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Objectives To explore health behavior profiles of AI/AN youth involved in native students together against negative decisions (STAND), a national culture-based curriculum. Methods We analyzed data from 1236 surveys conducted among AI/AN youth at 40 native STAND implementation sites located in 16 states throughout the US from 2014 to 2017. Health profiles included demographics, sexual orientation, sexual activity, STI testing, cigarette use, and suicide attempts in the past 12-months. We used t-tests and chi square tests of independence to compare risk behavior prevalence among the sample. Results Health behavior profiles of AI/AN youth indicate that 45.6% of youth did not use condoms the last time they had sex, and 82.7% have never been tested for STIs. Differences in cigarette smoking were observed in questioning youth (questioning: 80.3%, straight/heterosexual: 63.8%, LGBTQ2S + : 49.9%, p = 0.03). Conclusions for Practice Health behaviors related to sex, substance, violence and self-harm, are at least as common for AI/AN youth as those observed in other US teens. Future research should consider similarities and differences in health profiles of AI/AN youth when designing interventions that affect them. Further, our findings underscore the need for culturally-relevant curricula like native STAND, not because their health behavior is different, but because their socio-ecologic environment is different.

Health advocates are increasingly using social media and mobile technology to reach American Indian and Alaska Native (AI/AN) youth to address important health topics and enhance protective factors. Public health experts did not know to what extent AI/AN youth used these tools to access health resources during the pandemic. The Native Youth Health Tech Survey was administered online from October to November 2020 with 349 AI/AN youth 15 to 24 years old. Survey results indicated frequent technology use-68.7% sent 1-50 text messages per day, and 65.3% were on social media 3-7 hours per day. Instagram was the most popular channel used, and 53.5% of participants relied heavily on the Internet to access health information. The three most important health topics were Native identity, mental health, and social justice and equality. These findings can inform the design and dissemination of culturally grounded health resources across AI/AN communities to improve their reach and appeal, improving health outcomes, self-esteem, and cultural connectedness.

Aims Emerging qualitative work documents that social media conflict sometimes results in violence in impoverished urban neighborhoods. Not all experiences of social media conflict lead to violence, however, and youth ostensibly use a variety of techniques to avoid violent outcomes. Little research has explored the daily violence prevention strategies youth use on social media, an important gap given the omnipresence of social media in youth culture. This paper examines youth strategies and factors that avoid violence resulting from social media conflict. Method Four focus groups with 41 teenagers of color solicited strategies to prevent violence resulting from social media conflict. Three coders analyzed data in Dedoose, guided by systematic textual coding using a multi-step thematic analysis. Results Four approaches emerged to avoiding violence from social media conflict: avoid, de-escalate, reach out for help, and bystander intervention. Conclusion Our findings position youth as key players in efforts to prevent violence from resulting from social media conflict.

The COVID-19 pandemic has disproportionately impacted American Indian and Alaska Native (AI/AN) communities. Tribes, tribal organizations, AI/AN youth and community-serving programs, and tribal health organizations have responded and adapted programs and services in response to the COVID-19 pandemic. This paper explores how COVID-19 impacted Native PRIDE, an American Indian non-profit organization, and the tribal communities involved in the Intergenerational Connections Project (ICP). Native PRIDE utilized a mixed-method Indigenous Evaluation Framework (IEF) to reflect on COVID-19 impacts. Qualitative data collected during the COVID-19 pandemic and quantitative data from an online survey helped Native PRIDE explore impacts and recommendations for future programming. With a focus on context and relationship, this paper explores what was felt, observed, and known by program participants and Native PRIDE staff in the delivery of ICP during the COVID-19 pandemic. Results from this evaluation are a reminder of the importance of strengthening cultural resilience by providing access and opportunities for AI/AN youth, elders, and adults.

American Indian and Alaska Native (AI/AN) youth are strong in culture and rich in heritage and experience unique strengths and challenges throughout adolescence. Documenting conditions that protect against risk factors associated with poor health outcomes are needed. We explored scales that measure self-esteem, culture, social support, and community from a sample of 1,456 youth involved in Native STAND, a culturally-relevant evidence-based sexual health intervention. We established content validity by reviewing existing literature and community feedback. Construct validity was examined using factor analysis. The final self-esteem model included seven items, factor loadings ranged from 0.47 to 0.63 for positive self-esteem and 0.77 to 0.81 for negative self-esteem. The final culture model included three items, factor loadings 0.73 to 0.89. The social support scale included four items, factor loadings ranged from 0.86 to 0.87 for family social support and 0.75 to 0.77 for friends social support. The community and community safety scale included three items; factor loadings ranged from 0.52 to 0.82. Coefficient alphas for scales ranged from α = 0.63 to α = 0.86. This study validated scales in a national sample of AI/AN youth–psychometric scales provide an essential tool for documenting the needs and strengths of AI/AN youth.

