Native Adolescents Research Articles

Do different dimensions of ethnic identity reduce the risk of violence among Asian American and Pacific Islander adolescents in Hawai‘i?

ABSTRACTThis study examines whether different dimensions of ethnic identity are associated with reduced risk of violence among an understudied population: Asian American and Pacific Islander adolescents. Drawing from survey data of 298 Native Hawaiian, Samoan, Japanese, and Filipino adolescents in Hawai‘i, this study focuses on whether three dimensions of ethnic identity (“affirmation and belonging,” “ethnic identity achievement,” and “other-group orientation”) related to overall and different types of violence. Results of the multivariate analyses reveal that higher levels of ethnic identity achievement are associated with reduced risk of overall violence and family/partner violence, which suggests that this dimension is a beneficial social-psychological resource. Contrary to our expectations, higher levels of ethnic affirmation and belonging are associated with attacking someone. In addition, other-group orientation has no relationship with violence. Implications of our findings regarding distinct effects for different dimensions of ethnic identification are discussed pertaining to developmental research and violence prevention.

Identifying Protective Factors to Promote Health in American Indian and Alaska Native Adolescents: A Literature Review.

Exposure to protective factors, conditions that protect against the occurrence of an undesirable outcome or promote the occurrence of a desirable outcome within an adolescent's environment, can foster healthy adolescent behaviors and reduce adult morbidity and mortality. Yet, little is known about the nature and effect of protective factors on the positive social and health outcomes among American Indian and Alaska Native (AIAN) adolescents. We conducted a review of the literature to identify the protective factors associated with positive health outcomes among AIAN adolescents. We consulted Elsevier Science Direct, ERIC EBSCOhost, PubMed, and the Web of Science databases. A total of 3421 articles were encountered. Excludedpublications were thosethat did not focus on AIAN adolescents (n=3341), did not identify protective factors (n=56), were not original research studies (n=8), or were notwritten in the English language. We identified nine categories of protective factors positively associated with health and social outcomes, including: current and/or future aspirations, personal wellness, positive self-image, self-efficacy, non-familial connectedness, family connectedness, positive opportunities, positive social norms, and cultural connectedness. Such factors positively influenced adolescent alcohol, tobacco, and substance use; delinquent and violent behavior; emotional health including depression, suicide attempt; resilience; and academic success. Protective factors spanned multiple domains of the socio-ecological model. Strengths-based health promotion efforts that leverage local, innate protective factors and work with AIANs to create environments rich in protective factors are key to improving the health and wellbeing of AIAN adolescents.

3.39 FETAL ALCOHOL SPECTRUM DISORDER IN ABORIGINAL YOUTH: A DESCRIPTIVE STUDY OF PRESENTATIONS TO CHILD AND ADOLESCENT PSYCHIATRY EMERGENCY

This study aims to examine the presentations of Aboriginal children and adolescents with Fetal Alcohol Spectrum Disorder (FASD) admitted to the Child & Adolescent Psychiatric Emergency (CAPE) at BC Children’s Hospital over a 5-year period.

Mental health problems in a regional population of Australian adolescents: association with socio-demographic characteristics.

BackgroundPopulation level data regarding the general mental health status, and the socio-demographic factors associated with the mental health status of adolescents in Australia aged 12–16 years is limited. This study assessed prevalence of mental health problems in a regional population of Australian students in Grades 7–10, and investigated associations between mental health problems and socio-demographic factors.MethodsA web-based survey was conducted in 21 secondary schools located in disadvantaged local government areas in one regional local health district of NSW Australia. Mental health problems were measured using the youth self-report Strengths and Difficulties Questionnaire (SDQ) total SDQ score and three subscale scores (internalising problems, externalising problems and prosocial behaviour). Associations between each SDQ outcome and student socio-demographic characteristics (age, gender, Aboriginal and/or Torres Strait Islander Status, remoteness of residential location and socio-economic disadvantage) were investigated.ResultsData are reported for 6793 students aged 12–16 years. Nineteen percent of participants scored in the ‘very high’ range for the total SDQ, 18.0 % for internalising problems, 11.3 % for externalising problems and 8.9 % for prosocial behaviour problems. Gender and Aboriginal status were associated with all four SDQ outcomes, while age was associated with two, excluding externalising problems and prosocial behaviour. Aboriginal adolescents scored higher for mental health problems than non-Aboriginal adolescents for all four SDQ outcomes. Females scored higher than males for total SDQ and internalising problems, with mean difference greatest at age 15. Males scored higher for externalising problems and lower for prosocial behaviour than females.ConclusionsThe finding that mental health problems significantly varied by age, gender and Aboriginality may suggest a need for tailored interventions for groups of adolescents with highest levels of mental health problems.Trial Registration ANZCTR ACTRN12611000606987. Registered 14/06/2011.

