American Indian and Alaska Native (AI/AN) youth use alcohol and drugs at a higher rate with earlier onset than the overall youth population in the United States. Youth interventions are needed to support the prevention and reduction of substance misuse-related issues. Connecting AI/AN children to their heritage through culturally grounded prevention programs has been shown to be more effective than programs designed for the general population. The objective of this formative evaluation was to provide community-informed updates for an existing culturally grounded substance use prevention program, The Beauty Way. This study was conducted in partnership with an AI/AN-serving community organization using key informant interviews and talking circles with community members and parents. Participants revealed the challenges and obstacles AI/AN youth face, the impact of cultural values, and activities which engage youth to prevent problematic substance use. Recommendations include the importance of 1) incorporating current challenges to behavioral health such as social media and vaping, 2) including cultural values and activities including land-based learning, and 3) creating a robust facilitator guide and hiring culturally sensitive program staff. These results generated recommendations to strengthen the cultural focus and application of The Beauty Way for AI/AN youth.

American Indian and Alaska Native (AI/AN) adolescents face health disparities resulting from historical traumas. There is a paucity of research focusing on mental health in AI/AN adolescents or the relationship between cultural connection and health. This project assesses the relationship between cultural identity and markers of mental health and well-being for AI/AN adolescents. Adolescents 12 to 18 years old from the Lumbee Tribe of North Carolina participated in this mixed-methods study. Phase 1, discussed in this manuscript, involved surveys using validated instruments to assess cultural connection and markers of mental health and well-being. Characteristics of the 122 AI/AN youth who completed the survey included: mean age 14.9 years (SD = 2.0); 61% (n = 75) assigned female at birth; 56% (n = 70) identified as female; and 4.1% (n = 5) identified as non-binary. Mean tribal affiliation (TA) and ethnic identity (EI) scores suggest strong cultural connection (TA: M = 3.1/5, SD = 0.6; EI: M = 3.4/5, SD = 0.9). Sleep quality (M = 2.63/5) and positive stress management (M = 2.06/5) were low. Bivariate and logistic regression demonstrated moderate positive correlations between EI and friendship, EI and emotional support, TA and friendship, and TA and emotional support. AI/AN adolescents in this sample have a moderate-strong connection with Native culture, marked by ethnic identity and tribal affiliation, and positive markers of mental health and well-being. Data from this study may be used for policy formulation to promote increased funding and programming addressing mental health for AI/AN youth.

The primary purpose of this study was to 1) explore the relationship among the following variables: thoughts and feelings associated with historical loss, levels of acculturation, alcohol expectancies, and alcohol use among American Indian and Alaska Native (AI/AN) people, as well as to 2) explore predictive relationships among historical loss thoughts and feelings, alcohol expectancies, and alcohol use for AI/AN people within this sample. A convenience (community, non-clinical) sample of 188 AI/AN people completed an online survey, including questions related to alcohol use, alcohol expectancies, thoughts and feelings of historical loss, and acculturation experiences. Results indicated that gender and feelings of historical loss were the significant individual predictors of alcohol use and alcohol expectancies in a sample of AI/AN people. In addition, specific types of alcohol expectancies, when considered together, explained 24% of the variance in alcohol use experiences. Gender differences were noted in that AI/AN men were more likely than AI/AN women to engage in hazardous drinking and expected more feelings of social and physical pleasure as well as power and aggression as a result of drinking alcohol. Areas for further research were highlighted, with an emphasis on further research exploring the correlates and predictors of alcohol use and alcohol expectancies for community, non-clinical samples of AI/AN people, to further understand alcohol use motivation among AI/AN people.

This study aimed to determine the prevalence of breastfeeding initiation and continuation at two months postpartum in American Indian (AI) mothers in South Dakota and to identify factors associated with breastfeeding. Using logistic regression, data from the South Dakota Pregnancy Risk Assessment Monitoring System were used to investigate the relationship between binary breastfeeding initiation and continuation outcomes and maternal behaviors and experiences including access to health care, safe sleep practices, ability to handle life events, depression, and sources of breastfeeding information. Higher odds of initiation were seen for factors including access to health care services, ability to handle life events, and sources of breastfeeding information, while lower odds were seen for factors including safe sleep. Higher odds of continuation were seen among mothers who reported not taking long to get over setbacks and among mothers who reported no postpartum depression, while lower odds of continuation were seen among mothers practicing safe sleep. Several modifiable factors were identified as reasons for stopping breastfeeding. This information about factors associated with higher odds of breastfeeding initiation and continuation at two months postpartum can be used to inform interventions, programs, and policies designed to support breastfeeding among AI women and to guide future research in this area.

