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Centuries of historical oppression have targeted and undermined Indigenous foodways, which fundamentally disrupts the culture and wellness, yet decolonized, resilient, and transcendent Indigenist practices persist. The purpose of this research was to use the framework of historical oppression, resilience, and transcendence (FHORT) to understand foodway practices among Indigenous Peoples. Given a limited understanding of how foodways may promote health and wellness the focal research questions for this critical ethnographic inquiry were: (a) How do participants describe Indigenist foodways? (b) How do Indigenist foodways reflect decolonized values and practices? and (c) How may Indigenist foodways be promotive for health and wellness? Data were drawn from 31 participants across a rural, reservation-based Southeast (SE) region and an urban Northwest (NW) region. Reconstructive data analysis revealed the following emergent themes: (a) Indigenous Values of Generosity Expressed Through Foodways: “It’s Always About Sharing, and Caring, and Loving, and Giving”; (b) Gardening, Subsistence, and Food Sharing: “You Bring Enough for Everybody to Share”; (c) Decolonized Feasts and Foodways: “Everybody Pitch in and Help as Much as They Can.” Despite centuries of historical oppression, participants reported decolonized values, worldviews, and foodways that reflected unity, cooperation, sharing, and social cohesion and caring, which were promotive factors for family resilience, health, and cultural identification. This research provides promising pathways about how Indigenist foodways remain salient in daily and cultural life, reflect decolonized values and practices, and may be promotive for health and wellness within the natural world.

Active social work leadership is necessary to achieve national goals of health equity. Indeed, the nation’s health depends on the development of this next wave of interprofessional and transdisciplinary collaboration (McGovern, Miller, & Hughes-Cromwick, 2014). This chapter describes a “geography of science” approach that draws upon diverse disciplines, community leaders, and theoretical and community-center perspectives. Social work, must train professionals in how improve availability and access to the social determinants of good health. This includes understand how racism constitutes an important social determinant of health. We must also educate allied professionals to develop the practice and research tools, community partnerships, and localized programs necessary to combat social and economic inequities. Ten priorities for changing health systems to achieve equitable health care are advanced. Finally, to secure true, sustainable, population-based health changes, social work must assist the health professions to unite and develop transdisciplinary approaches to addressing the multilayered contributions of political, economic, and social determinants of population health inequities.

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately impacted communities of color (CoC) amid increasing incidents of racial injustices and racism. In this article, we describe our culturalist methodologies for designing and implementing a multi-ethnic, interdisciplinary national needs assessment developed in partnership with CoC. Instead of a typical western-centric social science approach that typically ignores and perpetuates structural racism and settler colonialism, the research team implemented culturalist and community-partnered approaches that were further contextualized to the context of structural racism and settler colonialism. The culturalist approach yielded two sets of themes both related to the impact of the pandemic on CoC. The first set involved syndemic factors that contribute to the adverse impact of COVID-19. These include historical trauma; racism, racial stress, and discrimination; and cultural mistrust. The second set consisted of factors that potentially mitigate the impact of the COVID-19. These include cultural protective factors; community engagement; communal ethos, and data disaggregation. Our methodologies and the resulting findings encourage research praxis that uplifts the shared effects of the social determinants of health while honoring unique cultural and contextual experiences-a lesson that social science researchers largely have yet to learn.

Relationship to place is integral to Indigenous health. A qualitative, secondary phenomenological analysis of in-depth interviews with four non-Choctaw Indigenous women participating in an outdoor, experiential tribally-specific Choctaw health leadership study uncovered culturally grounded narratives using thematic analysis as an analytic approach. Results revealed that physically being in historical trauma sites of other Indigenous groups involved a multi-faceted process that facilitated embodied stress by connecting participants with their own historical and contemporary traumas. Participants also experienced embodied resilience through connectedness to place and collective resistance. Implications point to the role of place in developing collective resistance and resilience through culturally and methodologically innovative approaches.

American Indian and Alaska Natives (AIAN) comprise about 2% of the US population and 0.5% of the faculty in higher education. While scholars have documented the experiences of underrepresented mino...