Beginning the trajectory to ESKD in adult life: albuminuria in Australian aboriginal children and adolescents.

Globally, disadvantaged populations suffer a high burden of chronic kidney disease (CKD). The trajectory to CKD during childhood and adolescence remains unclear due to a paucity of longitudinal studies. This was a prospective, population-based cohort study in which since 2002 we have followed 3418 children (1469 non-Aboriginal and 1949 Aboriginal) attending participating schools across New South Wales (NSW), Australia. The albumin:creatinine ratio was measured by dipstick every 2 years together with the body mass index (BMI) and blood pressure. We used multivariable logistic generalised estimating equation models to examine whether Aboriginal children had a higher prevalence of albuminuria compared with non-Aboriginal children with increasing age and to identify potential risk factors. The mean age at enrolment was 10.6years, at which time 14.2% of the children were obese and 16.0% overweight, with 11.5% found to have albuminuria. Over 8years (11,387 participant-years) of follow-up the prevalence of albuminuria increased to 18.5%, overweight to 16.1% and obesity to 17.2%. The BMI standard deviation score (SDS) was found to have a differential effect on the risk of albuminuria in Aboriginal and non-Aboriginal children (P interaction < 0.01). The prevalence of albuminuria decreased as the BMI SDS increased in both groups of children, but it increased more in non-Aboriginal children, leading to a 2.5% higher prevalence of albuminuria in overweight Aboriginal children (95 % confidence interval 1.0-4.2%). Compared with non-Aboriginal children, Aboriginal children are of higher risk of albuminuria when overweight or obese. We hypothesise that overweight and obesity are key contributors to the development of adult onset CKD among Aboriginal Australians, which needs further exploration in future studies.

Social determinants in the sexual health of adolescent Aboriginal Australians: a systematic review.

While research indicates that Aboriginal and Torres Strait Islander adolescents may be at increased risk of some sexually transmitted infections, there is limited information about factors that may place these young people at more risk of adverse sexual health than their non-Indigenous counterparts. Current research has tended to focus on surveillance-type data, but there is an increasing need to understand social determinants of sexual health risk. This systematic review assessed the evidence of social determinants impacting on Aboriginal and Torres Strait Islander adolescents' sexual health in Australia. Published, English-language literature was searched across key databases from 2003 to 2015. Fourteen studies were included in the qualitative synthesis. Findings suggest that social determinants such as access to healthcare, poverty, substance use, educational disadvantage, sociocultural context, gender inequalities, status and identity, and social disadvantage impacted on Indigenous adolescents' sexual behaviours and sexual health risk. Evidence from the literature included in the review suggests that peer education may be an acceptable and appropriate approach for addressing such issues. There remains a need for programmes and services to be community-developed and community-led, thus ensuring cultural appropriateness and relevance. However, there is also a significant need for such programmes to be effectively and rigorously evaluated with data that goes beyond surveillance, and seeks to unpack how sexual norms are experienced by Indigenous adolescents, particularly outside of remote Australia - and how these experiences act as either risk or protective factors to good sexual health and positive social and emotional well-being.

The lived experiences of aboriginal adolescent survivors of childhood cancer during the recovering process in Taiwan: A descriptive qualitative research.