Historic loss and historic loss-associated symptoms were examined in a cross-section of 60 American Indian and Alaska Native students attending a Native American serving college that is also a former Indian boarding school. To measure awareness of current events regarding finding unmarked graves at boarding schools, authors developed and used the Truth and Reconciliation Scale. Levels of self-compassion were assessed in participants to determine if there was a correlation between negative feelings towards oneself and psychological risk factors brought forth as a result of how aware students were of current events surrounding former Indian boarding schools. Self-compassion was predicted to act as a protective factor and a positive coping mechanism for those most impacted by historic loss and intergenerational trauma. Participants reported thinking about, and being psychologically impacted by, historic loss. Psychological impacts were stronger in participants who were more aware of current reconciliation efforts and those who had higher levels of negative thoughts towards themselves. This suggests the possibility that current events, such as the finding of unmarked graves at former Indian boarding schools, might be increasing trauma responses in current students. Working to reduce negative thoughts about self and increase self-compassion may help buffer the negative impacts of the current truth and reconciliation work. Researchers and practitioners are encouraged to engage in more research and practice exploring the potential benefits of self-compassion for those adversely affected by historic loss, thus improving the likelihood of cultural revitalization from a broad perspective.

A mixed methods community-based participatory research study was conducted with Native American Lifelines of Baltimore to: (1) understand prevalence, correlates, and lived experiences with food insecurity and (2) explore the effects of and potential solutions to food insecurity. An online survey was completed by 250 American Indian and Alaska Native adults, and a subset of survey respondents (N=11) completed interviews. Quantitative analysis revealed food insecurity prevalence of 28% and increased odds of food insecurity with higher levels of food stress and COVID-19 hardships. Qualitative inquiry revealed harmful long-term effects of food insecurity on eating behaviors and several food sovereignty-oriented solutions to food insecurity.

Community health needs assessments (CHNAs) often lack sufficient community member participation. This lack of participation contributes to a continuation of unmet needs and systematic inequities. Southcentral Foundation (SCF) is an Alaska Native-owned, nonprofit healthcare organization serving 70,000 Alaska Native and American Indian (AN/AI) people living in and around Anchorage and 55 rural villages. Results of a 1993 CHNA shaped the organizational mission, vision, organizational principles, objectives, and initiatives as SCF assumed care from the Indian Health Service. We describe methods used by SCF to maximize participation of diverse community members in a second large-scale CHNA in 2018, how results align with existing organizational values and priorities, and how results were disseminated. We discuss the benefits of periodic CHNAs and ongoing community engagement.

This evaluation explored the benefits of Complementary Alternative Medicine (CAM) within a reservation-based, State-certified outpatient treatment provider. The three CAM strategies provided were massage, acupuncture, and chiropractic therapies. The evaluation team worked with a peer recovery support specialist and tribal evaluation intern to co-create a one-page, eight-question, fixed-response instrument based on previous work in the community. Surveys were collected by the peer support specialist post-session with individuals receiving CAM therapies. Surveys assessed self-reported impacts, reasons for attending CAM sessions, and mental, physical, spiritual, and emotional health before and after CAM sessions. Paired t-tests were used to examine significant differences in mean scores before and after CAM sessions. A total of 40 participants completed the survey between March 2021 and March 2022. The evaluation found a significant increase in the mean scores for all measured self-reported health ratings: physical, spiritual, emotional, and mental. The greatest increase observed was for physical health (M = 5.32, SD = 2.53) and physical health after (M = 8.38, SD = 1.60) based on self-report data; t(78) = 6.46, p = .0001. CAM sessions positively influenced participants; 83% (n = 33) reported being more hopeful about their overall health and wellness. The holistic approach demonstrated promising results and potential benefits of CAM on overall wellness and belonging. Further research is needed to explore how CAM may be implemented as a culturally centered approach to managing chronic pain often associated with opioid use disorder.

