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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.

Culturally relevant interventions have the potential to improve adolescent health and protective factors associated with sexual risk taking. We evaluated the impact of the Native STAND curriculum with American Indian and Alaska Native (AI/AN or Native) high school students living across the U.S. using a pre-post evaluation design. Native STAND is a comprehensive sexual health curriculum for Native high school students that focuses on sexually transmitted infections, HIV/AIDS, and teen pregnancy prevention, while also covering drug and alcohol use, suicide, and dating violence. The curriculum was implemented in 48 AI/AN communities from 2014 to 2019. A significantly higher percentage of youth reported at post-test having a serious conversation about sex with their friends (post 36% vs. pre 28%, p &lt, 0.001), thinking about lessons learned (post 24% vs. pre 7%, p &lt, 0.0001), and sharing lessons learned during the conversation (post 21% vs. pre 4%, p &lt, 0.001). A lower percentage of AI/AN youth reported being bullied in the last year (post 31% vs. pre 37%, p &lt, 0.001). Family social support was moderated by dose, with subscale scores of 3.75 at post-with &lt, 27 sessions vs. 3.96 at post-with all 27 sessions (p = 0.02). The results demonstrate the effectiveness of Native STAND when delivered in a variety of settings. Efforts are now underway to update Native STAND for medical accuracy, improve alignment with typical class periods, and promote its use and an effective EBI for AI/AN youth.

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.

Documenting Tribal health priorities is needed to inform research agendas, policy efforts, advocacy, and funding. However, published literature rarely documents the methods used to develop surveys in Indigenous communities. This methods paper includes two objectives: (1) increase knowledge and understanding about the importance of community involvement in public health activities; and (2) provide an example of how the Rocky Mountain Tribal Leaders Council Epidemiology Center (RMTEC) worked with one Tribal community to develop a health priorities survey. This paper describes how the RMTEC worked with a Tribal community and Tribal College students to develop, pilot, and revise a health priorities survey. Recommendations focus on the need for more culturally-responsive survey methods, the importance of building Tribal capacity for health research, and the value of piloting surveys in communities prior to implementation.

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.

Native American youth are placed at greater risk for suicide than any other age or ethnic population in the United States. Resilience has helped Native Americans overcome adversity. In this paper, authors provide an example of how intergenerational mentoring can moderate or reduce these risk factors. The Intergenerational Connection Project at Native PRIDE (ICP) works with advisory councils in four Native communities in Montana and South Dakota. To better understand resilience, this paper answers two questions: (1) how do communities define cultural resilience, and (2) how can cultural resilience be operationalized in a cultural context? The ICP team worked with community advisory councils to develop a cultural resilience scale that was administered at the beginning of the project and six months later, at the end of the Project. An independent samples t-test demonstrated a significant increase in all scale items from baseline and at six-month follow-up. Results indicate that all community definitions include terms related to adversity and the transfer of cultural knowledge through sharing, participation, and involvement. Community definitions also included conversations about spirituality, language, values, and interactions between elders and youth. Authors conclude with a strong message that strengths-based interventions like the ICP are needed to address suicide risk in Native communities.

Peer Recovery Support (PRS) is emerging as a key intervention for communities and individuals as they address high rates of substance abuse and limited recovery resources. American Indian populatio...

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.

Visual methods serve a unique purpose in that they help generate data that uncover experiences, knowledge, and contextual factors that lead to a greater shared understanding about a topic. We describe the process and results of one American Indian community-based organization's success using visual methods to prompt community conversations about mental health and substance abuse. We uncovered community members' mental health perspectives and experiences through visual vignettes. Our hope is that other communities and funding agencies see the value and promise of visual methods as a valid approach that promotes shared dialogue, decision making, and conversations for future generations.

Peer recovery support (PRS) offers significant benefits for individuals in recovery from substance abuse disorders. This research describes the experiences of the first 12 months of a tribally led, American Indian community-based PRS project in two American Indian communities. An intrinsic qualitative case-study design was used to answer the research question, “What are some considerations for implementing PRS services in an American Indian reservation community?” Results showed PRS services fill a much-needed gap in American Indian communities where recovery support resources are limited and substance abuse is pervasive.

