Alaska Native Youth Research Articles

P3.393 Iknowmine.org - a Comprehensive Wellness Website For Alaska Native Youth

BackgroundAlaska has some of the highest rates of Chlamydia and gonorrhoea in the United States. The Centers for Disease Control and Prevention (CDC) ranked Alaska #1 for Chlamydia and #3...

O22.5 Providing Discrete and Reliable STD Testing in Alaska Via a Web-Based At-Home Service

BackgroundAlaska has one of the highest rates of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in the United States. Alaska Native people, women and youth (ages 15–29) are disproportionately affected....

Lived Challenges and Getting Through Them

Because of imposed rapid social change, Alaska Native youth are growing up in a context different from their elders and suffering far worse health and behavioral outcomes. This research seeks to understand (a) their everyday struggles and life challenges, (b) the practices and resources they rely on to get through challenges, and (c) the meaning they make from these experiences. Data were generated from interviews with 20 Alaska Native youth between the ages of 11 and 18 years, balanced by gender and age-group (early and late adolescence). Purposive sampling identified participants with a broad range of experiences. Following a semistructured guide, youth participated in face-to-face, audio-recorded interviews, transcribed verbatim. A codebook was developed using an iterative process and transcripts were coded using ATLAS.ti. The most commonly identified stressors were relationship loss, "not being there for me," nonsupportive/hostile experiences, transitioning into adulthood, and boredom. Resilience strategies included developing and maintaining relationships with others, being responsible, creating systems of reciprocity, practicing subsistence living, and giving back to family and the community. These opportunities allowed youth to gain a sense of competence and mastery. When difficult experiences align with opportunities for being responsible and competent, youth are most likely to exhibit resilience.

Promoting Positive Youth Development and Highlighting Reasons for Living in Northwest Alaska Through Digital Storytelling

Using a positive youth development framework, this article describes how a 3-year digital storytelling project and the 566 digital stories produced from it in Northwest Alaska promote protective factors in the lives of Alaska Native youth and serve as digital "hope kits," a suicide prevention approach that emphasizes young people's reasons for living. Digital stories are short, participant-produced videos that combine photos, music, and voice. We present process data that indicate the ways that digital stories serve as a platform for youth to reflect on and represent their lives, important relationships and achievements. In so doing, youth use the digital storytelling process to identify and highlight encouraging aspects of their lives, and develop more certain and positive identity formations. These processes are correlated with positive youth health outcomes. In addition, the digital stories themselves serve as reminders of the young people's personal assets--their reasons for living--after the workshop ends. Young people in this project often showed their digital stories to those who were featured positively within as a way to strengthen these interpersonal relationships. Evaluation data from the project show that digital storytelling workshops and outputs are a promising positive youth development approach. The project and the qualitative data demonstrate the need for further studies focusing on outcomes related to suicide prevention.

Development of a tobacco cessation intervention for Alaska Native youth

Tobacco cessation treatments have not been evaluated among Alaska Native (AN) adolescents. This pilot study evaluated the feasibility and acceptability of a targeted cessation intervention developed for AN youth. Intervention components were informed by prior focus groups assessing treatment preferences among AN youth, a social cognitive theoretical framework and feedback obtained from a teen advisory group. The intervention consisted of a weekend program where youth traveled by small airplane from their villages to stay overnight with other adolescents who quit tobacco use together. The program included recreational activities, talking circles, personal stories from elders and teen advisors, and cognitive behavioral counseling. Two intervention pilots were conducted from October 2010 to January 2011 using a non-randomized, uncontrolled study design with assessments at baseline and six-week follow-up. One village in Western Alaska was selected for each pilot with a targeted enrollment of 10 adolescents each. Participants were recruited for each pilot within five days, but recruitment challenges and “lessons learned” are described. The first pilot enrolled nine adolescents (all female) aged 13–16 years; all nine attended the intervention program and 78% (7/9) completed follow-up. The second pilot enrolled 12 adolescents (eight females, four males) aged 12–17 years, of which seven attended the intervention program. Six of these seven participants (86%) completed follow-up. In both pilots, participants rated the intervention as highly acceptable. A targeted cessation intervention was feasible and acceptable to AN youth. The intervention will be tested for efficacy in a subsequent randomized controlled trial.

