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Objective: We examined the relationship of childhood exposure to adversity and risk of substance-use disorder in two culturally distinct American Indian reservation communities, exploring both the role of early initiation of substance use in mediating this relationship and variation in risk across types of adversity exposure.Method: The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project provided data from 2,927 American Indians on the occurrence and age at onset of adversities, substance use, and substance-use-disorder symptoms.Results: The risk of substance-use disorder associated with early adversity was explained partially by early initiation of substance use. Three types of adversity (major childhood events, traumas, and witnessed violence) were associated with early onset of substance use and increased risk of substance-use disorder. Gender and tribe were also related to variation in both early substance use and substance-use disorder.Conclusions: Early exposure to adverse events was associated with early substance use and the subsequent development of substance-use disorders among American Indians. public health initiatives targeting substance use and substance-use disorders in American Indian communities should include efforts to help children in these communities cope with adversities they encounter. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) provided estimates of the prevalence of DSM-III-R disorders and utilization of services for help with those disorders in American Indian populations. Completed between 1997 and 1999, the AI-SUPERPFP was designed to allow comparison of findings with the results of the baseline National Comorbidity Survey (NCS), conducted in 1990-1992, which reflected the general United States population. METHOD: A total of 3,084 tribal members (1,446 in a Southwest tribe and 1,638 in a Northern Plains tribe) age 15-54 years living on or near their home reservations were interviewed with an adaptation of the University of Michigan Composite International Diagnostic Interview. The lifetime and 12-month prevalences of nine DSM-III-R disorders were estimated, and patterns of help-seeking for symptoms of mental disorders were examined. RESULTS: The most common lifetime diagnoses in the American Indian populations were alcohol dependence, posttraumatic stress disorder (PTSD), and major depressive episode. Compared with NCS results, lifetime PTSD rates were higher in all American Indian samples, lifetime alcohol dependence rates were higher for all but Southwest women, and lifetime major depressive episode rates were lower for Northern Plains men and women. Fewer disparities for 12-month rates emerged. After differences in demographic variables were accounted for, both American Indian samples were at heightened risk for PTSD and alcohol dependence but at lower risk for major depressive episode, compared with the NCS sample. American Indian men were more likely than those in NCS to seek help for substance use problems from specialty providers; American Indian women were less likely to talk to nonspecialty providers about emotional problems. Help-seeking from traditional healers was common in both American Indian populations and was especially common in the Southwest. CONCLUSIONS: The results suggest that these American Indian populations had comparable, and in some cases greater, mental health service needs, compared with the general population of the United States. [ABSTRACT FROM AUTHOR]

OBJECTIVE: American Indian populations have often been considered to be at greater risk for major depressive episode than are other groups in the United States. The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP), completed between 1997 and 1999, was designed to allow comparisons with the baseline National Comorbidity Survey (NCS), conducted in 1990-1992. The prevalence of lifetime and 12-month DSM-III-R major depressive episode was compared between the AI-SUPERPFP and NCS samples. METHOD: A total of 3,084 tribal members (1,446 in a Southwest tribe [73.7% of eligible participants] and 1,638 in a Northern Plains tribe [76.8% of eligible participants]) age 15-54 years living on or near their home reservations were interviewed. An adaptation of the University of Michigan Composite International Diagnostic Interview and the NCS algorithm for diagnosis were used to estimate the prevalence of lifetime and 12-month major depressive episode in these groups. RESULTS: The prevalence estimates for lifetime and 12-month major depressive episode were substantially lower in the American Indian samples, compared to the NCS sample. Detailed analyses indicated differential endorsement of lifetime symptoms between the American Indian groups and the NCS participants. Furthermore, American Indians were substantially less likely than NCS participants to indicate that depressive symptoms had co-occurred during an episode lasting at least 2 weeks. The lifetime prevalence estimates based on the NCS algorithm ranged from 3.8% to 7.9% for men and women in the two tribes. The analogous rates based on an adapted AI-SUPERPFP algorithm ranged from 7.2% and 14.3%. Few tribe, age, and gender differences were found. CONCLUSIONS: The findings underscore the need for careful examination of diagnostic instruments cross-culturally. Adaptation of the NCS algorithm for diagnosis appears necessary for estimation of the prevalence of major depressive episode in the American Indian populations included in this study. In striving to better reflect the clinical diagnostic process in epidemiological and services research, careful consideration of the resulting complexity becomes increasingly critical. [ABSTRACT FROM AUTHOR]

This study first examined a model of the predictors and mediators of both suicidal ideation and violent ideation, particularly since both types of ideation were highly correlated (r=.55) among our young adolescent participants. The variables in the model were those identified in media accounts of the histories of the 10 high-profile school shooting cases, and that have also been included in our earlier model of the predictors of suicidal ideation, which we expanded to include violent ideation. Perceptions of competence or adequacy and social support from peers and parents predicted two mediators in the model, an adjustment/depression composite (self-esteem, hope to hopelessness, and affect, along a continuum from cheerful to depressed) and anger-induced physical aggression. These variables, in turn, predicted both suicidal and violent ideation. Secondly, we examined adolescents' reactions to vignettes that described harassing events, at the hands of peers and teachers simulating the type of audience-observed ridicule experienced by the school shooters. We were particularly interested in the emotional reaction of humiliation, an effect that has received surprisingly little attention in the emotion literature. Humiliation was related to other emotions such as anger and depression, consistent with the co-occurence of internalizing and externalizing symptoms demonstrated in the overall model. Next we compared those who reported that they would respond violently to the events in vignettes compared to those reporting nonviolent reactions. Examining the variables in the general model, those who reported violent ideation reported markedly lower perceptions of adequacy, lower levels of social support, lower self-esteem, greater hopelessness, depressed affect, and anger-induced aggression. The violent ideators also reported higher levels of both homicidal and suicidal ideation. Discussion focused on the fact that thoughts of violence toward others as well as toward the self have similar psychosocial origins that should be considered in the prevention and intervention efforts. [ABSTRACT FROM AUTHOR]

Objective: We explored patterns of alcohol use among American Indian youths as well as concurrent predictors and developmental outcomes 6 years later.Method: This study used six semi-annual waves of data collected across 3 years from 861 American Indian youths, ages 14-20 initially, from two western tribes. Using a latent Markov model, we examined patterns of change in latent states of adolescent alcohol use in the past 6 months, combining these states of alcohol use into three latent statuses that described patterns of change across the 3 years: abstainers, inconsistent drinkers, and consistent drinkers. We then explored how the latent statuses differed, both initially and in young adulthood (ages 20-26).Results: Both alcohol use and nonuse were quite stable across time, although we also found evidence of change. Despite some rather troubling drinking patterns as teens, especially among consistent drinkers, most of the youths had achieved important tasks of young adulthood. But patterns of use during adolescence were related to greater levels of substance use in young adulthood.Conclusions: Latent Markov modeling provided a useful categorization of alcohol use that more finely differentiated those youths who would otherwise have been considered inconsistent drinkers. Findings also suggest that broad-based interventions during adolescence may not be the most important ones; instead, programs targeting later alcohol and other drug use may be a more strategic use of often limited resources. [ABSTRACT FROM AUTHOR]

