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Dickerson DL, D'Amico EJ, Kennedy DP, Brown RA, Klein DJ, Etz K, Johnson CL, Funmaker G, Arvizu-Sanchez V, Malika N. The Role of Social Networks on Depression and Anxiety Among a Sample of Urban American Indian/Alaska Native Emerging Adults. J Adolesc Health 2024; 74:556-562. [PMID: 38085209 DOI: 10.1016/j.jadohealth.2023.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Mental health inequalities continue to persist among American Indian/Alaska Native (AI/AN) people. However, few studies have examined the association of social networks and depression and anxiety among urban emerging AI/AN adults. METHODS This study analyzes the association of social network characteristics with depression and anxiety among a sample of urban AI/AN emerging adults. A second set of regression models tested the same associations but controlling for respondent sexual and gender minority (SGM) status. Data were from a sample of 150 AI/AN emerging adults residing in urban areas from 20 different states (86% female; mean age 21.8; 48.0% SGM) who participated in a randomized controlled trial analyzing the effects of culturally grounded interventions on alcohol and other drug use and cultural connectedness. RESULTS Participants with a higher proportion of network members who were around the same age reported significantly less anxiety. Those who had a higher proportion of network members who they sometimes/often argue/fight with were more likely to report greater depression and anxiety. Participants with higher proportions of social network members who have ever lived on a reservation/Rancheria/tribal land/tribal village reported significantly less depression. However, participants with higher proportions of social network members who lived 50 miles away or more reported significantly more depression. Controlling for SGM status, results were largely similar. DISCUSSION Results highlight the role of social connections on the mental well-being of urban AI/AN emerging adults.
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Affiliation(s)
- Daniel L Dickerson
- University of California, Los Angeles, Integrated Substance Abuse Programs (ISAP), Los Angeles, California.
| | - Elizabeth J D'Amico
- Division of Social and Economic Well-Being, RAND Corporation, Santa Monica, California
| | - David P Kennedy
- Division of Social and Economic Well-Being, RAND Corporation, Santa Monica, California
| | - Ryan A Brown
- Division of Social and Economic Well-Being, RAND Corporation, Santa Monica, California
| | - David J Klein
- Division of Social and Economic Well-Being, RAND Corporation, Santa Monica, California
| | - Kathy Etz
- National Institute on Drug Abuse (NIDA), Gaithersburg, Maryland
| | | | | | | | - Nipher Malika
- Division of Social and Economic Well-Being, RAND Corporation, Santa Monica, California
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Palimaru AI, Brown RA, Dickerson DL, Kennedy D, Johnson CL, D'Amico EJ. Mixed Methods Evaluation of Satisfaction with Two Culturally Tailored Substance use Prevention Programs for American Indian/Alaska Native Emerging Adults. Prev Sci 2024; 25:330-346. [PMID: 37923885 PMCID: PMC10891245 DOI: 10.1007/s11121-023-01612-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2023] [Indexed: 11/06/2023]
Abstract
American Indian/Alaska Native (AI/AN) communities are disproportionately affected by the opioid epidemic. AI/AN emerging adults (ages 18-25) in urban areas are at particularly high risk, with the overdose death rate among urban-dwelling AI/AN people 1.4 times higher than rural-dwelling AI/AN people. Despite these challenges, there are no evidence-based culturally tailored prevention or intervention programs to address opioid, alcohol and other drug use among urban AI/AN emerging adults. This study focused on understanding AI/AN emerging adults' experiences with two culturally tailored programs addressing opioid, cannabis, and alcohol use as part of the randomized controlled trial for Traditions and Connections for Urban Native Americans (TACUNA) in order to enhance feasibility of this intervention. Using a convergent mixed methods design at 3-month follow-up, we collected satisfaction and experience ratings and written narratives (total n = 162; intervention n = 77; control n = 85) from a sample of urban-dwelling AI/AN emerging adults who participated in both programs. We analyzed data through simultaneous examination of qualitative and quantitative data. The quantitative ratings show that both programs were rated highly. The qualitative data contextualized these ratings, illustrating pathways through which specific components were perceived to cause desired or observed behavioral change in participants. Among the elements that mattered most to these participants were the convenience of the virtual format, having a comfortable and safe space to share personal stories, and learning new information about their social networks. Negative comments focused on workshop length and inconvenient scheduling. This is one of the first studies to explore participant satisfaction and experience with culturally tailored substance use programming among a historically marginalized and understudied population. It is important to consider the voices of urban-dwelling AI/AN people in program development because hidden factors, such as limited financial resources, limited time, and misalignment with cultural values may prevent existing programs from being feasible.
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Affiliation(s)
- Alina I Palimaru
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Ryan A Brown
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - David Kennedy
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
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Mousavi Z, Troxel WM, Dickerson DL, Dong L, Brown RA, Palimaru AI, Klein DJ, Johnson CL, D’Amico EJ. Neighborhood determinants of sleep and the moderating role of cultural factors among native adolescents. Health Psychol 2024; 43:101-113. [PMID: 38127509 PMCID: PMC10842707 DOI: 10.1037/hea0001342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
OBJECTIVE This study examined the association between neighborhood social environment and sleep among urban American Indian and Alaska Native (AI/AN) adolescents as well as the moderating role of cultural factors in this association. METHOD The analytic sample included 133 urban AI/AN adolescents (age 12-16, 57.1% female, Mage = 14.03, SDage = 1.35). Perceived neighborhood social environment included safety and cohesion. Cultural factors included AI/AN cultural identification and historical loss. Sleep duration, efficiency, and wake after sleep onset (WASO) were measured via actigraphy. Sleep disturbance was measured via a questionnaire. RESULTS Greater neighborhood safety was significantly associated with lower sleep disturbance (b = -2.17, SE = 0.8, p = .008), higher sleep efficiency (b = 1.75, SE = 0.64, p = .006), and lower WASO (b = -8.60, SE = 3.34, p = .01). Neighborhood cohesion was not associated with any sleep outcomes. Cultural factors moderated the association between neighborhood social environment and sleep outcomes (p < .05). Specifically, both neighborhood safety and cohesion were associated with lower sleep disturbance, only among individuals reporting higher levels of AI/AN cultural identification. Further, neighborhood safety was associated with greater sleep efficiency and lower WASO (i.e., better sleep) only among adolescents with higher contemplation of historical loss. CONCLUSIONS Findings highlight the importance of considering cultural factors in addressing sleep and health disparities. AI/AN cultural identification and a sense of historical loss may be important targets for identifying adolescents who might benefit the most from policies and interventions focused on improving the social environment in order to improve sleep and other health outcomes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Zahra Mousavi
- Department of Psychological Science, University of California, Irvine, California, USA
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
| | - Wendy M. Troxel
- Division of Behavior and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania, USA
| | - Daniel L. Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | - Lu Dong
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
| | - Ryan A. Brown
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
| | - Alina I. Palimaru
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
| | - David J. Klein
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
| | - Carrie L. Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, California, USA
| | - Elizabeth J. D’Amico
- Division of Behavior and Policy Sciences, RAND Corporation, Santa Monica, California, USA
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Dong L, D'Amico EJ, Dickerson DL, Brown RA, Palimaru AI, Johnson CL, Troxel WM. Bidirectional Associations Between Daily Sleep and Wake Behaviors in Urban American Indian/Alaska Native Youth. J Adolesc Health 2024; 74:350-357. [PMID: 37815766 PMCID: PMC10841395 DOI: 10.1016/j.jadohealth.2023.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 08/05/2023] [Accepted: 08/30/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE This is the first study to examine daily, bidirectional associations between sleep and wake behaviors/mood in urban American Indian/Alaska Native (AI/AN) adolescents. METHODS Participants were 142 urban AI/AN adolescents (mean age = 14 years, 58% female). Sleep was measured with actigraphy (total sleep time [TST] and sleep efficiency) and daily diary (bedtime, wakeup time, and sleep quality) over seven consecutive days. Wake behaviors (caffeine consumption, physical activity, participation in cultural activities, and electronic use after 8p.m.) and mood upon awakening (higher rating indicates greater happiness) were measured via daily diary for seven consecutive days. Multilevel models examined the degree to which nightly sleep predicted next day's wake behaviors and, conversely, wake behaviors and mood predicted nightly sleep, controlling for age, gender, and weekday/weekend. RESULTS Earlier bedtime and wakeup times predicted greater participation in physical activity the following day. Later bedtime and wakeup time, worse sleep quality, and shorter TST predicted greater electronic use the following night. Earlier bedtime and wakeup time and better sleep quality predicted higher mood ratings. Conversely, greater caffeine consumption during the day predicted both later bedtime and wakeup time. Participation in cultural activities is predicted later bedtime. More nighttime electronic use predicted both later bedtime and wakeup time, poorer sleep quality, and worse TST and sleep efficiency. Higher mood ratings in the morning predicted earlier bedtime and later wakeup time. DISCUSSION Findings highlight dynamic associations between sleep and wake behaviors and mood in AI/AN adolescents and may elucidate novel pathways for intervention and future research.