The purpose of this study was to understand the experiences of Taiwanese aboriginal adolescent survivors of childhood cancer during the process of recovery. A snowball sampling strategy was used to recruit participants from the pediatrics unit of a medical center in the eastern region of Taiwan. In-depth interviews were conducted with 11 aboriginal adolescent childhood cancer survivors. The data were analyzed using content analysis. The results revealed three major themes with subthemes within each theme. The three major themes are: roots of resilience, transformation and growth, and meaning of traditional rituals for resilience. The three subthemes within "roots of resilience" include: "feeling secure through company of family, care and financial support", "receiving support from the important others and religion" and "learning to self-adjust". The three subthemes revealed within "transformation and growth" are: restructuring the relationship with peers, "appreciating parents' hard work", and "learning to seize the moment". The two subthemes within "meaning of traditional rituals to resilience" include: "feeling blessed with the power of ancestral spirits" and "strengthening ethnic identity". This study provided insight into the experiences of aboriginal adolescents as they recovered from childhood cancer. The experiences made positive impacts by inspiring growth in maturity and consolidating aboriginal ethnic identity. The adolescents were empowered by support from family, friends and clansmen, and by their participation in aboriginal rituals. As healthcare professionals care for the aboriginal adolescents, it is critical to consider this culturally and ethnically specific knowledge/experience of surviving cancer to improve quality of care.

Quality of life of Portuguese and Spanish adolescents. A comparative study between natives and immigrants.

The aim of this study was to analyse differences in quality of life (QOL) between Spanish and Portuguese immigrant and native adolescents. In total, 475 native and immigrant adolescents (52% boys) from Algarve (Portugal) and Huelva (Spain), aged between 12 and 17 years old, were assessed with the KIDSCREEN-52. QOL dimensions were not related to most academic variables, with the exception of number of school failures, Financial Resources and Social Support from Peers. Multivariate analysis of variance (MANOVA) was used to examine statistical differences in adolescents QOL. Age differences in QOL levels were not found. Girls reported worse QOL levels on Physical Wellbeing than boys (F = 10.32, p = .001, η2 =.02). Immigrant Portuguese adolescents scored higher on Mood (F = 17.57, p = .000, η2 =.11), and native Portuguese adolescents scored higher on Social Acceptance (F = 4.87, p = .002, η2=.033). Immigrant and native adolescents had similar levels of perceived QOL. Overall, it seems that in both countries, the living contexts for immigrant and native adolescents are fairly homogeneous.

Parental solicitation, parental control, child disclosure, and substance use: native and immigrant Dutch adolescents

ABSTRACTObjectives. The present study examined whether the relation of parental solicitation, parental control, and child disclosure with adolescent alcohol and cannabis use is similar for native and non-Western immigrant Dutch adolescents.Design. Questionnaire data from two study-samples were used with a combined sample of 705 adolescents (mean age 16.2 years; 47.2% female; 25.2% non-Western immigrant background).Results. Native Dutch adolescents reported more weekly alcohol use than immigrant adolescents, while rates of cannabis use by native and immigrant adolescents were similar. Immigrant females reported lower levels of parental solicitation and child disclosure, but higher levels of parental control than native females. There were no differences in the sources of parental knowledge between native and immigrant males. Regression analyses showed no significant interaction effects of parental solicitation, parental control, or child disclosure with ethnic background for both alcohol and cannabis use (all p values > .05).Conclusion. Despite mean level differences in various factors, we did not find evidence of an interaction effect of the sources of parental knowledge with ethnic background on alcohol and cannabis use. This suggests that theories and prevention strategies focusing on these sources of parental knowledge in relation to substance use can be applicable to both native and immigrant Dutch adolescents.

