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Abstract Background Disparities in sexual health outcomes persist among American Indian and Alaska Native (AIAN) youth due to intersectional challenges accessing youth-friendly health services. AIAN youth have an increased prevalence of STIs and teen pregnancy. To address disparities in sexual health outcomes, the Ask Auntie/Ask Your Relative (AYR) Q&A service has been used by AIAN youth and young adults for over seven years as a trusted resource for information on sensitive health topics. There is a continued need to better understand the health-seeking behaviors of AIAN youth, especially those related to healthy relationships and sexual health, to improve the alignment of health resources to their needs. Methods This mixed-method study began with two phases. Phase 1 involved an analysis of all AYR data using Google Analytics and basic frequency counts. Phase 2 reviewed all questions and answers related to sexual health and healthy relationships (N = 240) using thematic analysis, NVivo 12.0, and intersectionality, guided by the social determinants of health. All AYR answers were coded based on type, name/location, number of times viewed, and examples. The final step of the analytic process was to utilize an intersectional approach and socioecological model (Individual, Community, Tribe/Nation, and World) to create a visual model with results. Results Phase 1—Since We R Native began tracking AYR data, the service has been utilized by 2.37 M users, with 1.16 M unique pageviews. The average time on the page was 4 min and 46 s. The number of AYR questions submitted varied by year, and were most frequent in 2016, then decreased in subsequent years. In Phase 2, the main themes identified in AYR questions were (1) Reaching Out for Help, (2) Identity and Physical Development, and (3) Healthy Relationships. Analysis of the Q&A answers identified 244 resources, and of these, 100 were Native-specific. The context-specific resources represented 21 uniquely coded health topics, ranging from women's health to behavioral health. Conclusions The broad range of healthy relationship and sexual health questions submitted to the AYR service reflects the types of health information that AIAN young adults want to know about. Resources provided in response to their questions connected Q&A viewers to a wide variety of organizations and programs designed to support AIAN young adults in their health and wellness journey. Findings from this study may be useful for creating additional culturally tailored resources.

AbstractCase management (CM) is increasingly used in community settings to support individuals as they transition from one point in their lives to the next. This study sought to explore the perspectives of front-line Community Health Workers CMs working in Albuquerque, New Mexico. The objective of this study was to answer the question ‘How do CHWs define effective CM and outreach?’ A follow-up question was, ‘What are the barriers to conducting CM and outreach?’ Qualitative research methods, Critical Race Theory, and Social Work Theory guided this study. Five CHW CMs participated in a 90-minute focus group. Results present their perspectives on effective CM and outreach. Barriers include limited collaborations, excessive documentation requirements, and communication. Findings demonstrate that what constitutes effective CM and outreach is based on the program and context. Future work must focus on balancing the need for shared definitions and embracing the flexibility required for CMs working on the ground in diverse settings and populations.

Summary: There are 574 federally recognized Tribes in the United States. Tribes have experienced increased rates of domestic violence (DV) due to structural determinants like gender violence, loss of control, discrimination, marginalization, oppression, and political violence. American Indian and Alaska Native girls and women experience the highest rates of DV and abuse in the US, yet policy change, funding, and advocacy has been slow to address high DV rates. In this commentary, we comprehensively review the structural determinants of DV in American Indian and Alaska Native populations. We review policies and the complexities of criminal jurisdiction in Tribal nations and provide key recommendations to build a new framework that addresses DV in American Indian Alaska Native women in the future. Less than half of federally recognized Tribes receive funding through the Family Violence Prevention and Services Act. Structural determinants explain why housing and funding are advocacy issues, where unequal access and differential effects lead to increased risk for DV. We advocate for future work that addresses the interplay of multiple structural determinants while advocating for funding and culturally safe research and support to address DV in American Indian Alaska Native populations.