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Affiliation(s)
- Lu Dong
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California.
| | - Elizabeth J D'Amico
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California
| | - Ryan A Brown
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California
| | - Alina I Palimaru
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California
| | | | - Wendy M Troxel
- Department of Behavioral and Policy Sciences, RAND Corporation, Pittsburgh, Pennsylvania
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Kennedy DP, Brown RA, D'Amico EJ, Dickerson DL, Johnson CL, Malika N, Rodriguez A, Arvizu-Sanchez V. Social Networks, Cultural Pride, and Historical Loss Among Non-Reservation American Indian / Alaska Native Emerging Adults. Res Sq 2023:rs.3.rs-3547685. [PMID: 38045309 PMCID: PMC10690312 DOI: 10.21203/rs.3.rs-3547685/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Health disparities among American Indian/Alaska Native (AI/AN) populations in the United States are the result of historical traumas, such as colonization, forced relocation, and federal policies focused on cultural assimilation. Culturally-tailored health interventions aim to address intergenerational trauma by emphasizing cultural strengths and building positive social connections. In this article, we explore the social network characteristics of participants of the first culturally-tailored health intervention for AI/AN emerging adults (18-25) living outside of tribal lands. Participants (N = 150; 86% female) were recruited across the United States via social media and completed online egocentric network interviews prior to the start of intervention workshops. Participants' networks were diverse in composition and structure. They were primarily composed of family and friends, were people they had regular contact with, were similar age, and provided participants with support. We tested for significant associations between network characteristics, individual characteristics (age, gender, travel to reservations, speaking tribal languages, etc.) and two dependent measures: 1) cultural pride and belongingness and 2) thoughts of historical loss. Multiple regression results show that higher proportions of network members who discussed AI/AN identity with participants and having more network members who engage in traditional practices was associated with stronger cultural pride and belongingness. Higher proportions of network members having discussion of AI/AN identity with participants was also associated with more frequent thoughts of historical loss. Controlling for network factors, no individual characteristics were associated with either dependent variable. We discuss implications for the development of culturally-tailored health interventions.
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Komro KA, D'Amico EJ, Dickerson DL, Skinner JR, Johnson CL, Kominsky TK, Etz K. Culturally Responsive Opioid and Other Drug Prevention for American Indian/Alaska Native People: a Comparison of Reservation- and Urban-Based Approaches. Prev Sci 2023; 24:88-98. [PMID: 35750937 PMCID: PMC9244356 DOI: 10.1007/s11121-022-01396-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2022] [Indexed: 11/24/2022]
Abstract
There are few substance use treatment and prevention programs for AI/AN people that integrate culturally based practices with evidence-based treatment and prevention. The National Institutes of Health's (NIH's) Helping to End Addiction Long-term (HEAL) Prevention Cooperative supports two projects focused on AI/AN populations. One focuses on youth ages 15 to 20 years living within the Cherokee Nation reservation, a multicultural rural area in northeastern Oklahoma, and the second focuses on emerging adults ages 18 to 25 years living in diverse urban areas. We provide a brief overview of the two prevention trials and a case comparison across approaches using the framework of promising practices for intervention science with Indigenous communities (Whitesell et al., 2020) related to (1) integration of Indigenous and academic perspectives to respond to community needs, (2) community partnership and engagement, (3) alignment with Indigenous cultural values and practices, (4) capacity building and empowerment, (5) implementation within complex cultural contexts, and (6) tribal oversight. Overall, these two projects highlight the importance of long-standing relationships with community partners, engaging the community at all levels to ensure that programming is culturally and developmentally appropriate, and having tribal and elder oversight. These practices are key to establishing trust and building confidence in research in these communities and ensuring that research can benefit AI/AN people. These studies showcase how strong partnerships can advance health and support the conduct of rigorous science to help pinpoint optimal health solutions by identifying efficacious, culturally grounded intervention strategies. Although the sovereign status of tribes demands this type of partnership, this research serves as a model for all community research that has a goal of improving health.
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Affiliation(s)
- Kelli A Komro
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
| | | | - Daniel L Dickerson
- Integrated Substance Abuse Programs (ISAP), University of California Los Angeles, Los Angeles, CA, USA
| | | | | | | | - Kathy Etz
- Epidemiology Research Branch, National Institute On Drug Abuse, North Bethesda, USA
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Patel SV, Cance JD, Bonar EE, Carter PM, Dickerson DL, Fiellin LE, Fernandes CSF, Palimaru AI, Boomer TMP, Saldana L, Singh RR, Tinius E, Walton MA, Youn S, Young S, Philbrick S, Lambdin BH. Accelerating Solutions for the Overdose Crisis: an Effectiveness-Implementation Hybrid Protocol for the HEAL Prevention Cooperative. Prev Sci 2023; 24:40-49. [PMID: 36399222 PMCID: PMC9673891 DOI: 10.1007/s11121-022-01465-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/19/2022]
Abstract
Given increasing opioid overdose mortality rates in the USA over the past 20 years, accelerating the implementation of prevention interventions found to be effective is critical. The Helping End Addiction Long-Term (HEAL) Prevention Cooperative (HPC) is a consortium of research projects funded to implement and test interventions designed to prevent the onset or escalation of opioid misuse among youth and young adults. The HPC offers a unique opportunity to synthesize and share lessons learned from participating research projects' varied implementation experiences, which can facilitate quicker integration of effective prevention interventions into practice. This protocol paper describes our hybrid approach to collecting and analyzing information about the implementation experiences of nine of the HPC research projects while they maintain their focus on assessing the effectiveness and cost-effectiveness of prevention interventions. To better understand implementation within this context, we will address five research questions: (1) What were the context and approach for implementing the prevention interventions, and how was the overall implementation experience? (2) How representative of the target population are the participants who were enrolled and retained in the research projects' effectiveness trials? (3) For what purposes and how were stakeholders engaged by the research projects? (4) What are the adaptable components of the prevention interventions? And finally, (5) how might implementation of the prevention interventions vary for non-trial implementation? This work will result in intervention-specific and general practical dissemination resources that can help potential adopters and deliverers of opioid misuse prevention make adoption decisions and prepare for successful implementation.
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Affiliation(s)
- S V Patel
- RTI International, Research Triangle Park, Durham, NC, USA.
| | - J D Cance
- RTI International, Research Triangle Park, Durham, NC, USA
| | - E E Bonar
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - P M Carter
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
| | - D L Dickerson
- Integrated Substance Abuse Programs (ISAP), University of California, Los Angeles, Los Angeles, CA, USA
| | | | | | | | | | - L Saldana
- Oregon Social Learning Center, Eugene, OR, USA
| | - R R Singh
- Oregon Social Learning Center, Eugene, OR, USA
| | - E Tinius
- Texas Christian University, Fort Worth, TX, USA
| | - M A Walton
- University of Michigan, Ann Arbor, MI, USA
- Injury Prevention Center, University of Michigan, Ann Arbor, MI, USA
- Addiction Center, University of Michigan, Ann Arbor, MI, USA
| | - S Youn
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - S Young
- Texas Christian University, Fort Worth, TX, USA
| | - S Philbrick
- RTI International, Research Triangle Park, Durham, NC, USA
| | - B H Lambdin
- RTI International, Research Triangle Park, Durham, NC, USA
- University of Washington, Seattle, WA, USA
- University of California San Francisco, San Francisco, CA, USA
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D'Amico EJ, Kennedy DP, Malika N, Klein DJ, Brown RA, Rodriguez A, Johnson CL, Schweigman K, Arvizu-Sanchez V, Etz K, Dickerson DL. Risk and protective factors of social networks on alcohol, cannabis, and opioid use among urban American Indian/Alaska Native emerging adults. Psychol Addict Behav 2023; 37:657-669. [PMID: 37023284 PMCID: PMC10440259 DOI: 10.1037/adb0000918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
OBJECTIVES Assess associations between social networks and urban American Indian/Alaska Native emerging adults' alcohol, cannabis, and opioid use and intentions. METHOD American Indian/Alaska Native participants ages 18-25 (N = 150; 86% female) were recruited across the United States from 12/20 to 10/21 via social media. Participants named up to 15 people whom they talked with most over the past 3 months and reported who (a) used alcohol and cannabis heavily or used other drugs (e.g., opioid use), (b) engaged in traditional practices, and (c) provided support. They also reported past 3-month alcohol, cannabis, and opioid use and intentions to use. RESULTS Having a higher proportion of network members engaging in regular cannabis and heavy alcohol use (but not other drugs) was associated with more frequent cannabis use and stronger cannabis use intentions. Participants with higher proportions of members engaging in heavy alcohol use, regular cannabis use, or other drug use and who did not engage in traditional practices were more likely to report cannabis use and greater intentions to use cannabis and drink alcohol. In contrast, participants with higher proportions of network members engaging in traditional practices and who did not report heavy alcohol use, regular cannabis use, or other drug use were less likely to report intentions to use cannabis or drink alcohol. CONCLUSIONS Findings emphasize what many studies have shown among various racial/ethnic groups-having network members who use substances increases the chance of use. Findings also highlight that traditional practices may be an important part of the prevention approach for this population. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine
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Palimaru AI, Brown RA, Arvizu-Sanchez V, Mike L, Etz K, Johnson CL, Dickerson DL, D'Amico EJ. Risk and Resilience Among Families in Urban AI/AN Communities: the Role of Young Adults. J Racial Ethn Health Disparities 2023; 10:509-520. [PMID: 35118610 PMCID: PMC8812358 DOI: 10.1007/s40615-022-01240-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/11/2022] [Accepted: 01/12/2022] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Alina I Palimaru
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Ryan A Brown
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | | | - Lynette Mike
- Santa Cruz Indian Council Board of Directors, Santa Cruz, CA, USA
| | - Kathleen Etz
- National Institute On Drug Abuse, Rockville, MD, USA
| | | | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Dong L, D'Amico EJ, Dickerson DL, Brown RA, Palimaru AI, Johnson CL, Troxel WM. Food insecurity, sleep, and cardiometabolic risks in urban American Indian/Alaska Native youth. Sleep Health 2023; 9:4-10. [PMID: 36328921 PMCID: PMC9991968 DOI: 10.1016/j.sleh.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 09/13/2022] [Accepted: 10/02/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Food insecurity contributes to racial/ethnic disparities in health. This is the first study to examine associations among food insecurity, sleep, and cardiometabolic outcomes in urban American Indian/Alaska Native (AI/AN) youth. DESIGN Participants were 142 urban AI/AN youth (mean age = 14 years, 58% female). Food insecurity and self-reported sleep disturbance were measured using validated surveys. A multi-dimensional sleep health composite was derived using questionnaires (ie, satisfaction, alertness) and actigraphy-derived indices (ie, duration, efficiency, regularity, timing). Cardiometabolic measures included body mass index, blood pressure, glycosylated hemoglobin, waist circumference, cholesterol, and triglycerides. Covariates were sex, age, and single-parent household. RESULTS Greater food insecurity was significantly associated with greater body mass index (b = 0.12, p = .015), higher systolic blood pressure (b = 0.93, p = .03), and greater sleep disturbance (b = 1.49, p < .001), and marginally associated with lower sleep health composite scores (b = -0.09, p = .08). There was a significant indirect path from greater food insecurity to greater waist circumference through poorer sleep health (0.11, 95% bootstrapping CI: [0.01, 0.30]). CONCLUSION Food insecurity is an important correlate of sleep and cardiometabolic health among urban AI/AN youth and should be addressed to reduce emerging health risks during this important developmental period. Policies to reduce food insecurity and increase access to healthy foods as well as sleep interventions for these youth could help, as preliminary findings suggest that sleep health may mediate the negative impact of food insecurity on cardiometabolic risks.
