Beyond resilience: A scoping review of Indigenous survivance in the health literature

Health inequity scholars, particularly those engaged with questions of structural and systemic racism, are increasingly vocal about the limitations of "resilience." This is true for Indigenous health scholars, who have pushed back against resilience as a descriptor of modern Indigeneity and who are increasingly using the term survivance. Given the growing frequency of survivance in relation to health, we performed a scoping review to understand how survivance is being applied in health scholarship, with a particular interest in its relationship to resilience. Results from 32 papers indicate that health scholars are employing survivance in relation to narrative, temporality, community, decolonization, and sovereignty, with varying degrees of adherence to the term's original conception. Overwhelmingly, authors employed survivance in relation to historical trauma, leading us to propose the analogy: as resilience is to trauma, so survivance is to historical trauma. There may be value in further operationalizing survivance for health research and practice through the development of a unified definition and measurement tool, ensuring comparability across studies and supporting future strengths-based Indigenous health research and practice.

Food Security and Food Sovereignty: The Difference Between Surviving and Thriving

Previous research in American Indian and Alaska Native (AI/AN) communities has documented high prevalence of food insecurity. Yet many AI/AN scholars and communities have expressed concerns that the dominant societal conceptions of food security are not reflective of the teachings, priorities, and values of AI/AN communities. Food security initiatives often focus on access to food and, at times, nutrition but little consideration is given to cultural foods, the spirituality carried through foods, and whether the food was stewarded in a way that promotes well-being not just for humans but also for plants, animals, land, and water. Despite the concerns of AI/AN communities that their needs are not centered in dominant societal food conceptualizations and food security programming, the food sovereignty efforts of AI/AN communities have captured national attention as a solution to modern food system inequities. Indigenous Food Sovereignty (IFS) is a holistic approach to food that incorporates values of relationality, reciprocity, and relationships. Fundamental differences exist between food security and food sovereignty, yet dominant society often reduces IFS as a solution to food security, rather than an entirely different food system that is predicated on values that contrast with that of dominant society. Despite calls to decolonize the definition and measurement of food security, we explore whether fixing the concept of food security is a worthy endeavor or whether efforts would be better spent supporting the resurgence and revitalization of AI/AN food values, food knowledge, and community food sovereignty initiatives.

Food Sovereignty and Health: A Conceptual Framework to Advance Research and Practice

Settler colonialism disrupted traditional Indigenous foodways and practices and created high rates of diet-related disease among Indigenous peoples. Food sovereignty, the rights of Indigenous peoples to determine their own food systems, is a culturally centered movement rooted in traditional Indigenous knowledge. This approach directly intervenes upon systems-level barriers to health, making it an important strategy for health equity. While food sovereignty initiatives can be found within many Indigenous communities, the conceptual linkages between food sovereignty and health have not been well documented within the public health literature. We present a practice-informed conceptual framework developed as part of the Center for Indigenous Innovation and Health Equity (CIIHE) initiative, a community-academic partnership with the goal of strengthening Indigenous food systems and practices to promote health and well-being. The framework emphasizes connectedness, including the transmission of knowledge across generations and the restoration of relational responsibilities, as central to Indigenous concepts of health and wellness.

Framing an Indigenous Food Sovereignty Research Agenda

Access to healthy and appealing food is essential for individuals to be able to live a healthy and quality life. For decades, food security has been a priority issue for public health professionals. Food sovereignty expands upon the concept of food insecurity (i.e., having access to nutritious and culturally relevant food) by incorporating people's rights to define their own food system. The expanded focus of food sovereignty on food systems prioritizes public health professionals' role in supporting environmental- and systems-level initiatives and evaluating their implications for health, economics, and the natural environment. Food sovereignty is of particular importance for Indigenous peoples (i.e., American Indian, Alaska Native, Native Hawaiian, and Pacific Islander communities). Colonization had demonstrable consequences, with many Indigenous communities being forcibly relocated from traditional lands, alongside the destruction of traditional food sources. Indigenous food sovereignty aligns with the sovereign nation status that American Indian tribes and Alaska Native communities have with the United States. Furthermore, the worldviews that incorporate Indigenous communities' relational responsibilities to care for their food systems, according to their traditional practices and beliefs (Coté, 2016; Morrison, 2011), uniquely positions Indigenous peoples to lead food sovereignty initiatives. In this article, we explore what is currently known regarding food sovereignty and health. We then discuss opportunities to expand the evidence on Indigenous food sovereignty's relationships with (1) health and well being, (2) economics, (3) the natural environment, and (4) programming facilitators and barriers.