BackgroundWhen a person dies by suicide, it takes a reverberating emotional, physical, and economic toll on families and communities. The widespread use of social media among youth and adolescents, disclosures of emotional distress, suicidal ideation, intent to self-harm, and other mental health crises posted on these platforms have increased. One solution to address the need for responsive suicide prevention and mental health services is to implement a culturally-tailored gatekeeper training. The Northwest Portland Area Indian Health Board (NPAIHB) developed Mind4Health, an online gatekeeper training (90 min) and text message intervention for caring adults of American Indian/Alaska Native (AI/AN) youth.MethodsThe Mind4Health intervention was a multi-phase, single-arm, pre-and post-test study of users enrolled in the intervention that is available via text message (SMS) or via a 90 min online, self-paced training. We produced four datasets in this study: Mobile Commons, pre-survey data, post-survey data, and Healthy Native Youth website’s Google Analytics. The analysis included data cleaning, basic frequency counts, percentages, and descriptive statistics. Qualitative data were analyzed using thematic content analysis methods and hand-coding techniques with two independent coders.ResultsFrom 2022 to 2024, 280 people enrolled in the Mind4Health SMS training, and 250 completed the 8-week intervention. Many messages in the sequence were multi-part text messages and over 21,500 messages were sent out during the timeframe. Of the 280 subscribers, 52 participated in the pre-survey. Pre-survey data show that 94% of participants were female, and nearly one-fourth lived in Washington state, 92% of participants in the pre-survey were very to moderately comfortable talking with youth about mental health (n = 48). Most participants interact with youth in grades K–12. Post-survey data demonstrate changes in knowledge, beliefs, comfort talking about mental health, and self-efficacy among participants. Mind4Health improved participant’s skills to have mental health conversations with youth and refer youth to resources in their community.

IntroductionSchool-based health centers (SBHCs) are an evidence-based model for providing contraceptives to adolescents. SBHCs ability to provide reproductive health services is often limited by school district policies, state laws, and health center policies.MethodsWe used data from the Teens Exploring and Managing Prevention (TEMPO) study to document demographic characteristics and birth control methods among patients at four SBHCs in New Mexico. A total of 264 teens were included in the baseline data collection at SBHCs in New Mexico. A baseline survey was administered via iPad, that specifically focused on questions related to sexual experiences and sexual health topics. Baseline questions included demographic questions, gender identity, sexual orientation, reasons for visits, reproductive practices, and birth control methods. Descriptive statistics were calculated, including means and standard deviations for continuous variables and categorical frequencies.ResultsOur findings present reproductive health behaviors among New Mexican patients attending schools with SBHCs. More than 74% of respondents were Hispanic or Latino. The most common reason teens went to the SBHC was for birth control, and just 62% of teens reported using birth control methods in the past.DiscussionThese behaviors are essential for policymakers to consider as they address policy gaps, the complex landscape of parental permission, reproductive rights, and health as a human right.

American Indian and Alaska Native populations in the United States face significant disparities related to opioid use disorder and opioid-related mortality. Inequitable access to medications and harm reduction strategies due to structural, societal, and geographical factors prevent Tribal communities from obtaining needed services, and further contribute to the opioid epidemic. One Tribal Healing Center in the Rocky Mountain region identified mobile outreach to build upon existing opioid prevention, treatment, and harm reduction efforts. The Healing Center purchased a mobile outreach vehicle and worked with a combination of clinical staff, peer recovery support specialists, and Tribal elders to reach identified high-risk areas on the reservation. As of December 2023, the mobile outreach vehicle has disseminated 150 Narcan kits, 150 Fentanyl testing strips, 20 self-care kits, and 500 brochures detailing Healing Center services. Preliminary results from this formative evaluation demonstrate the success of MOV efforts and the process required to purchase and launch an MOV campaign.

IntroductionStructural racism, bias, and discrimination within institutions of higher education prevent Hispanic women from becoming university leaders and professors, especially when they do not have a formal degree. Hispanic leaders in higher education often have lived experiences based on their cultural values, family connections, and time working in community settings. However, lived experience is not always viewed as an equal qualification to college degrees when it comes to teaching, leading, or managing programs and departments.MethodsThe purpose of this study is to present a case study of one program operations director (leader) working at a University who does not have a terminal or advanced degree but holds the lived and professional experiences of working in community health worker programs with minority and underserved populations. This study examined her experience as a Hispanic female leading in higher education. We used qualitative phenomenological methods grounded in a descriptive case study design to inform our work.ResultsThe themes from the analysis process represent how LE influences the participant’s work as a leader in academia and give insight into how she navigates academia without a college degree.DiscussionHigher education must meet the needs of Hispanic students and leaders. By elevating Hispanic women in leadership positions, even without degrees, institutions of higher education are demonstrating a commitment to Hispanic student support, development, diversity, and culture.