Lesbian, gay, bisexual, transgender, two-spirit, and American Indian and Alaska Native community members share long histories of discrimination and poorer health status as compared to mainstream Americans. In particular, these groups experience bias-related victimization, a type of discrimination based on inherent traits such as race or ethnicity and sexual orientation. This cross-sectional study (N = 334) used a revised bias-related victimization measure and examined the relationship between self-reported bias-related victimization and generalized anxiety disorder, depression, and substance abuse among lesbian, gay, bisexual, transgender, and two-spirit American Indians and Alaska Natives. The results showed that 84.4% reported experiencing bias-related victimization. Those with the highest levels of bias-related victimization had 2.79 times (p = .009; 95% CI [1.30, 6.02]) the risk of reporting symptoms of generalized anxiety disorder as compared to those with no bias-related victimization, controlling for income, education, sex, age, sexual orientation, and chronic disease. There was no significant relationship between bias-related victimization and major depression or substance dependence/abuse. Our results support a potential relationship between bias-related victimization and generalized anxiety disorder for lesbian, gay, bisexual, transgender, and two-spirit American Indians and Alaska Natives. Including diverse populations in research is essential to a better understanding of the impact on health outcomes. Inclusion of bias-related victimization questions in clinical treatment may help identify at-risk patients.

Research regarding men who have sex with men (MSM) indicates that exposure to discrimination based on race and sexuality are positively associated with increased incidence of unprotected anal intercourse (UAI). In an effort to better understand this association, we assessed the associations of discriminatory distress with UAI among a sample of 183 American Indian and Alaska Native (AI/AN) MSM using survey data drawn from the HONOR Project. The HONOR Project examined the relationship between trauma, coping, and health behaviors among Two-Spirits (a contemporary name for gender and sexual minorities among American Indian and Alaska Native people). Using multivariable logistic regression techniques, our analysis showed participants reporting higher mean levels of distress from two-spirit discrimination had higher odds of reporting UAI (OR = 1.99, 95% CI, 1.19–3.32) compared to those reporting lower levels of distress. This analysis also showed lower odds of engaging in UAI among participants reporting higher levels of participation in LGBT specific online forums (OR = 0.86, CI = 0.75, 0.99; p < .05) and attending Two-Spirit events (OR = 0.82, CI = 0.71, 0.94; p < .01). Future prevention research and program designs should address the differential impact of discrimination and community participation on sexual behavior specifically among AI/AN MSM.

Given the paucity of empirically based health-promotion interventions designed by and for American Indian, Alaska Native, and Native Hawaiian (i.e., Native) communities, researchers and partnering communities have had to rely on the adaptation of evidence-based interventions (EBIs) designed for Non-Native populations, a decidedly sub-optimal approach. Native communities have called for development of Indigenous health-promotion programs in which their cultural worldviews and protocols are prioritized in the design, development, testing, and implementation. There is limited information regarding how Native communities and scholars have successfully collaborated to design and implement culturally based prevention efforts “from the ground up.” Drawing on five diverse community-based Native health-intervention studies, we describe strategies for designing and implementing culturally grounded models of health promotion developed in partnership with Native communities. Additionally, we highlight indigenist worldviews and protocols that undergird Native health interventions with an emphasis on the incorporation of: (1) Original Instructions, (2) relational restoration, (3) narrative- [em]bodied transformation, and (4) Indigenist community-based participatory research (ICBPR) processes. Finally, we demonstrate how culturally grounded interventions can improve population health when they prioritize local Indigenous knowledges and health-positive messages for individual to multi-level community interventions.

This community-based research applied principles of wilderness experience programming and Indigenous knowledges in an exploratory intervention designed to address health disparities in a tribal community. Drawing on historical trauma frameworks, tribal members rewalked the Trail of Tears to consider its effect on contemporary tribal health. Qualitative data from tribal members suggest that engagement with place and experiential learning, particularly the physical and emotional challenge of the Trail, facilitated changes in health beliefs, attitudes, and behaviors. Deep engagement outside of traditional health service settings should be considered in interventions and may be particularly effective in promoting positive health behaviors in Native communities.

American Indian and Alaska Native sexual minority (two-spirit) women are vulnerable to substance misuse and mental health challenges due to multiple minority oppressed status and exposure to stress and trauma. Yet, these women find pathways toward healing and wellness. We conducted a qualitative data analysis of interviews derived from a national health study and gained an understanding of 11 two-spirit women’s resilience and recovery patterns. Emergent from the data, a braided resiliency framework was developed which elucidates multi-layered abilities, processes, and resources involved in their resiliency. We recommend that resilience-promoting strategies be incorporated into substance misuse and mental health interventions.

