Indigenous Adults Research Articles

Development and validation of an HPV infection knowledge assessment scale among Aboriginal and Torres Strait Islander Peoples

BackgroundAn increased incidence of Human Papillomavirus (HPV) infection and its related cancers has been observed in recent years. Correct knowledge about HPV infection can lead to a significant decrease in transmission and a subsequent increase in vaccine uptake. Awareness and behavioural perception towards HPV infections are critical for improving HPV vaccination rates among Aboriginal and/or Torres Strait Islander Peoples. However, to the best of our knowledge, there has been no instrument designed to measure knowledge about HPV infection that is culturally appropriate and validated among Aboriginal and/or Torres Strait Islander People. AimTo address this research gap, this paper aims to examine the psychometric properties of the HPV Knowledge Tool (HPV-KT) in an Indigenous population sample from South Australia. MethodologyData from 747 Indigenous Australian Adults who participated in the 12-month follow-up of the HPV and Oropharyngeal Carcinoma in Indigenous Australians Study was utilised for this study. The psychometric properties examined included1) dimensionality and item redundancy; (2) network loadings; (3) model fit; (4) criterion validity; and (5) reliability. The network model was estimated using the Graphical Least Absolute Shrinkage and Selector Operator (GLASSO). Evaluation of the HPV-KT (10 items) dimensionality and item redundancy was conducted within the framework of Exploratory Graph Analysis (EGA). Reliability was evaluated with the McDonald’s Omega (ω) coefficient. ResultsAfter the exclusion of two items, the HPV-KT exhibited good psychometric properties for Aboriginal and/or Torres Strait Islander Peoples. The two dimensions of “General HPV Knowledge” and “Commonness of HPV” were identified. The dimension of “Commonness of HPV” displayed poor reliability, so a sum score for this subscale is not recommended (i.e. the items can still be used individually) The network model of the 7-item HPV-KT was fitted in the validation sample and model fit was adequate (x2 (7) = 17.17, p < 0.016; CFI = 0.980; TLI = 0.94; RMSEA = 0.063, 90% CI = 0.025–0.010). Furthermore, the reliability of the “General HPV Knowledge” subscale (ω = 0.76, 95% CI: 0.72–0.79), while the reliability of the “Commonness of HPV” subscale (ω = 0.58, 95% CI0.58–0.88) was poor. ConclusionThe HPV-KT was adapted for an Aboriginal and/or Torres Strait Islander population and is readily available for future use in Australia. The addition of items assessing specifications of HPV infection, natural history and behaviour will improve the reliability and usability to assess the level of accurate knowledge about HPV infection. Future studies should investigate the possibility of developing new items for the dimension ‘Commonness of HPV’.

The Indigenous Australian Human Papillomavirus (HPV) Cohort Study 2, Continuation for 5 to 10 Years: Protocol for a Longitudinal Study.

Human papillomavirus (HPV) infection, a common sexually transmitted disease, is associated with cancers of the cervix, vulva, vagina, penis, anus, and head and neck. Oropharyngeal squamous cell carcinoma (OPSCC; throat cancer) is a type of cancer involving the head and neck area that is rapidly increasing across the globe. There are higher rates of OPSCC among Indigenous populations relative to non-Indigenous Australian populations, although the HPV-attributable fraction remains unknown. For the first time at a global level, we plan to extend an Indigenous Australian adult cohort to monitor, screen, and ultimately prevent HPV-associated OPSCC and to undertake extensive cost-effectiveness modelling around HPV vaccination. This study aims to (1) extend follow-up to a minimum of 7 years post recruitment to describe the prevalence, incidence, clearance, and persistence of oral HPV infection; and (2) conduct clinical examinations of the head and neck, oral cavity, and oropharynx and collect saliva samples for early-stage OPSCC testing. We will continue to implement a longitudinal design for the next study phase, where we will ascertain the prevalence, incidence, clearance, and persistence of oral HPV infection at 48, 60, and 72 months; undertake clinical examinations/saliva assessments to detect early-stage OPSCC; and refer for treatment. The primary outcome measures are changes in oral HPV infection status, biomarker measures of early HPV-related cancer, and clinical evidence of early-stage OPSCC. Participant 48-month follow-up will commence in January 2023. The first results are expected to be submitted for publication 1 year after 48-month follow-up begins. Our findings have potential to change the way in which OPSCC among Australian Indigenous adults is managed, with desired impacts including cost-savings on expensive cancer treatments; improved nutritional, social, and emotional outcomes; and improved quality of life for both Indigenous adults and the Indigenous community more broadly. Continuing a large, representative Indigenous adult cohort to track oral HPV infection and monitor early OPSCC is essential to yield critical information to include in the management armamentarium of health and well-being recommendations for Australia's First Nations. PRR1-10.2196/44593.

