures of Indigenous peoples. Critical ethnographic analysis focused on data from 31 interviews with participants from a rural Southeast reservation and a Northwest urban context. Results revealed participants' descriptions of changing foodways situated in a system of historical oppression, with themes including (a) historical oppression and changing values and foodway practices; (b) settler colonial governmental programs interrupting foodways through commodities and rations; and (c) changing foodway practices: from homegrown and homemade to fast food and premade. Participants described the aftermath of settler colonial governmental policies and programs undermined foodways, connectedness, cultural knowledge, family and interpersonal relationships, ceremonies, and outdoor activities-all of which promote health and wellness. To redress historical oppression, including settler colonial governmental policies, decolonized decision-making, foodways, and Indigenous food sovereignty are recommended as approaches to inform policy and programming that affirms Indigenous values and worldviews.

High-Risk Contexts for Violence Against Women: Using Latent Class Analysis to Understand Structural and Contextual Drivers of Intimate Partner Violence at the National Level

Introduction: Intimate partner violence (IPV) affects 1 in 3 women and poses a major human rights threat and public health burden, yet there is great variation in risk globally. Whilst individual risk factors are well-studied, less research has focussed on the structural and contextual drivers of IPV and how these co-occur to create contexts of high risk. Methods: We compiled IPV drivers from freely-accessible global country-level data sources and combined gender inequality, natural disasters, conflict, colonialism, socioeconomic development and inequality, homicide and social discrimination in a latent class analysis, and identified underlying 'risk contexts' based on fit statistics and theoretical plausibility (N=5,732 country-years; 190 countries). We used multinomial regression to compare risk contexts according to: proportion of population with disability, HIV/AIDS, refugee status, and mental health disorders; proportion of men with drug use disorders; men's alcohol consumption; and population median age (N=1,654-5,725 country-years). Finally, we compared prevalence of physical and/or sexual IPV experienced by women in the past 12 months across risk contexts (N=3,175 country-years). Results: Three distinct risk contexts were identified: 1) non-patriarchal egalitarian, low rates of homicide; 2) patriarchal post-colonial, high rates of homicide; 3) patriarchal post-colonial conflict and disaster-affected. Compared to non-patriarchal egalitarian contexts, patriarchal post-colonial contexts had a younger age distribution and a higher prevalence of drug use disorders, but a lower prevalence of mental health disorders and a smaller refugee population. IPV risk was highest in the two patriarchal post-colonial contexts and associated with country income classification. Conclusions: Whilst our findings support the importance of gender norms in shaping women's risk of experiencing IPV, they also point towards an association with a history of colonialism. To effectively address IPV for women in high prevalence contexts, structural interventions and policies are needed that address not only gender norms, but also broader structural inequalities arising from colonialism.

"We were always doing something outside. … I had a wonderful, wonderful life": U.S. Indigenous peoples' subsistence, physical activity, and the natural world

Obesity tends to be higher, whereas physical activity (PA) tends to be lower for U.S. Indigenous peoples, which drives chronic health problems and mortality. Historical oppression and nutritional colonialism have disrupted Indigenous peoples' subsistence and concomitant PA. The purpose of this research is to use the framework of historical oppression, resilience, and transcendence (FHORT) with 31 participants in a critical ethnography identifying past and present forms of PA. By examining universal themes across two tribal contexts-a Southeast reservation tribal context and an urban Northwestern context-important knowledge about promising forms of PA can inform culturally relevant and effective interventions to promote health and prevent obesity and chronic health problems. Reconstructive thematic qualitative analysis resulted in the following themes: (a) Family-Centered Physical Activity: "The Kids Would … Follow Along, Dropping Seeds and Covering it … the Seeds Grew"; (b) Staying Active in the Natural World: "When I Would Go Home [from boarding school] in the Summertime, That's When … We'll Be Back Being an Indian"; (c) Staying Active through Culture: "The Traditional Dancing … [is] a Form of Exercise"; (d) Mental Wellness in Nature: "It Seemed Like Just Sitting Out There Makes You Feel Better"; and (e) Sports and Competitions Fostering PA: "A lot … Prefer Playing Softball, Basketball, Volleyball, Nowadays". Results highlighted how participants preferred and participated in subsistence and PA growing up, how this had evolved over time, and how being outside in nature contributed to a sense of wellness and overall health.

"Why I Stayed in That Relationship": Barriers to Indigenous Women's Ability to Leave Violent Relationships

Indigenous women in the United States are among the most vulnerable to intimate partner violence (IPV), which has reached endemic levels. The purpose of this qualitative inquiry was to understand contextual factors and barriers to becoming liberated from violence. Reconstructive analysis of data from a critical ethnography with a sample of 231 women across two tribes who described IPV relationships identified the following themes: controlling relationships, losing sense of priorities, using children, socioeconomic stress, family pressures, and restricting relationships. Results revealed these tactics, which parallel those used in the patriarchal colonialism of historical oppression, impeded women's liberation from relationships.