Breakfast habits and heath perceptions in South-eastern Spanish adolescents

The principal aims of this study are to describe breakfast consumption patterns of south-eastern Spanish adolescents, examine the relationship between breakfast consumption and feelings of well-being and fitness and compare breakfast behaviour between men and women to identify if there is a gender gap. Design: A cross-sectional research with cluster sampling in two primary schools and seven secondary schools. The instrument used was a modified version of the Kidscreen-27 questionnaire. Sample: 2,125 students aged between 10 and 19 years old from different nationalities, mainly Romanian, Moroccan and Spanish. Results: The study identifies some youngsters who skip breakfast and no have no food intake over the course of the morning. About 35% of the teenagers skip daily breakfast before they leave for school, and a worrying 1,8% do not eat any food during the whole morning. Questionnaire outcomes also expresses that the amount of biscuits ingested increased as the number of times that adolescents have breakfast at home decreases. There are significant gender differences, women it less foods than men. Differences are especially significant in case of milk, bread or cereals and butter or oil. Finally, chisquare contrast analysis show students that have breakfast before leaving to school perceive better feelings about how well and fit they are than those student who do not have breakfast daily. Conclusions. Findings supports the need for further enhance health education programs focused on breakfast habits, especially with women. This study is part of the project “Education for Cross-cultural Health in Immigrant and Native Adolescents from Almeria: Analysis and intervention for optimization and improvement” supported by the National R+D Plan of the Ministry of Economy and Finance (Ref: EDU2011-26887)

Misuse of Prescription Opioid Medication among Women: A Scoping Review.

Background. National data from Canada and the United States identify women to be at greater risk than men for the misuse of prescription opioid medications. Various sex- and gender-based factors and patient and physician practices may affect women's use and misuse of prescription opioid drugs. Objectives. To explore the particular risks, issues, and treatment considerations for prescription opioid misuse among women who experience chronic noncancer pain and trauma. Methods. A scoping review for articles published between January 1990 and May 2014 was conducted on sex- and gender-based risks and treatment considerations among women who experience chronic noncancer pain and trauma. Results. A total of 57 articles were identified. The present narrative review summarizes the specific risks for the misuse of prescription opioid medication among women who have experienced violence and trauma, Aboriginal women, adolescents and young women, older women, pregnant women, women of a sexual minority, and transwomen. Discussion. The majority of the literature is descriptive, with few studies that evaluate approaches and interventions to respond to the issue of chronic pain, trauma, and misuse of prescription opioids among women, particularly vulnerable subgroups of women. Conclusions. Trauma-informed and women-centred approaches that address women's vulnerabilities and complex needs require further attention.

Supporting parents of Aboriginal children with asthma: Preferences and pilot interventions

Asthma is one of the most common chronic conditions affecting Aboriginal children and adolescents in Canada, with associated high rates of hospitalization and emergency room visits. Social support deficits and social isolation pose significant problems for Aboriginal families coping with asthma challenges. However, support interventions that focus on the unique support needs of parents of Aboriginal children affected by asthma have not been investigated. Consequently, our study introduced support interventions to meet parents’ perceived support needs and intervention preferences. The study was conducted in urban and rural sites in three Canadian provinces. The interdisciplinary research team encompassed Aboriginal researchers and knowledge users, and the multimethod participatory research design was guided by Aboriginal community advisory committees. Diverse support interventions, designed to address the particular preferences and needs of parents in specific communities, were offered. Seventy-seven parents participated. These parents reported expanded support resources, increased support seeking, improved coping skills, and decreased support and education needs following the interventions, which were tailored to their unique needs. These participatory interventions were considered accessible, acceptable, relevant, and useful by parents.

Use of prescription stimulant for Attention Deficit Hyperactivity Disorder in Aboriginal children and adolescents: a linked data cohort study

BackgroundIncreasing recognition of Attention Deficit Hyperactivity Disorder (ADHD) among Aboriginal children, adolescents and young adults is a public health challenge. We investigated the pattern of prescription stimulants for ADHD among Aboriginal individuals in Western Australia (WA).MethodsUsing a whole-population-based linked data we followed a cohort of individuals born in WA from 1980–2005, and their parents were born in Australia, to identify stimulant prescription for ADHD derived from statutory WA stimulant prescription dispensing between 2003 and 2007. Parental link was ascertained through WA Family Connections Genealogical Linkage System. Cox proportional hazards regression (HR) models were performed to determine the association between stimulant use and Aboriginal and non-Aboriginal status.ResultsOf the total cohort of 186,468, around 2 % (n = 3677) had prescription stimulants for ADHD. Individuals with both Aboriginal parents were two-thirds (HR 0.33, 95 % CI 0.26–0.42), and with only Aboriginal mother were one-third (HR 0.69, 95 % CI 0.53–0.90) less likely to have stimulants, compared to individuals with non-Aboriginal parents. HR in Aboriginals was 62 % lower (HR 0.35, 95 % CI 0.25–0.49) in metropolitan areas, and 72 % lower (HR 0.28, 95 % CI 0.20–0.38) in non-metropolitan areas, than non-Aboriginals. The risk for simulant use was four times higher among Aboriginal boys than Aboriginal girls (HR 4.08, 95 % CI, 2.92–5.69).ConclusionAboriginal cultural understanding of ADHD and attitude towards stimulant medication serve as a determinant of their access to health services. Any ADHD intervention and policy framework must take into account a holistic approach to Aboriginal culture, beliefs and individual experience to provide optimal care they need.Electronic supplementary materialThe online version of this article (doi:10.1186/s40360-015-0035-8) contains supplementary material, which is available to authorized users.