(1) Background: Settler colonialism has severely disrupted Indigenous ancestral ways of healing and being, contributing to an onslaught of health disparities. In particular, the United Houma Nation (UHN) has faced large land loss and trauma, dispossession, and marginalization. Given the paucity of research addressing health for Indigenous individuals living in Louisiana, this study sought to co-identify a United Houma Nation health framework, by co-developing a community land-based healing approach in order to inform future community-based health prevention programs. (2) Methods: This pilot tested, co-designed and implemented a land-based healing pilot study among Houma women utilizing a health promotion leadership approach and utilized semi-structured interviews among 20 UHN women to identify a UHN health framework to guide future results. (3) Results: The findings indicated that RTOR was a feasible pilot project. The initial themes were (1.) place, (2.) environmental/land trauma, (3.) ancestors, (4.) spirituality/mindfulness, (5.) cultural continuity, and (6.) environment and health. The reconnection to land was deemed feasible and seen as central to renewing relationships with ancestors (aihalia asanochi taha), others, and body. This mindful, re-engagement with the land contributed to subthemes of developing stronger tribal identities, recreating ceremonies, and increased cultural continuity, and transforming narratives of trauma into hope and resilience. Based on these findings a Houma Health (Uma Hochokma) Framework was developed and presented. (4) Conclusions: Overall, this study found that land can serve as a feasible therapeutic site for healing through reconnecting Houma tribal citizens to both ancestral knowledges and stories of resilience, as well as viewing self as part of a larger collective. These findings also imply that revisiting historically traumatic places encouraged renewed commitment to cultural continuity and health behaviors—particularly when these places are approached relationally, with ceremony, and traumatic events tied to these places, including climate change and environmental/land trauma, are acknowledged along with the love the ancestors held for future generations.

Cardiovascular disease is the number one cause of death among American Indians and Alaska Natives (AI/AN). Utilizing narratives from members of a Pacific Northwest tribe, this paper explores perceptions about behaviors affecting cardiovascular health through tribal members' lived experiences related to place-based environmental historical trauma. Findings from narrative analysis indicate that ambivalence is an effect of historical trauma and complicates the adoption of protective cardiovascular health behaviors. Tribal narratives indicate a path to overcome this ambivalence stemming from historical environmental trauma through revitalization, adaptation, and re-integration of traditional cultural practices to contemporary contexts. By creating their own health promotion response, one that is not imposed or colonizing, tribal members are re-generating cultural practices and health behaviors associated with lowered risks of cardiovascular disease.

More than 60 million Americans experience devastating one-two punches to their health -- they have inadequate access to basic health care while also enduring the effects of discrimination, poverty, and dangerous environments that accelerate higher rates of illness. Innovative and evidence-based social strategies can improve health care and lead to broad gains in the health of our entire society.

Introduction/Importance: Given the promise of integrating traditional healing practices into primary care, we sought to examine the influence of primary care providers’ racial concordance and Indigenous patients’ ethnic salience on traditional healing treatment decisions. Method: Using a descriptive comparative design with an online clinical case vignette, we measured provider decision making via a 5-point Provider Acceptance of Traditional Healing–Referral and Consult questionnaire. Aggregated results of the main effects and interactional effects were analyzed using a 2 × 2 analysis of variance between-subjects design. Results: The main effect for patient racial concordance on the dependent variable was significant, F(1, 89) = 5.71, p = .02. Conclusions: Provider–patient racial concordance does increase the providers’ likelihood of consulting with and referring patients to traditional healing practices, regardless of the patient’s ethnic salience. Implications for Practice: All health care providers require training in traditional healing practices for Indigenous persons as guided by the cultural safety framework.

We investigated how HIV discourse is negotiated and given meaning in the lives of young, male two-spirit leaders, when considering their communities' and their own health and wellness. These menare also unique in that they have always lived under the specter and dominant discourse of HIV, that is, they are part of a second generation since the time of HIV/AIDS.We conducted a Discourse Analysis of six qualitative interviews from the HONOR Project, a multi-site, mixed-methods study of the two-spirit community across the United States, foregrounding the relationships amongst trauma, coping, and health.HIV functions discursively in four ways, as a: shadow presence, professionalized identity, health sub-/priority, and vehicle for belonging and (re)claiming.This study is important to social work as well as HIV prevention and care as it affords voice to two-spirit men, a highly marginalized community and one often silenced in scientific discourse. And, it centralizes language and context, complicating social epidemiological characterizations of HIV/AIDS, risk, and historically traumatized populations.