"We've Already Endured the Trauma, Who is Going to Either End that Cycle or Continue to Feed It?": The Influence of Family and Legal Systems on Native American Women's Intimate Partner Violence Experiences

Native American (NA) women experience higher rates of intimate partner violence (IPV) compared to other U.S. racial/ethnic groups, yet previous research has not sufficiently examined the complex determinants shaping their IPV experiences. This research explores the interplay of family networks and legal systems influencing NA women's IPV experiences. Data were collected through in-depth individual and group interviews with 42 NA survivors and 41 health/social service providers from July 2016 to June 2017 in NA communities from three different U.S. regions. We used Grounded Theory to develop emergent themes from the data, focusing on system-level risk and protective factors of women's of IPV experiences. In terms of family systems, participants indicated that NA communities were comprised of highly influential and interwoven family systems, making them powerful sources of support for both survivors and their partners who use violence. Participants described how intergenerational violence exposures contributed to the normalization of violence. In terms of legal systems, participants described inconsistent consequences for abusers of NA women, insufficient protection from legal systems, and manipulation of jurisdictional complexities. Interactions between family and legal systems influenced decision-making and outcomes. Family and community-based approaches, and the incorporation of traditional language and cultures, are needed to promote healing. Our findings reflect the complex ways that family and legal systems shape NA women's IPV experiences. Results provide insight into how NA women interact with and navigate these systems when experiencing IPV and how these systems impact decision-making and the ability to be safe from IPV. Research is needed to advance understanding of the inter-relationships between intergenerational trauma, family systems, and legal systems on IPV survivors' mental health and wellness. To make meaningful change, further research examining IPV from an interdisciplinary perspective that explores the interplay of social determinants of health inequities is needed.

Healthcare needs and infrastructure obstacles for a state-recognised Indigenous tribe in the United States

Although Indigenous groups continue to experience extensive health disparities, little research explores the role of structural barriers in contributing to health disparities for state-recognised tribes, who do not receive healthcare services from the Indian Health Service. In addition, much research focuses on discrete physical health outcomes, without utilising community-based approaches to allow participants to identify healthcare priorities and needs in their own voices. In partnership with a community advisory board, a qualitative descriptive methodology was used to conduct 31 life-course interviews with participants of a state-recognised tribe in the Gulf South region of the United States to explore healthcare experiences. Participants identified unmet healthcare needs and healthcare infrastructure barriers. Some of the most common barriers and unmet healthcare needs included: Long Distance to Healthcare Services and Difficulty in Accessing Specialists, Need for Increased Communication, Long Hospital or Appointment Wait Times, Unmet Mental Health Needs, Need for Substance Use or Abuse Prevention Programs and Need for Health Education. These findings highlight some of the structural barriers that exacerbate existing health disparities and suggest important areas of intervention, such as including a focus on mental health needs. Increased healthcare resources and recognition of sovereignty for this state-recognised tribe are also needed to begin to address these barriers. In addition, because of the long history of exploitation of Indigenous communities, healthcare interventions should meaningfully include Indigenous tribes in the development and implementation of any healthcare programs.

The importance of community support for women in a Gulf Coast Indigenous tribe

Purpose

Community support is an integral aspect of health and well-being for Indigenous peoples. The purpose of this paper is to demonstrate the valuable role of community support for Indigenous women specifically, who experience reproductive health disparities at alarming rates. This study helps fill an important gap in Indigenous scholarship by centering the resilience of women and Indigenous tribes and by using a framework that is consistent with Indigenous holistic views of health.

Design/methodology/approach

The data for this paper was collected as part of a larger study exploring the reproductive health experiences of a state-recognized Gulf Coast tribe. A total of 31 semi-structured interviews were conducted with individuals who identify as women and as members of this tribe using qualitative descriptive methodology. This method is recommended for research with Indigenous communities. A community advisory board with representatives from this tribe provided feedback throughout the project.

Findings

Themes expressed by participants included Community Closeness and Support; Community Support in Raising Children; Informal Adoption Common; and Community Values of Mutual Aid and Self-Sufficiency. The findings support current literature noting the value of generational and communal ties for Indigenous peoples. Implications of this research include the need to value and support community networks in programs serving tribes, in addition to meaningfully including Indigenous communities in developing interventions.

Originality/value

This paper centers Indigenous women’s resilience, approaches the health and well-being of Indigenous tribes holistically and helps to fill an important gap in literature describing informal adoption (outside the legal system) in state-recognized Indigenous communities.

"You Can Get Away with Anything Here… No Justice at All"- Sexual Violence Against U.S. Indigenous Females and Its Consequences

Sexual violence against Indigenous women has long been used as a tool of colonial violence and conquest. As a contemporary form of historical oppression that may drive associated health and mental health inequities, Indigenous women in the United States experience sexual violence at greater levels than the general population and at and twice the rate of Indigenous men. We use the Indigenous framework of historical oppression, resilience, and transcendence (FHORT) to understand Indigenous women's experiences of sexual violence and how it differentiates across ecological outcomes related to health and wellness. This exploratory sequential multimethod study with 563 participants (n = 436 qualitative and n = 127 quantitative survey participants) qualitatively explores how Indigenous peoples describe sexual violence and quantitatively investigates key differences across ecological outcomes of wellness related to sexual violence, including alcohol use and post-traumatic stress disorder (PTSD). Results indicated that all participants (100 percent) who reported sexual violence were women. Thematic analysis of qualitative results revealed the themes related to familial, non-familial, and the historical oppression of a lack of accountability for perpetrators. Quantitative t-Tests results revealed that experiencing sexual violence was associated with significant differences across ecological dimensions of wellness including (a) structural: higher historical oppression, historical loss, oppression, and discrimination; (b) relational: higher adverse childhood experiences and stressful life events and lower family resilience and social support; (c) spiritual: lower spiritual-well-being and life satisfaction; and (d) psychological/behavioral: higher levels of alcohol use, PTSD, and lower levels of psychological resilience. Thus, sexual violence profoundly affected Indigenous women.