American Indian and Alaska Native (AI/AN) young adults are strong and resilient. Interventions designed to improve their mental health and help-seeking skills are especially needed, particularly those that include culturally relevant resources and relatable role models. This paper presents formative research from the BRAVE study, a five-year community based participatory research project led by the Northwest Portland Area Indian Health Board. Formative research included three phases and more than 38 AI/AN young adults and content experts from across the United States. Results indicate that behavioral interventions can be feasibly delivered via text message to AI/AN young adults and that including Native youth in the formative research is critical to designing a comprehensive, culturally-responsive intervention. Lessons learned from this five-year process may help other youth-serving organizations, prevention programs, policymakers, researchers, and educators as they support the next generation of AI/AN leaders.

Urban American Indian and Alaska Native (AI/AN) youth represent a unique and growing population in the United States. Culture and participation in cultural activities is associated with resilience; however, urban AI/AN youth often report limited access to their culture. This paper presents results from a mixed-method feasibility evaluation of the Native Youth Leaders (NYL) program, a culturally-grounded youth program for urban AI youth. The NYL feasibility evaluation sought to answer two questions: (1) is the NYL program feasible and appropriate and (2) what are urban AI youth perspectives on the NYL program? Results indicate the NYL program was feasible and appropriate for urban AI youth. Recommendations may be useful to other tribal organizations as they design and implement culture-based programs for urban AI youth.

American Indian youth substance use is a major public health concern. To date, there has been limited evaluation of American Indian youth substance use prevention programs. Evaluation of prevention programs is necessary to understand the aspects of programming that are effective or not effective. This mixed-methods evaluation focuses on select outcomes of a 3-year culturally-based prevention program located in six American Indian communities in the Rocky Mountain Region. The goals of the prevention program are to reduce binge drinking by 30% and increase community readiness by 1-point over a 5- year period. In the first year of the program, community members worked with program staff to develop an evaluation plan that would measure the following outcomes: lowering substance use, increasing community readiness, and increasing the reach of prevention messaging through culturally based prevention. The primary research questions this outcome evaluation sought to answer were as follows: 1) Are there differences in American Indian youth who participate in culturally-based prevention activities compared with American Indian youth who do not participate in these activities? 2) Was the prevention program effective in increasing community readiness over a 3-year period? 3) Did community involvement in prevention activities increase overtime? Results from this evaluation indicate that substance use was similar among intervention (n = 200) and non-intervention youth (n = 369). This was somewhat surprising because Intervention youth reported higher levels of social support and community connections than non-intervention group youth. Community readiness decreased -.81 point from 2015 to 2017. The reach of prevention activities increased 365% from 2015 to 2017. We provide lessons learned that may help other communities as they document outcomes related to prevention efforts. Substance use is a multi-faceted problem facing our communities, families, schools, and nation. Innovative, effective, culturally-based prevention programs like the one highlighted in this paper underscore the need for primary prevention strategies.

Background Culturally relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. Objective We aim to conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. Methods From October to December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044 participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health, help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested using linear mixed-effect models and linear regressions. Results A total of 833 AI/AN teenagers and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and help-seeking behavior. Mean scores were significantly different for health (P Conclusions This is the first national randomized controlled trial of a mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career messages. This study provides new insights for supporting the next generation of AI/AN changemakers. Trial Registration ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481

This paper shares lessons learned recruiting and engaging participants in the BRAVE study, a randomized controlled trial carried out by the Northwest Portland Area Indian Health Board and the mHealth Impact Lab. The team recruited 2330 American Indian/Alaska Native (AI/AN) teens and young adults nationwide (15&ndash, 24 years old) via social media channels and text message and enrolled 1030 to participate in the 9 month study. Teens and young adults who enrolled in this study received either: 8 weeks of BRAVE text messages designed to improve mental health, help-seeking skills, and promote cultural pride and resilience, or 8 weeks of Science Technology Engineering and Math (STEM) text messages, designed to elevate and re-affirm Native voices in science, technology, engineering, math and medicine, and then received the other set of messages. Results indicate that social media channels like Facebook and Instagram can be used to recruit AI/AN teens and young adults. Retention in this study was high, with 87% of participants completing both the BRAVE and STEM intervention arms. Lessons learned from this process may help teen and young adult-serving organizations, prevention programs, policy makers, researchers, and educators as they support the next generation of AI/AN change makers.