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Affiliation(s)
- Lu Dong
- RAND Corporation, Santa Monica, California, USA.
| | | | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, Los Angeles, California, USA
| | | | | | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, California, USA
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Kennedy DP, D'Amico EJ, Brown RA, Palimaru AI, Dickerson DL, Johnson CL, Lopez A. Feasibility and acceptability of incorporating social network visualizations into a culturally centered motivational network intervention to prevent substance use among urban Native American emerging adults: a qualitative study. Addict Sci Clin Pract 2022; 17:53. [PMID: 36180896 PMCID: PMC9523629 DOI: 10.1186/s13722-022-00334-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/12/2022] [Indexed: 11/16/2022] Open
Abstract
Background Coupling social network visualizations with Motivational Interviewing in substance use interventions has been shown to be acceptable and feasible in several pilot tests, and has been associated with changes in participants’ substance use and social networks. The objective of this study was to assess acceptability and feasibility of an adaptation of this behavior change approach into a culturally centered behavior change intervention for American Indian/Alaska Native (AI/AN) emerging adults living in urban areas. AI/AN populations experience high rates of health disparities and substance use. Although 70% of AI/AN people live outside of tribal lands, there are few culturally tailored health interventions for these AI/AN populations. Social networks can both increase and discourage substance use. Leveraging healthy social networks and increasing protective factors among urban AI/AN emerging adults may help increase resilience. Methods We conducted thirteen focus groups with 91 male and female participants (32 urban AI/AN emerging adults ages 18–25, 26 parents, and 33 providers) and one pilot test of the three workshop sessions with 15 AI/AN emerging adults. Focus group participants provided feedback on a proposed workshop-based intervention curriculum that combined group Motivational Interviewing (MI) and social network visualizations. Pilot workshop participants viewed their own social networks during group MI sessions focused on substance use and traditional practices and discussed their reactions to viewing and discussing their networks during these sessions. We used a combination of open coding of focus group and workshop session transcripts to identify themes across the group sessions and content analysis of comments entered into an online social network interview platform to assess the extent that participants had an intuitive understanding of the information conveyed through network diagrams. Results Focus group and pilot test participants reacted positively to the intervention content and approach and provided constructive feedback on components that should be changed. Themes that emerged included feasibility, acceptability, relevance, understandability, and usefulness of viewing personal network visualizations and discussing social networks during group MI workshops. Workshop participants demonstrated an intuitive understanding of network concepts (network composition and structure) when viewing their diagrams for the first time. Conclusions Social network visualizations are a promising tool for increasing awareness of social challenges and sources of resilience for urban AI/AN emerging adults. Coupled with Motivational Interviewing in a group context, social network visualizations may enhance discussions of network influences on substance use and engagement in traditional practices. Trial Registration: ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020
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Affiliation(s)
- David P Kennedy
- RAND Corporation, 1776 Main St., 2138, Santa Monica, CA, 90401, USA.
| | | | - Ryan A Brown
- RAND Corporation, 1776 Main St., 2138, Santa Monica, CA, 90401, USA
| | - Alina I Palimaru
- RAND Corporation, 1776 Main St., 2138, Santa Monica, CA, 90401, USA
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA, 90025, USA
| | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
| | - Anthony Lopez
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
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12
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Dickerson DL, D'Amico EJ, Palimaru A, Brown R, Kennedy D, Johnson CL, Schweigman K. Traditions and Connections for Urban Native Americans (TACUNA): Utilizing community-based input to develop an opioid prevention intervention for urban American Indian/Alaska Native emerging adults. J Subst Abuse Treat 2022; 139:108764. [PMID: 35450751 PMCID: PMC9187599 DOI: 10.1016/j.jsat.2022.108764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/26/2022] [Accepted: 03/07/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Although approximately 70% of American Indian/Alaska Native (AI/AN) people reside in urban areas, very few opioid prevention interventions exist for urban AI/AN emerging adults. The study team conducted this study to develop Traditions and Connections for Urban Native Americans (TACUNA), a new opioid prevention intervention for urban AI/AN emerging adults ages 18-25. TACUNA comprises three 2-hour virtual workshops. METHODS We conducted thirteen focus groups in three urban communities in northern, central, and southern California (six with urban AI/AN emerging adults ages 18-25 [n = 32], four with parents [n = 26], and three with providers [n = 33]) to identify relevant intervention domains. We then incorporated the results of a rapid analysis of the focus groups to develop intervention workshops followed by a pilot test (n = 15) to further refine the intervention and assess feasibility. RESULTS Four major domains emerged from focus groups: 1) historical trauma/cultural identity, 2) AI/AN traditional practices, 3) social networks, and 4) substance use. We incorporated all feedback relating to each theme to enhance content of the TACUNA intervention. Pilot test participants felt that TACUNA content was interesting, addressed their issues and concerns as urban AI/AN emerging adults, and believed that the program could help them to establish cultural and social connections to live healthier lives. CONCLUSIONS Research activities demonstrate how a community-informed and culturally grounded opioid prevention intervention can be developed for urban AI/AN emerging adults. Addressing issues and challenges with culturally and developmentally relevant intervention content can help to build resilience and hopefully decrease opioid use among this underserved population.
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Affiliation(s)
- Daniel L Dickerson
- University of California, Los Angeles, Integrated Substance Abuse Programs (ISAP), 17707 Santa Monica Blvd., #200, Los Angeles, CA 90025, USA.
| | | | - Alina Palimaru
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.
| | - Ryan Brown
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.
| | - David Kennedy
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA.
| | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA 90017, USA
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13
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Brown RA, Palimaru AI, Dickerson DL, Etz K, Kennedy DP, Hale B, Johnson CL, D’Amico EJ. Cultural Dynamics, Substance Use, and Resilience Among American Indian/Alaska Native Emerging Adults in Urban Areas. Advers Resil Sci 2022; 4:23-32. [PMID: 35756141 PMCID: PMC9206083 DOI: 10.1007/s42844-022-00058-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 03/28/2022] [Indexed: 01/05/2023]
Abstract
Identity development during emerging adulthood helps lay down the structure of values, social bonds, and decision-making patterns that help determine adult outcomes, including patterns of substance use. Managing cultural identity may pose unique challenges for American Indian/Alaska Native (AI/AN) emerging adults in "urban" areas (away from tribal lands or reservations), who are relatively isolated from social and cultural connections. This isolation is in turn a product of cultural genocide and oppression, both historically and in the present day. This paper uses qualitative data from 13 focus groups with urban AI/AN emerging adults, parents, and providers to explore how cultural dynamics are related to substance use outcomes for urban AI/AN emerging adults. We found that cultural isolation as well as ongoing discrimination presents challenges to negotiating cultural identity, and that the AI/AN social and cultural context sometimes presented risk exposures and pathways for substance use. However, we also found that culture provided a source of strength and resilience for urban AI/AN emerging adults, and that specific cultural values and traditions - such as mindfulness, connection to nature, and a deep historical and cosmological perspective - offer "binding pathways" for positive behavioral health. We conclude with two suggestions for substance use prevention and intervention for this population: (1) incorporate these "binding pathways" for health and resilience explicitly into intervention materials; (2) emphasize and celebrate emerging adulthood itself as a sacred cultural transition. Supplementary Information The online version contains supplementary material available at 10.1007/s42844-022-00058-w.