Predictors of STD Screening From the Indigenist Stress-Coping Model Among Native Adults With Binge Substance Use

Objective

The American Indian/Alaska Native (AI/AN) population in the U.S. is thriving in spite of settler colonialist efforts of erasure. AI/AN people, however, continue to experience persistent health disparities including a disproportionate burden of substance use and sexually transmitted diseases/infections (STDs/STIs), as well as a disproportionate lack of public health STD screening services and STD prevention interventions grounded in AI/AN social contexts, experiences, and epistemologies. The present study explored how stressors and protective factors based on the Indigenist Stress Coping framework predict STD screening outcomes among Native adults.

Methods

We analyzed baseline self-report data from 254 Native adults ages 18-55 years with recent binge substance use who were enrolled in an evaluation of "EMPWR," a two-session STD risk reduction program in a rural, reservation-based community in the U.S. Southwest. Logistic regression models with robust variance were used to estimate odds ratios of lifetime STD testing for the theoretical stressors and cultural buffers.

Results

A little over half the sample were males (52.5%, n = 136), with a mean age of 33.6 years (SD = 8.8). The majority (76.7%, n = 195) reported having ever been screened for STD in their life. Discrimination score were significantly associated with lifetime STD testing: The higher discrimination was associated with lower odds of STD testing in the fully adjusted model (aOR = 0.40, 95%CI: 0.18, 0.92). The effects of AI/AN-specific cultural buffer such as participation in traditional practices on STD testing outcomes was in the expected positive direction, even though the association was not statistically significant. Household size was significantly associated with STD screening: The higher the number of people lived together in the house, the higher the odds of STD testing in the fully adjusted model (aOR = 1.19, 95%CI: 1.04, 1.38).

Conclusion

Our findings suggest that STD prevention programs should take into consideration AI/AN-specific historical traumatic stressors such as lifetime discrimination encounters and how these interact to drive or discourage sexual health services at local clinics. In addition, larger household size may be a protective factor functioning as a form of social support, and the extended family's role should be taken into consideration. Future research should consider improvement in measurements of AI/AN enculturation constructs.

"When You Come Together and Do Everything, It'll be Better for Everybody": Exploring Gender Relations Among Two Southeastern Native American Tribes

Prior to the imposition of patriarchal colonial norms, Native American (NA) gender relations were characterized as complementary and egalitarian; however, little research has explored gender relations within NA communities today. This study used a community-based critical ethnography to explore contemporary NA gender relations with a purposive sample of 208 individuals from the "Coastal Tribe" and 228 participants from the "Inland Tribe." After participant observation, interviews, and focus groups were conducted, a collaborative approach to reconstructive analysis was used to identify themes in the data. Within these communities, gender relations tended to reflect egalitarian and cooperative but gendered norms, and participants provided examples of how tribal members are transcending patriarchal colonialism. Through the lens of the Framework of Historical Oppression, Resilience, and Transcendence, we theorize how these gender norms may protect families from risks associated with historical oppression and promote family resilience with implications for research, practice, and policy.

'Marriage is Going to Fix It': Indigenous Women's Experiences with Early Childbearing, Early Marriage and Intimate Partner Violence

Intimate partner violence (IPV), early childbearing (ECB) and early marriage (EM) are interconnected to the historical oppression of patriarchal colonialism imposed upon Indigenous peoples throughout the world by colonising nations, such as the UK. The artefacts of colonial oppression persist in both colonising nations and those that have been colonised through social norms of patriarchal oppression perpetuated upon women with far-reaching consequences. Indigenous women of the US experience higher rates of IPV, ECB and EM than any other ethnic group-which pose risks to women's physical, psychological, socioeconomic and educational status. The purpose of this study is to explore Indigenous women's experiences with ECB and EM through a critical ethnography with two US tribes. Through reconstructive analysis the following themes emerged: (i) ECB as a Precursor to Marriage; (ii) Unequal and Overburdened Marriages; (iii) ECB, EM and IPV; and (iv) Continued Harmful Effects of Multiple Abusive Relationships. Indigenous women's experiences of ECB and EM are connected to patriarchal historical oppression that systematically dehumanises and oppresses Indigenous women, who were once treated with respect and esteem. Decolonisation and re-visualisation to promote the status of women and girls are needed to offset women's constrained wellness, socio-political status and safety.