Community engagement (CE) is widely acknowledged as a way to enhance the ethics, rigor, and impact of research. Additionally, CE is a demonstrated way to integrate Indigenous and colonial (western) research systems. For these reasons and others, designers of the Multi-site Implementation Evaluation of Tribal Home Visiting (MUSE) used a community-engaged approach to study the implementation of federally funded home-visiting programs across 17 Indigenous communities throughout the United States. This paper describes MUSE's community-engaged approach and its practical applications from the perspective of the MUSE study team. The paper highlights key outcomes attributable to CE, addresses barriers to CE, and details responses to these barriers and their impacts. Adding to the rich evidence base demonstrating the value of community-engaged approaches, MUSE demonstrates that in-depth CE is feasible and valuable in multisite studies done in partnership with Indigenous communities., (© 2024 The Author(s). Infant Mental Health Journal published by Wiley Periodicals LLC on behalf of Michigan Association for Infant Mental Health.)

Background: Rich cultural and traditional practices make interpersonal relationships vital for American Indian (AI) youth. Social relations and multigenerational networks (i.e., peer, family, kinship, and community) remain a salient fixture of AI culture, survival and thriving in reservation communities. Research in other populations has demonstrated how social networks impact youth risk and resilience, but data are lacking on AI adolescent networks. Intergenerational trauma from settler colonialism leads some AI youth to early initiation of substance use and subsequent substance misuse, along with disproportionately high risk for suicide and vulnerability to witnessing and experiencing violence. Using network data to develop prevention strategies among this population is a promising new avenue of research. In this study protocol paper, we describe the rationale and methodology of an exploratory study to be conducted with American Indian 9th and 10th graders at three schools on a Northern Plains reservation., Methods: This mixed methods study will collect quantitative social network surveys (N = 300) and qualitative interviews (n = 30). The study will examine the extent to which existing social network theories and data metrics adequately characterize AI youth networks or how they may need to be expanded for this population. Associations of network characteristics with risk and protective factors for substance use, exposure to violence, and suicide will also be examined., Discussion: This innovative methodological approach holds promise for informing the development of effective preventive approaches to address co-occurring risks for substance use, violence and suicide among AI adolescents. Understanding processes that impact social networks among AI adolescents can promote culturally resonant social relationships that may support better outcomes for youth., (Copyright © 2023. Published by Elsevier Ltd.)

Native American (NA) populations in the USA (i.e., those native to the USA which include Alaska Natives, American Indians, and Native Hawaiians) have confronted unique historical, sociopolitical, and environmental stressors born of settler colonialism. Contexts with persistent social and economic disadvantage are critical determinants of substance misuse and co-occurring sexual risk-taking and suicide outcomes, as well as alcohol exposed pregnancy among NA young people (i.e., adolescents and young adults). Despite intergenerational transmission of resistance and resiliencies, NA young people face continued disparities in substance misuse and co-occurring outcomes when compared to other racial and ethnic groups in the USA. The failure in progress to address these inequities is the result of a complex set of factors; many of which are structural and rooted in settler colonialism. One of these structural factors includes barriers evident in health equity research intended to guide solutions to address these disparities yet involving maintenance of a research status quo that has proven ineffective to developing these solutions. Explicitly or implicitly biased values, perspectives, and practices are deeply rooted in current research design, methodology, analysis, and dissemination and implementation efforts. This status quo has been supported, intentionally and unintentionally, by researchers and research institutions with limited experience or knowledge in the historical, social, and cultural contexts of NA communities. We present a conceptual framework illustrating the impact of settler colonialism on current research methods and opportunities to unsettle its influence. Moreover, our framework illustrates opportunities to resist settler colonialism in research. We then focus on case examples of studies from the Intervention Research to Improve Native American Health program, funded by the NIH, that impact substance use and co-occurring health conditions among NA young people., Competing Interests: Competing Interests The authors declare no competing interests.

Adolescence is a critical period for reducing skin cancer risks, yet the development of effective interventions for middle and high school youth has lagged behind those for younger children. We developed and implemented the "Youth Engaged Strategies for Changing Adolescent Norms!" (YESCAN!) program, a school-based peer leader program that uses a youth-researcher partnership approach and a project-based curriculum to support high school students in developing and delivering short narrative videos and related material about skin cancer prevention to middle school students. Participating middle and high school students completed pre- and post-program surveys assessing skin cancer attitudes, perceived norms, and behavioral intentions. Middle school students (N = 97) reported positive pre- to post-program changes in future intentions to engage in sun protection and reduce UV exposure behaviors and on numerous measures of normative beliefs and attitudes. High school students (N = 13) reported positive changes on a smaller set of behavioral intentions, normative beliefs, and attitudes. These findings add to a growing body of support for youth-participatory, peer-led approaches to adolescent risk reduction in general and to skin cancer risks specifically. The YESCAN! program fills a need for effective skin cancer prevention among adolescents, while at the same time addressing educational objectives to develop 21st Century Skills., (© 2021. The Author(s) under exclusive licence to American Association for Cancer Education.)

Research in Indigenous communities continues to lead innovations in the adversity and resilience sciences. These innovations highlight the strengths of Indigenous communities and are an act of resistance against prevailing stereotypes that Indigenous communities are vulnerable and wholly restrained by health deficits. The aim of this Supplemental Issue on Substance Misuse and Disorder and American Indian, Alaska Native, and Native Hawaiian Children's Development: Understanding Root Causes and Lifting up Solutions Grounded in Indigenous Community Strengths is to highlight the promising new approaches and perspectives implemented by a group of engaged researchers and their community partners, as they seek to move resilience science research forward. Case studies presented in this issue are from projects led by teams connected to the Native Children's Research Exchange (NCRE) conference, all of whom conduct health promotion and disease prevention research among American Indians, Alaska Natives, and Native Hawaiians. Sparked by several major exogenous shocks to the current landscape of the American milieu, namely, the COVID-19 pandemic, the murder of George Floyd (increased visibility of overt racism in the USA), and climate change, this article presents a model for conducting research with Indigenous Communities that acknowledges these forces while highlighting community strengths., Competing Interests: Conflict of Interest The authors declare no competing interests.

