Alaska Native Communities Research Articles

THE CHALLENGES OF LARGE QUALITATIVE DATASETS AND MEETING THE EXPECTATIONS OF INDIGENOUS COMMUNITIES AND FUNDERS

Abstract Literature on Alaska Native Elders and how they subjectively define a successful older age is limited. The lack of a culturally specific definition often results in the use of a generic definition that portrays Alaska Native Elders as aging less successfully than their White or non-Native counterparts. However, there is very little understanding of the diverse array of successful aging experiences and how this data will translate to other racial and ethnic minority populations, as well as advance the field of successful aging. This decade long study research the concept of successful aging from an Alaska Native perspective, or what it means to age well in Alaska Native communities and the lessons Elders. Qualitative, in-depth, interviews have been conducted with 154 Elders representing 20 participating communities to explore the concept of successful aging and the role of their community in the aging process. This study highlights the four (6) elements of successful aging, or “Eldership:” emotional wellbeing, spirituality, community engagement, Native ways of life, generativity, and physical health. These elements serve as the foundation of how communities define who is an Elder and what is important when considering who has aged successfully or not. This presentation will discuss challenges of analyzing large datasets to inform future studies, the development of a theory and measure of successful aging, as well as how to balance the needs of Indigenous community partners and the funders.

A PUBLIC HEALTH APPROACH TO BRAIN HEALTH: THE HBI ROAD MAP SERIES

Abstract In 2005, congressional support led to the creation of the Healthy Brain Initiative (HBI) and the longstanding collaboration between the Alzheimer’s Association and the Centers for Disease Control and Prevention to advance understanding of and support for cognitive decline as a central part of public health practice. Since then, HBI partners have worked together to implement public health strategies that promote brain health, address dementia and help support caregivers. The Healthy Brain Initiative Road Map Series guides this effort. The first HBI Road Map was released by CDC and the Alzheimer’s Association in 2007 and was the first framework for viewing cognitive health and dementia as a public health issue. The second HBI Road Map was released in 2013 and expanded the role of state and local public health departments and partners in improving cognitive health. The third HBI Road Map, published in 2018, continued to chart a course for state and local public health departments and their partners by aligning actions with the essential services of public health. The HBI Road Map for Indian Country, published in 2019, is the first public health guide focused on dementia in American Indian and Alaska Native communities. The release of the fourth HBI Road Map in 2023 continues to advance the field and prepare public health departments to better address health equity and build capacity as new treatments become available. This symposium highlights successes of the Road Map Series and the development of the 4th edition of the HBI Road Map.

INDIGENOUS CULTURAL GENERATIVE ACTS TO REDUCE GENERATIVE MISMATCH AND IMPROVE HEALTH OF ALL GENERATIONS

Abstract The gerontological literature predominantly focuses on aging-related losses and less on the gifts we acquire as we age. Alaska Native Elders have experienced a lifetime of adversity, which persists today, but they have also remained resilient. One characteristics of successful aging among Alaska Native Elders is their commitment and passion for sharing their teachings with the youth. Generativity is concerned with using personal resources to improve the quality of life for future generations. While not commonly used in gerontological social work research, it is a cultural practice among Indigenous Elders. This decade long study has been exploring the concept of successful aging from an Alaska Native perspective, or what it means to age in a good way in Alaska Native communities. Qualitative, in-depth, interviews have been conducted with 154 Elders representing 20 participating communities across the State of Alaska to explore the concept of successful aging and the role of generativity in the aging process. For this presentation, 108 interviews with Alaska Native Elders explored successful aging. This presentation will highlight the critical role generativity plays in Alaska Native Elders’ ability age in a good way, how generativity can be adapted to bridge the generative mismatch happening between generations and support each generation to healthy and meaningful lives. This presentation will also explore innovative and culturally responsive ways to teach the youth about aging in a good way and how families and communities can support their Elders to be meaningful engaged in the rapidly changing families in the Arctic.