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Affiliation(s)
- Ryan A. Brown
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401 USA
| | | | - Daniel L. Dickerson
- UCLA Integrated Substance Abuse Programs, David Geffen School of Medicine, Semel Institute for Neuroscience and Human Behavior, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025 USA
| | - Kathy Etz
- National Institute On Drug Abuse, National Institutes of Health, Bethesda, MD USA
| | | | - Benjamin Hale
- Sacred Path Indigenous Wellness Center, Los Angeles, CA 90017 USA
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14
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Troxel WM, Palimaru AI, Klein DJ, Dong L, Dickerson DL, Brown RA, Johnson CL, D’Amico EJ. Changes in Sleep-Wake Patterns and Disturbances Before and During COVID-19 in Urban American Indian/ Alaska Native Adolescents. Behav Sleep Med 2022; 20:343-356. [PMID: 34989300 PMCID: PMC9167151 DOI: 10.1080/15402002.2021.2022679] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND COVID-19 has profoundly affected sleep, although little research has focused on high-risk populations for poor sleep health, including American Indian/Alaska Native (AI/AN) adolescents. METHODS This is the first longitudinal study to examine changes in sleep with surveys completed before the pandemic and during the early months of COVID-19 in a sample of urban AI/AN adolescents (N = 118; mean age = 14 years at baseline; 63% female). We use a mixed-methods approach to explore how COVID-19 affected urban AI/AN adolescents' sleep, daily routines, and interactions with family and culture. Quantitative analysis examined whether pandemic-related sleep changes were significant and potential moderators of COVID-19's effect on sleep, including family and community cohesion and engagement in traditional practices. RESULTS : Findings demonstrate changes in sleep, including increases in sleep duration, delays in bedtimes and waketimes, and increases in sleep-wake disturbances (p's <.001). Higher levels of family cohesion and higher levels of engagement in traditional practices moderated pandemic-related increases in weekday sleep duration. Qualitative analyses revealed changes in adolescents' sleep and daily behaviors, as well as strategies adolescents used to cope with pandemic-related disruptions in sleep and routines. CONCLUSION Findings demonstrate positive and negative changes in sleep during COVID-19 stay-at-home orders, including simultaneous increases in sleep duration and sleep-wake disturbances. Results highlight the importance of considering multi-level influences on adolescent sleep, such as early school start times, family dynamics, and cultural factors. A multi-level approach may help guide prevention and intervention efforts to improve adolescent sleep health.
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Affiliation(s)
| | | | | | - Lu Dong
- RAND Corporation, Santa Monica, CA
| | - Daniel L. Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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15
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Palimaru AI, Dong L, Brown RA, D'Amico EJ, Dickerson DL, Johnson CL, Troxel WM. Mental health, family functioning, and sleep in cultural context among American Indian/Alaska Native urban youth: A mixed methods analysis. Soc Sci Med 2022; 292:114582. [PMID: 34826766 PMCID: PMC8748395 DOI: 10.1016/j.socscimed.2021.114582] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/11/2021] [Accepted: 11/17/2021] [Indexed: 01/03/2023]
Abstract
Mental health problems contribute significantly to the global burden of disease. Driven in part by family stressors and insufficient sleep, mental health disproportionately affects low SES urban adolescents. In the United States, American Indian/Alaska Native (AI/AN) youth exhibit excessively high rates of mental health problems. Family functioning is strongly associated with adolescent mental health, and sleep problems may serve as a pathway between family functioning and mental health. Using mixed methods we examine the associations among family functioning, subjective- and actigraphy-measured sleep, mental health (depressive and anxiety symptoms), and cultural identity in a sample of urban AI/AN youth. All participants (N = 142) completed surveys; a random subsample (n = 26) completed qualitative interviews to assess family and cultural dynamics related to sleep, which informed hypothesized direct and indirect effects that were tested using survey data. Narratives identified mechanisms of family cohesion (e.g., daily interactions that build perceived family togetherness and family-centered traditional activities) and the role that family cohesion plays in sleep (e.g., ensuring stability of sleep environments). Path analysis showed direct effects of improved family functioning on fewer depressive and anxiety symptoms, and indirect effects through lower self-reported sleep disturbance (but not through greater actigraphy-measured sleep duration or efficiency). Cultural identity did not moderate effects in quantitative tests. Our findings illustrate the complex associations among family functioning, sleep, and mental health in AI/AN youth. Family-based interventions to improve adolescent mental health should address modifiable intervention targets such as sleep, and address sources of both risk and resilience relevant to urban AI/AN families, including extended family and cultural practices.
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Affiliation(s)
| | - Lu Dong
- RAND Corporation, Santa Monica, CA, USA.
| | | | | | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
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16
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D'Amico EJ, Dickerson DL, Rodriguez A, Brown RA, Kennedy DP, Palimaru AI, Johnson C, Smart R, Klein DJ, Parker J, McDonald K, Woodward MJ, Gudgell N. Integrating traditional practices and social network visualization to prevent substance use: study protocol for a randomized controlled trial among urban Native American emerging adults. Addict Sci Clin Pract 2021; 16:56. [PMID: 34565444 PMCID: PMC8474938 DOI: 10.1186/s13722-021-00265-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/10/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nonmedical use of prescription opioids (defined as taking opioid medications for hedonic effects or in a manner other than prescribed) and the use of heroin have emerged in recent years as major public health concerns in the United States. Of particular concern is the prevalence of opioid use among emerging adults (ages 18-25), as this is a developmental period of heightened vulnerability and critical social, neurological, and psychological development. Data from 2015 show that American Indian/Alaska Native (AI/AN) people have the highest rates of diagnosis for opioid use disorders (OUDs). One recent study found that the overdose death rate among urban-dwelling AI/AN individuals was 1.4 times higher compared to those living in rural areas. To date, there are no evidence-based prevention programs addressing opioid use among urban AI/AN emerging adults that integrate culturally-appropriate strategies with evidence-based treatment. Traditions and Connections for Urban Native Americans (TACUNA) builds on our prior work with AI/AN communities across California to develop and evaluate culturally appropriate programming to address opioid, alcohol, and cannabis use among urban AI/AN emerging adults. METHODS/DESIGN In a randomized controlled trial, 18-25 year old urban AI/AN emerging adults will receive either TACUNA (n = 185), which comprises three virtual workshops utilizing motivational interviewing, social network visualization, and integrating traditional practices and a wellness circle, or one virtual culturally sensitive opioid education workshop (n = 185). We will evaluate intervention effects on primary outcomes of frequency of opioid, alcohol, and cannabis use, as well as secondary outcomes of social network characteristics and cultural connectedness, over a 12-month period. DISCUSSION This project has the potential to expand the range and effectiveness of opioid, alcohol, and cannabis services for urban AI/AN emerging adults by addressing the opioid epidemic and use of other substances at both the community and individual level. In addition, it provides important culturally grounded conceptual and practical information to advance the field of substance use interventions and enhance resiliency among this population. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04617938. Registered October 26, 2020 https://clinicaltrials.gov/ct2/show/record/NCT04617938 .
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Affiliation(s)
- Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA.
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, 1640 Sepulveda Blvd., Suite 200, Los Angeles, CA, 90025, USA
| | | | - Ryan A Brown
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - David P Kennedy
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Alina I Palimaru
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Carrie Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
| | - Rosanna Smart
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Jennifer Parker
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Keisha McDonald
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Michael J Woodward
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
| | - Ninna Gudgell
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, USA
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17
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D'Amico EJ, Dickerson DL, Brown RA, Klein DJ, Agniel D, Johnson C. Unveiling an 'invisible population': health, substance use, sexual behavior, culture, and discrimination among urban American Indian/Alaska Native adolescents in California. Ethn Health 2021; 26:845-862. [PMID: 30626198 PMCID: PMC7510334 DOI: 10.1080/13557858.2018.1562054] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 12/17/2018] [Indexed: 06/09/2023]
Abstract
Objectives: There are limited public health data on urban American Indian/Alaska Native (AI/AN) populations, particularly adolescents. The current study attempted to address gaps by providing descriptive information on experiences of urban AI/AN adolescents across northern, central, and southern California.Design: We describe demographics and several behavioral health and cultural domains, including: alcohol and other drug (AOD) use, risky sexual behavior, mental and physical health, discrimination experiences, involvement in traditional practices, and cultural pride and belonging. We recruited 185 urban AI/AN adolescents across northern, central, and southern California from 2014 to 2017 who completed a baseline survey as part of a randomized controlled intervention trial.Results: Average age was 15.6 years; 51% female; 59% of adolescents that indicated AI/AN descent also endorsed another race or ethnicity. Rates of AOD use in this urban AI/AN sample were similar to rates for Monitoring the Future. About one-third of adolescents reported ever having sexual intercourse, with 15% reporting using alcohol or drugs before sex. Most reported good mental and physical health. Most urban AI/AN adolescents participated in traditional practices, such as attending Pow Wows and learning their tribal history. Adolescents also reported discrimination experiences, including being a victim of racial slurs and discrimination by law enforcement.Conclusions: This study describes a select sample of California urban AI/AN adolescents across several behavioral health and cultural domains. Although these adolescents reported numerous discrimination experiences and other stressors, findings suggest that this sample of urban AI/AN teens may be particularly resilient with regard to behavioral health.