Background : Effective substance use prevention strategies are needed for American Indian (AI) youth, who face disproportionate risk for early substance use and consequently bear a disproportionate burden of health and developmental disparities related to early use. With few exceptions, significant advances in prevention science have largely excluded this population, leaving gaps in the evidence of effective practice. This paper builds on emerging efforts to address this gap, reporting first outcome findings from an evidence-based early substance use prevention program culturally adapted for young adolescents on a Northern Plains reservation. Methods : Using a community-based participatory approach, the Thiwáhe Gluwáš'akapi Program (TG, sacred home in which family is made strong ) was developed by embedding cultural kinship teachings within the Strengthening Families Program for Parents and Youth 10-14 and aligning other elements of program content with local culture and context. Results : Results of pre and post comparisons of proximal program outcomes showed that youth reported significant improvements in parental communication about substance use, substance use resistance skills, stress management, family cohesion, and overall well-being. Adults reported improvements in a wide array of parenting behaviors and indicators of family dynamics. Conclusions : These findings provide an initial glimpse into the potential effects of the TG program and suggest that it holds promise for helping AI families address risks for youth substance use through positive impacts on modifiable risk and protective factors documented to influence early substance use.

Children are highly regarded and treasured as the future of American Indian and Alaska Native (AIAN) communities. Developmental disorders, however, are more frequently undiagnosed and untreated in AIAN children compared to others in the United States. Developmental screening can help communities ensure that their children reach their full potential, but lack of culturally sensitive and valid screening measures complicates screening among AIAN children. This can, in turn, delay access to early intervention and undermine the ability of AIAN communities to support children's optimal development. This study explored families' and professionals' perceptions of screening systems and processes in AIAN communities and to identify gaps and opportunities. A total of 53 interviews and 23 focus groups were conducted with 157 parents and early childcare professionals in four AIAN communities. A conceptual framework to describe systems of screening for young children was developed by AIAN early childhood program partners and early childhood researchers working together on a Tribal Early Childhood Research Center Community of Learning; this framework guided study design and interview guides. Transcripts were coded for themes in alignment with the conceptual framework; 13 key themes and 81 subthemes were identified. Findings are discussed in terms of implications for enhancing screening efforts in Tribal communities., (© 2022 Michigan Association for Infant Mental Health.)

Screening children from birth through age 5 is critical to early identification of challenges and referral to intervention to support optimal development. Screening of American Indian and Alaska Native (AIAN) children lags behind that of other children, partly due to the lack of screening tools validated for this population. This study tested the feasibility of an online data collection strategy for use in a future study of the validity of existing screening instruments for AIAN children. Parents of AIAN children in four communities were recruited to complete screeners, provide demographic information, and provide feedback on experiences with online data collection. Participants were given the option of receiving screening results from the local early childhood program through which they were recruited. 240 participants began the process, 183 were enrolled in a partner program and reported a birthdate for at least one AIAN child, 157 had an age-eligible child, 81 began the consent process, 62 consented, and 39 fully completed data collection. Most participants were female and AIAN, the majority reported that online data collection was easy. Collecting screener validation data on a large sample of AIAN children may be able to utilize online data collection tools, with in-person support to facilitate participation., (© 2022 Michigan Association for Infant Mental Health.)

Globally, Indigenous communities, leaders, mental health providers, and scholars have called for strengths-based approaches to mental health that align with Indigenous and holistic concepts of health and wellness. We applied the Indigenist Ecological Systems Model to strengths-based case examples of Indigenous youth mental health and wellness work occurring in CANZUS (Canada, Australia, New Zealand, and United States). The case examples include research, community-led programs, and national advocacy. Indigenous youth development and well-being occur through strengths-based relationships across interconnected environmental levels. This approach promotes Indigenous youth and communities considering complete ecologies of Indigenous youth to foster their whole health, including mental health. Future research and programming will benefit from understanding and identifying common, strengths-based solutions beyond narrow intervention targets. This approach not only promotes Indigenous youth health and mental health, but ripples out across the entire ecosystem to promote community well-being.

Inequities impact American Indian, Alaska Native, and Native Hawaiian populations across various health conditions; in particular, many Native communities bear a disproportionate burden of substance use disorder. Such inequities persist despite concerted efforts of communities and significant research directed toward prevention and intervention. One factor hampering these efforts is the underrepresentation of researchers who are themselves Native and uniquely equipped to respond to the needs of their communities. This paper describes the innovative Native Children's Research Exchange (NCRE) Scholars program, now entering its ninth year of successful career development support for emerging Native scholars. We summarize the history of NCRE Scholars, outline the mentoring and training approaches taken to meet the unique needs of early-career Native scholars, and present key progress of program alumni. The current cohort of Scholars provide first-person perspectives on how four key program elements have supported their career development to date. NCRE Scholars has been an effective approach for supporting the next generation of Native research leaders and for helping to build an essential mass of Native researchers prepared to respond to Native community health priority needs., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Ivanich, Sarche, White, Marshall, Russette, Ullrich and Whitesell.)

Objectives: HIV and sexually transmitted diseases (STDs) are serious health conditions among American Indian and Alaska Native (AIAN) populations, especially youth. However, few sexual risk reduction evidence-based interventions (EBIs) have been implemented by AIAN-serving organizations. This project sought to identify and assess the parameters facilitating the uptake and use of EBIs in order to strengthen opportunities for sustainability and improved sexual health among AIANs. Design: Guided by Rogers' theory of diffusion of innovation, we conducted a survey with a national sample of stakeholders involved with sexual health and well-being of AIAN youth ( N  = 142). We collected surveys for nine months beginning September 2010 and analyzed data in 2014 and 2015. We assessed respondents' perceptions of factors that might facilitate or hinder the use of a sexual risk reduction EBI, called RESPECT, in their communities. We regressed the scale of likely program uptake (alpha = 0.88) on each of five measures of perception of diffusion and uptake: trialability (extent new program can be altered), relative advantage (more advantageous than current program), observability (impact of program), complexity (difficulty of implementation), and compatibility (consistent with community values and practices). Results: Trialability ( p  = .009), observability ( p  = .003), and compatibility ( p  = .005) were found to be significantly related to program uptake in the adjusted model. Standardized betas showed that compatibility ranked highest of the three, followed by trialability and observability. Conclusions: For AIAN-serving organizations and AIAN communities, demonstrating trialability, compatibility, and observability of a sexual risk reduction EBI in specific cultural settings may increase likelihood of implementation and sustainability.