Umyuangcaryaraq “Reflecting”: Multidimensional Assessment of Reflective Processes on the Consequences of Alcohol Use among Rural Yup’ik Alaska Native Youth

Background and aims: Concerns in some settings regarding the accuracy and ethics of employing direct questions about alcohol use suggest need for alternative assessment approaches with youth. Umyuangcaryaraq is a Yup’ik Alaska Native word meaning “Reflecting.” Objectives: The Reflective Processes Scale was developed as a youth measure tapping awareness and thinking over potential negative consequences of alcohol misuse as a protective factor that includes cultural elements often shared by many other Alaska Native and American Indian cultures. This study assessed multidimensional structure, item functioning, and validity. Methods: Responses from 284 rural Alaska Native youth allowed bifactor analysis to assess structure, estimates of location and discrimination parameters, and convergent and discriminant validity. Results: A bifactor model of the scale items with three content factors provided excellent fit to observed data. Item response theory analysis suggested a binary response format as optimal. Evidence of convergent and discriminant validity was established. Conclusion: The measure provides an assessment of reflective processes about alcohol that Alaska Native youth engage in when thinking about reasons not to drink. Scientific significance: The concept of reflective processes has potential to extend understandings of cultural variation in mindfulness, alcohol expectancies research, and culturally mediated protective factors in Alaska Native and American Indian youth.

Patterns of Protective Factors in an Intervention for the Prevention of Suicide and Alcohol Abuse with Yup’ik Alaska Native Youth

Background: Community-based participatory research (CBPR) with American Indian and Alaska Native communities creates distinct interventions, complicating cross-setting comparisons. Objective: The objective of this study is to develop a method for quantifying intervention exposure in CBPR interventions that differ in their forms across communities, permitting multi-site evaluation. Methods: Attendance data from 195 youth from three Yup’ik communities were coded for the specific protective factor exposure of each youth, based on information from the intervention manual. The coded attendance data were then submitted to latent class analysis to obtain participation patterns. Results: Five patterns of exposure to protective factors were obtained: Internal, External, Limits, Community/family, and Low Protection. Patterns differed significantly by community and youth age. Conclusion: Standardizing interventions by the functions an intervention serves (protective factors promoted) instead of their forms or components (specific activities) can assist in refining CBPR interventions and evaluating effects in culturally distinct settings.

Community First: Fighting Childhood Obesity in American Indian and Alaska Native Youth

Community First: Fighting Childhood Obesity in American Indian and Alaska Native Youth

Alaska Native and Rural Youth Views of Sexual Health: A Focus Group Project on Sexually Transmitted Diseases, HIV/AIDS, and Unplanned Pregnancy

The disparity in rates of sexually transmitted diseases (STDs), HIV/AIDS, and unplanned pregnancy between Alaska Native (AN) and non-AN populations, particularly among young adults and females, is significant and concerning. Focus groups were conducted to better understand the knowledge, attitudes, and beliefs of rural Alaska youth (both AN and non-AN) and communities regarding STDs, HIV/AIDS, and unplanned pregnancy and to determine the best methods to educate and facilitate behavior change in AN youth regarding these issues. A convenience sample of AN and rural youth (n = 105) from 5 communities in Alaska, ages 15-24 years, participated in 21 focus groups. Focus group participants were divided by sex and age. We assessed themes related to knowledge, attitudes, and beliefs about STDs, HIV/AIDS, and unplanned pregnancy, as well as perceptions of how youth prefer to learn about sexual health issues. The major themes identified were: (1) sexual health is not viewed only in relation to a physical act; (2) there is a basic understanding of sexual health, but youth have a lot of unanswered questions pertaining to STDs and HIV/AIDS; (3) sexual health messages should be delivered via the Internet and school; (4) youth want to hear messages promoting STD/HIV testing and condom use; (5) easier access to condoms is needed; (6) alcohol and drug use affect sexual behavior and risk taking; and (7) issues of confidentiality and embarrassment affect health care-seeking behaviors for sexual health issues. One of the fundamental principles of public health practice is community participation, which asserts that success in achieving change is enhanced by the active participation of the intended audience in defining their own high-priority solutions. Our findings-driven by youth themselves-are critical in designing and implementing future sexual health interventions and promoting greater community involvement and acceptance.