The community mental health center era in the United States was based on delivering services cataloged in three areas of behavioral health needs; (1) primary prevention of mental illness: the prevention of illness before it develops; (2) secondary prevention services: the early treatment of mental illness to reduce the severity of illness, and (3) tertiary prevention: treatment aimed at the reduction of the burdens of chronic mental illness. To attain these goals in a particular state in the United States has been very difficult, and Alaska, which has only been a state since 1959, is not close to attaining these goals. As a matter of fact, this paper will demonstrate that Alaska has had more trouble than most states in providing even rudimentary services in several of these areas. Yet, because of a curious constellation of factors, this paper presents the reader with a hopeful possible alignment of programs which, if more fully developed and linked in Alaska, can become an integrated public behavioral health system open to all the residents in the state.

Experiences of discrimination are linked to mental health in American Indians. Less is known about how place of residence (i.e., living on or off a reservation) relates to discrimination frequency and whether the strength and nature of the relationship between discrimination and mental health varies as a function of different living environments. In the current study, we examined frequency of discrimination, main reasons for discrimination, and relationships between discrimination for American Indians living both on and off a reservation. Relative to American Indian adults living off a reservation, American Indian adults living on reservation reported more experiences of discrimination (F(1, 846) = [15.94], p<.01, η² = .02) and identified more reasons for discrimination (F(1, 846) = [17.789], p<.001, η² = .02). Across residential contexts, race-related discrimination was most common, followed by gender discrimination. The relationship between discrimination and anxiety was significant in both residential contexts, while the relationship between discrimination frequency and depressive symptoms was only significant for those living outside of a tribal reservation. These findings highlight the importance of understanding how environmental context may affect patterns of discrimination and the relationship between discrimination and mental health in American Indians. Future research should elucidate resilience factors that are specific to living environments to reduce the negative impacts of discrimination on mental health for American Indian adults.

This study utilized interpretive phenomenological analysis to explore the experiences of three American Indian/Alaska Native counselors working on federal Indian reservations. Data analysis yielded four themes: the worth and weight of counseling on a reservation, the impact of culture and community on counseling, four forms of trauma impacting the counselor, and the effects of personal and professional wellness. This research contributes valuable insights into the nuanced experiences of American Indian/Alaska Native counselors working within reservation contexts and highlights the importance of addressing the unique challenges they face in delivering counseling services to their communities. Future research, support infrastructure, and counselor training initiatives should prioritize specialized training and systemic support for counselors tailored specifically to address the needs of American Indian/Alaska Native counselors and the communities they serve.

American Indians and Alaska Natives (AI/ANs) were disproportionately affected by the COVID-19 pandemic, experiencing excess hospitalization, mortality, and economic losses compared to the non- Hispanic Whites. This study sought to document the Indigenous determinants of health (IDOH) in AI/AN communities that shaped mental wellbeing for four groups: educators, traditional knowledge holders/practitioners, first responders, and substance abuse recovery community, during the pandemic. This work was a collaboration with and had research approval from three Native nations in Arizona. In-depth interviews were conducted from May to November 2021; 92 participants were interviewed. The most prevalent IDOH and associated themes included strategies to cope with emotional and social stressors and the impact on physical and mental health, relationships, kinship, cultural continuity, and self-determination. The groups experienced differences in mental wellbeing aligned with their occupation. For example, first responders experienced disruption and social dissonance in the workplace due to varying political views, and traditional knowledge holders/ practitioners experienced a revitalization of cultural strategies to maintain health. Although the differences between occupational groups are striking, the similarities that did exist were grounded in Indigenous identity and worldview that emphasize relationships and connection to the natural environment.

While ethnic racial identity (ERI) development is associated with a variety of psychological well-being outcomes, the mechanisms through which this association operates is yet to be fully explained. During adolescence, social belonging is a developmentally salient process that can play a key role in how ERI impacts well-being. We sought to explore the mediating role of belonging to peer networks in the association between ERI and self-esteem among Native American adolescents. In this cross-sectional, mediational study, we used survey data from 317 Native American students attending a reservation high school (46.9% female; M age =16). Students' levels of ERI development were measured by combining items from two scales pertaining to ethnic identity development and racial identity. We employed a structural equation modeling approach to explore the mediating role of peer belonging in the association between ERI and self-esteem. Results suggest that our 4-item index of peer belonging was an acceptable measure of this construct. Further, the significant indirect effect of peer belonging explains a notable portion (β=.22, p ≤ .05) of the total effects of ERI on self- esteem (β=.54, p ≤ .05). This finding suggests that higher levels of ERI achievement contribute to higher levels of peer belongingness, which in turn lead to improved self-esteem among students. Implications for research and practice are discussed.