Introduction: Sexual health disparities are leading causes of morbidity among youth of color in the United States. We conducted a scoping review of the literature on precursors to sexual risk-taking among young adolescents of color (ages 10-14) to assess precedents of sexual experience and their utility as measurable proximal constructs and behaviors gauging sexual risk and sexual risk prevention efforts., Methods: This study was conducted using the PRISMA extension for scoping reviews (PRISMA-ScR) guidelines. We searched for quantitative studies that assessed the relationships between precursors and subsequent sexual behaviors, incorporated youth of color, and specified young adolescents as the study sample. All articles were in English, however we explored both U.S. and International databases., Results: The database search yielded 11 studies published between 2000 and 2017. Most literature focused on youth in urban settings, and on Black and Latinx youth, while only two addressed the special circumstances of American Indian and Alaska Native youth. Sex expectancies outcomes for youth of color were likely to predict sexual risk taking and self-efficacy about sex was related to abstinence., Conclusions: Etiologic studies that seek to understand precursors to sexual risk taking among youth of color are limited and this paucity truncates the ability to develop sexual risk prevention programs for the age group in which prevention is most needed., Competing Interests: Declaration of competing interest No conflicts of interest to report., (Published by Elsevier Ltd.)

This concluding article to the Supplemental Issue on Promoting Health Equity through Rigorous, Culturally Informed Intervention Science: Innovations with Indigenous Populations in the United States draws themes and conclusions from the innovative practices implemented by the National Institutes of Health Intervention Research to Improve Native American Health (IRINAH) consortium. The IRINAH work highlights promising practices for advancing the diverse and underrepresented perspectives essential to develop and test culturally appropriate, effective health interventions in American Indian, Alaska Native, and Native Hawaiian settings. Four emergent themes appear through the IRINAH work. First, community-based participatory research (CBPR) has provided projects an intersectional worldview for bridging cultures and informing an ethics of local control. Second, culture is fundamental as a central organizing principle in IRINAH research and intervention implementation. Third, crucial demands for sustainability of interventions in Indigenous intervention science require a rethinking of the intervention development process. Finally, tensions persist in Indigenous health research, even as significant strides are made in the field. These themes collectively inform an ethical and rigorous Indigenous intervention science. Collectively, they suggest a roadmap for advancing Indigenous perspectives and self-determination in health intervention research. IRINAH studies are leading innovation in intervention science by advancing applications of CBPR in intervention science, promoting new directions in small populations health research, and demonstrating value of participatory team science.

Indigenous communities often face disproportionate challenges across a variety of health domains, and effective prevention strategies are sorely needed. Unfortunately, evidence is scant regarding what approaches are effective for these communities. A common approach is to take an evidence-based practice or program with documented effectiveness in other populations and implement it with Indigenous populations. While a science of intervention adaptation is emerging, there remains little guidance on processes for adaptation that strategically leverage both existing scientific evidence and Indigenous prevention strategies. In this paper, two case studies illustrate promising practices for adaptation, documenting the approaches of two research teams funded under the National Institutes of Health's initiative to support Intervention Research to Improve Native American Health (IRINAH). These teams worked with distinct Indigenous populations in the USA and Canada to culturally adapt the same prevention program, the Iowa Strengthening Families Program for Parents and Youth 10-14. The approaches of these two teams and the programs that resulted are compared and contrasted, and critical elements of adaptation in partnership with Indigenous communities are discussed.

Research in indigenous communities is at the forefront of innovation currently influencing several new perspectives in engaged intervention science. This is innovation born of necessity, involving efforts to create health equity complicated by a history of distrust of research. Immense diversity across indigenous cultures, accompanied by variation in associated explanatory models, health beliefs, and health behaviors, along with divergent structural inequities add further complexity to this challenge. The aim of this Supplemental Issue on Promoting Health Equity through Rigorous, Culturally Informed Intervention Science: Innovations with Indigenous Populations in the United States is to highlight the promising new approaches and perspectives implemented by a group of engaged researchers and their community partners, as they seek to move intervention research forward within indigenous communities. Case studies presented are from projects led by members of the National Institutes of Health Intervention Research to Improve Native American Health (IRINAH) consortioum, investigators who conduct health promotion and disease prevention research among American Indians, Alaska Natives, and Native Hawaiians. The promising practices profiled include new strategies in (a) community partnerships, engagement, and capacity building; (b) integration of indigenous and academic perspectives; (c) alignment of interventions with indigenous cultural values and practices; and (d) implementation and evaluation of multilevel interventions responsive to complex cultural contexts. The IRINAH projects illustrate the evolution of an intervention science responsive to the needs, realities, and promise of indigenous communities, with application to health research among other culturally distinct health inequity groups.

Initiation of substance use often occurs earlier among American Indian (AI) youth than among other youth in the USA, bringing increased risk for a variety of poor health and developmental outcomes. Effective prevention strategies are needed, but the evidence base remains thin for this population. Research makes clear that prevention strategies need to be culturally coherent; programs with an evidence base in one population cannot be assumed to be effective in another. However, guidance on effective adaptation is lacking. This paper reports on cultural adaptation of an evidence-based program utilizing the multiphase optimization strategy (MOST) framework embedded within a community-engaged process to evaluate intervention components. The Strengthening Families Program for Parents and Youth 10-14 was adapted to become the Thiwáhe Gluwáš'akapi Program for American Indian youth and families. Three program components were evaluated for their effectiveness with regard to outcomes (youth substance use, theoretical mediators of program effects on substance use, and program attendance) in a sample of 98 families (122 youth and 137 adults). Consistent with the MOST framework, the value of components was also evaluated with regard to efficiency, economy, and scalability. Expanding on the MOST framework for cultural adaptation, we also considered the results of the MOST findings regarding the acceptability of each component from the perspectives of community members and participants. The promise of a strategic component-based approach to adapting evidence-based interventions is discussed, including the benefits of engaging community to ensure relevance and considering both cultural and scientific rationale for each component to enhance impact.

Research is an important tool in addressing myriad American Indian and Alaska Native (AIAN) health disparities; however, tensions exist between common empirical measurement approaches that facilitate cross-cultural comparisons and measurement specificity that may be more valid locally and/or culturally appropriate. The tremendous diversity of AIAN communities, small population sizes of distinct AIAN cultural groups, and varying cultural contexts and worldviews should influence measurement decisions in health research. We provide a framework for guiding measurement in collaboration with AIAN communities using examples from substance abuse research for illustration. Our goal is to build upon ongoing efforts to advance measurement validity for AIAN research by engaging community-researcher partnerships and critical thinking in the selection, adaptation, creation, and implementation of measures.