Aims Community management of youth with problematic sexual behavior (PSB) is complex. Public policies and service practices have historically utilized adult-focused approaches with limited research outcomes. This descriptive case study aimed to address this gap by documenting current PSB policies and policy reforms for community-based management systems. Method Semi-structured interviews with 219 professionals from eight urban and rural communities throughout the United States served as the primary data source for the study. The three-stage Framework Method was used to guide the data analysis process. Results This study covered three areas: context of policy development, attitudes, and perceptions of policy for youth with PSB, and existing policy and policy reform initiatives. Conclusion Findings support benefits of collaborative multidisciplinary teams that cross agency policies and procedures on management of cases involving youth with PSB. Implications for practitioners, policymakers, and community members are discussed.

Suicide is the leading cause of injury-related death in the United States, and between 1999 and 2009 the greatest increases in suicide were among American Indians and Alaska Natives. The present study highlights the efforts of 1 American Indian community to prevent suicide using the public health approach as a framework. A survey was developed and administered by the community between March 2014 and July 2014 at various community events. The sample included 100 participants with a mean age of 15.62 years. Questions related to stress, suicide ideation, anxiety, self-esteem, and antisocial behaviors. Results from this study indicate that depression and stressful life events are the strongest predictors of suicide ideation among tribal youth. (PsycINFO Database Record

Strength-based approaches that explore resilience and health among Native communities are needed. This report highlights the results from a sources of strength inventory reported over a 2-year period by participants (N = 48) from a Montana tribe who attended cultural camps. The authors found the sources of strength scale to be a reliable and valid measure for the population (N = 11 items, α = .945). The community plans to use the results of this study to inform and promote strength-based measures grounded in the resilience of youth, families, and culture.

American Indian youth experience higher rates of substance use than non-American Indian youth. Researchers, clinicians, and treatment programs embrace evidence-based practices (EBPs) and practice based evidence (PBE) as a primary method for addressing substance abuse and advancing behavioral health. However, less is known about the use of tribal best practices (TBPs) and how they are implemented in American Indian substance use prevention contexts.The main objective of this systematic review was to determine how TBPs are implemented and shared in the context of tribal substance use prevention. The second objective was to document TBP examples from three tribal communities involved in a 5-year substance use prevention initiative.A systematic review of published and grey literature was conducted using funding agencies websites, EBSCO Host and national registries. Three tribal communities involved in the initiative documented current TBPs to highlight characteristics of TBPs, costs, and approval processes.TBPs are very limited in the literature. Despite tribal use for thousands of years, TBPs are underrepresented and misunderstood. This review found that the terminology used to describe TBPs is not consistent across agencies, publications, websites, or reports. There is also variation in how TBPs originate in substance use prevention contexts and there is not a primary resource or protocol for sharing TBPs. Continued efforts are needed to support the use and dissemination of TBPs in substance use prevention.

Purpose: In this article, we report a pilot study that tested the feasibility and initial efficacy of a culturally, linguistically, and developmentally tailored risky sex prevention intervention for middle school–age Latinas and their mothers. Design: We used a one-group pre-test, post-test, and 3-month post-intervention follow-up design. Data were collected at three points on aspects of the girls’ communication, beliefs, and behaviors. Results: Promising results included improvements in girl’s self-efficacy regarding condom communication and condom consistent use, and in mother–teen sexual risk communication. There were also trends in demonstration of fewer risky sex behaviors. Discussion: These findings suggest that the “Latina–Girls Empowered through Mind and Mission” (L-GEMM) intervention for young Latinas and their mothers is feasible and warrants further testing. Implications: Nurses are uniquely positioned to deliver risky sex preventive interventions to young Latinas. Including mothers and tailoring interventions to build on cultural strengths are important for success.