We Will be Known Forever by the Tracks we Leave: Rising up to Meet the Reproductive Health Needs of American Indian and Alaska Native Youth

Many U.S. adolescents of all races/ethnicities engage in multiple behaviors that increase their risk for poor reproductive health outcomes (Eaton, 20101; Everett Jones, Anderson, Lowry, & Conner, 2011; Ramisetty-Mikler & Ebama, 2011; Rutman, Park, Castor, Taualii, & Forquera, 2008). American Indian and Alaska Native (AI/AN) youth are disproportionately affected by poor reproductive health outcomes, including high rates of sexually transmitted diseases (STDs) and teen pregnancy. Peer-reviewed literature on AI/AN reproductive health issues is sparse and often not generalizable to all AI/AN because of small and geographically specific study populations. In the limited studies that have been conducted, some have shown high rates of STDs and teen pregnancy among AI/AN adolescents may result from a lack of familial support, a history of sexual and physical abuse, and early sexual debut (Palacios & Kennedy, 2010); alcohol and substance use and low and inconsistent condom use (Kaufman, 2006); and multiple sex partners (Marsiglia, Nieri, & Stiffman, 2006). The Journal of American Indian and Alaska Native Mental Health Research disseminated the call for submissions for this special issue through its extensive formal and informal networks. The journal received 11 submissions; 9 of those are included in this special issue of the journal and 2 will appear in a later issue. No submission was rejected. Authors were instructed to attain necessary approvals prior to submission. Every author was assigned a mentor to help polish and finalize the manuscripts; the articles were reviewed by two external reviewers with expertise in the manuscripts’ subject areas. We hope that this special journal issue on sexual risk behaviors and assets among AI/AN youth will lead to increased attention and efforts to meet the health care needs of Native youth and that the tracks that we leave will lead to the elimination of health disparities. STD rates among AI/AN youth are among the highest in the country. In 2009, non-Hispanic AI/ANs had the second highest rates of STDs in the U.S.; compared to non-Hispanic White (NHW) youth, they were 4.5 times as likely to be diagnosed with chlamydia, more than three times as likely to be diagnosed with gonorrhea, and twice as likely to be diagnosed with primary or secondary

Circle of Life HIV/AIDS-prevention intervention for American Indian and Alaska Native youth.

This article describes the objectives, theoretical bases, development process, and evaluation efforts to-date for the Circle of Life (COL) curricula, HIV/AIDS prevention interventions designed for American Indian and Alaska Native (AI/AN) youth. The curricula are based on Indigenous models of learning and behavior encompassing concepts of Western theories of health behavior change. The curricula underwent extensive national and community review. Subsequent advances include the development of a computer-based version of the intervention.

Use of cognitive question testing methodologies in participant action research: Implementing the three-step test-interview method in Indian county.

This study describes the use of cognitive question testing methods to pretest a Web-based questionnaire designed to gather information from American Indian and Alaska Native (AI/AN) youth between the ages of 18 and 25. The questionnaire included items related to risk and resiliency factors as well as potentially sensitive topics of victimization and delinquency. Question testing was completed with a sample of 15 youth living in three different regions of the United States. The Three Step Test Interview Method was modified to collect information related to interface usability, cognitive response, and cultural interpretation of survey items. Data collected from the question testing process resulted in questionnaire changes that included query wording, the inclusion and exclusion of survey items based on cultural input, the reordering and rendering of survey items, and improvements in interface usability. Implications for survey research with the AI/AN youth population are discussed.

The Brief Family Relationship Scale

The Relationship dimension of the Family Environment Scale, which consists of the Cohesion, Expressiveness, and Conflict subscales, measures a person’s perception of the quality of his or her family relationship functioning. This study investigates an adaptation of the Relationship dimension of the Family Environment Scale for Alaska Native youth. The authors tested the adapted measure, the Brief Family Relationship Scale, for psychometric properties and internal structure with 284 12- to 18-year-old predominately Yup’ik Eskimo Alaska Native adolescents from rural, remote communities. This non-Western cultural group is hypothesized to display higher levels of collectivism traditionally organized around an extended kinship family structure. Results demonstrate a subset of the adapted items function satisfactorily, a three-response alternative format provided meaningful information, and the subscale’s underlying structure is best described through three distinct first-order factors, organized under one higher order factor. Convergent and discriminant validity of the Brief Family Relationship Scale was assessed through correlational analysis.