Maternal correlates of body mass index in American Indian/Alaska Native and White adolescents: Differences between mother/son and mother/daughter pairs

IntroductionObesity rates for American Indian and Alaska Native (AI/AN) adolescents are among the highest in the US. However, little is known about the influence of maternal correlates on adolescent body mass index (BMI), and the extent to which the size and significance of these correlates vary by adolescent sex and race. MethodsWe conducted a cross-sectional analysis with a sample of 531 AI/AN and 8896 White mother/adolescent pairs from Wave 1 of the National Longitudinal Study of Adolescent to Adult Health. We used generalized estimating equations to measure the association of maternal educational attainment, marital status, employment status, obesity status, and adolescent BMI of AI/AN and White adolescents, while controlling for adolescents' demographic and behavioral covariates. We sought to determine whether the size and statistical significance of maternal correlates differed by race, and between mother/son and mother/daughter pairs. ResultsThe strength and statistical significance of maternal correlates varied between mother/son and mother/daughter pairs in both races. However, we did not find effect modification by race.Maternal obesity showed the strongest effect on adolescent BMI in all mother/adolescent pairs. ConclusionOur findings suggest that maternal factors are critical in the transmission of obesogenic behaviors from one generation to the next, and their effects vary between mother/son and mother/daughter pairs, and are similar for AI/ANs and Whites. We encourage future work aimed at preventing adolescent obesity to investigate causal pathways between maternal correlates and adolescent BMI.

O16.5 Health care attendance among aboriginal youth aged 15–19 years provides opportunities to improve human papillomarus virus (hpv) vaccination coverage

<h3>Introduction</h3> A national school-based HPV vaccination program for 12–13 year olds was introduced in Australia in 2007 for females, and 2013 for males, with about 70% coverage achieved for 3-doses. However lower coverage has been reported in some states. In the context of an Aboriginal Sexual and Reproductive Health Program (2010–2014), we examined health care attendance among Aboriginal adolescents and young Aboriginal people attending Aboriginal Medical Services (AMSs) to determine clinical opportunities to offer HPV vaccination and HPV vaccination uptake. <h3>Methods</h3> We extracted de-identified clinical data from 15–24 year old Aboriginal clients attending six AMSs between mid-2013 and mid-2014, and calculated total individuals attending, the median number of medical consultations per person and HPV vaccinations recorded. We used ranksum tests to compare medians. <h3>Results</h3> Over 12 months, 1814 15–19 year old Aboriginal people attended (715 males, 1099 females), with similar proportions aged 15, 16, 17, 18 and 19 years in males and females. Among 15–19 year olds, there was a median of 4 consultations per person, higher in females (5, IQR: 2–11) than males (3, IQR: 1–5), p &lt; 0.001. A similar number of 20–24 year olds attended (n = 1785), with a median of 5 consultations, higher in females (6, IQR: 3–13) than males (3, IQR: 1–6), p &lt; 0.001. HPV vaccination was documented in the records of only three people, all 15 years old females (&lt;2% all 15–19 yos). <h3>Conclusion</h3> Despite concerns that many teenagers have poor health seeking behaviour, at six participating AMSs, we found that 15–19 year olds attend at a similar rate to 20–24 year olds, with females in both age groups attending more frequently. However, very few HPV vaccination doses were reported as given. Considering HPV vaccination is provided free at AMSs in NSW, these data highlight the need for better systems to support AMSs to identify incompletely vaccinated Aboriginal adolescents in addition to clinic-based prompts, reminders and feedback reports to raise clinician awareness. <h3>Disclosure of interest statement</h3> The Aboriginal Sexual and Reproductive Health Program was funded by the New South Wales Ministry of Health.