This article releases the Gathering of Native Americans (GONA) Fidelity Tool to the public. The paper describes the methods in the development of the GONA Fidelity Tool and how it is used in planning, implementing, evaluating, and in further tailoring the GONA process more precisely to the community's needs and strengths. Development and revision of the tool occurred over 10 years with participation and input from 7 Urban Indian Health Organizations funded under Title V of the Indian Health Care Improvement Act, using the tool to advance local GONAs across the state of California. Participating organizations used the tool in partnership with Indigenous evaluators to measure GONA implementation. Process evaluations were conducted to support tool advancements over time and an Annual GONA Training of Facilitators provided a forum for consensus building of GONA best practices for tool revisions. Results indicate that the tool is useful in the planning, implementation, and quality improvement to advance local GONAs over time. The most effective use of the tool is when the items are adapted to the local culture, context, and spiritual practices of the community(ies) served. The tool is now being used nationally and has become an important resource for measuring practice-based evidence and community-defined evidence in the implementation of GONA for Indigenous communities.

Elder tribal members are important cultural and spiritual leaders and experts among many American Indian and Alaska Native (AI/AN) cultures. AI/AN Elders play a key role in the maintenance and transmission of traditional cultural knowledge and practices and are highly valued members of AI/AN communities. AI/AN populations face disparities in healthcare outcomes, and the healthcare needs of AI/AN Elders remain an understudied area of research, particularly among tribes in the South and for tribes who do not have federal recognition. Qualitative data was collected through semi-structured interviews among 31 women, all of whom are members of a state-recognized Tribe in the Southern United States. While the interview questions were specific to their own reproductive healthcare experiences, repeated concerns were voiced by the women regarding the health of the Elders in their community. Key findings captured several concerns/barriers regarding Elders' healthcare experiences including: (a) Language and communication barriers between Elders and healthcare workers; (b) Prior negative experiences with Western medicine; (c) Lasting impacts of educational discrimination; (d) Concerns over self-invalidation; (e) Transportation barriers; and (f) Need for community programs. Issues related to these barriers have resulted in a concern that Elders are not receiving the full benefit of and access to Western healthcare systems. The purpose of this analysis was to highlight the concerns voiced by women tribal members on the health and wellbeing of Elders in their community. Opportunities related to the importance of prioritizing and improving AI/AN Elders' healthcare experiences and access are also described.

Gardening for Health Utilizing Traditions (GHUTS) is a new diabetes prevention intervention for urban American Indian and Alaska Native (AI/AN) adults receiving mental health treatment in Los Angeles County. The two main objectives of this study are to: 1) further our understanding of diabetes prevention and the role of gardening for urban AI/AN adults receiving mental health treatment and 2) finalize the development of GHUTS. To inform the feasibility of the intervention and to gain perspective, three focus groups were conducted among urban AI/AN adults receiving mental health treatment (n = 7), providers who serve urban AI/AN people (n = 7), and the GHUTS Community Advisory Board (n = 5). Three overarching conceptual themes emerged: 1) Diabetes is an important issue among urban AI/AN people receiving mental health treatment, 2) AI/AN traditional practices have an important role in diabetes prevention among urban AI/AN adults receiving mental health treatment, and 3) Gardening is beneficial for AI/AN people. Feedback on the GHUTS curriculum featured diabetes education, cultural elements, concerns specific to AI/AN people in Los Angeles County, cooking, physical exercise and diet, prayer and mindfulness, community sharing, and field trips. This study highlights the process of developing a community-grounded diabetes prevention intervention for urban AI/AN adults receiving mental health treatment.