Alcohol/Drug Exposure, HIV-Related Sexual Risk Among Urban American Indian and Alaska Native Youth: Evidence From a National Survey

Migration of the native populations from reservations to the urban areas has resulted in mixed ethnicities of American Indian/Alaskan Native (AIAN) children. Minority youth require special attention and services in urban schools as they disproportionately experience poverty, low educational attainment, unemployment, and single-parent status. We used 2005 and 2007 Youth Risk Behavior Survey data to examine alcohol/drug use patterns and their association with sexual risk taking among AIAN only (single-racial) and biracial youth in combination with White, African American, or Hispanic ethnicities (N = 1178). Overall, one half of the students were sexually active, with significantly higher rates among males; AIAN-Black students initiated sex earlier than the other groups. Condom nonuse is higher among AIAN-Whites (>50%) compared to one third of AIAN-Hispanics and one fourth of AIAN-Blacks. Nearly 10% of all students, except AIAN-Blacks, reported lifetime use of heroin/meth. Sexual behavior was significantly associated with episodic drinking. Students with Hispanic background have twice the odds of being sexually active compared to AIANs. Our findings underscore growing health care needs and targeted prevention initiatives for mixed racial underserved native youth. Urban school settings have potential to deliver services and offer alcohol/drug prevention programs to address the needs of mixed racial native urban youth. Using the School Based Health Clinic model has been successful; we need to reform prevention approaches to accommodate needs of multiracial urban native youth.

Assessment of awareness of connectedness as a culturally-based protective factor for Alaska native youth.

Research with Native Americans has identified connectedness as a culturally based protective factor against substance abuse and suicide. Connectedness refers to the interrelated welfare of the individual, one's family, one's community, and the natural environment. We developed an 18-item quantitative assessment of awareness of connectedness and tested it with 284 Alaska Native youth. Evaluation with confirmatory factor analysis and item response theory identified a 12-item subset that functions satisfactorily in a second-order four-factor model. The proposed Awareness of Connectedness Scale (ACS) displays good convergent and discriminant validity, and correlates positively with hypothesized protective factors such as reasons for living and communal mastery. The measure has utility in the study of culture-specific protective factors and as an outcomes measure for behavioral health programs with Native American youth.

Recognizing the Payoff for Investing in Prevention

Early in August, we had a major victory for prevention. The U.S. Department of Health and Human Services released requirements for new health insurance plans to cover eight preventive women’s health services at no cost for women (Institute of Medicine 2011). The recommended services are screenings for gestational diabetes, cervical cancer, HIV, and sexually transmitted infections; lactation counseling and breastfeeding support; screening and counseling for domestic violence; contraception; and yearly preventive care visits. These services were recommended by the Institute of Medicine Committee on Preventive Services for Women, who carefully considered the evidence upon which they based their recommendations. Major victories such as this one are the result of years of research from prevention scientists to understand modifiable risk factors; develop and test methods of screening and intervention; translate effective programs into practice; conduct effectiveness studies that also examine cost, dissemination, and adoption; and conduct methodological studies to strengthen the ways in which we research these topics. Manuscripts in this issue address important prevention topics such as drug use prevention in youth, the promotion of positive behaviors among young girls, an environmental intervention to increase access to fresh fruits and vegetables, the prevalence and emergence of cigar and cigarillo use among teens, suicide prevention, prevention of abuse, and ways Native American youth access health information. Studies in this issue reflect the prevention research continuum, from conducting needs assessments to more rigorous randomized designs. For example, the Rushing and Stephens article examines new technological avenues for reaching American Indian and Alaska Native youth, finding that as many as 75% of those youth reported searching online for health information. These data are already being used to design technology-based interventions for this high-risk population. At the other end of the research spectrum, Portwood and colleagues conducted a randomized trial to examine the impact of a primary prevention program, finding that the Adults and Children Together Against Violence Parents Raising Safe Kids program is a promising strategy to reduce child maltreatment in diverse communities. Another article by Cross and colleagues reminds us of the importance of training others to be agents of public health by examining approaches to better enhance and maintain suicide prevention gatekeeper skills over time. S. R. Tortolero (&) Health Promotion and Behavioral Sciences, The University of Texas School of Public Health, Houston, TX, USA e-mail: Susan.Tortolero@uth.tmc.edu