Examining the Relationship between Attachment Styles and Resilience Levels among Aboriginal Adolescents in Canada

The history of colonization in Canada has a traumatic intergenerational impact on young Aboriginal people's health, which is evidenced by the wide health disparities (Adelson, 2005; Health Council of Canada, 2012). However, extant research shows that, through resilience, many Aboriginal adolescents overcome adverse situations and develop into healthy adults (Andersson &amp; Ledogar, 2008). Knowledge of the ways and extent to which Aboriginal youth seek support to cope with stressful events may be improved by examining the distribution of attachment styles and their relationship with resilience. The data (n = 136) used for this study were obtained from the British Columbia Adolescent Substance Use Survey. Findings indicate resiliency was significantly associated with attachment style (p &lt; .01). The study findings provide support for tailoring resilience mental health promotion and intervention resources according to attachment style to foster long-term engagement in programming that helps Aboriginal youth live a healthy and holistically balanced life.

An Internationally Comparative Study of Immigration and Adolescent Emotional and Behavioral Problems: Effects of Generation and Gender

PurposeAlthough the potential consequences of immigration for adolescent problem behaviors have been addressed in many former studies, internationally comparative research is scarce. This study investigated the impact of immigration on four indicators of adolescents' emotional and behavioral problems in 10 countries, taking into account gender and immigrant generation as moderating factors. MethodsAnalyses were based on data from 11-, 13-, and 15-year-old adolescents participating in the Health Behavior in School-aged Children study in Denmark, Germany, Greece, Iceland, Ireland, Italy, the Netherlands, Spain, the United States, and Wales (total N = 53,218). ResultsBoth first- and second-generation immigrant adolescents reported higher levels of physical fighting and bullying and a lower life satisfaction than native adolescents, whereas second-generation immigrant adolescents reported more psychosomatic symptoms than native adolescents. Effect sizes varied considerable for the different outcomes, and similar effects were found for first- and second-generation immigrant adolescents. Differences in these indicators of emotional and behavioral problems between immigrant and native adolescents did not vary significantly with the receiving country. With two exceptions, effects of immigrant status were similar for boys and girls. Although no differences in psychosomatic symptoms were found between first-generation immigrant and native girls, first-generation immigrant boys reported less psychosomatic symptoms than native boys. Furthermore, both second-generation immigrant boys and girls reported higher levels of physical fighting than their native peers, but differences were more pronounced for boys than for girls. ConclusionsOverall, the results of this study support a risk perspective on the impact of immigration on adolescent problem behaviors.

Drowning in Aboriginal and Torres Strait Islander children and adolescents in Queensland (Australia).