Community-based system dynamics modelling of stigmatized public health issues: Increasing diverse representation of individuals with personal experiences

Utility of community-based system dynamics (CBSD) models on stigmatized public health issues and health disparities depends upon how representative the model is to real-world experience within the community. "Personal experience" participants (PEP), especially from marginalized groups, are essential model contributors, but are often underrepresented in modeling groups due to multiple barriers. This study details a method to increase PEP representation for models on stigmatized issues. We use a case study from a CBSD project on health disparities within the association between alcohol misuse (AM) and intimate partner violence (IPV) for Northern Plains Indigenous women. Short group model building sessions were held at three community organizations providing relevant resources. Each model contributed unique system components, and there were few similarities between models. A consolidated model provided a rich picture of the complex system. Adding brief PEP-based group modeling sessions can enhance PEP representation in model development for stigmatized public health issues.

'A learning experience': Disciplinary and parenting practices among Native American families

Research indicates that effective disciplinary practices, such as offering praise and teaching acceptable versus non-acceptable behaviour, can act as protective factors against the social and behavioural health disparities experienced by Native Americans (NA). The purpose of this critical ethnographic study (n = 436 qualitative elder, adult, youth and professional participants) was to use the Framework of Historical Oppression, Resilience, and Transcendence (FHORT) to qualitatively examine participants' reported experiences of disciplinary practices. Thematic analysis of qualitative results indicated several approaches to disciplining children, which included the following themes: (a) Establishing Structure and Boundaries; (b) Taking Away Privileges and Rewarding Good Behavior; and (c) Teaching Right from Wrong. Results indicate that despite experiencing historical oppression, NAs still report many disciplinary and other parenting practices contributing to family resilience that were present prior to colonization. Communal and relational supports contribute to positive parenting practices, indicating an importance to promote holistic and inclusive clinical treatment approaches.

Substance and Behavioral Addictions among American Indian and Alaska Native Populations

OBJECTIVE

This paper examines substance and behavioral addictions among American Indian and Alaska Natives (AIAN) to identify the structural and psychosocial risk and cultural protective factors that are associated with substance use and behavioral addictions.

METHODS

Five databases were used to search for peer reviewed articles through December 2021 that examined substance and behavioral addictions among AIANs.

RESULTS

The literature search identified 69 articles. Numerous risk factors (i.e., life stressors, severe trauma, family history of alcohol use) and protective factors (i.e., ethnic identity, family support) influence multiple substance (i.e., commercial tobacco, alcohol, opioid, stimulants) and behavioral (e.g., gambling) addictions.

CONCLUSIONS

There is a dearth of research on behavioral addictions among AIANs. Unique risk factors in AIAN communities such as historical trauma and socioeconomic challenges have interfered with traditional cultural resilience factors and have increased the risk of behavioral addictions. Future research on resilience factors and effective prevention and treatment interventions could help AIANs avoid behavioral addictions.

Historical trauma and oppression: Associations with internalizing outcomes among American Indian adults with type 2 diabetes

American Indian (AI) people experience disproportionate exposure to stressors and health inequities, including type 2 diabetes (T2D) and mental health problems. There is increasing interest in how historical trauma and ongoing experiences of discrimination and marginalization (i.e., historical oppression) interact to influence AI health. The purpose of this study is to examine the relationships between historically traumatic experiences (i.e., boarding schools, relocation programs, and foster care), current reports of historical cultural loss, microaggressions, and their relationship to internalizing symptoms among AI adults living with T2D. This community-based participatory research study with five AI tribal communities includes data from 192 AI adults with T2D recruited from tribal clinics. Results from structural equation modeling revealed that personal experiences in foster care and ancestral experiences in boarding schools and/or relocation were associated with increased reports of historical loss, and indirectly associated with internalizing symptoms through racial microaggressions and historical losses. The findings highlight the importance of considering multiple dimensions of historical trauma and oppression in empirical and practice-based assessments of mental health problems.

Mobilizing Established School Partnerships to Reach Underserved Children During a Global Pandemic

The coronavirus disease 2019 pandemic has led to drastic public health measures, including school closures to slow the spread of severe acute respiratory syndrome coronavirus 2 infection. Reopening educational settings by using diagnostic testing approaches in schools can help accelerate the safe return of students and staff to on-site learning by quickly and accurately identifying cases, limiting the spread of severe acute respiratory syndrome coronavirus 2, and ultimately preventing unnecessary school and work absenteeism. Although the National Institutes of Health has identified community partnerships as the foundation for reducing health disparities, we found limited application of a community-based participatory research (CBPR) approach in school engagement. Guided by the CBPR conceptual model, we provide case studies of 2 established and long-standing school-academic partnerships built on CBPR processes and practices that have served as a research infrastructure to reach underserved children and families during the coronavirus disease 2019 pandemic. The process described in this article can serve as an initial platform to continue to build capacity toward increasing health equity.

"It's in the family circle": Communication promoting Indigenous family resilience

OBJECTIVE

We use the Framework of Historical Oppression, Resilience, and Transcendence (FHORT) to investigate the framework's core concept of family resilience and related protective and promotive factors that contribute to greater resilience, namely communication.

BACKGROUND

Scant research has examined communication in Indigenous families; yet general research suggests that family communication is a prominent aspect of family resilience.

METHODS

In this exploratory sequential mixed-methods study with data from 563 Indigenous participants (n = 436 qualitative and n = 127 quantitative survey), thematic reconstructive analysis was used to qualitatively understand participants' experiences of family communication and quantitatively examine protective factors for family resilience.