CYCLICAL MIGRATION IN ALASKA NATIVE ELDERS AND ITS IMPACT ON ELDERS’ IDENTITY AND LATER LIFE WELL-BEING

Abstract This paper outlines a unique culturally driven cyclical migration of Alaska Native Elders. This Indigenous cyclical migration is distinct from other previously described mobility observations in that Elders spend extended time in more than one community. We describe the cyclical migration of Alaska Native (AN) Elders and its influence on the Elders’ identity, health, and well-being. Employing a life course perspective and social theory of migration, inductive content analysis was employed to identify themes related to Elders’ cyclical migration between rural and urban communities and the impact on their identity, health, and well-being. Interviews with 125 AN Elders were conducted across five regions of Alaska: Bristol Bay, Interior, Norton Sound, Aleutian Pribilof Islands, and Southcentral. AN Elders traveled between rural and urban communities to access resources and connections critical to their identities, health, and well-being. Urban Elders maintained a connection to rural villages because they perceive them as healthier places to age based on access to traditional practices, land, and the community. Rural Elders spent extended time in urban settings to access health care services, be closer to family, and to benefit from the lower costs of living. This study builds upon existing migration theories by introducing a cyclical pattern uniquely driven by AN identity, culture, and traditional practices. Findings illustrate how AN communities can support Elders who experience cyclical migration patterns to ensure they age successfully in both locations. Future recommended research should explore cyclical migration patterns among other Indigenous populations with histories of migration.

Provider- and System-Level Barriers and Facilitators to Colonoscopy and Multi-Target Stool DNA for Colorectal Cancer Screening in Rural/Remote Alaska Native Communities.

The Alaska Tribal Health System is working to increase colorectal cancer (CRC) screening among Alaska Native people, who experience the highest CRC rates in the world. This study examined CRC screening provider- and system-level barriers and facilitators from the perspective of healthcare providers serving Alaska Native people in rural/remote communities. A total of 28 provider (physicians, advanced practice, and Community Health Aides/Practitioners) interviews were held from 1 February to 30 November 2021. Colonoscopy provider-level barrier themes included time, competing priorities, and staffing, while system-level barriers included travel costs, weather, and the COVID-19 pandemic. Multi-target stool DNA (mt-sDNA) barrier themes included test viability and unfamiliarity, and previous stool tests experiences. For both tests, limited medical record reminders was a major barrier. Facilitator themes for both tests included community outreach, cultural competency and patient navigation, and clinic/system improvements. In-depth interviews with tribal health providers showed that adding mt-sDNA testing may help address system-level colonoscopy barriers such as waitlists and travel costs, but other barriers remain. Further research is needed into patient barriers and facilitators, as well as the effectiveness of integrating mt-sDNA into a geographically dispersed tribal health system to reduce cancer disparities and build equity in CRC prevention among Alaska Native people.

Supporting Traditional Foodways Knowledge and Practices in Alaska Native Communities: The Elders Mentoring Elders Camp.

The transmission of generational knowledge in Alaska Native communities has been disrupted by colonization and led to declining health among Alaska Natives, as evidenced by the loss of knowledge regarding traditional foods and foodways and increasing rates of cardiometabolic disorders impacting Alaska Natives. Elders play a central role in passing down this generational knowledge, but emerging Elders may have difficulty in stepping into their roles as Elders due to the rapid social and cultural changes impacting their communities. The Center for Alaska Native Health Research (CANHR) and the Denakkanaaga Elders Program are partnering with the Center for Indigenous Innovation and Health Equity to uplift and support traditional food knowledge and practices to promote health in Alaska Native communities. Guided by a decolonizing and Indigenizing framework, researchers at CANHR are working with Athabascan Elders in the Interior of Alaska to strengthen and protect the intergenerational transmission of cultural knowledge and practices for emerging Elders. This community-academic partnership will implement and evaluate an Elders Mentoring Elders Camp to focus on repairing and nurturing relationships through the practice and preservation of cultural knowledge and practices, including traditional foodways. This initiative contributes to the intergenerational transmission of knowledge, which is necessary to keep culture alive and thriving.

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.

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.