Purpose – Effective community-based suicide prevention strategies require culturally relevant contextually driven approaches, validated by community members. Existing literature, funding agencies, and polices do not adequately address the differences in community vs non-community definitions and approaches to suicide prevention. These differences and the process must be articulated to fully understand the complexities of effective American Indian community-based suicide prevention strategies. This paper aims to discuss these issues. Design/methodology/approach – This study uses a qualitative methodology to understand the process and meaning of an American Indian reservation's community-based approach to suicide prevention. Findings – Seven recommendations emerge. These include: expand the understanding of suicide; plan activities and outreach early; uphold cultural values; build administrative and community capacity; prepare and respond to community needs and situations; anticipate challenges and develop solutions; and recognize the spiritual aspects of the endeavor. Originality/value – This study provides new insight about the process in which American Indian communities define, develop and implement suicide prevention strategies that are culturally relevant and community driven. The process and recommendations may be useful for institutions, funding agencies, policy makers, and tribal leaders, and community-based prevention partners.

Objective To compare American-Indian and Caucasian mortality rates from diabetes among tribal Contract Health Service Delivery Areas (CHSDAs) in the Great Plains Region (GPR) and describe the disparities observed. Research design and methods Mortality data from the National Center for Vital Statistics and Seer*STAT were used to identify diabetes as the underlying cause of death for each decedent in the GPR from 2002 to 2010. Mortality data were abstracted and aggregated for American-Indians and Caucasians for 25 reservation CHSDAs in the GPR. Rate ratios (RR) with 95% CIs were used and SEER*Stat V.8.0.4 software calculated age-adjusted diabetes mortality rates. Results Age-adjusted mortality rates for American-Indians were significantly higher than those for Caucasians during the 8-year period. In the GPR, American-Indians were 3.44 times more likely to die from diabetes than Caucasians. South Dakota had the highest RR (5.47 times that of Caucasians), and Iowa had the lowest RR, (1.1). Reservation CHSDA RR ranged from 1.78 to 10.25. Conclusions American-Indians in the GPR have higher diabetes mortality rates than Caucasians in the GPR. Mortality rates among American-Indians persist despite special programs and initiatives aimed at reducing diabetes in these populations. Effective and immediate efforts are needed to address premature diabetes mortality among American-Indians in the GPR.

The aim of this study was to understand adolescent mothers’ childbirth experiences. Semistructured interviews were conducted with participants recruited from a community-based program for adolescent mothers. Fourteen mothers described their birth experiences. Using a narrative analytic approach, responses were reconstructed into birth stories. Stories, condensed into poetic form, were compared and contrasted. Four unique categories emerged: connected births, surreal births, disconnected births, and disempowered births. Categories differed by agency, support, and emotional tone. Positive support was found in stories that portrayed high agency and positive affect, whereas problematic support was apparent in stories that conveyed passivity, frustration, and disappointment. This study has implications for tailoring childbirth education for adolescent mothers and can inform health-care professionals working with this population.

Institutional review boards (IRBs) function to regulate research for the protection of human participants. We share lessons learned from the development of an intertribal IRB in the Rocky Mountain/Great Plains Tribal region of the United States. We describe the process through which a consortium of Tribes collaboratively developed an intertribal board to promote community-level protection and participation in the research process. In addition, we examine the challenges of research regulation from a Tribal perspective and explore the future of Tribally regulated research that honors indigenous knowledge and promotes community accountability and transparency. We offer recommendations for researchers, funding agencies, and Tribal communities to consider in the review and regulation of research.

Introduction: Training for new and existing researchers in community-based participatory research (CBPR) approaches requires flexibility and a departure from traditional research methods courses. The literature has not fully reported how universities teach CBPR or the impact of CBPR courses on students and researchers. Method: In this paper, I use a reflective, inquiry-based methodology to find meaning from my experience in a doctoral level CBPR course offered by a southeastern university. Results: Five recommendations, complementary to guiding CBPR principles emerge. These include: Know the inherent challenges, find meaning and purpose, seek to understand complexities, recognize the implications, and use CBPR as a means to redress power. Discussion: The reflection process and recommendations may be useful for institutions, funding agencies, policy makers, and community-engaged researchers.