Objectives: U.S. Hispanic teens experience higher rates of unintended pregnancy than white teens. Limited research has been done to explore the sociocultural factors that impact Hispanic teens and their decisions about birth control and long-acting reversible contraception (LARC). The theory of planned behavior served as a framework for this study and teen perspectives about contraceptive decision making. This study aimed to identify the sociocultural factors that impact Hispanic teens when they make decisions about birth control and LARC. Study Design and Methods: We interviewed Hispanic teens from school-based health centers in New Mexico during their schedule medical appointments. Interviews were audio recorded, transcribed, and coded using content analysis coding methods and a descriptive qualitative design. Results: A total of 20 Hispanic teens participated in this study, all were female and between the ages of 14 and 19 years. Themes: Five themes emerged from the analysis process that impact Hispanic teen contraceptive choice, these are family, religion, culture, peer influence, and other factors. Conclusions and Implications: Among both LARC and non-LARC groups, peer influence was the most frequently cited reason for contraceptive decision making. Relationships with family were cited as barriers for Hispanic teens, where lack of communication and abstinence-only beliefs made it difficult to seek contraception. Findings demonstrate that teens selected LARCs because of the impacts on menstrual cycles and clinician influence. Teens who did not self-select LARC discussed ease of protection and the utilization of birth control as a transition to LARC.

Purpose and Objectives: American Indian/Alaska Native (AI/AN) hypertension contributes to cardiovascular disease, the leading cause of premature death in this population. The purpose of this article is to document strategies, concerns, and barriers related to hypertension and cardiovascular disease from Native-Controlling Hypertension and Risks through Technology (Native-CHART) symposiums facilitated by the Center for Native American Health (CNAH). The objectives of this evaluation were to combine Health Needs Assessment (HNA) data and explore barriers and strategies related to hypertension while assessing changes in participants’ perspectives over time (2017-2021). Approach: CNAH followed an iterative process each year for planning the HNA, facilitating the HNA, and refining and reflecting on HNA findings over time. This involved 3 interconnected steps: (1) developing a shared understanding for the HNA, “Why are we here?,” (2) facilitating the HNA during annual symposiums “What do we do?,” and (3) reflecting on “What did we learn?”. Evaluation Methods: Data were collected using a culturally centered HNA co-created by the CNAH team and tribal partners. Qualitative data analysis utilized a culturally centered thematic approach and NVivo software version 12.0. Quantitative data analysis included summarizing frequency counts and descriptive statistics using Microsoft Excel. Results: Over the 5-year period, 212 Native-CHART symposium participants completed HNAs. Data collected from HNAs show persistent barriers and concerns and illuminate potential strategies to address AI/AN hypertension. Future efforts must explore effective strategies that build on community strengths, culture and traditions, and existing resources. This is the path forward. Implications for Public Health: CNAH’s culturally centered and unique HNA approach helped assess participant perspectives over time. CNAH facilitated symposiums over multiple years, even amid a global pandemic. This demonstrates resilience and continuity of community outreach when it is needed the most. Other universities and tribal partners could benefit from this iterative approach as they work to design HNAs with tribal populations.

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 < 0.001), thinking about lessons learned (post 24% vs. pre 7%, p < 0.0001), and sharing lessons learned during the conversation (post 21% vs. pre 4%, p < 0.001). A lower percentage of AI/AN youth reported being bullied in the last year (post 31% vs. pre 37%, p < 0.001). Family social support was moderated by dose, with subscale scores of 3.75 at post-with 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.