Disability and Suicidal Ideation among Indigenous Adults in Canada: Cultural Resources as Contingencies

Objectives The present study asks: Is disability associated with suicidal ideation among Indigenous adults in Canada? And if so, do cultural resources—as measured by cultural identity affect, cultural group belonging, cultural engagement, and cultural exploration—modify this association? Methods Data were from a nationally representative sample of First Nations peoples living off-reserve, Métis, and Inuit across Canada—the 2017 Aboriginal Peoples Survey (N = 16,125). A series of weighted logistic regression models were performed. Results Indigenous adults with disabilities were significantly more likely than those without disabilities to report suicidal ideation, even after controlling for socio-demographic characteristics and physical and mental health conditions. At the same time, people with multiple disabilities were at greater risk for suicidal ideation, with the largest association among those with five or more disabilities. Furthermore, the detrimental association between disability status and suicidal ideation attenuated among those who reported cultural group belonging. In a similar vein, the buffering role of cultural group belonging was also observed in the association between the number of disabilities and suicidal ideation. Conclusions This study provides compelling evidence that disability is a risk factor for suicidal ideation among Indigenous adults and that cultural group belonging plays a stress-buffering role in this relationship.

Oaxaca Resurgent: Indigeneity, Development, and Inequality in Twentieth-Century Mexico

In Oaxaca Resurgent, A. S. Dillingham explores the paradoxes of Mexican indigenista education and development in the Mixteca Alta. Indigenista thought “simultaneously cast the ‘Indian’ as the origin of national identity, a barrier to be overcome, and a source of inspiration for a multicultural future” (4). Indigenismo sought to recognize Native communities, but their resistance defied expectations. Triqui women of San Andrés Chicahuaxtla frowned and stared at the ground in the photographs of anthropologist Frederick Starr. Decades later, an elderly Mixtec man scolded a teacher: “Damn, Ramón. We sent you to Mexico [City] to learn la castilla [Spanish] so you could return and teach it to us. Now it turns out you want to teach us in our own language?” (58). Throughout the mountainous western region, the teachers, agriculturalists, and other promotores bilingües like Ramón joined Indigenous communities to engage, reject, and reshape state initiatives to modernize living standards.Dillingham captures the dissonant voices and visions that indigenistas represented. Early chapters explore economic development and inequality during the sexenios of Adolfo Ruiz Cortines (1952–58) and Adolfo López Mateos (1958–64), Spanish literacy campaigns, and land and labor systems. Anthropologists of the Instituto Nacional Indigenista (INI) Julio de la Fuente and Alejandro Marroquin, and the economist Moisés de la Peña, associated Indigeneity with colonialism. They reported that local mestizo elites, mine owners, forestry officials, merchants, coffee estate coyotes, and parasitic agraristas exploited Mixtecs at the Tlaxiaco market. For its short-wave radio broadcasts in both Spanish and Mixtec, INI hired Ramón Hernández López of San Agustín Tlacotepec and fifty other radio auxiliary teachers (nine were women) to educate Mixtecs over the radio station XEINI. The broadcasts invoked declarations that God or the devil spoke Mixtec. Two-hour daily lessons covered languages, literacy, and math and reached forty-nine schools at a time when children traveled miles to classrooms with a week’s worth of tortillas and no formal sleeping arrangements. In 1963, INI resettlement of Mixtecs to Oaxaca’s Costa Chica erupted into racial violence that required federal intervention.Dillingham devotes later chapters to Third Worldist development strategies, dissident trade unionism, and anti-colonial multiculturalism. The Oaxaca State Institute of Social Research and Integration (IIISEO) adopted anti-colonialist pedagogies during Luís Echeverría’s presidency (1970–76). Leading critics of indigenista policy, Guillermo Bonfil Batalla, Margarita Nolasco, and Mercedes Olivera deployed INI to politicize Indigenous claims to rights and autonomy. University students seized coordinating centers and demanded professional training. IIISEO director Gloria Ruiz de Bravo Ahuja hired Nolasco and recruited Indigenous children and young adults to promote their culture. IIISEO educators embraced the New Left, formed the Coalición de Promotores Culturales Bilingües (CPCB), and coordinated strikes until the PRI shuttered the organization in 1977. A year later, Santiago Salazar, Eva Ruiz, and the Coalition of Indigenous Promoters of Oaxaca (CMPIO) occupied the SEP building until President José López Portillo (1976–82) and the national teacher’s union Sindicato Nacional de Trabajadores de la Educación (SNTE) honored their demands. Dillingham argues that Oaxacan teachers who declared their own multicultural visions for rural education, development, and equality predated the critique of neoliberalism and the Zapatista uprising in 1994. The rise of the Pátzcuaro Ethnolinguistic Program, decline of the SIL, and publication of school textbooks in twenty-two Indigenous languages (including Tutu sa’an ñuu savi, my first-grade Mixtec book) further valorized bilingual teachers. CMPIO’s resurgent anti-colonial agenda blossomed into the 2006 Oaxacan social movement, which “drew on decades of teacher activism and the strength of Oaxacan community ties” (187).Dillingham’s research on the Mixteca Alta presents myriad perspectives over decades, granting vast dimensions to a subject difficult to historicize and problematize. With exceptional gifts in interpretation, empathy, and exposition, he might consider producing an authoritative study of nineteenth-century Indigenous Oaxaca.