RESULTS

The following themes related to family communication as a component of family resilience emerged from qualitative analysis: "It's in the Family Circle": Discussing Problems as a Family with the subtheme: Honesty between Partners; (b) "Never Bring Adult Business into Kids' Lives": Keeping Adult Conversations Private; and (c) "Trust Us Enough to Come to Us": Open Communication between Parents and Children. Regression analysis indicated that higher community and social support, relationship quality, and life satisfaction were associated with greater family resilience.

CONCLUSIONS

Positive communication practices are a strong component of resilience, healthy Indigenous families. Promotive factors at the community (social and community support), relational (relationship quality), and individual (life satisfaction) levels positively contribute to Indigenous family resilience.

IMPLICATIONS

Clinical programs providing practical tools to foster healthy communication - both about difficult topics as well as positive topics - are promising avenues to foster resilience.

"I Have to Watch Them Closely": Native American Parenting Practice and Philosophies

One of many ways that Native American (NA) families demonstrate resilience is by parenting children in some of the most adverse contexts in U.S. society. We use the framework of historical oppression, resilience, and transcendence (FHORT) in a critical ethnography to qualitatively explore the parenting philosophies and practices that NAs use to protect children from the risks of an oppressive context. Data were drawn from 436 members of two Southeastern NA tribes. A team-based critical ethnographic data analysis approach was used to analyze these findings, revealing the following themes: (a) "Your Kids Come First": Prioritizing Children's Needs; (b) "They Should Enjoy their Childhood": Sheltering Children from Family Stressors; (c) "I Have to Watch Them Closely": Closely Monitoring Children; and, (d) "There's No Drinking at My House": Preventing Children's Exposure to Substance Abuse. Results indicate that NA parents adopt child-centric mindsets and use a number of positive practices to protect their children from the potentially harmful environments created through historical oppression.

"A Dad Can Get the Money and the Mom Stays at Home": Patriarchal Gender Role Attitudes, Intimate Partner Violence, Historical Oppression, and Resilience Among Indigenous Peoples

Research has shown that gender role attitudes influence a number of health-related outcomes, including intimate partner violence (IPV). Yet the gender role attitudes of Indigenous peoples - a population that experiences persistent health and violence disparities - have received scant scholarly attention. Using the Framework of Historical Oppression, Resilience, and Transcendence (FHORT), the purpose of this mixed methodology was to qualitatively explore U.S. Indigenous peoples' gender role attitudes and quantitatively examine how key social determinants of health, including IPV perpetration, historical oppression, and resilience, relate to gender role attitudes. This research integrates qualitative and quantitative data from two Southeastern tribes with a total of 563 unique data sources. Regression analysis revealed male sex and IPV victimization were associated with higher patriarchal gender role attitudes, while historical oppression and resilience were associated with lower patriarchal gender role attitudes. Resilience was also associated with lower "victim blaming." Ethnographic team-based data analysis methods revealed qualitative themes of patriarchal gender role attitudes and gendered socialization processes. This work highlights how key aspects of the FHORT might explain Indigenous peoples' patriarchal gender role attitudes, suggesting the need to redress historical oppression and patriarchal roles through decolonization.

Concerns and priorities of Aboriginal and Torres Strait Islander peoples regarding food and nutrition: a systematic review of qualitative evidence

Background

Aboriginal and Torres Strait Islander Australians experience persistent health and social inequities. Chronic conditions, many of which are diet-related, are leading contributors to the burden of disease and health inequity in Australia. First Nations Peoples have the right to be involved in all policy decisions affecting them. This review aimed to synthesise Aboriginal and Torres Strait Islander Peoples’ concerns and priorities about food and nutrition in order to inform policies to improve health equity.

Methods

MEDLINE, CINAHL, Informit and Google Scholar were systematically searched to identify qualitative studies–published from January 2008–that included data from Aboriginal and/or Torres Strait Islander Peoples about their concerns and priorities related to food and nutrition. Data were extracted from included studies using a pre-determined template and study quality was assessed using the Aboriginal and Torres Strait Islander Quality Appraisal Tool. Qualitative findings were synthesised using inductive thematic analysis and categorised based on an ecological model of health.

Results

Twenty-one studies were included. Key factors influencing food and nutrition were identified across all levels of the ecological framework. These included interpersonal and institutional racism, junk food availability and marketing, food accessibility and affordability, housing conditions, food knowledge and cooking skills, and connection to family and culture.

Conclusions

Documenting Aboriginal and Torres Strait Islander Peoples’ lived experiences of the colonised food system is one step necessary for informing policy to tackle food and nutrition inequities. Based on existing qualitative research, food and nutrition policymakers should prioritise building a supportive food environment by focusing on self-determination; ensuring access to healthy, affordable food and safe housing; and by eliminating systemic racism.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12939-021-01551-x.