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Affiliation(s)
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA, USA
| | | | | | | | - Carrie Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, USA
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18
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Dickerson DL, D'Amico EJ, Klein DJ, Johnson CL, Hale B, Ye F, Dominguez BX. Drum-Assisted Recovery Therapy for Native Americans (DARTNA): Results from a feasibility randomized controlled trial. J Subst Abuse Treat 2021; 126:108439. [PMID: 33966952 DOI: 10.1016/j.jsat.2021.108439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/23/2020] [Accepted: 04/21/2021] [Indexed: 12/30/2022]
Abstract
Alcohol and other drug (AOD) use among American Indians and Alaska Natives (AI/ANs) is a significant health issue in the United States. However, few evidence-based substance use interventions that utilize AI/AN traditional practices, such as drumming, exist. The current study is a feasibility randomized controlled trial (RCT) analyzing the potential benefits of DARTNA (Drum-Assisted Recovery Therapy for Native Americans) among 63 AI/AN adults seeking substance use treatment within an urban area in southern California. We compared DARTNA participants to usual care plus, which involved an integrated multimedia health educational program and usual care from providers for AOD use. At end of treatment, DARTNA participants reported significantly lower cognitive impairment and lower counts of physical ailments. Given that this was a feasibility trial, we also used Cohen's d = 0.20 or odds ratio = 2 or 0.5 to determine clinical significance. At end of treatment, we found promising benefits for DARTNA participants related to better physical health, fewer drinks per day, and lower odds of marijuana use in the past 30 days compared to the control group. Using these criteria, at 3-month follow-up, DARTNA participants reported less adoption of 12-step principles, less cognitive impairment, and lower anxiety with relationships. However, DARTNA participants reported more drinks per day and more cigarettes compared to the control group. Overall, this study demonstrates feasibility of conducting an RCT with AI/AN people in urban settings and highlights how a substance use treatment intervention utilizing drumming may help to meet the diverse needs of AI/AN people seeking substance use treatment.
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Affiliation(s)
- Daniel L Dickerson
- Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA.
| | | | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, USA
| | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, 981 West Arrow Highway, #412, San Dimas, CA 91773, USA
| | - Benjamin Hale
- Sacred Path Indigenous Wellness Center, 981 West Arrow Highway, #412, San Dimas, CA 91773, USA
| | - Feifei Ye
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA
| | - Blanca X Dominguez
- Integrated Substance Abuse Programs (ISAP), Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, USA
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19
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Dickerson DL, D'Amico EJ, Klein DJ, Johnson CL, Hale B, Ye F. Mental Health, Physical Health, and Cultural Characteristics Among American Indians/Alaska Natives Seeking Substance Use Treatment in an Urban Setting: A Descriptive Study. Community Ment Health J 2021; 57:937-947. [PMID: 32720004 PMCID: PMC7855095 DOI: 10.1007/s10597-020-00688-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/18/2020] [Indexed: 01/14/2023]
Abstract
Although approximately 70% of American Indians/Alaska Natives (AI/ANs) reside in urban areas, our knowledge of risk and protective factors among AI/ANs seeking substance use treatment within urban areas is limited. We analyze substance and commercialized cigarette use, AI/AN cultural identity and involvement, physical health and cognitive functioning, and mental health symptoms among 63 AI/AN adults seeking substance use treatment within an urban area in California. Alcohol (37%), marijuana (27%), and methamphetamine (22%) were the most commonly reported substances. Sixty-two percent used commercialized tobacco use. The majority of AI/AN adults (78%) engaged in at least one traditional practice during the past month and endorsed high levels of spiritual connectedness. Those who engaged in traditional practices demonstrated significantly less depression (p = 0.007) and anxiety (p = 0.04). Medical and mental health issues were not prominent, although participants revealed high levels of cognitive impairment. Results highlight the importance of utilizing AI/AN traditional practices for AI/AN adults seeking substance use treatment within urban areas. Clinical Trials Registry Number NCT01356667.
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Affiliation(s)
- Daniel L Dickerson
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, 90025, USA.
| | | | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
| | - Benjamin Hale
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
| | - Feifei Ye
- RAND Corporation, 4570 Fifth Avenue, Pittsburgh, PA, 15213, USA
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20
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D'Amico EJ, Palimaru AI, Dickerson DL, Dong L, Brown RA, Johnson CL, Klein DJ, Troxel WM. Risk and Resilience Factors in Urban American Indian and Alaska Native Youth during the Coronavirus Pandemic. Am Indian Cult Res J 2021; 44:21-48. [PMID: 35719739 PMCID: PMC9205322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
American Indians and Alaska Natives suffer disproportionately from poverty and other inequities and are vulnerable to adverse health and socioeconomic effects of COVID-19. Using surveys and interviews (May - July 2020), we examined urban American Indian/Alaska Native adolescents' (N=50) health and behaviors, family dynamics, community cohesion, and traditional practice participation during COVID-19. About 20% of teens reported clinically significant anxiety and depression, 25% reported food insecurity, and 40% reported poor sleep. Teens also reported high family and community cohesion, and many engaged in traditional practices during this time. Although many teens reported problems, they also emphasized resilience strategies.
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Affiliation(s)
| | | | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs; Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine; 1640 Sepulveda Blvd., Suite 200; Los Angeles, CA
| | - Lu Dong
- RAND Corporation; 1776 Main St., Santa Monica, CA 90401
| | - Ryan A Brown
- RAND Corporation; 1776 Main St., Santa Monica, CA 90401
| | | | - David J Klein
- RAND Corporation; 1776 Main St., Santa Monica, CA 90401
| | - Wendy M Troxel
- RAND Corporation, 4570 Fifth Avenue, Suite 600, Pittsburgh, Pennsylvania 15213
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21
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Abstract
Mutual help groups are a ubiquitous component of the substance abuse treatment system in the United States, showing demonstrated effectiveness as a treatment adjunct; so, it is paramount to understand whether they are as appealing to, and as effective for, racial or ethnic minority groups as they are for Whites. Nonetheless, no known comprehensive reviews have examined whether there are racial/ethnic disparities in mutual help group participation. Accordingly, this study comprehensively reviewed the U.S. literature on racial/ethnic disparities in mutual help participation among adults and adolescents with substance use disorder treatment need. The study identified 19 articles comparing mutual help participation across specific racial/ethnic minority groups and Whites, including eight national epidemiological studies and 11 treatment/community studies. Most compared Latinx and/or Black adults to White adults, and all but two analyzed 12-step participation, with others examining "self-help" attendance. Across studies, racial/ethnic comparisons yielded mostly null (N = 17) and mixed (N = 9) effects, though some findings were consistent with a racial/ethnic disparity (N = 6) or minority advantage (N = 3). Findings were weakly suggestive of disparities for Latinx populations (especially immigrants, women, and adolescents) as well as for Black women and adolescents. Overall, data were sparse, inconsistent, and dated, highlighting the need for additional studies in this area.
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Affiliation(s)
| | - Paul A Gilbert
- Department of Community and Behavioral Health, University of Iowa, Iowa City, Iowa
| | - Miguel Pinedo
- Center for Health and Social Policy, College of Education-Kinesiology and Health Education, University of Texas, Austin, Texas
| | - Shiori Tsutsumi
- School of Environment and Society, Department of Social and Human Sciences, Tokyo Institute of Technology, Tokyo, Japan
| | - Briana McGeough
- Cofrin Logan Center for Addiction Research and Treatment, School of Social Welfare, University of Kansas, Lawrence, Kansas
| | - Daniel L Dickerson
- Integrated Substance Abuse Programs, University of California, Los Angeles, California
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22
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Dickerson DL, Parker J, Johnson CL, Brown RA, D'Amico EJ. Recruitment and retention in randomized controlled trials with urban American Indian/Alaska Native adolescents: Challenges and lessons learned. Clin Trials 2021; 18:83-91. [PMID: 33231130 PMCID: PMC7878293 DOI: 10.1177/1740774520971774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although the majority of American Indians/Alaska Natives reside in urban areas, there are very few randomized controlled trials analyzing culturally centered substance use prevention interventions for this population. METHODS We describe methods employed to recruit and retain urban American Indian/Alaska Native adolescents into a randomized controlled trial, which was focused on testing the potential benefits of a substance use prevention intervention for this population. We also report challenges encountered in recruitment and retention of participants and strategies employed addressing these challenges. Data collection occurred from August 2014 to October 2017. RESULTS We partnered with two community-based organizations in different cities in California. We utilized American Indian/Alaska Native recruiters from communities, placed flyers in community-based organizations, and asked organizations to post flyers on their web and social media sites. We also offered gift cards for participants. Our initial recruitment and retention model was moderately successful; however, we encountered five main challenges: (1) transportation, (2) increasing trust and interest, (3) adding research sites, (4) getting the word out about the project, and (5) getting youth to complete follow-up surveys. Strategies employed to overcome transportation challenges included shortening the number of sessions, offering sessions on both weekends and weekdays, and increasing bus tokens and transportation options. We hired more staff from American Indian/Alaska Native communities, added more research sites from our previously established relationships, and were more proactive in getting the word out on the project in American Indian/Alaska Native communities. We also utilized more field tracking and emailed and mailed survey invitations to reach more participants for their follow-up surveys. Because of our efforts, we were nearly able to reach our initial recruitment and retention goals. CONCLUSION Although our research team had previously established relationships with various urban American Indian/Alaska Native communities, we encountered various recruitment and retention challenges in our study. However, by identifying challenges and employing culturally appropriate strategies, we were able to collect valuable data on the potential effectiveness of a substance use prevention intervention for urban American Indian/Alaska Native adolescents. Findings from this study assist toward the development of potentially successful strategies to successfully recruit and retain urban American Indian/Alaska Native adolescents in randomized controlled trials.