BackgroundAboriginal and Torres Strait Islander (Indigenous) children are at greater risk of drowning than other children, however little is known about drowning of Indigenous children. This study identifies the previously unpublished incidence and characteristics of fatal and non-fatal drowning in Indigenous children and adolescents.MethodsRetrospective data (Jan 2002-Dec 2008) on fatal and non-fatal drowning events among Indigenous and Non-Indigenous Queensland residents aged 0-19 years were obtained from multiple sources across the continuum of care (pre-hospital; emergency department; admitted patients; fatality) and manually linked. Crude incidence rates for fatal and non-fatal events were calculated using population data from the Australian Bureau of Statistics.ResultsThere were 87 (6.7 % of all events) fatal and non-fatal (combined) Indigenous drowning events yielding a crude Incidence Rate of 16.8/100,000/annum. This is 44 % higher than the incidence rate for Non-Indigenous children. For every fatality, nine others were rescued and sought medical treatment (average 12 per year). There were no significant changes in Indigenous drowning incidents over the study period. Drowning rates were higher for Indigenous females than males. Overall incidence was higher among Indigenous children and adolescents than Non-Indigenous children for every calendar year and age-group (0-4 years; 5-9 years; 10-14 years) except those aged 15-19 years where no drowning events were recorded for males.Location of drowning sites was similar in both populations 0-19 years, however there were slight differences in frequency at each of the locations. The three leading drowning locations for Indigenous 0-19 years olds were pool (48 %), bath (21 %) and natural water (16 %), and for non-Indigenous 0-19 years the leading locations were pool (66 %), natural water (13 %) and bath (12 %) (p < .01). Except for pool drowning, Indigenous drowning occurred more often in geographic areas of relative disadvantage. Among Indigenous children drowning location varied with age (p < .001). Most frequent locations by age were: <1 year bath (71 %); 1-4 years pools (80 %); 5-9 years pools (75 %) and 10-19 years beach/ocean (36 %). Severity of event differed statistically with Indigenous status and by remoteness with all fatal drowning events occurring in Regional or Remote areas, and none in Major Cities.ConclusionsFor every fatal drowning among Indigenous children in Queensland aged 0-19 years there are nine non-fatal events. This previously unreported survival ratio of 9:1 indicates the non-fatal injury burden in Indigenous children aged 0-19 years. Although higher Indigenous drowning rates prevailed, no significant changes over time are concerning. Equally the apparent over-representation of Indigenous adolescent females should be weighed against the absence of drowning among Indigenous male adolescents in the same age group in consecutive years of the study. Further investigation around behaviour and culture may highlight protective factors. Culturally specific prevention strategies which take into account social and demographic indicators identified in this study should be delivered to carers and peers of vulnerable age groups who frequent specific locations. Females, swimming ability, supervision and the young are areas which need to be incorporated into Indigenous-specific interventions for drowning prevention.

Dialectical behavior therapy with American Indian/Alaska Native adolescents diagnosed with substance use disorders: Combining an evidence based treatment with cultural, traditional, and spiritual beliefs

This pilot study examined pre to post-change of patients in a substance use residential treatment center that incorporated Dialectical Behavior Therapy with specific cultural, traditional and spiritual practices for American Indian/Alaska Native adolescents. Specifically, the incorporation of cultural, spiritual and traditional practices was done while still maintaining fidelity to the evidence based treatment (DBT). 229 adolescents participated in the study and were given the Youth Outcome Questionnaire-Self-Report version at pre-treatment and post-treatment and the total scores were compared. The results of the research study showed that 96% of adolescents were either “recovered” or “improved” using clinical significant change criteria. Additionally, differences between the group's pre-test scores and post-test scores were statistically significant using a matched standard T-test comparison. Finally, the effect size that was calculated using Cohen's criteria was found to be large. The results are discussed in terms of the implication for integrating western and traditional based methods of care in addressing substance use disorders and other mental health disorders with American Indian/Alaska Native adolescents.

Child and adolescent mental health problems in Tyva Republic, Russia, as possible risk factors for a high suicide rate.

High rates of child mental health problems in the Russian Federation have recently been documented; the rates of youth suicide are among the highest in the world. Across the Russian regions, Republic of Tyva has one of the highest rates of child and adolescent suicide and the lowest life expectancy at birth. The aim of this study was to investigate the prevalence and associations of mental health problems in Native Tyvinian children and adolescents using internationally recognised measures and diagnoses. A two-stage, two-phase design involved selection of schools in five rural settlements in Western Tyva and two schools in the capital city followed by selection of Native Tyvinian children in grades 3-4 (ages 9-10) and 6-7 (ages 14-15). In the first phase, a screening measure of psychopathology, the Rutter Teacher Questionnaire, was obtained on 1048 children with a 97% participation rate. In the second phase, more detailed psychiatric assessments were carried out for subgroups of screen-positive and screen-negative children. The prevalence of mental health problems was about 25%, ranging from 40% in adolescent boys from rural areas to 9% in adolescent girls from the city. The patterning of disorders and risk factors were similar to those in other countries, rural areas were associated with an increased risk of psychopathology. The findings indicate that there is an urgent need for interventions to reduce risk in this population and provide effective help for Tyvinian children and adolescents with mental health problems.