BackgroundMany American Indian and Alaska Native (AI/AN or Native) communities express concern about high rates of suicide and poor mental health. Technology-based health interventions that nurture resilience, coping skills, connectedness, and help-seeking skills may be an effective strategy for promoting health and wellbeing among AI/AN youth. The Northwest Portland Area Indian Health Board designed the BRAVE intervention for AI/AN youth. BRAVE 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. ObjectiveThe aim of this study is to explore system data from the BRAVE intervention to determine patterns of user engagement and differences in psychosocial outcomes based on the number of clicks on BRAVE content. MethodsThe BRAVE study included 1030 AI/AN teens and young adults nationwide (15 to 24 years old). The message series in the BRAVE and STEM study arms included 3 to 5 SMS text messages per week, featuring 1 role model video and 1 image per week. Messages were sent out via Mobile Commons (Upland Software Inc), a mobile messaging provider that supports text, picture, and video SMS. ResultsOf the 509 participants in the original BRAVE analysis, 270 had sufficient data to analyze user engagement, with at least 1 trackable click on a study SMS text message. Of the 270, 184 (68.1%) were female, 50 (18.5%) were male, and 36 (13.3%) selected another gender category. The average participant was 20.6 years old, with a minimum and maximum age of 15 and 26 years. Most participants had relatively low engagement measured by the number of clicks (median 2; mean 3.4), although others clicked message content as many as 49 times. Users engaged most frequently with the YouTube-based content (viewing 1 of 7 role model videos), with 64.8% (175/270) of total clicks coming from the role model videos, and earlier episodes receiving the highest number of clicks. Most baseline psychosocial measures were not significantly associated with the number of links clicked. However, help-seeking behavior was highly significant (P

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.

BackgroundCulturally 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. ObjectiveWe 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. MethodsFrom 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. ResultsA 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

Culturally-adapted evidence-based programs (EBPs) are needed to promote healthy behaviors among Native teens and young adults. Little is known about the facilitators and barriers of implementing and sustaining EBPs in Native communities. This paper aims to identify those factors described by educators who implemented the Native Students Together Against Negative Decisions (STAND) curriculum. Methods: We conducted qualitative, semi-structured interviews with 44 Native STAND educators from 48 sites throughout the United States. We used a modified grounded theory approach to explore barriers, facilitators, and sustainability factors related to implementing Native STAND. Results: We learned that disruptions to staffing, coordination, and organizational factors were the most common barriers. Factors that improved implementation success included: tailoring the program to local needs/constraints, having a supportive Project Manager, improved fidelity due to check-in calls, and participation in summer training. Factors that improved sustainability included: access to needed infrastructure, administrative support, community support, and student interest. Discussion: The delivery of Native STAND was further improved by person-to-person communication and resource sharing across sites. Sustaining EBPs in AI/AN settings requires culturally-tailored technical assistance, sufficient implementation funds for materials and staffing, and a community of peer educators to inspire forward progress. Conclusion: EBPs that reflect the needs and experiences of American Indian and Alaska Native (AI/AN) youth are necessary to address systemic inequities in adolescent health outcomes. The Native STAND Dissemination and Implementation study is among the first to assess facilitators and barriers to program delivery in diverse AI/AN settings.

This qualitative study explored resident and nonresident fathers’ perspectives about factors that facilitated and inhibited their ability to play a positive and active role in their children’s lives. A total of 30 fathers were recruited from a support/mentoring group and from the general population to complete a semi-structured, audio-taped interview. A content analysis revealed that both groups of fathers were committed to maintaining a relationship with their children, and that by being present, they protected their children, helped them emotionally and financially, helped in their overall development, acted as a role model, and shared parenting responsibilities with their children’s mothers. Factors that facilitated parenting for resident and nonresident fathers included receiving proper guidance about fathering, a positive mother−father relationship, support from family, and church. Inhibiting factors were more prevalent for nonresident fathers that included mothers obstructing the father−child relationship, negative views/remarks about them as fathers, father−child visitation that is contingent upon child support, and fathers’ financial difficulties. The findings suggest a need for coparenting counseling, faith-based interventions, and employment services to address the complex socio-economic challenges that fathers face.