Dietary Patterns of Off-Reserve Indigenous Peoples in Canada and Their Association with Chronic Conditions

Nationally representative nutrition surveys (Canadian Community Health Survey (CCHS) Cycle 2.2, Nutrition 2004 and 2015) were used to examine dietary patterns and their association with socioeconomic/sociodemographic factors and chronic conditions in off-reserve Indigenous population in Canada. A cluster analysis was used to identify dietary patterns (DPs), and the Nutrient Rich Food Index (NRF 9.3) was used as the diet quality score and stratified by age/gender groups. In 2004 (n = 1528), the dominant DPs among Indigenous adults (age = 41 ± 2.3) were "Mixed" (mean NRF = 450 ± 12) and "Unhealthy" among men (mean NRF = 426 ± 18), "Fruits" among women (mean NRF = 526 ± 29), and "High-Fat/High-Sugar" among children (age = 10.2 ± 0.5) (mean NRF = 457 ± 12). In 2015 (n = 950), the dominant DPs were "Unhealthy" (mean NRF = 466 ± 6), "Mixed" (mean NRF = 485 ± 21), Healthy-Like (mean NRF = 568 ± 37), and "Mixed" (mean NRF = 510 ± 9) among adults (age = 45.6 ± 2.2), men, women, and children (age = 10.9 ± 0.3) respectively. The majority of Indigenous peoples had the "Unhealthy" DP with a low diet quality, which may contribute to a high prevalence of obesity and chronic diseases. The income level and smoking status among adults and physical inactivity among children were recognized as important factors that may be associated with the dietary intake of off-reserve Indigenous population.

Associations of Cultural Characteristics with Sedentary Behaviour and Screen Time Among Indigenous Adults in Saskatchewan.

Indigenous Peoples: First Nations, Métis and Inuit, have experienced significant disruptions of physical, mental, emotional and spiritual health and well-being through centuries of ongoing colonization and assimilation. Consequently, breakdown of cultural connections, increasingly sedentary lifestyles and high levels of screen time contribute to health inequity experiences. The purpose of this study is to examine associations of cultural connectedness with sedentary behaviour and the influence of relocation from home communities for Indigenous Peoples in Saskatchewan. Cultural connectedness, sedentary and screen time behaviour were evaluated through online questionnaires among 106 Indigenous adults. Within Indigenous identities, 2 × 2 factorial ANOVA compared cultural connectedness scores with sedentary behaviour and traditional activity participation by relocation from home communities. Among First Nations and specifically Cree/Nehiyawak who relocated from home communities, positive associations of cultural connectedness scores with sedentary behaviour and screen time were identified, with no associations identified among those not relocating. Among Métis who did not relocate, greater ethnic identity, identity, spirituality and cultural connectedness (57.8 ± 5.36 vs. 81.25 ± 16.8; p = 0.02) scores were reported among those reporting 5 or more hours of continuous sitting. Cultural connectedness associations with sedentary behaviour depend on relocation from home communities and differ between First Nations and Métis. Understanding associations of sedentary behaviour specific to First Nations and Métis populations may enable appropriate strategies to improve health outcomes.