The CPT1A Arctic variant: perspectives of community members and providers in two Alaska tribal health settings.

Newborn screening in Alaska includes screening for carnitine palmitoyltransferase 1A (CPT1A) deficiency. The CPT1A Arctic variant is a variant highly prevalent among Indigenous peoples in the Arctic. In this study, we sought to elicit Alaska Native (AN) community member and AN-serving healthcare providers' knowledge and perspectives on the CPT1A Arctic variant. Focus groups with community members and healthcare providers were held in two regions of Alaska between October 2018 and January 2019. Thematic analysis was used to identify recurring constructs. Knowledge and understanding about the CPT1A Arctic variant and its health impact varied, and participants were interested in learning more about it. Additional education for healthcare professionals was recommended to improve providers' ability to communicate with family caregivers about the Arctic variant. Engagement with AN community members identified opportunities to improve educational outreach via multiple modalities for providers and caregivers on the Arctic variant, which could help to increase culturally relevant guidance and avoid stigmatization, undue worry, and unnecessary intervention. Education and guidance on the care of infants and children homozygous for the CPT1A Arctic variant could improve care and reduce negative psychosocial effects.

Wellness Tour for Tribal Communities During the COVID-19 Pandemic: Uniting Sacred Space with Western Medicine to Prevent Substance Use

Substance use disorders (SUD) and overdose deaths worsened further during the Covid-19 pandemic in American Indian and Alaska Native (AIAN) communities. The Native Dad’s Network (NDN) delivered the Wellness Tour, offering cultural activities and SUD prevention education, from March 2021 to June 2022, to 11 AIAN tribal communities across California. The in-person program created a “sacred space” through culturally congruent song, dance, and prayer. SUD education included: a lecture about opioids and SUD; group talking circles; an educational skit led by adolescents; and training in naloxone and fentanyl testing strip use along with supplies. After the day-long program, 341 participants agreed strongly on a 5-point Likert type question that it improved their quality of life (mean = 4.7). Among 243 respondents, agreement was strong (mean = 4.8) to two Likert-type questions about cultural relevance and confidence in using naloxone. This AIAN-led program adopted safe practices during the pandemic to deliver culturally congruent SUD prevention education to severely affected AIAN communities.

Mobile Mental Health Applications for American Indian and Alaska Native Communities: Review and Recommendations

Mobile Mental Health Applications for American Indian and Alaska Native Communities: Review and Recommendations

Experiences With and Access to Evidence-Based Health Promotion Programs for Older American Indian, Alaska Native, and Native Hawaiian Peoples.

Evidence-based programs (EBPs) work effectively for participants whose characteristics match those of the EBP research participants. However, EBPs have been almost exclusively developed and evaluated for the general U.S. population with limited American Indian, Alaska Native, and Native Hawaiian (AI/AN/NH) community engagement. Thus, an AI/AN/NH Evidence-Based Program Advisory Council sought to identify AI/AN/NH peoples' experiences with and access to EBPs. We held 20 listening sessions with AI/AN/NH Elder services program staff (n = 118) and with AI/AN/NH Elders (n = 82) and conducted a self-administered online survey with Title VI Directors (n = 63). The six themes that emerged from the listening sessions with staff included misunderstanding community engagement, valuing fidelity over flexibility, lack of cultural awareness, assumptions about available infrastructure, unrealistic implementation timelines, and funding restrictions. Listening session themes with Elders included definitions of aging well, participation motivators, preferred activities, participation barriers, and unmet needs. Survey data indicated that programming of greatest interest for Elders as identified by Title VI Directors and staff included and/or addressed cultural activities (81%), socialization (75%), diabetes (73%), caregiving (68%), and nutrition (68%). Seventy-six percent of survey respondents had heard of EBPs and 24% indicated that EBPs were not being implemented in their community. The Advisory Council developed specific action steps with the goal of improving AI/AN/NH communities' access to culturally appropriate and feasible EBPs. The steps require collective action from federal agencies, national partners, EBP program developers and administrators, local organizations, and Elders to ensure EBPs are accessible and culturally appropriate for AI/AN/NH Elders.