Ideals of counseling practice: Therapeutic insights from an Indigenous first nations-controlled treatment program

Indigenous Canadians suffer disproportionately from mental health concerns tied to histories of colonization, including exposure to Indian Residential Schools. Previous research has indicated that preferred therapies for Indigenous populations fuse traditional cultural practices with mainstream treatment. The present study comprised 32 interviews conducted with Indigenous administrators, staff, and clients at a reserve-based addiction treatment center to identify community-driven and practical therapeutic solutions for remedying histories of coercive colonial assimilation. Thematic analysis of semi-structured interviews revealed that counselors tailored therapy through cultural preferences, including the use of nonverbal expression, culturally appropriate guidance, and alternative delivery formats. Additionally, they augmented mainstream therapeutic activities with Indigenous practices, including the integration of Indigenous concepts, traditional practices, and ceremonial activities. Collectively, this integration of familiar counseling approaches and Indigenous cultural practices in response to community priorities resulted in an innovative instance of therapeutic fusion that may be instructive for cultural adaptation efforts in mental health treatment for Indigenous populations and beyond. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Behavioral health services in Urban American Indian Health Programs: Results from six site visits

This study explores behavioral health services for American Indians and Alaska Natives (AIANs) at six Urban Indian Health Programs (UIHPs). Interviews and focus groups with clinicians and staff inquired about behavioral health treatment available, service needs, client population, and financial and staffing challenges. Resulting site profiles were created based on focused coding and integrative memoing of site visit field notes and respondent transcripts. These six UIHPs evidenced diversity across multiple facets of service delivery even as they were united in their missions to provide accessible and effective behavioral health treatment to urban AIAN clients. Primary challenges to service provision included heterogenous client populations, low insurance coverage, limited provider knowledge, lack of resources, and incorporation of traditional healing. Collaborative research with UIHPs harbors the potential to recognize challenges, identify solutions, and share best practices across this crucial network of health care sites for improving urban AIAN well-being.

Conceptualization, Operationalization, and Utilization of Race and Ethnicity in Major Epidemiology Journals, 1995-2018: A Systematic Review

Despite repeated calls by scholars to critically engage with the concepts of race and ethnicity in US epidemiologic research, the incorporation of these social constructs in scholarship may be suboptimal. This study characterizes the conceptualization, operationalization, and utilization of race and ethnicity in US research published in leading journals whose publications shape discourse and norms around race, ethnicity, and health within the field of epidemiology. We systematically reviewed randomly selected articles from prominent epidemiology journals across 5 periods: 1995-1999, 2000-2004, 2005-2009, 2010-2014, and 2015-2018. All original human-subjects research conducted in the United States was eligible for review. Information on definitions, measurement, coding, and use in analysis was extracted. We reviewed 1,050 articles, including 414 (39%) in our analyses. Four studies explicitly defined race and/or ethnicity. Authors rarely made clear delineations between race and ethnicity, often adopting an ethnoracial construct. In the majority of studies across time periods, authors did not state how race and/or ethnicity was measured. Top coding schemes included "Black, White" (race), "Hispanic, non-Hispanic" (ethnicity), and "Black, White, Hispanic" (ethnoracial). Most often, race and ethnicity were deemed "not of interest" in analyses (e.g., control variables). Broadly, disciplinary practices have remained largely the same between 1995 and 2018 and are in need of improvement.

"American Indian" as a Racial Category in Public Health: Implications for Communities and Practice

When public health considers the health and disease status of Indigenous people, it often does so using a racial lens. In recent decades, public health researchers have begun to acknowledge that commonly employed racial categories represent history, power dynamics, embodiment, and legacies of discrimination and racism, rather than innate biology. Even so, public health has not yet fully embraced an understanding of other components of identity formation for Indigenous people, including political status within Native nations. In this article, we discuss why the continued racial conceptualization of Indigeneity in US public health is inadequate. We begin by providing a brief account of racialization as a tool of colonization, of failure to recognize and acknowledge Indigenous sovereignty, and of common public health practices of Indigenous data collection and interpretation. We then articulate the stakes of racialized health data for Native communities. We end by offering alternative approaches, many drawn from scholarship from Indigenous researchers. (Am J Public Health. 2021;111(11):1969-1975. https://doi.org/10.2105/AJPH.2021.306465).

Looking Back to Leap Forward: A Framework for Operationalizing the Structural Racism Construct in Minority Health Research

Racism is now widely recognized as a fundamental cause of health inequalities in the United States. As such, health scholars have rightly turned their attention toward examining the role of structural racism in fostering morbidity and mortality. However, to date, much of the empirical structural racism-health disparities literature limits the operationalization of structural racism to a single domain or orients the construct around a White/Black racial frame. This operationalization approach is incomprehensive and overlooks the heterogeneity of historical and lived experiences among other racial and ethnic groups. To address this gap, we present a theoretically grounded framework that illuminates core mutually reinforcing domains of structural racism that have stratified opportunities for health in the United States. We catalog instances of structural discrimination that were particularly constraining (or advantageous) to the health of racial and ethnic groups from the late 1400s to present. We then illustrate the utility of this framework by applying it to American Indians or Alaska Natives and discuss the framework's broader implications for empirical health research. This framework should help future scholars across disciplines as they identify and interrogate important laws, policies, and norms that have differentially constrained opportunities for health among racial and ethnic groups.