"She's the Center of My Life, the One That Keeps My Heart Open": Roles and Expectations of Native American Women

Historically, Native American (NA) mothers have proven essential to the survival of their families and communities, yet scant research has examined their roles today. Current gender roles in NA communities are influenced by historical oppression (both historic and contemporary forms) that acted to reverse matrilineal gender norms in favor of patriarchy. The present study sought to explore norms and expectations for women among two NA tribes located in the southeastern region of the United States. The framework of Historical Oppression, Resilience and Transcendence (FHORT), Hill-Collins's concept of "motherwork," and a framework of reproductive justice were used to frame the study and interpret findings. This critical ethnography included data from field notes, semistructured interviews, and focus groups. Reconstructive analysis, a specific type of thematic qualitative analysis for critical ethnographies, was used to interpret data. Participants from both tribes described themes related to the expectations and roles of mothers. These expectations included themes of (a) mothers as caretakers, (b) mothers as the centers of family and role models, (c) women to prioritize family over economic and educational aspirations, and (d) decolonizing norms for mothers. While historical oppression and patriarchal norms have constrained and regulated expectations for motherhood and the domestic roles of NA women, these findings also highlight how women decolonize these norms and find ways to reclaim their power through their roles as mothers.

Weaving Healthy Families Program: Promoting Resilience While Reducing Violence and Substance Use

PURPOSE

We examine pilot results for the culturally adapted Weaving Healthy Families (WHF) program to promote resilience and wellness while preventing substance abuse and violence among Native American (NA) families.

METHODS

Results were drawn from paired sample t tests and analyses of variance (ANOVA) with a convenience sample of 24 adults and adolescents from eight NA families (pretest, posttest, and, where available, 6-month postintervention).

RESULTS

Along with substance abuse reduction and prevention, t test results indicated reductions in (a) adult depressive symptoms and improvements in adult conflict resolution and health behaviors; (b) adolescent wellness; and (c) adult and adolescent resilience, communal mastery, social support, and sugar-sweetened beverage consumption. ANOVA tests revealed reductions in adult psychological and physical violence and improvements in adult and adolescent family resilience, family environment, and emotional regulation.

CONCLUSIONS

Results reveal promising preliminary results for the WHF program to promote resilience and thriving while reducing risk for substance abuse and violence in NA families.

"Leaving Was a Process, Not an Event": The Lived Experience of Dating and Domestic Violence in 140 Characters

One of the most frequent refrains heard in the public discourse on intimate partner violence (IPV) is why do they stay? The literature has demonstrated that IPV victims face multiple barriers to safely exiting their relationships. Currently, there has been a limited examination of the role social media can play in elucidating the lived experience of IPV. With 25% of the population using Twitter, there are opportunities to examine its utility for deepening understandings of IPV. Using data generated from the #WhyIStayed Twitter campaign, the purpose of this study is to examine Twitter users' reasons for staying in their abusive relationships. The study sample (n = 3,086) is composed of a random sample of 61,725 English speaking tweets globally that employed the #WhyIStayed and #WhyILeft hashtags. We analyzed all tweets using thematic content analysis methods. This process involved multiple rounds of coding. In response to #WhyIStayed, Tweeters worldwide shared the barriers they faced that made leaving their abusive partners difficult. Seven primary themes emerged that influenced their decision-making processes: (a) impact of IPV on personal well-being, (b) lack of awareness regarding the dynamics of abusive relationships, (c) not identifying as a stereotypical IPV victim, (d) fear of reinforcing racial stereotypes, (e) internalizing social scripts regarding relationships, (f) structural barriers, and (g) leaving takes time. Twitter messages have the capacity to function as micronarratives that recount the complex barriers IPV victims confront when negotiating their relationships. This analysis provides a multifaceted description of the challenges associated with leaving abusive relationships that can augment existing theoretical frameworks on victim readiness. Furthermore, these findings demonstrate the myriad ways that societal representations of domestic violence (DV) serve as impediments for victims leaving their abusive relationships. Therefore, social media has the potential to provide a platform for capturing the lived experience of IPV.

All Work and No Play: Indigenous Women "Pulling the Weight" in Home Life

The invisible labor of household management, including child care, housework, and financial responsibilities, is a contemporary form of historical oppression adding strain and contributing to mothers' role overload, depression, distress, and health impairments. The purpose of this article is to use the Framework of Historical Oppression, Resilience, and Transcendence to understand the experiences of gender dynamics in home life responsibilities among two Southeastern tribes. Reconstructive analysis from a critical ethnography with 436 participants revealed the following themes: (1) moms "mostly pulling the weight"; (2) women and child care: "We do it all," and men-"If they're there, they're there"; (3) financial imbalances; and (4) women's resilience and resistance. Despite experiencing the resilience of gender egalitarianism prior to colonization, women persistently experience the effects of the historical oppression of patriarchal colonialism through being overburdened and undervalued in home life. Decolonization is needed to re-establish gender egalitarianism to redress this patriarchal oppression.

Foods of Oppression

The growing recognition of food justice as an element of food studies inquiry has opened a productive vein that allows for analyzing the effects of oppression on traditional foods of Indigenous peoples. We provide a preliminary classification of food oppression by presenting several different types of foods from a number of cultures: (1) replaced and repressed foods; (2) disempowered and misrepresented foods; and (3) foods of oppression of the dispossessed. Our main argument is that these food types represent different faces of oppression and state power that, regardless of the inherent differences, have permeated diets and imaginaries in various spatial scales and, in doing so, have caused deprivation in local communities, despite being accepted in many cases as traditional food items in oppressed cultures. We conducted a systematic literature review in Scopus focusing on the traditional foods of Indigenous people and elements of oppression and revitalization. The results of our review are discussed in light of what we identify as aspects of culinary oppression. We conclude our paper by sketching the plausible first steps for redemptory solutions based on Indigenous food work aimed at reclaiming basic revalorization and revitalization.