“In the beginning, I said I wouldn't get it.”: Hesitant adoption of the COVID-19 vaccine in remote Alaska between November 2020 and 2021

Achieving sufficient COVID-19 vaccination coverage has been hindered in many areas by vaccine hesitancy. Many studies based on large survey samples have characterized vaccine refusal, but there are fewer in-depth qualitative studies that explore hesitant adoption: the middle-ground between vaccine acceptance and refusal, and how individuals may move across this continuum depending on their lived experience. For this paper, we use the narratives of 25 adults living in off-road, predominately Alaska Native communities to describe the complex decision-making processes undertaken by ‘hesitant adopters’, defined in our study as those who completed their initial COVID-19 series despite reporting hesitancy. Interviewees' stories help illustrate how hesitant adopters' decision-making processes involved making sense of information through interactions with trusted individuals, lived experiences, observations, emotions, and personal motivations. For the majority of these hesitant adopters' (n = 20, 80%) interpersonal interactions were key in helping to make the decision to get vaccinated. Over half of the interviewees (n = 14, 56%) described how conversations with individuals they trusted, including healthcare providers, family, friends, and interactions through their professional network made them feel safe. One third of the hesitant adopters (n = 7, 28%) attributed their decision to get vaccinated based on the influence of Alaska Native Elders including their knowledge, personal experiences, as well as being motivated by the desire to protect them. Independent research was also important to about a quarter of hesitant adopters (n = 6, 24%), and for these interviewees it was the process of gathering information on their own and learning from others, especially healthcare providers who could answer their questions and alleviate their concerns. This paper illustrates the temporality of vaccine decision-making: vaccine acceptance for those who are hesitant may be an ongoing process that is influenced by personal experience, relationships, and context.

COVID-19 vaccine hesitancy among American Indian and Alaska native college students: the roles of discrimination, historical trauma, and healthcare system distrust.

For American Indians and Alaska Native (AIAN) and other communities of color, experiences with discrimination and historical trauma may contribute to healthcare system distrust and negatively affect health care decisions, including vaccination. A saturated path analysis was conducted to examine the direct and indirect associations of thoughts regarding historical losses (of culture, language, and traditional ways) and AIAN racial discrimination with historical loss associated distress, healthcare system distrust, and COVID-19 vaccine hesitancy among AIAN college students (N = 391). Historical loss thoughts and experiences with racial discrimination were strongly associated with each other, and both were uniquely associated with greater historical loss associated distress. In turn, historical loss associated distress was associated with greater healthcare system distrust, which in turn was associated with greater likelihood of being COVID-19 vaccine hesitant. While further research is needed, the findings suggest that to address health disparities for AIAN people it is necessary to consider how to best overcome healthcare system distrust and factors that contribute to it, including historical trauma and contemporary experiences with discrimination.

Knowledge Shared by Alaska Native Commercial Salmon Set Gillnetters in Norton Sound to Reduce Marine Fatalities

ABSTRACT Objectives The goal of this exploratory pilot study was to reduce marine fatalities in Norton Sound using knowledge shared from Alaska Native salmon set gillnetters in Unalakleet, AK. The following objectives to address this goal were: 1) identify factors that influence safety for Alaska Native commercial set gillnetters in Norton Sound; 2) use findings from objective 1 to improve commercial fishing training, education, and resources; and 3) disseminate and communicate results from objective 1 to commercial fishers in the Norton Sound fleet, commercial fishing safety partners, and the Alaska Native injury prevention community. Methods Ten semi-structured interviews were conducted with Alaska Native commercial set gillnetters in Unalakleet, AK. We utilized knowledge shared to identify factors that influence safety for their fleet. Using an Interpretative Phenomenological Analysis Methodology, 10 interviews were recommended for a homogenous sample. Results Most participants learned to fish at a young age from the family, with safety lessons passed on by family members. Fishing is a lifestyle and interconnected with harvesting and a way of living. Set gillnetters in Norton Sound use open skiffs and have limited access to workable Personal Flotation Devices (PFDs) and safety training. Participants reported health benefits but also negative long term physical effects, financial stress, and difficulty fishing with age. Respect and awareness of the ocean was reported as the most important strategy to reduce risk. Stories were shared of falls overboard, capsizing, and local fatalities and hazards, such as being overloaded with fish, entanglement, and maneuvering a small boat in large waves. Stronger winds and shifting weather patterns were experienced from climate change. Conclusion This exploratory pilot study identified factors that influence safety for Alaska Native commercial set gillnetters. Findings should be used to 1) determine best methods to influence behaviors to reduce risks in this hazardous fishery; 2) increase awareness and promote expanded application of best practices, equipment, and resources; 3) encourage and promote outreach initiatives targeted for this unique population; and 4) develop tailored training programs for commercial fishing in an open skiff. Research with Alaska Native fishing communities will require value and respect of indigenous knowledge, collaboration with local people, and follow-up to bring findings back to the community.