Psychosocial support for indigenous informal caregivers in Colombia

PurposeThis paper aims to analyze how psychosocial support influences caring activities toward indigenous older adults.Design/methodology/approachA descriptive study with the participation of 229 informal indigenous caregivers. The study considered both sociodemographic and medical variables. It used the mini-mental test to determine the cognitive level in the elderly. It applied the Yesavage and Zarit scales to establish depressive symptomatology and caregiver burden. Finally, the study used the MOS psychosocial support and Apgar screening questionnaires to assess the psychosocial dimension and the patient’s family functional state, respectively.FindingsThe study observed a low caregiver burden effect using the MOS questionnaire. This may be explained due to variability in the Zarit Scale Score product of other variables like years of care (−0.17 and −0.28), depressive symptoms (0.16 and 0.18), cognitive level (mini-mental) (−0.13 and −0.14) and comorbidity (0.26 and −0.27). The study obtained an incidence between (−0.02 and −0.12) when including all assessed dimensions into the model. The instrumental dimension in the social support questionnaire obtained the highest score.Originality/valueProtective factors prevail in the group of indigenous caregivers allowing this activity to not trigger overload. Yet, variables such as the female gender, some comorbidities and the presence of depressive symptoms could be potential variables for dysfunction in this occupational role.

Provision of Dental Care to Indigenous South Australians and Impacts on Improved General Health: Study Protocol.

Indigenous South Australians carry a disproportionate burden of dental diseases, with approximately 80 percent of Indigenous adults having both periodontal disease and dental caries. The chronic inflammatory nature of many dental conditions means there are widespread systemic impacts, particularly on type 2 diabetes, chronic kidney disease and cardiovascular disease. Evidence suggests there are barriers experienced by Indigenous South Australians in accessing timely and culturally safe dental care. This study aims to: (1) elicit the views of Indigenous South Australians regarding their perspectives of what comprises culturally safe dental care; (2) provide such dental care and; (3) assess any changes in both oral and general health using point-of-care testing following receipt of timely, comprehensive and culturally safe dental care. This mixed-methods study will involve qualitative interviews and an intervention without randomisation. The qualitative component will comprise seeking perspectives of Indigenous South Australians regarding what culturally safe dental care means for them. For the intervention component, participants will take part in oral epidemiological examinations at baseline and 12-month follow-up (after receipt of dental care), which will include collection of saliva, plaque and calculus, as well as completion of a self-report questionnaire. The primary outcome measures-changes in type 2 diabetes (HbA1c), cardiovascular disease (CRP) and chronic kidney disease (ACR)-will be obtained by blood/urine spot from a finger prick/urine collection at baseline and 12-month follow-up via point-of-care testing. Participant recruitment will commence in July 2022. The first results are expected to be submitted for publication one year after recruitment begins. The project will have a number of important outcomes, including increased understanding of what culturally safe dental care means for Indigenous South Australians, the delivery of such care, and empirical evidence of how culturally safe dental care leads to better prognosis for chronic diseases linked with poor oral health. This will be important for health services planning, especially in the Aboriginal Community Controlled Health Organisation sector, where the management of dental diseases in a culturally safe manner for better chronic disease outcomes is currently insufficiently understood, planned and budgeted for.

The Weaving Healthy Families program: Promoting parenting practices, family resilience, and communal mastery.

Parenting quality, family resilience, and community resilience and support have been found to be primary protective factors for the disproportionate burden of anxiety, posttraumatic stress disorder (PTSD), substance use disorder (SUD), depression, and suicide that US Indigenous youth and adults tend to experience. The purpose of this research study was to examine pilot results for outcomes related to relational factors for Indigenous family members who participated in the Weaving Healthy Families (WHF) program (translated to Chukka Auchaffi' Natana, in the Choctaw tribal language), a culturally grounded and empirically informed program geared toward promoting wellness, family resilience, parenting practices, and community resilience while also preventing SUD and violence. This nonrandomized pre-experimental pilot intervention followed a longitudinal design, which included pre-test, a post-test, and a 6-, 9-, and 12-month post-intervention follow-up surveys. Repeated-measures regressions were utilized with generalized estimating equations (GEE) to examine changes in parenting, family resilience, and communal mastery before and after the intervention for 24 adults and adolescents (12-17) across eight tribal families. Results indicate that the overall quality of parenting improved, as measured by improved parental monitoring and reductions in inconsistent discipline and corporal punishment. We identified sex differences in positive parenting, poor monitoring, and corporal punishment, with greater decreases in these measures among males over time. Family resilience and communal mastery improved for adolescent and adult participants after the WHF program. Our results indicate promising improvements across relational, familial, and community ecological, which provide clear clinical implications.