Use of Media Technologies by Native American Teens and Young Adults in the Pacific Northwest: Exploring Their Utility for Designing Culturally Appropriate Technology-Based Health Interventions

American Indian and Alaska Native (AI/AN) youth are disproportionally burdened by many common adolescent health issues, including drug and alcohol use, injury and violence, sexually transmitted infections, and teen pregnancy. Media technologies, including the Internet, cell phones, and video games, offer new avenues for reaching adolescents on a wide range of sensitive health topics. While several studies have informed the development of technology-based interventions targeting mainstream youth, no such data have been reported for AI/AN youth. To fill this gap, this study quantified media technology use among 405 AI/AN youth (13-21years old) living in tribes and urban communities in the Pacific Northwest, and identified patterns in their health information-seeking practices and preferences. Overall, technology use was exceptionally common among survey respondents, mirroring or exceeding national rates. High rates of online health information seeking were also reported: Over 75% of AI/AN youth reported searching online for health information. These data are now being used by the Northwest Portland Area Indian Health Board and NW tribes to design culturally-appropriate, technology-based health interventions targeting AI/AN youth.

Best Practices Guidelines for Nurse Practitioners Regarding Smoking Cessation in American Indian and Alaskan Native Youth

The greatest prevalence of tobacco use in the United States occurs with the American Indian and Alaskan Native (AI/AN). A critical need exists for a culturally specific tobacco cessation option for AI/AN youth. The nurse practitioner is positioned to provide a culturally specific commercial tobacco cessation option by incorporating the transcultural nursing theory into the development of a decision tree to expand understanding of culturally appropriate best practices regarding screening and management of tobacco smoking cessation in AI/AN youth. Presented is the Nurse Practitioner Culturally Specific American Indian and Alaskan Native Youth Decision Tree for Smoking Cessation with supporting evidence-based best practices.

The home food environment is associated with child traditional food intake: an analysis of parent-child dyads in rural, remote Alaska Native communities

Traditional foods are the underpinning of diet quality in rural, remote Alaska Native communities. Relatively low intake of traditional foods among Alaska Native children is therefore of concern. We conducted formative research to understand the influence of the home food environment on child intake of traditional foods. Two 24-hour recalls were collected from 29 Yup'ik Eskimo parent and child dyads using NDSR software. A survey assessing perceptions and availability of traditional foods was administered. Overall, intake of traditional foods was significantly lower among children than parents. Child intake of traditional foods, however, was positively correlated with parent intake (r= 0.70, P<0.01). Child intake of traditional foods was higher among those whose parents placed a greater importance on eating traditional foods. Findings suggest that interventions targeting parents may be an effective strategy to increase intake of traditional foods and improve diet quality among Alaska Native youth. Supported by NIH grant P20-RR016430

Youth-Onset Type 2 Diabetes Among American Indians and Alaska Natives

Youth-onset type 2 diabetes has emerged as a significant public health concern for American Indians and Alaska Natives. Data from the National Institutes of Health longitudinal epidemiological study among the Pima Indians of southern Arizona and the Indian Health Service continue to document a rising incidence and prevalence of type 2 diabetes among American Indian and Alaska Native youth. Although national trends related to lack of physical activity and to unhealthy nutrition behaviors have contributed to the epidemic, the adverse conditions created by poverty, social injustice, trauma, and cultural disruption are also important in understanding the underlying causes for this public health crisis. This adverse environment is likely to provide little support for healthy nutrition and physical activity behaviors as well as other diabetes self-care behaviors. Known risk factors from the Pima Indian studies, such as intrauterine exposure to diabetes, bottle-feeding, and obesity, provide a basis for worthwhile intervention strategies. In this article, the author will review the current literature on the epidemiology of youth-onset type 2 diabetes among American Indians and Alaska Natives, discuss causes for the diabetes epidemic among American Indians and Alaska Natives, review risk factors for youth-onset type 2 diabetes in this population, and share promising youth physical activity promotion programs created and implemented specifically for American Indian and Alaska Native youth. However, more research on interventions to address the Native communities' psychosocial issues and concerns around youth-onset type 2 diabetes is urgently needed.