Cancer Screening Prevalence among Participants in the Southcentral Alaska Education and Research towards Health (EARTH) Study at Baseline and Follow-Up.

Alaska Native communities are working to prevent cancer through increased cancer screening and early detection. We examined the prevalence of self-reported colorectal (CRC), cervical, and breast cancer screening among Alaska Native participants in the southcentral Alaska Education and Research toward Health (EARTH) study at baseline (2004-2006) and ten-year follow-up (2015-2017); participant characteristics associated with screening; and changes in screening prevalence over time. A total of 385 participants completed questionnaires at follow-up; 72% were women. Of those eligible for CRC screening, 53% of follow-up participants reported a CRC screening test within the past 5 years, significantly less than at baseline (70%) (p = 0.02). There was also a significant decline in cervical cancer screening between baseline and follow-up: 73% of women at follow-up vs. 90% at baseline reported screening within the past three years (p < 0.01). There was no significant difference in reported breast cancer screening between baseline (78%) and follow-up (77%). Colorectal and cervical cancer screening prevalence in an urban, southcentral Alaska Native cohort declined over 10 years of follow-up. Increased cancer screening and prevention are needed to decrease Alaska Native cancer-related morbidity and mortality.

Opposing growth trends in juvenile and mature Humpback Whitefish within the upper Tanana River drainage, Alaska, revealed using otolith biochronology

AbstractObjectiveWithin areas of Alaska, Humpback Whitefish Coregonus pidschian are an important subsistence resource for many Alaska Native communities. Recently, Humpback Whitefish in the upper Tanana River drainage were reported to be smaller at a given age and reach smaller maximum sizes than fish sampled 20 years ago. The objective of this study was to identify the factors that influence annual growth of Humpback Whitefish within the upper Tanana River drainage based on an analysis of otolith increments.MethodsA series of mixed‐effects models were used to determine the relative importance of biotic (i.e., age, age at capture) and abiotic (i.e., year, sampling time period) factors on the growth of Humpback Whitefish. Juvenile (&lt;5 years of age) and mature (≥5 years of age) growth periods were examined separately due to the unique habitats occupied by each life stage. Climate variables were correlated with the mature Humpback Whitefish biochronology to assess environmental drivers of adult growth.ResultBiochronologies spanning over three decades (1982–2018) revealed patterns of variation in Humpback Whitefish otolith growth across years. A negative temporal trend spanning the entire study period was evident for juvenile growth, while a mostly positive trend was observed for mature growth. Between time periods, otolith growth was significantly different from zero for juvenile (estimate: −0.087; 95% CI = −0.151 to −0.023) but not mature (estimate: −0.030; 95% CI: −0.092 to 0.032) growth periods. Several environmental factors were positively (i.e., mean monthly temperature, growth degree days) and negatively (e.g., snow depth) correlated with the mature Humpback Whitefish biochronology. However, the model with mean April snow depth was the best‐performing environmental model.ConclusionThese results suggest years with elevated snow depths negatively impact mature Humpback Whitefish growth. Cumulatively, these results illustrate the importance of juvenile growth periods and how early‐in‐life declines in growth may not be offset by above average growth as adults and help further our understanding of how environmental conditions influence growth.