Smoke-Free Multiunit Housing Policy: Caretakers' Perspectives on Economic and Personal Impacts

Objective: Multiunit housing (MUH) operators may be motivated to adopt smoke-free policies to achieve cost savings. MUH caretakers provide a unique perspective for understanding the implications of smoke-free policies because of their role in property maintenance. We examine MUH caretakers’ perceptions regarding the economic and personal impact of smoke-free policies at their properties. Methods: We conducted and analyzed qualitative interviews with 20 multiunit housing caretakers from two large property management companies in the southeastern United States that had implemented smoke-free policies. Results: For non-smoking units, caretakers reported shortened turnover times, in addition to reduction in the need for turnover supplies and capital replacements. Caretakers reported an improvement in their work environments due to reduced workload and exposure to secondhand and thirdhand smoke after implementation of smoke-free policies. Conclusion: The potential for cost savings exists for MUH operators who enact smoke-free policies because of decreased labor, supplies, and capital costs. Smoke-free policies may also improve the work environment of caretakers and other frontline MUH employees. These are important findings for MUH companies seeking to lower their operation costs and improve their employees’ working conditions, as well as for smoke-free advocates seeking to promote policy change.

Abstract 81: Dietary supplement use among German colorectal cancer patients: The ColoCare Study

Introduction: Colorectal cancer (CRC) is the second most common type of cancer in the United States and Europe and a leading cause of cancer death in the Western world. Except for age and inherited syndromes, risk factors are mainly lifestyle-related, including diets high in red meat, lack of physical activity, obesity, or smoking. These factors may also affect clinical outcomes among colorectal cancer patients. One potentially relevant health behavior is use of nutritional supplements. The effects of supplement use after diagnosis, and particularly during chemotherapy are unknown, while their use, particularly in the United States, is high.

Objective: To analyze preliminary trends of supplement use over time in CRC patients enrolled at the German study site (Heidelberg) of the international ColoCare Consortium.

Methods: The intake of dietary supplements was assessed among 83 patients recruited from 2010-2012 in the ongoing prospective patient cohort study ColoCare. Data on supplement use, including frequency, duration, dose per day, and type, was obtained by questionnaire. At diagnosis we assessed information regarding supplement use two years prior to diagnosis (TP1) and one month prior to diagnosis (TP2); six months later, we assessed use between TP2 and the six month timepoint (TP3) and at six months (TP4). Demographic and clinical data were obtained by questionnaires and clinical chart abstraction. The distributions of supplement users and non-users with respect to demographic, clinical, and lifestyle factors were assessed using frequency tables and Fisher's exact tests.

Results: In total 33 different supplements were reported, most commonly vitamin use. A tendency towards increased supplement intake after diagnosis was observed. The intake was highest after diagnosis (TP3: 36.1%) compared to prior to diagnosis (TP1: 26.5%) and at six months (TP4:27.7%). Investigation of potential predictors of supplement use, including demographic (sex, age), clinical (tumor stage), and lifestyle characteristics (smoking, income, education) did not show any difference; when supplement use status was categorized by BMI a significant difference was observed at TP2 (p<0.01).

Conclusion: Among German CRC patients, supplement use was highest shortly after diagnosis, and potentially BMI dependent. This increase in supplement use may be important with respect to cancer therapy and potential drug interactions. Continued surveillance through the ColoCare study will investigate the role of supplements in recurrence of disease, and thus support the development of clinical guidelines for supplement use among cancer patients.

Citation Format: Petra Schrotz-King, Kira Dölp, Michael Paskow, Katharina Buck, Clare Abbenhardt, Jürgen Staffa, Stephanie Tosic, Verena Widmer, Dominique Scherer, Nina Habermann, Kathy Vickers, Rachel E. Wilbur, Michael Hoffmeister, Jenny Chang-Claude, Hermann Brenner, Cornelia M. Ulrich. Dietary supplement use among German colorectal cancer patients: The ColoCare Study. [abstract]. In: Proceedings of the AACR Special Conference on Post-GWAS Horizons in Molecular Epidemiology: Digging Deeper into the Environment; 2012 Nov 11-14; Hollywood, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(11 Suppl):Abstract nr 81.