This study drew on the Theory of Gender and Power (TGP) as a framework to assess power inequalities within heterosexual dyads and their effects on women. Structural equation modeling was used to better understand the relationship between structural and interpersonal power and HIV sexual risk within African American and Latina women's heterosexual dyads. The main outcome variable was women's sexual HIV risk in the dyad and was created using women's reports of condomless sex with their main male partners and partners' reports of their HIV risk behaviors. Theoretical associations developed a priori yielded a well-fitting model that explained almost a quarter of the variance in women's sexual HIV risk in main partner dyads. Women's and partner structural power were indirectly associated with women's sexual HIV risk through substance use and interpersonal power. Interpersonal power was directly associated with risk. In addition, this study found that not identifying as heterosexual was directly and indirectly associated with women's heterosexual sex risk. This study provides further support for the utility of the TGP and the relevance of gender-related power dynamics for HIV prevention among heterosexually-active women.

Drawing on previous studies and the collective experience of conducting rigorous evaluations as part of the Tribal Maternal, Infant, and Early Childhood Home Visiting grants, we outline methodological considerations that will inform future research in tribal communities, particularly in the area of home visiting. The methodological issues we discuss are study design choices, measurement and data collection, and including community members in all aspects of the research., (© 2018 Michigan Association for Infant Mental Health.)

In this article, Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) grantees share strategies they have developed and adopted to address the most common barriers to effective measurement (and thus to effective evaluation) encountered in the course of implementation and evaluation of their home-visiting programs. We identify key challenges in measuring outcomes in Tribal MIECHV Programs and provide practical examples of various strategies used to address these challenges within diverse American Indian and Alaska Native cultural and contextual settings. Notably, high-quality community engagement is a consistent thread throughout these strategies and fundamental to successful measurement in these communities. These strategies and practices reflect the experiences and innovative solutions of practitioners working on the ground to deliver and evaluate intervention programs to tribal communities. They may serve as models for getting high-quality data to inform intervention while working within the constraints and requirements of program funding. The utility of these practical solutions extends beyond the Tribal MIECHV grantees and offers the potential to inform a broad array of intervention evaluation efforts in tribal and other community contexts., (© 2018 Michigan Association for Infant Mental Health.)

Evidence-based interventions hold promise for reducing gaps in health equity across diverse populations, but evidence about effectiveness within these populations lags behind the mainstream, often leaving opportunities to fulfill this promise unrealized. Mismatch between standard intervention outcomes research methods and the cultural and community contexts of populations at greatest risk presents additional challenges in designing and implementing rigorous studies; these challenges too often impede efforts to generate needed evidence. We draw on experiences with American Indian and Alaska Native (AIAN) communities to illustrate how consideration of culture and context can constructively shape intervention research and improve the quality of evidence produced. Case examples from a partnership with one AI community highlight opportunities for increasing alignment in intervention development, research design, and study implementation to maximize both validity and feasibility. We suggest that responsively tailoring intervention outcome research to cultural and community contexts is fundamental to supporting health equity.

Background: Early substance use threatens many American Indian/Alaska Native (AI/AN) communities, as it is a risk factor for maladaptive use and adverse health outcomes. Marijuana is among the first substances used by AI/AN youth, and its use becomes widespread during adolescence. Interventions that delay or reduce marijuana use hold the promise of curbing substance disorders and other health risk disparities in AI/AN populations., Objectives: We evaluated the effectiveness of the Circle of Life (COL) program in reducing marijuana use among young AI adolescents. COL is a culturally tailored, theory-based human immunodeficiency virus (HIV) and sexually transmitted disease (STD) intervention shown to delay sexual initiation among AI youths., Methods: We conducted secondary analyses of data from a school-based group randomized trial conducted between 2006 and 2007 in all 13 middle schools on a rural, Northern Plains reservation (N = 635, 47% female). We used discrete-time survival analysis (DTSA) to assess COL effectiveness on risk of marijuana initiation among AI youths and latent growth curve modeling (LGCM) to evaluate effects on frequency of marijuana use over time., Results: DTSA models showed that the overall risk of marijuana initiation was 17.3% lower in the COL group compared to the control group. No intervention effect on frequency of marijuana use emerged in LGCM analyses., Conclusion: COL is a multifaceted, culturally tailored, skills-based program effective in preventing marijuana uptake among AI youth.

For adolescents, normative development encompasses learning to negotiate challenges of sexual situations; of special importance are skills to prevent early pregnancy, HIV, and other sexually transmitted diseases. Disparities in sexual risk among American Indian youth point to the importance of intervening to attenuate this risk. This study explored the impact of Circle of Life (COL), an HIV prevention intervention based on social cognitive theory, on trajectories of self-efficacy (refusing sex, avoiding sexual situations) among 635 students from 13 middle schools on one American Indian reservation. COL countered a normative decline of refusal self-efficacy among girls receiving the intervention by age 13, while girls participating at age 14 or older, girls in the comparison group, and all boys showed continuing declines., (© 2017 The Authors. Journal of Research on Adolescence © 2017 Society for Research on Adolescence.)

This study examined the feasibility of the Survey of Well-Being of Young Children (SWYC), a new screener for socioemotional and developmental problems and family risk in children birth to age 5 years, for use in American Indian and Alaska Native (AIAN) communities. A Community of Learning within the Tribal Early Childhood Research Center, composed of university researchers, tribal early childhood program staff and evaluators, and federal partners, utilized a community-based participatory research approach to guide this qualitative study. Thirty-two focus groups and 20 key informant interviews (N = 199) were conducted with staff from Head Start, Home Visiting, and Child Care programs; pediatricians; behavioral health providers; parents of young children; tribal leaders; and other stakeholders in seven diverse AIAN communities. Three themes emerged: (a) a strong need to screen early for socioemotional and developmental problems and family risk; (b) the importance of a carefully designed process for screening; and (c) the importance of examining the content of the SWYC for cultural fit specific to tribal communities. Findings support two recommendations: (a) the development of guidelines for using the SWYC in tribal early childhood settings and (b) a full-scale validation study to determine appropriate use with and norms for children in tribal communities., (© 2015 Michigan Association for Infant Mental Health.)

Objectives: We assessed the effectiveness of Circle of Life (COL), an HIV-preventive intervention developed specifically for American Indian and Alaska Native (AI/AN) middle school youths., Methods: By partnering with a tribal community, we conducted a longitudinal wait-listed group randomized trial with 635 seventh and eighth graders in 13 schools of a Northern Plains tribe. We surveyed participants at baseline, 3 months, and 12 months from 2006 to 2007., Results: COL was found to increase HIV knowledge in the short term, but had no effect on sexual activity compared with those who did not receive it. However, COL was found to be effective for delaying the onset of sexual activity, with the greatest reduction in risk occurring for those receiving COL at early ages., Conclusions: Community partnership was key to successful project design, implementation, and analysis. The project confirmed the importance of the timing of interventions in early adolescence. COL may be a key resource for reducing sexual risk among AI/AN youths.