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Affiliation(s)
- Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs (ISAP), University of California Los Angeles, Los Angeles, CA, USA
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23
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Brown RA, Dickerson DL, Klein DJ, Agniel D, Johnson CL, D’Amico EJ. Identifying as American Indian/Alaska Native in Urban Areas: Implications for Adolescent Behavioral Health and Well-Being. Youth Soc 2021; 53:54-75. [PMID: 34176991 PMCID: PMC8232344 DOI: 10.1177/0044118x19840048] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
American Indian and Alaska Native (AI/AN) youth exhibit multiple health disparities, including high rates of alcohol and other drug (AOD) use, violence and delinquency, and mental health problems. Approximately 70% of AI/AN youth reside in urban areas, where negative outcomes on behavioral health and well-being are often high. Identity development may be particularly complex in urban settings, where youth may face more fragmented and lower density AI/AN communities, as well as mixed racial-ethnic ancestry and decreased familiarity with AI/AN lifeways. This study examines racial-ethnic and cultural identity among AI/AN adolescents and associations with behavioral health and well-being by analyzing quantitative data collected from a baseline assessment of 185 AI/AN urban adolescents from California who were part of a substance use intervention study. Adolescents who identified as AI/AN on their survey reported better mental health, less alcohol and marijuana use, lower rates of delinquency, and increased happiness and spiritual health.
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Palimaru AI, Brown RA, Troxel WM, Dickerson DL, Johnson CL, D'Amico EJ. Understanding sleep facilitators, barriers, and cultural dimensions in Native American urban youth. Sleep Health 2020; 6:478-488. [PMID: 32527661 PMCID: PMC7529658 DOI: 10.1016/j.sleh.2020.03.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 02/20/2020] [Accepted: 03/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES American Indian/Alaska Native (AI/AN) youth are a high-risk group for sleep problems and associated chronic conditions. Urban AI/AN youth may face certain challenges, including specific psychosocial stressors (e.g., discrimination) and environmental factors (e.g., noise, light) that render them particularly vulnerable to poor sleep health. However, few studies have explored AI/AN adolescent sleep. To our knowledge, this is the first study to use systematic qualitative methods with AI/AN youth to explore their sleep environment and sleep behaviors. DESIGN In-depth interviews with 26 youth. SETTING Two urban areas in Central and Southern California. PARTICIPANTS Urban-dwelling AI/AN youth, age 12-16 years. INTERVENTION N/A. MEASUREMENT N/A. RESULTS We identified five main themes, each with subthemes: sleep patterns and desired sleep, sleep barriers inside the home, environmental factors, sleep facilitators, and cultural dimensions. Key concerns discussed were poor sleep hygiene, excessive use of electronics prior to bedtime, issues with temperature regulation, and noise both within and outside the home. Parents can be an important vehicle for messaging around sleep health and for behavior management. Participating adolescents also indicated differing levels of attachment to Native identity, suggesting that culturally-targeted sleep interventions should build in openness and flexibility to a range of identity starting points. Further, we identified cultural practices, such as sweat lodges and dreamcatchers, that could be incorporated in future sleep interventions for this population. CONCLUSION Findings increase our understanding of urban AI/AN youth's sleep environments and behaviors, thus potentially informing program development around sleep health for this vulnerable population.
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Affiliation(s)
| | | | | | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Program, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, Los Angeles, CA, USA
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D'Amico EJ, Dickerson DL, Brown RA, Johnson CL, Klein DJ, Agniel D. Motivational interviewing and culture for urban Native American youth (MICUNAY): A randomized controlled trial. J Subst Abuse Treat 2020; 111:86-99. [PMID: 32087841 PMCID: PMC7477923 DOI: 10.1016/j.jsat.2019.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022]
Abstract
To date, few programs that integrate traditional practices with evidence-based practices have been developed, implemented, and evaluated with urban American Indians/Alaska Natives (AI/ANs) using a strong research design. The current study recruited urban AI/AN teens across northern, central, and southern California during 2014-2017 to participate in a randomized controlled trial testing two cultural interventions that addressed alcohol and other drug (AOD) use. Adolescents were 14-18 years old (inclusive), and either verbally self-identified as AI/AN or were identified as AI/AN by a parent or community member. We tested the added benefit of MICUNAY (Motivational Interviewing and Culture for Urban Native American Youth) to a CWG (Community Wellness Gathering). MICUNAY was a group intervention with three workshops that integrated traditional practices with motivational interviewing. CWGs were cultural events held monthly in each city. AI/AN urban adolescents (N = 185) completed a baseline survey, were randomized to MICUNAY + CWG or CWG only, and then completed a three- and six-month follow-up. We compared outcomes on AOD use, spirituality, and cultural identification. Overall, AOD use remained stable over the course of the study, and we did not find significant differences between these two groups over time. It may be that connecting urban AI/AN adolescents to culturally centered activities and resources is protective, which has been shown in other work with this population. Given that little work has been conducted in this area, longer term studies of AOD interventions with urban AI/AN youth throughout the U.S. are suggested to test the potential benefits of culturally centered interventions.
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Affiliation(s)
- Elizabeth J D'Amico
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America.
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine, 11075 Santa Monica Blvd., Ste. 200, Los Angeles, CA 90025, United States of America
| | - Ryan A Brown
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America
| | - Carrie L Johnson
- Sacred Path Indigenous Wellness Center, LA, CA 90017, United States of America
| | - David J Klein
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America
| | - Denis Agniel
- RAND Corporation, 1776 Main St., Santa Monica, CA 90401, United States of America
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Wendt DC, Hartmann WE, Allen J, Burack JA, Charles B, D'Amico EJ, Dell CA, Dickerson DL, Donovan DM, Gone JP, O'Connor RM, Radin SM, Rasmus SM, Venner KL, Walls ML. Substance Use Research with Indigenous Communities: Exploring and Extending Foundational Principles of Community Psychology. Am J Community Psychol 2019; 64:146-158. [PMID: 31365138 PMCID: PMC6777961 DOI: 10.1002/ajcp.12363] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Many Indigenous communities are concerned with substance use (SU) problems and eager to advance effective solutions for their prevention and treatment. Yet these communities also are concerned about the perpetuation of colonizing, disorder-focused, stigmatizing approaches to mental health, and social narratives related to SU problems. Foundational principles of community psychology-ecological perspectives, empowerment, sociocultural competence, community inclusion and partnership, and reflective practice-provide useful frameworks for informing ethical community-based research pertaining to SU problems conducted with and by Indigenous communities. These principles are explored and extended for Indigenous community contexts through themes generated from seven collaborative studies focused on understanding, preventing, and treating SU problems. These studies are generated from research teams working with Indigenous communities across the United States and Canada-inclusive of urban, rural, and reservation/reserve populations as well as adult and youth participants. Shared themes indicate that Indigenous SU research reflects community psychology principles, as an outgrowth of research agendas and processes that are increasingly guided by Indigenous communities. At the same time, this research challenges these principles in important ways pertaining to Indigenous-settler relations and Indigenous-specific considerations. We discuss these challenges and recommend greater synergy between community psychology and Indigenous research.
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Affiliation(s)
- Dennis C Wendt
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - William E Hartmann
- School of Interdisciplinary Arts and Sciences, University of Washington-Bothell, Bothell, WA, USA
| | - James Allen
- Memory Keepers Medical Discovery Team - American and Rural Health Equity, Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
| | - Jacob A Burack
- Department of Educational and Counselling Psychology, McGill University, Montreal, QC, Canada
| | - Billy Charles
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | | | - Colleen A Dell
- Department of Sociology, School of Public Health, University of Saskatchewan, Saskatoon, SK, Canada
| | - Daniel L Dickerson
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, USA
| | - Dennis M Donovan
- Department of Psychiatry and Behavioral Sciences, Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
| | - Joseph P Gone
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
- Department of Anthropology, Harvard University, Cambridge, MA, USA
| | - Roisin M O'Connor
- Department of Psychology, Concordia University, Montreal, QC, Canada
| | - Sandra M Radin
- Alcohol and Drug Abuse Institute, University of Washington, Seattle, WA, USA
| | - Stacy M Rasmus
- Center for Alaska Native Health Research, Institute for Arctic Biology, University of Alaska Fairbanks, Fairbanks, AK, USA
| | - Kamilla L Venner
- Department of Psychology and Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Melissa L Walls
- Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth Campus, Duluth, MN, USA
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Dickerson DL, Brown RA, Klein DJ, Agniel D, Johnson C, D'Amico EJ. Overt Perceived Discrimination and Racial Microaggressions and their Association with Health Risk Behaviors among a Sample of Urban American Indian/Alaska Native Adolescents. J Racial Ethn Health Disparities 2019; 6:733-742. [PMID: 30788812 PMCID: PMC6661006 DOI: 10.1007/s40615-019-00572-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 12/23/2018] [Accepted: 02/06/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Urban American Indian/Alaska Native (AI/AN) adolescents are an understudied population in the USA who are at risk for a variety of health problems. Perceived discrimination (PD), including both overt PD and racial microaggressions (RMA), is known to adversely affect health. However, studies analyzing associations between overt PD and RMA and various health behaviors are limited. METHODS This study measured past-year alcohol use, heavy drinking, marijuana use, commercialized tobacco use, consequences experienced from alcohol and marijuana use in the past 3 months, mental and physical health status, AI/AN traditional activity participation, and overt PD and RMA among 182 urban AI/AN adolescents in California. To assess the association between overt PD and RMAs and health outcomes, we conducted either logistic regression (for dichotomous outcomes: past-year alcohol use, past-year heavy drinking, past-year marijuana use, consequences of alcohol and marijuana use, commercialized tobacco use) or linear regression (for continuous outcomes: mental and physical health, AI/AN traditional practices). RESULTS In contrast to our hypotheses, overt PD and RMA were not significantly associated with substance use or mental or physical health among this sample of urban AI/AN adolescents. After adjusting for age and gender, overt PD and RMA were only correlated with past-year cigarette use and alcohol-related consequences experienced in the past 3 months. CONCLUSION Potential factors that may play a role in decreasing effects of overt PD and RMA among urban AI/AN adolescents are discussed, including participation in AI/AN traditional practices and community engagement.