Belajar SenangJer: A Mobile Application for Illiterate Indigenous Adults

During the Fourth Industrial Revolution (IR 4.0) era, personal electronic devices such as smartphones, laptops, and computers have become common in an individual’s daily activities. These devices have been used to communicate with others through various social media platforms such as Facebook, Youtube, Wechat, Whatsapp, and others. When the globe is facing the pandemic Covid-19, the importance of the devices had become more significant, along with the increased usage of digital wallets to enable contactless payments. Without literacy skills, an individual is far more likely to live in poverty and may be isolated in a world increasingly dependent on electronic devices. Although the Government of Malaysia has been putting a lot of effort to ensure that indigenous people’s education system is at a reasonable level, there are no significant and robust changes. The illiterate indigenous adults might still be left behind due to their inability to read. Thus, the main objective of this study is to develop a specialized user-friendly mobile educational application prototype to reduce the illiteracy rate among indigenous adults in Malaysia Personal Extreme Programming (PXP), which is the derivative of the Extreme Programming (XP) of the agile method was adopted to develop the mobile. The application is being developed with the intention to reduce the illiteracy rate among indigenous adults in Malaysia. The overall findings indicate that respondents are satisfied with Belajar SenangJer as it facilitates the learning of Malay language through flashcards and videos. In the future, the user interface of Belajar SenangJer could be improved by providing a voice guidance function and matching games. The application could be expanded to learn more languages, such as English and Mandarin.

Loneliness and Psychosocial Resources among Indigenous and Afro-Descendant Older People in Rural Areas of Chile.

(1) Background: loneliness is a problem that becomes increasingly acute in old age, with greater repercussions among socially disadvantaged groups such as indigenous and Afro-descendant older adults. The aim of this research is to analyze the psychosocial variables related to loneliness in old age. (2) Methods: a multi-ethnic sample was involved, with the participation of eight indigenous peoples and Afro-descendant tribal people (n = 1.348). Various gerontological scales previously validated among the Chilean population (De Jong Gierveld Loneliness Scale, Brief Resilient Coping Scale, Health Problems Questionnaire, and Family APGAR questionnaire) and a model are contrasted, establishing the relationship between psychosocial variables and loneliness. (3) Results: Structural equation modeling (SEM) showed the existence of indirect relationships between health problems, via family functioning and resilience, and loneliness. Resilience and family functioning were directly related to loneliness (WLSMV-χ2 (df = 345) = 875.106, p < 0.001; CFI = 0.992; TLI = 0.991; RMSEA = 0.034 [C.I. 90% = 0.031-0.037]). (4) Conclusions: loneliness has cross-culturally affected older Chilean people living in rural areas and it appears that the COVID-19 pandemic has had a negative effect on well-being. This study proves that loneliness is related to several psychosocial variables that can be intervened.

Cultural Infusions and Shifting Sands

Indigenous young adults experience disproportionately high rates of unemployment, which are exacerbated by systemic factors such as poverty and oppression (Britten &amp; Borgen, 2010). Despite these challenges, many Indigenous young adults do well in their educational and employment pursuits (Bougie et al., 2013). This study explored what helped and hindered the career decision-making of 18 Indigenous young adults in Canada who see themselves as doing well in this regard. Using the Enhanced Critical Incident Technique (ECIT), a qualitative research method which focuses on helping and hindering factors (Butterfield et al., 2009), 13 categories were identified: (a) Family/Relationships &amp; commitments, (b) Setting goals/Taking initiative/Focusing on interests, (c) Support from community/mentors, (d) A healthy way (physical, mental, social), (e) Finding meaning/motivation &amp; contributing, (f) Networking &amp; who you know, (g) Systemic/External factors (institution, job-market, sexism, racism, interpersonal aspects), (h) Financial situation, (i) Knowledge/Information/Certainty, (j) Experience (work/life), (k) Educational opportunities/Training &amp; specialized education, (l) Indigenous background/Cultural factors, and (m) Courage &amp; self-worth (vs. fear/doubt in self/others). These categories highlighted the systemic, interpersonal, and experiential processes in career decision-making for Indigenous young people in Canada. Implications for career counselling practice and future research are also discussed.

The willingness to forgive among the Wayuu and among people from other indigenous communities in Colombia

Introduction/aim: Willingness to forgive has been studied in different situations, however, there are no published studies in Colombia with indigenous populations and taking into account their worldview. The present research was aimed at examining the willingness to forgive of people from various ethnic minorities in Colombia such as the Embera, Nasa, Pijao and Kaamash-Hu communities and focusing in particular on the Wayuu community. Method: An experimental design was used and a cluster analysis was performed. The sample was composed of 159 indigenous adults (30% male) between the ages of 18 and 76, who were shown a series of scenarios describing a common situation in which an orchard was damaged by domestic animals belonging to a neighbour. Three factors were manipulated in the scenario: the severity of the damage, the level of carelessness of the animals’ owner, and the animals’ owner’s explanations and apologetic behaviour. Results: Cluster analysis yielded five qualitatively different positions: Never forgive under any circumstances (6% of the sample, primarily participants from the Embera community), Depends on apology and neglect (15%), Depends on apology, consequences, and neglect (30%, primarily participants from the Kaamash-Hu community), and Almost always forgive (36%, primarily people from the Wayuu community). Conclusion: Thus, there is a convergence between the results of this study and the anthropological observations of the participating ethnic communities. Forgiveness is closely linked to the cosmovision of each indigenous group.