Substance use often begins earlier among American Indians compared to the rest of the United States, a troubling reality that puts Native youth at risk for escalating and problematic use. We need to understand more fully patterns of emergent substance use among young American Indian adolescents, risk factors associated with escalating use trajectories, and protective factors that can be parlayed into robust prevention strategies. We used growth mixture modeling with longitudinal data from middle-school students on a Northern Plains reservation (Wave 1 N = 381, M age at baseline = 12.77, 45.6% female) to identify subgroups exhibiting different trajectories of cigarette, alcohol, and marijuana use. We explored how both risk (e.g., exposure to stressful events, deviant peers) and protective (e.g., positive parent-child relationships, cultural identity) factors were related to these trajectories. For all substances, most youth showed trajectories characterized by low rates of substance use (nonuser classes), but many also showed patterns characterized by high and/or escalating use. Across substances, exposure to stress, early puberty, and deviant peer relationships were associated with the more problematic patterns, while strong relationships with parents and prosocial peers were associated with nonuser classes. Our measures of emergent cultural identity were generally unrelated to substance use trajectory classes among these young adolescents. The findings point to the importance of early substance use prevention programs for American Indian youth that attenuate the impact of exposure to stressful events, redirect peer relationships, and foster positive parent influences. They also point to the need to explore more fully how cultural influences can be captured.

Posttraumatic stress disorder (PTSD) has been found to be more common among American Indian populations than among other Americans. A complex diagnosis, the assessment methods for PTSD have varied across epidemiological studies, especially in terms of the trauma criteria. Here, we examined data from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) to estimate the lifetime prevalence of PTSD in two culturally distinct American Indian reservation communities, using two formulas for calculating PTSD prevalence. The AI-SUPERPFP was a cross-sectional probability sample survey conducted between 1997 and 2000. Southwest (n = 1,446) and Northern Plains (n = 1,638) tribal members living on or near their reservations, aged 15-57 years at time of interview, were randomly sampled from tribal rolls. PTSD estimates were derived based on both the single worst and 3 worst traumas. Prevalence estimates varied by ascertainment method: single worst trauma (lifetime: 5.9% to 14.8%) versus 3 worst traumas (lifetime, 8.9% to 19.5%). Use of the 3-worst-event approach increased prevalence by 28.3% over the single-event method. PTSD was prevalent in these tribal communities. These results also serve to underscore the need to better understand the implications for PTSD prevalence with the current focus on a single worst event., (Copyright © 2013 International Society for Traumatic Stress Studies.)

Purpose: To determine conditional risk of posttraumatic stress disorder (PTSD) in two culturally distinct American Indian reservation communities., Method: Data derived from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project, a cross-sectional population-based survey that was completed between 1997 and 2000. This study focused on 1,967 participants meeting the DSM-IV criteria for trauma exposure. Traumas were grouped into interpersonal, non-interpersonal, witnessed, and "trauma to close others" categories. Analyses examined distribution of worst traumas, conditional rates of PTSD following exposure, and distributions of PTSD cases deriving from these events. Bivariate and multivariate logistic regressions estimated associations of lifetime PTSD with trauma type., Results: Overall, 15.9 % of those exposed to DSM-IV trauma qualified for lifetime PTSD, a rate comparable to similar US studies. Women were more likely to develop PTSD than were men. The majority (60 %) of cases of PTSD among women derived from interpersonal trauma exposure (in particular, sexual and physical abuse); among men, cases were more evenly distributed across trauma categories., Conclusions: Previous research has demonstrated higher rates of both trauma exposure and PTSD in American Indian samples compared to other Americans. This study shows that conditional rates of PTSD are similar to those reported elsewhere, suggesting that the elevated prevalence of this disorder in American Indian populations is largely due to higher rates of trauma exposure.

Background: The epidemiology and etiology of substance use and disorder in American Indian and Alaska Native (AI/AN) communities have received increasing attention over the past 25 years and accumulating evidence provides important insights into substance use patterns in these populations., Objectives and Methods: We provide a descriptive sketch of the AI/AN population in the United States today, present a brief review of the literature on the epidemiology and etiology of substance use within these populations, and discuss key implications of this literature for prevention efforts., Conclusions and Scientific Significance: Patterns of alcohol use and abuse in AI/AN populations are complex and vary across cultural groups, but alcohol clearly impacts both physical health and mental health within these communities. Tobacco use - and associated health consequences - is typically higher in these populations than among other US groups, although significant variation across Native communities is apparent here as with alcohol. Evidence regarding drug use and disorder is less extensive and thus less conclusive, but evidence demonstrates higher rates of use as well. Etiological explanations for substance use and disorder cut across individual characteristics (e.g., genetics) or experiences (e.g., exposure to trauma), to social contexts (e.g., family disruption), and to cultural factors (e.g., historical trauma). Protective factors likely cut across these multiple levels as well and deserve more focused attention for informing prevention efforts. The development of effective prevention strategies, built through collaboration between researchers and Native communities, drawing from the wisdom of both, is a high priority.

Background: Substantial evidence documents problematic substance use in Northern Plains American Indian communities. Studies suggest that disparities can be traced to disproportionate rates of early substance use, but most evidence comes from the retrospective reports of adults or older adolescents., Objective: To use a prospective longitudinal design to examine substance use initiation patterns as they emerge among young American Indian adolescents., Methods: Four waves of data were collected across three consecutive school years from middle school students on a Northern Plains reservation (N = 450). Discrete-time survival analyses were used to estimate risks of initiation of cigarettes, alcohol, and marijuana from age 10 to 13., Results: Risk for cigarette initiation was relatively high at age 10 and stable until age 13. Marijuana risk was low at age 10 but increased sharply by age 12. Alcohol initiation lagged, not surpassing risk for cigarette initiation until age 13 and remaining below risk for marijuana initiation throughout middle school. Hazards for girls trended higher than those for boys across all substances, but differences did not reach significance., Conclusion: Initiation patterns among these American Indian adolescents differed from patterns reported in other US groups, particularly with respect to deviation from the sequence characterized the initiation of marijuana before alcohol that is predicted by the gateway theory., Scientific Significance: Findings suggest that prevention efforts with youth in this community should begin early with a primary focus on marijuana use. They also suggest the importance of examining sequences of substance initiation among youth in other American Indian communities.