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Affiliation(s)
- Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs; Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA, 90025, USA.
| | - Ryan A Brown
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - David J Klein
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - Denis Agniel
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401, USA
| | - Carrie Johnson
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017, USA
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Abstract
American Indian / Alaska Native (AI/AN) youth exhibit high rates of alcohol and other drug (AOD) use, which is often linked to the social and cultural upheaval experienced by AI/ANs during the colonization of North America. Urban AI/AN youth may face unique challenges, including increased acculturative stress due to lower concentrations of AI/AN populations in urban areas. Few existing studies have explored cultural identity among urban AI/AN youth and its association with AOD use. This study used systematic qualitative methods with AI/AN communities in two urban areas within California to shed light on how urban AI/AN youth construct cultural identity and how this relates to AOD use and risk behaviors. We conducted 10 focus groups with a total of 70 youth, parents, providers, and Community Advisory Board members and used team-based structured thematic analysis in the Dedoose software platform. We identified 12 themes: intergenerational stressors, cultural disconnection, AI/AN identity as protective, pan-tribal identity, mixed racial-ethnic identity, rural vs. urban environments, the importance of AI/AN institutions, stereotypes and harassment, cultural pride, developmental trajectories, risks of being AI/AN, and mainstream culture clash. Overall, youth voiced curiosity about their AI/AN roots and expressed interest in deepening their involvement in cultural activities. Adults described the myriad ways in which involvement in cultural activities provides therapeutic benefits for AI/AN youth. Interventions that provide urban AI/AN youth with an opportunity to engage in cultural activities and connect with positive and healthy constructs in AI/AN culture may provide added impact to existing interventions.
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Affiliation(s)
- Ryan A Brown
- RAND Corporation, 1776 Main St., PO Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, 1640 Sepulveda Blvd., Suite 200, Los Angeles, CA, 90025, USA
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main St., PO Box 2138, Santa Monica, CA, 90407-2138, USA
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Dickerson DL, Brown RA, Johnson CL, Schweigman K, D'Amico EJ. Integrating Motivational Interviewing and Traditional Practices to Address Alcohol and Drug Use Among Urban American Indian/Alaska Native Youth. J Subst Abuse Treat 2016; 65:26-35. [PMID: 26306776 PMCID: PMC4732924 DOI: 10.1016/j.jsat.2015.06.023] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 06/26/2015] [Accepted: 06/29/2015] [Indexed: 12/20/2022]
Abstract
American Indians/Alaska Natives (AI/AN) exhibit high levels of alcohol and drug (AOD) use and problems. Although approximately 70% of AI/ANs reside in urban areas, few culturally relevant AOD use programs targeting urban AI/AN youth exist. Furthermore, federally-funded studies focused on the integration of evidence-based treatments with AI/AN traditional practices are limited. The current study addresses a critical gap in the delivery of culturally appropriate AOD use programs for urban AI/AN youth, and outlines the development of a culturally tailored AOD program for urban AI/AN youth called Motivational Interviewing and Culture for Urban Native American Youth (MICUNAY). We conducted focus groups among urban AI/AN youth, providers, parents, and elders in two urban communities in northern and southern California aimed at 1) identifying challenges confronting urban AI/AN youth and 2) obtaining feedback on MICUNAY program content. Qualitative data were analyzed using Dedoose, a team-based qualitative and mixed methods analysis software platform. Findings highlight various challenges, including community stressors (e.g., gangs, violence), shortage of resources, cultural identity issues, and a high prevalence of AOD use within these urban communities. Regarding MICUNAY, urban AI/AN youth liked the collaborative nature of the motivational interviewing (MI) approach, especially with regard to eliciting their opinions and expressing their thoughts. Based on feedback from the youth, three AI/AN traditional practices (beading, AI/AN cooking, and prayer/sage ceremony) were chosen for the workshops. To our knowledge, MICUNAY is the first AOD use prevention intervention program for urban AI/AN youth that integrates evidence-based treatment with traditional practices. This program addresses an important gap in services for this underserved population.
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Affiliation(s)
- Daniel L Dickerson
- UCLA Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine, 1640 Sepulveda Blvd., Suite 200, Los Angeles, CA, 90025
| | - Ryan A Brown
- RAND Corporation, 1776 Main St., Santa Monica, CA, 90401
| | | | - Kurt Schweigman
- Sacred Path Indigenous Wellness Center, Los Angeles, CA, 90017
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Anderson AL, Li SH, Markova D, Holmes TH, Chiang N, Kahn R, Campbell J, Dickerson DL, Galloway GP, Stock C, Elkashef AM, Stock C, Elkashef AM. Bupropion for the treatment of methamphetamine dependence in non-daily users: a randomized, double-blind, placebo-controlled trial. Drug Alcohol Depend 2015; 150:170-4. [PMID: 25818061 PMCID: PMC4388163 DOI: 10.1016/j.drugalcdep.2015.01.036] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/26/2015] [Accepted: 01/27/2015] [Indexed: 10/24/2022]
Abstract
AIM Bupropion was tested for efficacy to achieve methamphetamine (MA) abstinence in dependent, non-daily users. METHODS A randomized, double-blind, placebo-controlled trial, with 12-week treatment and 4-week follow-up, was conducted with 204 treatment-seeking participants having MA dependence per DSM-IV, who used MA on a less-than-daily basis. 104 were randomized to matched placebo and 100 to bupropion, sustained-release 150mg, twice daily. Participants were seen three times weekly to obtain urine for MA and bupropion assays, study assessments, and thrice weekly, 90-min, group psychotherapy. There was no biomarker for placebo adherence. The primary outcome was achievement of abstinence throughout the last two weeks of treatment; 'success' requiring at least two urine samples during each of Weeks 11 and 12, and all samples MA-negative (<300ng/mL). RESULTS Bupropion and placebo groups did not differ significantly in the percentage achieving abstinence for the last 2 weeks of treatment (chi-square, p=0.32). Subgroup analysis of participants with lower baseline MA use (≤18 of last 30 days before consent) also revealed no difference in success between groups (p=0.73). Medication adherence per protocol (detectable bupropion, >5ng/mL, in ≥50% of urine samples from Study Weeks 1-10 and ≥66% of urine samples from Weeks 11 to 12) was achieved by 47% of participants taking bupropion. CONCLUSIONS These data indicate that bupropion did not increase abstinence in dependent participants who were using MA less-than-daily. Medication non-adherence was a limitation in this trial. Psychosocial therapy remains the mainstay of treatment for MA dependence. Further research on subgroups who may respond to bupropion may be warranted.
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Affiliation(s)
- Ann L. Anderson
- National Institutes of Health, National Institute on Drug Abuse, Division of Pharmacotherapies and Medical Consequences, Bethesda, MD, USA
| | - Shou-Hua Li
- National Institutes of Health, National Institute on Drug Abuse, Division of Pharmacotherapies and Medical Consequences, Bethesda, MD, USA
| | | | - Tyson H. Holmes
- Stanford Center for Sleep Sciences and Medicine, Dept. of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, CA, USA
| | - Nora Chiang
- National Institutes of Health, National Institute on Drug Abuse, Division of Pharmacotherapies and Medical Consequences, Bethesda, MD, USA
| | - Roberta Kahn
- National Institutes of Health, National Institute on Drug Abuse, Division of Pharmacotherapies and Medical Consequences, Bethesda, MD, USA
| | | | - Daniel L. Dickerson
- Integrated Substance Abuse Programs, University of California, Los Angeles, CA, USA
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Moghaddam JF, Yoon G, Dickerson DL, Kim SW, Westermeyer J. Suicidal ideation and suicide attempts in five groups with different severities of gambling: Findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Am J Addict 2015; 24:292-8. [PMID: 25808267 DOI: 10.1111/ajad.12197] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 12/20/2014] [Accepted: 12/28/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Problem and pathological gamblers show high rates of suicidal behavior. However, previous research of suicide among this population has been inconsistent. Discrepancies may stem from methodological issues, including variable use of suicide nomenclature and selection bias in study samples. Furthermore, earlier research has rarely examined gambling severity aside from problem or pathological categories. This study utilized subgroups derived from a nationally representative data set, examining different characteristics of suicidal behavior and several gambling levels, including subclinical groups. METHODS Participants included 13,578 individuals who participated in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) and provided information on gambling behavior, lifetime suicidal ideation, and/or lifetime suicide attempts. Five gambling groups were derived using DSM-IV criteria for pathological gambling; non-gambling, low-risk gambling, at-risk gambling, problem gambling, and pathological gambling. RESULTS Problem gambling was associated with suicidal ideation [adjusted odds ratio (AOR) = 1.64, 95% confidence interval (CI) = 1.19-2.26] and suicide attempts [(AOR) = 2.42, 95% (CI) = 1.60-3.67] after adjustment for sociodemographic variables. Pathological gambling was associated with suicidal ideation [(AOR) = 2.86, 95% (CI) = 1.98-4.11] and suicide attempts [(AOR) = 2.77, 95% (CI) = 1.72-4.47) after adjustment for sociodemographic variables. DISCUSSION, CONCLUSIONS, AND SCIENTIFIC SIGNIFICANCE Our results from this population sample reinforce increased rates of suicidal behavior amongst smaller, clinical samples of problem and pathological gamblers. Education for providers about gambling is recommended, including screening for gambling-related symptoms such as suicidal behavior.