FINDING THE MINDS OF OUR ELDERS: TESTING THE MINORITY STRESS AND COGNITION MODEL WITH INDIGENOUS OLDER ADULTS

Abstract This study used data from the Health and Retirement Study (HRS) data to investigate how an understudied group of Indigenous Older Adults (IOAs) in the United States fared over a 14-year period (2006-2020) in the domain of global cognitive function. The number of IOAs, defined here as Native American and Alaska Natives, will more than double in the next 30 years. Concurrently, the number of IOAs living with cognitive impairments will also increase. Guided by the Minority Stress and Cognition Model, we tested the hypothesis that discriminatory stress increases the risk of cognitive impairment in later life. Using a robust set of psychosocial (e.g. educational quality, perceived everyday discrimination experiences), behavioral (e.g. substance use, exercise), and physiological (e.g. diabetes, hypertension, obesity) risk factors, we modeled the cognition trajectories 186 IOAs using mixed growth curves. We found that one third of these IOAs reported experiencing everyday discrimination at least once per month, the highest of any ethnic group. They also reported high rates of other risk factors for cognitive impairment like low education, SES, and physical activity, and high rates of depression and chronic health conditions. Our analysis found that everyday discrimination was negatively associated with total cognition among IOAs but that this relationship was mediated by allostatic loads. On average, the total cognition scores of IOAs declined significantly faster than those of Whites. This study has important implications for the integration of stress as a mechanism for cognitive decline and the health equity of Indigenous older adults.

CULTURAL AND SOCIAL ACTIVITIES AND MENTAL HEALTH AMONG INDIGENOUS OLDER ADULTS IN THE UNITED STATES

Abstract Although the number and percentage of indigenous older adults are growing, little is known about the risk and protective factors associated with mental health among this population. We estimated regression models for mental health using data from the 2017-2020 needs assessment of indigenous elders (aged 55+) administered by the University of North Dakota, which included 19,143 indigenous elders, including 17,184 American Indians, 1,521 Alaska Natives, and 438 Native Hawaiians. The Mental Health Index (MHI) was used, with five questions: during the past month, how much of the time (1) were you a happy person, (2) have you felt calm and peaceful, (3) have you been a very nervous person, (4) have you felt downhearted and blue, and (5) have you felt so down in the dumps that nothing could cheer you up? The answers for MHI-5 were standardized on a 0-100 scale, where higher scores indicate optimal mental health. Having ADL and/or IADL difficulties was associated with worse mental health. Frequent engagement in social activities was positively associated with mental health. Data also suggest that those engaged in cultural practice all the time compared to people who engaged in cultural practice less frequently had higher levels of MHI-5, controlling for other variables. These findings underscore the importance of cultural activities, as well as social activities and physical health, in the management of mental health.

LEVERAGING COMMUNITY-BASED KNOWLEDGE TO ADDRESS THE NEEDS OF OLDER ADULTS FROM RACIAL/ETHNIC MINORITY POPULATIONS

Abstract Racially and ethnically minoritized older adults constitute the fastest-growing demographic in the United States. Yet, they are largely underrepresented in population-based studies of aging despite NIH policies encouraging inclusion since the mid-1980s. The resulting and continued exclusion of racially and ethnically diverse populations in aging research limits efforts to elucidate and better understand the determinants of health and healthy aging to improve the lives of minoritized older adults, their families, and/or communities. To enhance the inclusion of racially and ethnically minoritized older adults in recruitment, survey development, analysis, and dissemination efforts, this symposium focuses on leveraging community-based knowledge that centers the lived experiences of community members that are needed to improve health outcomes and equitable changes, especially with the ongoing COVID-19 pandemic. The first paper in this symposium highlights how Community-Based Participatory Advocacy is used in the Dine community, which includes working with indigenous older adults and decolonizing methodologies to facilitate community healing. The second paper focuses on developing culturally informed instruments to collect data on dementia care needs and resources among African immigrants. A third paper focuses on critical lessons learned in Project RAMA that provided crucial insights for a new initiative focused on Hispanic immigrant families affected by rheumatoid arthritis in Washington, DC, including recruiting through embedded community clinics and integrating community needs into the study design. The final paper discusses the meaningful inclusion of Asian American older adults regarding their demographic diversity and prioritizing engagement of community members and community-based organizations in the survey research process.