Objective: To study the relationships between early and combined use of alcohol and marijuana with diagnoses of alcohol and marijuana use disorders in two American Indian (AI) populations., Method: Data were drawn from a psychiatric epidemiologic study of 3084 AIs living on or near two reservations. We analysed data for adults aged 18-54 years at the time of interview ( n = 2739). Logistic regression models were estimated to examine associations between early and combined use of alcohol and marijuana with lifetime diagnoses of abuse and dependence., Results: Overall, younger AIs (18-29 years old) were more likely than older AIs (40-54 years old) to initiate substance use early and initiate use with marijuana, with or without alcohol. Persons who initiated alcohol use before age 14 were more than twice as likely as those who initiated use at older ages to meet criteria for alcohol or marijuana use disorders ( p < 0.01). The odds of abuse or dependence were two to five times higher among persons who reported combined use of alcohol and marijuana ( p < 0.01) than among those who reported use of either substance., Conclusions: These findings document the need to address both early and combined use of alcohol and marijuana in prevention and treatment programmes.

In spite of significant disparities in sexual health outcomes for American Indian youth, no studies exist examining the effectiveness of HIV-prevention interventions. Circle of Life is an HIV-prevention intervention specifically developed for American Indian middle-school youth. We describe the rationale, methodology, and baseline results of a longitudinal randomized trial of Circle of Life conducted among American Indian youth aged 11-15 in a reservation community. The innovative design includes two pre-intervention waves to determine patterns of behavior prior to the intervention that might be associated with a differential impact of the intervention on sexual risk. We used one-way analysis of variance and chi-square tests to test for significant differences between randomized group assignment at each baseline wave and generalized estimating equations (GEE) to test significant differences in the rate of change in outcomes by group longitudinally. We present the collaborative and adaptive strategies for consenting, assenting, and data collection methodology in this community. Achieved response rates are comparable to other similar studies. Results from the two baseline waves indicate that few outcomes significantly varied by randomized intervention assignment. Ten percent of youth reported having had sex at Wave 1, rising to 15% at Wave 2. Among those who had had sex, the majority (>70%) reported using a condom at last sex. The project is well positioned to carry out the longitudinal assessments of the intervention to determine the overall impact of the Circle of Life and the differential impact by pre-intervention patterns of behavior across youth.

Objective: To evaluate the Health-Related Quality of Life (HRQoL) of American Indians with diabetes, hypertension, or both conditions using the SF36; and to explore how the HRQoL is associated with help seeking among American Indians with and without these chronic conditions., Methods: We analyzed data obtained from respondents with diabetes and/or hypertension who participated in a large epidemiological study of two culturally distinct American Indian tribes. Comparison data were provided by an age, gender, and tribe matched sample from the same study who did not report either condition., Results: The respondents with both diabetes and hypertension had the lowest HRQoL on all eight subscales of SF36. Confirmatory factor analysis (CFA) showed that the assumption of equivalent factor loadings for participants with and without diabetes and/or hypertension was not satisfied. Biomedical service use was significantly associated with the SF36 physical health factor in those with hypertension only. Help seeking from traditional healers was significantly negatively related to physical factor scores for all the respondents except those with diabetes only., Conclusions: Participants with comorbid diabetes and hypertension had worse HRQoL. The relationships between HRQoL and different types of help seeking varied depending on the comorbidity status of the respondents.

Latent growth curve modeling was used to estimate developmental trajectories of self-esteem and cultural identity among American Indian high school students and to explore the relationships of these trajectories to personal resources, problem behaviors, and academic performance at the end of high school. The sample included 1,611 participants from the Voices of Indian Teens project, a 3-year longitudinal study of adolescents from 3 diverse American Indian cultural groups in the western United States. Trajectories of self-esteem were clearly related to academic achievement; cultural identity, in contrast, was largely unrelated, with no direct effects and only very small indirect effects. The relationships between self-esteem and success were mediated by personal resources and problem behaviors.

Objective: To examine the association between psychosocial stress and diabetes in two American Indian reservation communities (Northern Plains and Southwest)., Research Design and Methods: The American Indian Services Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP), a cross-sectional probability sample survey, interviewed 3,084 randomly selected members of two American Indian tribal groups. Included were a psychiatric epidemiological interview, a physical health problems checklist, and an extensive sociodemographic section., Results: Stress was common in these reservation communities, and the stress burden was greater among those with diabetes. After adjusting for sociodemographic characteristics, early-life interpersonal trauma and community family dysfunction were significantly associated with increased odds of diabetes in the Northern Plains, while discrimination and community addiction problems were significantly associated with increased odds of diabetes in the Southwest., Conclusions: A number of psychosocial stresses were significantly associated with increased odds of self-reported diabetes in these two American Indian communities.

The proximal and distal effects of adversity on the onset of symptoms of substance dependence during adolescence were explored in two culturally distinct American Indian (AI) reservation communities (Northern Plains and Southwest). Data (N=3084) were from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP). The age-related risk of symptom onset increased gradually from age 11 through age 16, remained relatively high through age 18, then declined rapidly. Both tribe and gender were related to onset of dependence symptoms; men and Northern Plains tribal members were at greatest risk and Southwest women were at particularly low risk of symptom onset across adolescence. For all tribe and gender groups, both proximal and cumulative distal experiences of adversity were associated with substantially increased risk of symptom onset. The relationship of adversity to onset of substance dependence symptoms remained strong when previous symptoms of psychiatric disorder and childhood conduct problems were considered. These findings suggest that efforts to help children and adolescents in AI communities develop constructive mechanisms for coping with adversity may be especially valuable in substance dependence prevention.

Objectives: We examined disparities in age-related patterns of marijuana initiation in 2 culturally distinct American Indian reservation communities (from the Northern Plains and the Southwest) compared with a national sample., Methods: We used discrete-time survival models to estimate age-related risk for initiation with data from 2 population-based studies: the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project and the baseline National Comorbidity Survey., Results: Among respondents who were born before 1960, peak risk for marijuana initiation in all samples was at age 18 years, and risk was greatest in the national sample. Among those who were born later than 1960, risk peaked at age 16 years and was highest in the American Indian samples. Males were at increased risk compared with females, especially in the older cohort and the Southwest tribal sample., Conclusions: Findings of disproportionate risk for marijuana initiation among younger members of the tribal samples raise concerns that American Indian reservation youths may be increasingly vulnerable to drug use and its concomitants, which suggests a need for more aggressive prevention efforts in these communities.

Population-based samples provided estimates of drug use and disorder in two American Indian populations. Comparison to a national sample revealed tribal-national, intertribal, and intratribal gender and age differences. Findings suggest that disparities in drug use and disorder are complex, characterized by important variations across diverse American Indian tribal cultures.