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Affiliation(s)
- Jacquelene F Moghaddam
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles (UCLA) Gambling Studies Program, Los Angeles, California
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Moghaddam JF, Dickerson DL, Yoon G, Westermeyer J. Nicotine dependence and psychiatric and substance use disorder comorbidities among American Indians/Alaska Natives: findings from the National Epidemiologic Survey on Alcohol and Related Conditions. Drug Alcohol Depend 2014; 144:127-33. [PMID: 25240520 DOI: 10.1016/j.drugalcdep.2014.08.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 06/29/2014] [Accepted: 08/13/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND American Indians and Alaska Natives (AI/ANs) have high rates of tobacco use compared to the general population. AI/ANs also have elevated rates of psychiatric and substance use disorders associated with nicotine dependence. However, very few studies have examined the comorbidity between nicotine dependence and psychiatric and substance use disorders within this population. METHODS This study analyzes the comorbidity of lifetime nicotine dependence with both current and lifetime psychiatric disorders and substance use disorders in a nationally representative sample of 701 AI/AN women and men. RESULTS Using 95% confidence interval testing, lifetime nicotine dependence (29.5%) was associated with all main diagnostic categories (any mood disorder, any anxiety disorder, any personality disorder, any alcohol use disorder, and any drug use disorder) both at the lifetime level and current (12-month) level. Of the lifetime disorders, the strongest associations were with psychosis and drug dependence. For (current) 12-month disorders, the strongest associations were with alcohol dependence and drug dependence. Differences were noted between genders regarding personality disorders. CONCLUSIONS Culturally appropriate tobacco screening, prevention, and treatment curricula for adult AI/ANs with dual diagnoses are recommended. Understanding historically based factors that may contribute to psychiatric illness and substance use disorders may assist in more effective nicotine treatments for AI/ANs.
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Affiliation(s)
- Jacquelene F Moghaddam
- University of California Los Angeles (UCLA) Gambling Studies Program, UCLA Department of Psychiatry and Biobehavioral Sciences, 760 Westwood Plaza, Suite 38-153, Los Angeles, CA 90095-1759, USA.
| | - Daniel L Dickerson
- University of California Los Angeles Integrated Substance Abuse Programs, 11075 Santa, Monica Boulevard, Suite 100, Los Angeles, CA 90025, USA
| | - Gihyun Yoon
- Minneapolis VA Health Care System. One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota Medical School. One Veterans Drive, Minneapolis, MN 55417, USA
| | - Joseph Westermeyer
- Minneapolis VA Health Care System. One Veterans Drive, Minneapolis, MN 55417, USA; University of Minnesota Medical School. One Veterans Drive, Minneapolis, MN 55417, USA
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Dickerson DL, Venner KL, Duran B, Annon JJ, Hale B, Funmaker G. Drum-Assisted Recovery Therapy for Native Americans (DARTNA): results from a pretest and focus groups. Am Indian Alsk Native Ment Health Res 2014; 21:35-58. [PMID: 24788920 PMCID: PMC6064638 DOI: 10.5820/aian.2101.2014.35] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Drum-Assisted Recovery Therapy for Native Americans (DARTNA) is a substance abuse treatment intervention for American Indians/Alaska Natives (AI/ANs). This article provides results from 1) an initial pretest of DARTNA provided to 10 AI/AN patients with histories of substance use disorders, and 2) three subsequent focus groups conducted among AI/AN DARTNA pretest participants, substance abuse treatment providers, and the DARTNA Community Advisory Board. These research activities were conducted to finalize the DARTNA treatment manual; participants also provided helpful feedback which will assist toward this goal. Results suggest that DARTNA may be beneficial for AI/ANs with substance use problems.
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Dickerson DL, Fisher DG, Reynolds GL, Baig S, Napper LE, Anglin MD. Substance use patterns among high-risk American Indians/Alaska Natives in Los Angeles County. Am J Addict 2012; 21:445-52. [PMID: 22882395 DOI: 10.1111/j.1521-0391.2012.00258.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Substance abuse among American Indians/Alaska Natives (AI/ANs) is a significant and long-standing health problem in the U.S. Two-thirds of American AIs/ANs reside in the urban setting. However, studies analyzing substance use characteristics among urban AI/ANs are very limited. METHODS Substance use patterns among a sample of AI/ANs (n = 77) and other ethnic/racial groups in Los Angeles County at high risk of substance abuse were analyzed utilizing three datasets from programs targeting individuals at high risk for substance abuse and risky sexual behaviors. RESULTS Compared to all other ethnic/racial groups, AI/ANs demonstrated significantly younger age of onset of alcohol, marijuana, methamphetamine, and "other" drug use, higher correlations of age of first use of amphetamine with a measure of the drug's reinforcement, and higher mean number of illicit drug injections in the 30 days before being interviewed. CONCLUSIONS Results from this study highlight a critical need for furthering our understanding of substance abuse problems among urban AI/ANs.
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Affiliation(s)
- Daniel L Dickerson
- United American Indian Involvement, Inc. (UAII), Los Angeles, California 90025-7535, USA.
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Dickerson DL, Johnson CL. Design of a behavioral health program for urban American Indian/Alaska Native youths: a community informed approach. J Psychoactive Drugs 2012; 43:337-42. [PMID: 22400466 DOI: 10.1080/02791072.2011.629152] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
American Indian/Alaska Native (AI/AN) urban youths experience significant mental health and substance use problems. However, culturally relevant treatment approaches that incorporate community perspectives within the urban setting are limited. This study analyzes community perspectives from AI/AN parents, AI/AN youths, and services providers within Los Angeles County. Information gathered was utilized to develop a needs assessment for AI/AN youths with mental health and substance use problems and to design a community-informed treatment approach. Nine focus groups and key informant interviews were conducted. The Los Angeles County community strongly expressed the need for providing urban AI/AN youths with traditional healing services and cultural activities within their treatment program. However, various barriers to accessing mental health and substance abuse treatment services were identified. An integrated treatment approach was subsequently designed as a result of input derived from community perspectives. The community believed that providing urban AI/AN youths with an integrated treatment approach has the potential to decrease the risk of mental health and substance abuse problems in addition to enhancing their cultural identity and self esteem.
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Dickerson DL, Spear S, Marinelli-Casey P, Rawson R, Li L, Hser YI. American indians/alaska natives and substance abuse treatment outcomes: positive signs and continuing challenges. J Addict Dis 2011; 30:63-74. [PMID: 21218312 PMCID: PMC3042549 DOI: 10.1080/10550887.2010.531665] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Limited information is known with regard to substance abuse treatment outcomes among AI/ANs. Data retrieved from the Treatment System Impact (TSI) project and Methamphetamine Treatment Project (MTP) were used to compare treatment measures between a sample of AI/ANs and a matched comparison group. Our results revealed no significant differences between AI/ANs and the matched comparison group in treatment outcomes at 12-months post-treatment based on legal, employment, medical, and psychiatric measures. AI/ANs also received more family-related services (29.9% vs. 17.1%) and abuse-related services (21.3% vs. 7.6%). Addressing barriers to receiving substance abuse treatment and enhancing screening methods for AI/ANs are suggested.
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Affiliation(s)
- Daniel L Dickerson
- University of California, Los Angeles, Integrated Substance Abuse Programs (ISAP), Los Angeles, CA 90025-7535, USA.
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Abstract
This study assesses the impact of the 1993 NIH Revitalization Act on the inclusion and subgroup analysis of women and minorities in trials of FDA-approved smoking cessation pharmacotherapy. Female representation, while commensurate with population levels, declined significantly for trials that began recruitment after 1993(M = 47.2% vs. M = 53.9%), and fewer than half reported analyses by gender. Minorities continued to be under-represented in later trials; however, significant improvement in representation (M = 16.1% vs. M = 10%) and analysis by race occurred. Industry-sponsored studies had lower minority representation than NIH funded studies. Recommendations are offered to improve subgroup analyses and minority inclusion.
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Affiliation(s)
- Daniel L Dickerson
- Integrated Substance Abuse Programs, University of California at Los Angeles, Los Angeles, California 90025, USA.
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Dickerson DL, O'Malley SS, Canive J, Thuras P, Westermeyer J. Nicotine dependence and psychiatric and substance use comorbidities in a sample of American Indian male veterans. Drug Alcohol Depend 2009; 99:169-75. [PMID: 18845405 PMCID: PMC2662517 DOI: 10.1016/j.drugalcdep.2008.07.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 06/02/2008] [Accepted: 07/23/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND American Indians and Alaska Natives have the highest rates of nicotine dependence in the U.S. However, studies analyzing associations between nicotine dependence and psychiatric and substance use disorders in these groups have been limited. METHODS This study analyzes the co-occurrence of current and lifetime DSM-III-R nicotine dependence with psychiatric and substance use disorders in a community sample of 480 American Indian male veterans. RESULTS Lifetime nicotine dependence (23.3%) was associated with all lifetime disorders studied, including alcohol use and drug use disorders, affective and anxiety disorders, PTSD, pathological gambling and antisocial personality disorder. Current nicotine dependence was present in 19% of the sample and significantly associated with current affective and gambling disorder. CONCLUSIONS Substantial co-morbidity exists between nicotine dependence and other substance abuse and psychiatric disorders among this sample of American Indian male veterans, particularly for lifetime diagnoses. Screening for all psychiatric disorders among American Indian/Alaska Native smokers may be warranted. Although these results are similar to those observed among the general U.S. population, unique risk factors exist among American Indians/Alaska Natives which may require further attention. Specific public health and clinical interventions to reduce the rate of nicotine dependence among American Indians/Alaska Natives are recommended.
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