Young Adult Development Indicators for Indigenous and Non-Indigenous People: A Cross-National Longitudinal Study.

Worldwide, Indigenous youth face ongoing challenges and inequalities. Increasing our understanding of life course patterns in Indigenous youth will assist the design of strategies and interventions that encourage positive development. This study aimed to increase understanding of resilience and positive development in Indigenous and non-Indigenous youth across Australia and the United States of America. The Australian sample comprised 9680 non-Indigenous and 176 Pacific Islander and Aboriginal and Torres Strait Islander peoples. The USA sample comprised 2258 non-Indigenous and 220 Pacific Islander, Native Hawaiian and Native American/American Indian peoples. Data were used to examine how Indigenous background, volunteering, and community involvement at average age 15 years (Grade 9) predicted five young adult positive development indicators: Year 12 (Grade 12) school completion, tertiary education participation, independent income, paid employment, and intimate relationship formation from age 18 to 28 years. Multilevel regression analyses revealed that while Indigenous youth showed slower increases in positive young adult development over time, when adjusting for socioeconomic disadvantage, there was a reduction in this difference. Moreover, we found that Grade 9 community involvement and volunteering were positively associated with young adult development for Indigenous and non-Indigenous youth. Findings indicate the importance of addressing structural inequalities and increasing adolescent opportunities as feasible strategies to improve positive outcomes for young Indigenous adults.

Mental health and cultural continuity among an urban Indigenous population in Toronto, Canada.

Mental health and psychiatric disorders significantly affect individuals on personal and social levels. Indigenous populations in Canada have disproportionately high rates of mental health diagnoses. Our Health Counts (OHC) Toronto assessed mental health, racism, family disruption, and cultural continuity among urban Indigenous people. The objectives of this study were to understand (1) the demographics and characteristics of Indigenous adults with a diagnosed psychological/mental health disorder and (2) potential associations of psychological/mental health diagnoses with experiences of colonization and cultural continuity among Indigenous adults in Toronto. Using community-based participatory research methods, Indigenous adults in Toronto were recruited by respondent-driven sampling (RDS) to complete a comprehensive health assessment survey. RDS-II weights were applied to calculate population-based estimates, and adjusted odds ratios with 95% confidence intervals were produced using logistic regression, controlling for age and gender. Among Indigenous adults, nearly half (45%) reported receiving a mental health diagnosis. Participants reported lifetime anxiety disorders (53%), major depression (51%), and high rates of suicide ideation (78%). Of Indigenous adults with a diagnosed mental health disorder, 72.7% reported participating in ceremony. Attending residential schools (OR: 7.82) and experiencing discrimination (OR: 2.69) were associated with having a mental health disorder. OHC Toronto responded to the gaps in health assessment data for urban Indigenous people. Despite historic and ongoing trauma, Indigenous people have maintained cultural practices and a strong sense of identity. Efforts aimed at supporting Indigenous well-being must respond to the roots of trauma, racism, and existing Indigenous community knowledge and strengths.

Developing an Ethnographic Community‐Based Participatory Research Dementia Study with Diverse Indigenous Populations: Indigenous Cultural understandings of Alzheimer’s disease and related dementias – Research and Engagement (ICARE) project