Developmental trajectories of personal and collective self-concept were examined among American Indian adolescents. Personal self-concept (self-esteem) and collective self-concept (American Indian identity, Euro-American identity, community-mindedness) were assessed 6 times over 3 years in 4 cohorts of adolescents from 3 American Indian cultural groups (N=1,252). An accelerated longitudinal design was used to estimate developmental trajectories from 14 to 19 years; parallel-process and covariate models were used to examine variation in trajectories. Both personal and collective self-concepts were generally positive and showed small gains; they were moderately related to one another and differentially related to cultural group, gender, and perceived social support. The findings highlight the complexity of self-concept for American Indian youth and the significance of both personal and collective identity.

Objectives: This study examined the extent and types of help seeking (biomedical, traditional, and 12-step groups) for substance use problems in two American Indian reservation populations by using data from the American Indian Service Utilization, Psychiatric Epidemiology, Risk, and Protective Factors Project (AI-SUPERPFP). This study also sought to understand the correlates of such help seeking, including measures of need, demographic characteristics, spirituality, and ethnic identity., Methods: AI-SUPERPFP, completed between 1997 and 2000, was a cross-sectional probability sample survey. Altogether 2,825 tribal members, aged 18 to 54 years, representing two tribal groups living on or near their home reservations, were randomly sampled from the tribal rolls. Response rates averaged 75.3 percent. The primary outcome measure was help seeking in the past year for substance use problems, which was further divided into help seeking from biomedical services, traditional healing sources, and 12-step programs., Results: Help-seeking rates were high, with 13 percent of the population and 38 percent of those with diagnoses of substance use disorders in the past year having sought services for alcohol or drug problems in the preceding 12 months. Correlates of help seeking included variables related to need for services (substance use disorders, tobacco use, and mental and physical health problems), marital status, and spirituality. Slightly more than half of service users sought help from formal biomedical providers; use of traditional healing and 12-step programs was also common. Need and spirituality variables best differentiated among the users of the three modalities., Conclusions: Help seeking for alcohol and drug problems was common in these communities, with traditional healing and 12-step resources as essential components of the local service ecologies.

Objective: Our goal was to carefully examine disparities in substance use between two American Indian reservation communities and a national sample. We sought to identify characteristic patterns of use-both across and within samples-that could be used to inform intervention efforts aimed at reducing disparities., Method: Latent class analyses were used to identify subgroups within each sample that were characterized by distinctive patterns of use of alcohol and eight drugs; the use patterns and prevalence of subgroups were then compared across samples. American Indian data were from the American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP; N=2647), which comprised participants from two distinct cultural groups in the Southwest (SW; n=1244; 57% female) and Northern Plains (NP; n=1443; 52% female). National data were from the public use file of the 1999 National Household Survey of Drug Abuse (NHSDA; N = 39.152; 52% female)., Results: Four classes of lifetime users (abstainers, primarily alcohol users, primarily alcohol and marijuana users, and polysubstance users) and three classes of past-year users (abstainers, primarily alcohol users, and alcohol and drug users) were identified in each sample (SW, NP, NHSDA). Despite consistency in classes of users found across these samples, there were notable sample differences in class prevalence. The modal class for lifetime use, for example, was primarily alcohol users in the SW and NHSDA, and primarily alcohol and marijuana use in the NP. The concordance of lifetime and past-year use classes also varied across the three samples, and examination of past-year abstainers in conjunction with lifetime-use class suggested potentially important differences in the stability of substance-use patterns over time., Conclusions: Our findings highlight the utility of latent class techniques for understanding substance use, comparing substance use across populations and identifying key points of intervention, prevention, and treatment within different communities.

Background: The American Indian Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project (AI-SUPERPFP) estimated the mental health burden and associated help-seeking in select American Indian reservation communities., Objective: To determine the lifetime and 12-month prevalence of common DSM-IV disorders, their demographic correlates, and patterns of help-seeking in 2 culturally distinct American Indian reservation communities in the Southwest and Northern Plains., Design: Completed between 1997 and 2000, a cross-sectional probability sample survey., Setting: General community., Participants: Three thousand eighty-four (Southwest = 1446 and Northern Plains = 1638) members, aged 15-54 years, of 2 tribal groups living on or near their home reservations were randomly sampled from the tribal rolls. Response rates were 73.7% and 76.8% for the Southwest and Northern Plains tribes, respectively.Main Outcomes Measures The AI-SUPERPFP Composite International Diagnostic Interview, a culturally adapted version of the University of Michigan version of the Composite International Diagnostic Interview, to assess DSM-IV diagnoses and help-seeking., Results: Overall lifetime prevalence of AI-SUPERPFP DSM-IV disorders ranged from 35.7% for Southwest women to near 50% for both groups of men. Alcohol abuse and dependence were the most common disorders for men, with posttraumatic stress disorder most prevalent for women. Many of those with lifetime alcohol problems or posttraumatic stress disorder no longer met criteria for 12-month diagnoses. Significant levels of comorbidity were found between those with depressive and/or anxiety and substance disorders. Demographic correlates other than tribe, sex, and age were generally unrelated to disorder status. A majority of participants with lifetime disorders had sought help from mental health professionals, other medical personnel, or culturally traditional sources., Conclusions: Alcohol disorders and posttraumatic stress disorder were more common in these American Indian populations than in other populations using comparable methods. Substantial comorbidity between depressive and/or anxiety and substance disorders suggests the need for greater coordination of treatment for comorbid disorders.

Within the field of personality and social psychology, there has been historical controversy over whether constructs such as self-esteem are stable over time and situation or whether they are changeable. One response to this question has been to invoke two types of self-esteem or self-worth, trait self-esteem and state self-esteem. Thus it has been asserted that adolescents, the participants in this paper, have both a baseline self-esteem as well as a barometric self-esteem that represents short-term fluctuations (Rosenberg, 1986). In this paper, we contend that constructs such as self-esteem are not, in and of themselves, trait-like or state-like in nature. Rather, certain individuals display trait-like behavior, whereas others demonstrate change in self-esteem or self-worth across relatively long periods of time, on a short-term basis, and across situations. Three studies document these claims. The first addresses self-worth as a function of the transition from high school to college. The second examines short-term fluctuations in self-worth. The third investigates variability in self-worth across relational contexts, namely, relational self-worth. In each study, findings reveal that certain adolescents report stability in self-worth whereas others report change, fluctuations, or variability. Social causes of these individual differences are identified in each study, as are mental health implications. It is argued that such approaches provide a clearer understanding of the complexity of self-processes.