Non-pharmacotherapeutic Management of Alcohol Use Disorder in the Alaska Native Population: A Narrative Review.

Alcohol use disorder (AUD) is a leading preventable cause of death in the United States and has had a greater health impact on Alaska Natives than on any other racial group. To date, AUD in these communities has had wide-reaching negative impacts contributing to high rates of suicide, homicide, and accidents. A variety of genetic, experiential, social, and cultural factors have been associated with this trend. For decades, the Alaska Native subgroup has received inadequate treatment. The purpose of this review is to evaluate current trends in effective interventions and to help answer the question: What may comprise a successful non-pharmacotherapeutic interventional strategy to treat and prevent AUD in Alaska Natives?A database literature search was performed in September 2022 using the PubMed library. Search terms included (alcohol use disorder) AND ((Alaska OR Alaskan) Native). Inclusion criteria included full-text articles, a focus on specific non-pharmacotherapeutic treatment strategies, and a publication date after 2005. Studies that did not evaluate non-pharmacotherapeutic interventions, evaluated a population other than Alaska Natives, evaluated a disorder other than AUD,were written in a language other than English, or were editorials or opinion pieces were excluded. The selected studies were assessed for bias utilizing the Newcastle-Ottawa Scale (NOS). Twelve studies were included in this review. This review found that early social network intervention, incentive-driven programs, culturally-driven programs, and motivational interviewing are promising non-pharmacotherapeutic interventions in the treatment of AUD in Alaska Native communities. Evidence suggests that a shift in focus to the accentuation of protective factors and the mitigation of isolation as a risk factor, rather than on the reduction of more intractable risk factors, may be associated with improved outcomes in treating AUD. The literature also suggests that successful prevention strategies should be driven by indigenous knowledge and grounded in community and culture. This study has its limitations. These include a lack of direct comparisons between studies, a lack of pooled statistical analysis or synthesis, and a lack of quantitative analysis. Instead, the majority of data is gathered from more bias-prone cross-sectional studies and, thus, should be used to provide insight into potential risk factors and non-pharmacologic therapies effective in this population rather than as strong evidence in favor of one therapeutic regimen over another. For this, there is a need for more clinical trials evaluating treatments for AUD in this population.This review received support from the University of South Florida Department of Psychiatry. There were no sources of funding for this work from any institution. There are no competing financial or non-financial interests that may be interested in this work. This review is not registered. This review does not have a prepared protocol.

Cyclical Migration in Alaska Native Elders and Its Impact on Elders' Identity and Later Life Well-Being.

This paper outlines the unique culturally driven cyclical migration of Alaska Native (AN) Elders, distinct from previously described migration patterns in that Elders spend extended time in more than one community. We describe this Indigenous cyclical migration of AN Elders and its influence on their identity and later life health and well-being. Interviews with 124 AN Elders were conducted across 5 regions of Alaska: Bristol Bay, Interior, Norton Sound, Aleutian Pribilof Islands, and Southcentral. Within this sample, 87 participants engaged in cyclical migration. Thematic analysis was employed to identify themes related to Elders' cyclical migration between rural and urban communities and the impact on their identity and later life health and well-being. We identified 2 distinct patterns of Indigenous cyclical migration-Elders living primarily in rural communities migrating to urban communities and Elders living primarily in urban communities migrating to rural communities. Elders engaged in these 2 patterns of cyclical migration to maintain cultural practices, access social, and health care services to maintain their physical health and well-being, and continue their community roles contributing to their AN Elder identity. This study builds upon existing migration theories by introducing a cyclical pattern uniquely driven by AN identity, culture, and traditional practices. Findings illustrate how AN communities can support Elders who experience cyclical migration patterns to ensure they age successfully in both locations. Future research should explore cyclical migration patterns among other Indigenous populations with migration histories.

The Push to Integrate Mid-Level Providers into Dentistry

The Push to Integrate Mid-Level Providers into Dentistry