AbstractBackgroundDementia diagnoses have been increasing in Indigenous populations for over a decade and have now surpassed rates in non‐Indigenous populations in both Canada and the U.S. Prevalence rates of Alzheimer’s Disease and Related Dementias (ADRD) are approximately 3 times higher in Indigenous populations compared to White populations, with a 10‐year earlier onset . The ICARE project (NIH –5R56‐AG‐62307‐2) qualitatively explores the impact of ADRD in Indigenous populations across four diverse sites in Canada and the United States.MethodWe used a community‐based participatory research (CBPR) approach and a two‐eyed seeing framework to establish research partnerships with four Indigenous communities/regions: 7 Anishinaabe First Nations on Manitoulin Island, Ontario Canada; Red Lake Tribal Nation, Minnesota; Grand Portage Tribal Nation, MN; and the Oneida Nation, Wisconsin. The community engagement strategy supported the infrastructure needed to conduct dementia research in a culturally safe and appropriate way that respects Tribal Sovereignty.ResultIndigenous community‐based researchers were hired at each site and each underwent research training designed by the ICARE team. With guidance from local leadership, we established 8–12‐member community advisory groups at each site to serve as partners to guide the research. We collected preliminary ethnographic data on social determinants of health, demographics, community health, aging and dementia specific services. We demonstrated feasibility with pilot data collection of key informant interviews with Traditional Knowledge Keepers, Administrators, and Providers (n = 54) and sequential focus groups with local health care staff and formal caregivers that work with Indigenous older adults (n = 17).ConclusionNIH/NIA R56 funding resulted in the establishment of the community‐based infrastructure to support on‐going ADRD research in the four diverse communities. We demonstrated the feasibility of supporting community‐engaged dementia research partnerships with Indigenous communities who have differing cultural, political and historical contexts. This foundation is supporting the expansion of ICARE into a 5‐year ethnographic research study aimed at creating a foundational ethnographic database of AI/FN lived experience of ADRD across the disease trajectory that can be examined to inform the creation of culturally appropriate and safe approaches to improve dementia diagnostics, care, and outreach (NIH‐R01‐AG‐62307‐2).

Population-level contribution of interpersonal discrimination to psychological distress among Australian Aboriginal and Torres Strait Islander adults, and to Indigenous–non-Indigenous inequities: cross-sectional analysis of a community-controlled First Nations cohort study

International and population-specific evidence identifies elevated psychological distress prevalence among those experiencing interpersonal discrimination. We aim to quantify the potential whole-of-population contribution of interpersonal discrimination to psychological distress prevalence and Indigenous-non-Indigenous gaps in Australia. We did a cross-sectional analysis of data from Mayi Kuwayu: the National Study of Aboriginal and Torres Strait Islander Wellbeing. Baseline surveys were completed between June 8, 2018, and Sept 28, 2022. We analysed responses from participants who were aged 18 years or older at survey completion, whose surveys were processed between Oct 1, 2018, and May 1, 2021. Sample weights were developed on the basis of national population benchmarks. We measured everyday discrimination using an eight-item measure modified from the Everyday Discrimination Scale and classified experiences as racial discrimination if participants attributed these experiences to their Indigeneity. Psychological distress was measured using a validated, modified Kessler-5 scale. Applying logistic regression, we calculated unadjusted odds ratios (ORs), to approximate incident rate ratios (IRRs), for high or very high psychological distress in relation to everyday discrimination and everyday racial discrimination across age-gender strata. Population attributable fractions (PAFs), under the hypothetical assumption that ORs represent causal relationships, were calculated using these ORs and population-level exposure prevalence. These PAFs were used to quantify the contribution of everyday racial discrimination to psychological distress gaps between Indigenous and non-Indigenous adults. 9963 survey responses were eligible for inclusion in our study, of which we analysed 9951 (99·9%); 12 were excluded due to responders identifying as a gender other than man or woman (there were too few responses from this demographic to be included as a category in stratified tables or adjusted analyses). The overall prevalence of psychological distress was 48·3% (95% CI 47·0-49·6) in those experiencing everyday discrimination compared with 25·2% (23·8-26·6) in those experiencing no everyday discrimination (OR 2·77 [95% CI 2·52-3·04]) and psychological distress prevalence was 49·0% (95% CI 47·3-50·6) in those experiencing everyday racial discrimination and 31·8% (30·6-33·1) in those experiencing no everyday racial discrimination (OR 2·06 [95% CI 1·88-2·25]. Overall, 49·3% of the total psychological distress burden among Aboriginal and Torres Strait Islander adults could be attributable to everyday discrimination (39·4-58·8% across strata) and 27·1% to everyday racial discrimination. Everyday racial discrimination could explain 47·4% of the overall gap in psychological distress between Indigenous and non-Indigenous people (40·0-60·3% across strata). Our findings show that interpersonal discrimination might contribute substantially to psychological distress among Aboriginal and Torres Strait Islander adults, and to inequities compared with non-Indigenous adults. Estimated PAFs include contributions from social and health disadvantage, reflecting contributions from structural racism. Although not providing strictly conclusive evidence of causality, this evidence is sufficient to indicate the psychological harm of interpersonal discrimination. Findings add weight to imperatives to combat discrimination and structural racism at its core. Urgent individual and policy action is required of non-Indigenous people and colonial structures, directed by Aboriginal and Torres Strait Islander peoples. National Health and Medical Research Council of Australia, Ian Potter Foundation, Australian Research Council, US National Institutes of Health, and Sierra Foundation.