An ecological model of drug and alcohol use and related harms among Aboriginal and Torres Strait Islander Australians: A systematic review of the literature

Globally, Indigenous populations experience a disproportionately higher burden of disease related to substance use. Effective prevention of harm related to substance use is a key strategy for improving the health and wellbeing of Aboriginal and Torres Strait Islander peoples in Australia. To inform preventative approaches, this review synthesised the evidence of risk and protective factors of substance use and related harms among Aboriginal and Torres Strait Islander peoples. Eight peer-reviewed and two grey literature databases were systematically searched for quantitative or qualitative studies assessing factors associated with substance use and related harms among Aboriginal and Torres Strait Islander peoples, published between 1 January 1990 and 30 April 2018. Study quality was assessed using validated instruments. Risk or odds ratios were extracted or calculated and factors were summarised in an ecological model into individual, relationship, community, societal or culturally-distinct levels. Thirty-eight relevant studies were identified and reviewed. Individual-level risk factors for substance use were identified including low socio-economic status, high psychological distress, poly drug use and being male. Relationship-level factors were peer pressure and partner/family substance use; protective factors were supportive environments and positive role models. Community-level risk factors included availability of substances. Culturally-distinct factors included cultural connection as a protective factor, but cultural obligations around sharing was a risk factor. Societal risk factors included intergenerational trauma caused by government policies. These findings highlight the importance of tailored preventative approaches for Aboriginal and Torres Strait Islander communities that address identified risk factors and promote protective factors across all ecological levels.

Stress and Cardiometabolic Disease Risk for Indigenous Populations throughout the Lifespan

BACKGROUND

Indigenous people experience the greatest cardiometabolic disease disparity in the Unites States, yet high cardiometabolic disease risk factors do not fully explain the extent of the cardiometabolic disease disparity for Indigenous people. Stress, trauma, and racism occur at high rates within Indigenous communities and have not been well explored as significant contributors to cardiometabolic disease disparities despite emerging literature, and therefore will be described here.

METHODS

This descriptive study explores the relationship between cardiometabolic disease risks and Indigenous-specific stressors (e.g., early childhood stress and trauma, adulthood stress and trauma, and historical and intergenerational trauma) using current literature. Indigenous-specific protective factors against cardiometabolic disease are also reviewed.

RESULTS

Increasing research indicates that there is a relationship between Indigenous-specific stressful and traumatic life experiences and increased cardiometabolic disease risk. Mental health and psychophysiology play an important role in this relationship. Effective interventions to reduce cardiometabolic disease risk in Indigenous communities focus on ameliorating the negative effects of these stressors through the use of culturally specific health behaviors and activities.

CONCLUSIONS

There is increasing evidence that cultural connection and enculturation are protective factors for cardiometabolic disease, and may be galvanized through Indigenous-led training, research, and policy change.

American Indian women cancer survivors' perceptions and experiences with conventional and non-conventional mental health care for depressive symptoms

Background: Despite cancer and depression being disproportionately high for American Indian and Alaska Native (AI/AN) women, such cancer survivors' help-seeking practices and perceptions related to depression are absent in extant research. A broader context of historical oppression has set the stage for unequal health outcomes and access to quality services. The purpose of this article was to explore AI women cancer survivors' experiences with conventional mental health services and informal and tribally-based assistance, as well as barriers related to mental health service utilization.Methods: A qualitative descriptive study methodology, with qualitative content analysis, was used to examine the experiences of AI women cancer survivors as they related to help-seeking experiences for depressive symptoms. The sample included 43 AI women cancer survivors (n = 14 breast cancer, n = 14 cervical cancer, and n = 15 colon and other types of cancer survivors).Results: Since receiving a cancer diagnosis, 26 (62%) participants indicated they had feelings of depression. Some participants (n = 13) described mixed perceptions of the mental health service system. Generally, participants viewed families and informal support systems as primary forms of assistance, whereas conventional services were reported as a supplementary or 'as needed' forms of support, particularly when the informal support system was lacking. Participants received help in the forms of psychotropic medications and psychotherapy, as well as help from family and AI-specific healing modalities (e.g. sweat lodges and healing ceremonies). Stigma and confidentiality concerns were primary barriers to utilizing conventional services as described by 12 (29%) participants.Discussion: Participants' help primarily came from family and tribally-based entities, with conventional mental health care being more salient when informal supports were lacking. The mixed perceptions espoused by participants may be related to a broader context of historical oppression; family and social support and tribally-based services may be protective factors for cancer survivors with depression.