Native adolescents experiencing mental health challenges, including substance misuse, often prefer to seek support from their peers and other informal sources, which may be due to lack of access to, and cultural fit with, professional behavioral health services. xaʔtus (First Face) for Mental Health is a Tribal community-based intervention designed to strengthen networks of informal mental health support and open pathways to more formal support. We sought insights from key informants to optimize the planning, promotion, and delivery of First Face trainings to seven Tribal communities in the Northwest United States. We conducted three focus groups with (1) teens completing a residential chemical dependency program at the Healing Lodge of the Seven Nations (n = 10), (2) clinical staff representing the Healing Lodge's Behavioral Health Department (n = 9), and (3) community members representing educators and social service professionals at five of the Tribal nations that support the Healing Lodge (n = 6). Discussion generated planning, promotion, and training recommendations. Planning recommendations focused on showing respect for trainees' time by holding the training during convenient times and factoring in trainees' commitments to work and family, integrating the training into high school science or health education classes, and taking steps to protect trainees' physical safety in the age of COVID while avoiding "Zoom fatigue." Promotion recommendations highlighted community members' possible reluctance to become a First Face due to fear about the responsibilities associated with taking on this role and the need to emphasize the personal relevance of First Face training. In terms of training delivery, participants emphasized the importance of including engaging, interactive activities; instructing future First Faces in self-care; and acknowledging the impact of traumatic contemporary experiences on mental health, while at the same time preventing heated and distressing political debates. We describe our response to participants' recommendations and the rationale for those responses.

American Indian and Alaska Native (AI/AN) youth have the highest commercial tobacco smoking rate of any group in the United States. Unified by the aim to reduce AI/AN youth commercial tobacco use, six separately funded tobacco prevention programs serving Southern California tribes formed the Southern California Tribal Tobacco Coalition (SCTTC). Since joining forces, the SCTTC has hosted various activities and events that encourage community involvement, youth leadership, and commitment to tradition. The SCTTC's pinnacle event, the annual Inter-Tribal Tobacco Prevention Youth Summit, is an inspiring example of the organization's collaborative efforts, as it features youth- and elder-led activities and presentations by local tribal members. These community events have grown in participation from year to year and are widely supported by the surrounding AI/AN communities. This paper includes narratives from several coalition members, including youth activity organizers, that showcase the power of collaboration through the SCTTC's partnership and its success to date. The purpose of this paper is to share the SCTTC's positive impact in Southern California tribes and encourage similar programs across the nation to amplify their program impacts by forming a coalition of their own and embracing youth-led interventions.

Indigenous communities suffer from the highest rates of mental health disparities of any ethnic group in the United States, as well as experience significant amounts of historical and contemporary trauma including violence, racism, and childhood abuse. Unfortunately, the mental health workforce is unprepared to effectively work with this population due to the influence of stereotypes, bias, and lack of training. A 90-minute training for mental health agency employees using decolonizing methods was delivered to improve knowledge of and empathy for Indigenous patient populations (N = 166). Results indicated that the training increased participants' Indigenous knowledge and beliefs across demographic variables and may increase aspects of empathy including awareness. This training was feasible for a wide variety of mental health employees and resulted in increased learning about Indigenous people, which is a critical starting point for mental health professionals working with this population. Suggestions are offered to train mental health providers to deliver culturally responsive care to Indigenous clients and families and for decolonizing mental health professions.

Rates of opioid use and overdose in the United States increased during the COVID-19 pandemic, while opioid use disorder (OUD) treatment facilities faced disruptions to services during this time. American Indian and Alaska Native (AI/AN) communities were amongst those most affected by the pandemic, while also experiencing some of the highest rates of opioid-related overdose deaths. As such, this study aimed to investigate the ways in which AI/AN-servicing OUD treatment centers and their communities were impacted by the pandemic. Semi-structured interviews were conducted with ten service providers working at AI/AN-servicing OUD treatment centers between January and April 2021. Treatment centers were located in the Pacific Northwest, the North Midwest, and the South Atlantic regions, and all provided medications for OUD. Using thematic content analysis, three broad domains were identified: (1) impacts to the AI/AN communities; (2) impacts to family and social life; and (3) impacts to OUD treatment services. Our findings indicate that AI/AN clientele and communities were negatively impacted by the suspension of AI/AN traditional practices. The importance of family and community support within treatment was emphasized and how this was impacted during the pandemic, while positive changes to services brought about by the pandemic were also reported.