"Something Was Attacking Them and Their Reproductive Organs": Environmental Reproductive Justice in an Indigenous Tribe in the United States Gulf Coast

Environmental reproductive justice is increasingly being utilized as a framework for exploring how environmental exploitation and pollution contribute to reproductive health and reproductive injustices. However, little research explores how settler colonialism and historical oppression contribute to the physical transformation of land, and how this undermines tribal members' health. Even less research explores the intersection of environmental justice and reproductive justice among Indigenous groups, especially in the Gulf South, who are especially vulnerable to environmental justice issues due to climate change, land loss, and oil company exploitation, and for tribes that are non-federally recognized. A qualitative description research methodology was used to conduct 31 life-history interviews with women from a Gulf Coast Indigenous tribe. Findings of this study reveal that central components of reproductive justice, including the ability to have children and the ability to raise children in safe and healthy environments, are undermined by environmental justice issues in the community. Among concerns raised by women were high rates of chronic healthcare issues among community members, and issues with infertility. Recognizing Indigenous sovereignty is central to addressing these environmental reproductive justice issues. This research is unique in exploring the topic of environmental reproductive justice among a state-recognized Gulf Coast tribe.

American Indian Alcohol Use from a Sex-Specific Wellness Approach: Exploring Its Associated Physical, Behavioral, and Mental Risk and Protective Factors

PURPOSE

The top causes of death for American Indians (AIs), including heart and liver disease, are associated with alcohol use. Using the culturally based Framework of Historical Oppression, Resilience, and Transcendence (FHORT), the purpose of this article was to examine AI alcohol use from a sex-specific wellness approach, exploring its associated physical, behavioral, and mental risk and protective factors.

METHOD

Data were drawn from a cross-sectional survey with 479 AI adults in South Dakota. We employed a series of multiple hierarchical regression analyses to assess the associations of demographic (sex, age, marital status, income, and educational attainment), physical (Body Mass Index and cardiovascular risk), behavioral (smoking and health self-efficacy) and mental (depressive symptoms) factors with alcohol use.

RESULTS

Results indicated that surveyed males tended to drink three times that of females, and depressive symptoms were associated with higher levels of alcohol use.

DISCUSSION

This study highlights the need to examine AI alcohol use with sex in mind.

American Indian Women Cancer Survivors' Spiritual and Religious Coping Practices

Despite AI women's cancer disparities being a public health concern, a dearth of research on this populations' spiritual coping poses a barrier to redressing such disparities. The purpose of this article was to explore AI women cancer survivors' spiritual and religious coping. This qualitative descriptive study included a sample of 43 AI women cancer survivors. Qualitative content analysis revealed that 93% of AI women cancer survivors used a variety of AI spiritual coping, religious coping, and/or a mixture of the two. Results reveal the prevalence of AI spiritual coping, with traditional AI spiritual practices being particularly common.

Risk and protective factors for symptoms of depression and anxiety among American Indians: Understanding the roles of resilience and trauma

OBJECTIVE

Depression and anxiety are comorbid conditions that are disproportionately high among American Indians (AIs) or Alaska Natives. The purpose of this study was to identify potential risk (e.g., low income, intimate partner violence [IPV], adverse childhood experiences [ACEs]) and protective factors (e.g., family resilience, social and community support) related to symptoms of depression and anxiety among AI adults.

METHOD

As part of larger exploratory sequential mixed-methods research, the study focused on survey data with 127 AI adults from two Southeastern tribes (n = 117 when missing data were removed). We used the following three-stage hierarchical regression to understand factors related to depressive and anxiety symptoms: (a) demographics, including income; (b) ACEs and IPV; and (c) family resilience, along with family and community support.

RESULTS

Many participants experienced elevated levels of clinically significant symptoms of depression and anxiety (15% and 20%, respectively). Results indicated lower income was associated with higher depressive and anxiety symptoms. IPV and ACE variables were positively associated with depressive and anxiety symptoms. Family resilience was negatively associated with symptoms of anxiety and depression. Social and community support were associated with symptoms of anxiety.

CONCLUSIONS

The findings provide strong preliminary support for the role of family protective and promotive factors in offsetting symptoms of anxiety and depression. This is contrary to most models of interventions for anxiety and depression focusing on individual psychotherapy rather than promoting family resilience or involvement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

What's love got to do with it? "Love" and Alcohol Use among U.S. Indigenous Peoples: Aligning Research with Real-world Experiences

This research examines how Indigenous families report experiences of love (a component of family resilience) and its association with urgent health disparity of alcohol abuse. This exploratory mixed-methods first identified emergent results from qualitative data (n=436), which was then explored with follow-up and quantitative data (n =127) from a sample of Indigenous families in two Southeastern tribes. Love was a highly salient qualitative theme and component of family resilience. Quantitative results revealed cross-generational changes in family resilience, which was negatively associated with alcohol use. Current families may be transcending the effects of historical oppression and expressing love and family resilience.

Mental, Physical and Social Dimensions of Health Equity and Wellness among U.S. Indigenous Peoples: What is Known and Next Steps

This special issue and introduction focuses on promoting health equity and addressing health disparities among Indigenous peoples of the United States (U.S.) and associated Territories in the Pacific Islands and Caribbean. We provide an overview of the current state of health equity across social, physical, and mental health domains. In Part 1 of the special issue, we trace promotive, protective, and risk factors related to Indigenous health equity. Part 2 of the special issue describes interventions that address and promote wellness, providing promising pathways to achieving and transcending health equity.

Health disparities in American Indians/Alaska Natives: Implications for nurse practitioners

American Indians/Alaska Natives experience significant health disparities in many areas including metabolic and mental health disorders. The basis for these differences is grounded in the lasting effects of historical trauma. NPs have the opportunity to understand the underlying causes of these disparities and provide health interventions that promote wellness.