This study examined associations between alcohol misuse and childhood maltreatment and out-of-home placement among urban lesbian, gay, and bisexual (referred to as two-spirit) American Indian and Alaska Native adults. In a multi-site study, data were obtained from 294 individuals who consumed alcohol during the past year. The results indicated that 72.3% of men and 62.4% of women engaged in hazardous and harmful alcohol use and 50.8% of men and 48.7% of women met criteria for past-year alcohol dependence. The most common types of childhood maltreatment were physical abuse among male drinkers (62.7%) and emotional abuse (71.8%) among female drinkers. Men and women reported high percentages of out-of-home placement (39% and 47%, respectively). Logistic multiple regressions found that for male drinkers boarding school attendance and foster care placement were significant predictors of past-year alcohol dependence. For female drinkers, being adopted was significantly associated with a decreased risk of past-year drinking binge or spree. Dose-response relationships, using number of childhood exposures as a predictor, were not significant. The results highlight the need for alcohol and violence prevention and intervention strategies among urban two-spirit individuals.

This invited article introduces the concept of grand challenges—ambitious yet achievable goals for society that mobilize the profession, capture the public’s imagination, and require innovation and breakthroughs in science and practice to achieve (Kalil, 2012). We call for broad and deep participation of social work scientists and practitioners in the Grand Challenges for Social Work initiative, which will be coordinated by the American Academy of Social Work and Social Welfare.

The majority of literature on mentoring focuses on mentee training needs, with significantly less guidance for the mentors. Moreover, many mentoring the mentor models assume generic (i.e. White) mentees with little attention to the concerns of underrepresented racial/ethnic minorities (UREM). This has led to calls for increased attention to diversity in research training programs, especially in the field of HIV where racial/ethnic disparities are striking. Diversity training tends to address the mentees' cultural competency in conducting research with diverse populations, and often neglects the training needs of mentors in working with diverse mentees. In this article, we critique the framing of diversity as the problem (rather than the lack of mentor consciousness and skills), highlight the need to extend mentor training beyond aspirations of cultural competency toward cultural humility and cultural safety, and consider challenges to effective mentoring of UREM, both for White and UREM mentors.

Systematic efforts of assimilation removed many Native children from their tribal communities and placed in non-Indian-run residential schools.To explore substance use and mental health concerns among a community-based sample of 447 urban two-spirit American Indian/Alaska Native adults who had attended boarding school as children and/or who were raised by someone who attended boarding school.Eighty-two respondents who had attended Indian boarding school as children were compared to respondents with no history of boarding school with respect to mental health and substance use.Former boarding school attendees reported higher rates of current illicit drug use and living with alcohol use disorder, and were significantly more likely to have attempted suicide and experienced suicidal thoughts in their lifetime compared to non-attendees. About 39% of the sample had been raised by someone who attended boarding school. People raised by boarding school attendees were significantly more likely to have a general anxiety disorder, experience posttraumatic stress disorder symptoms, and have suicidal thoughts in their lifetime compared to others.

HIV/AIDS is a critical and growing challenge to American Indian and Alaska Native (AIAN) women's health. Conceptually guided by the Indigenist Stress-Coping Model, this paper explores the historical and contemporary factors implicated in the HIV epidemic among AIAN women and the co-occurring epidemics of sexual violence and substance abuse. The authors also outline multiple indicators of resiliency in AIAN communities and stress the need for HIV prevention interventions for AIAN women to capitalize on cultural and community strengths.

Community-based participatory research (CBPR) has been hailed as an alternative approach to one-sided research endeavors that have traditionally been conducted on communities as opposed to with them. Although CBPR engenders numerous relationship strengths, through its emphasis on co-sharing, mutual benefit, and community capacity building, it is often challenging as well. In this article, we describe some of the challenges of implementing CBPR in a research project designed to prevent cardiovascular disease among an indigenous community in the Pacific Northwest of the United States and how we addressed them. Specifically, we highlight the process of collaboratively constructing a Research Protocol/Data Sharing Agreement and qualitative interview guide that addressed the concerns of both university and tribal community constituents. Establishing these two items was a process of negotiation that required: (i) balancing of individual, occupational, research, and community interests; (ii) definition of terminology (e.g., ownership of data); and (iii) extensive consideration of how to best protect research participants. Finding middle ground in CBPR requires research partners to examine and articulate their own assumptions and expectations, and nurture a relationship based on compromise to effectively meet the needs of each group.

Increasingly, understanding how the role of historical events and context affect present-day health inequities has become a dominant narrative among Native American communities. Historical trauma, which consists of traumatic events targeting a community (e.g., forced relocation) that cause catastrophic upheaval, has been posited by Native communities and some researchers to have pernicious effects that persist across generations through a myriad of mechanisms from biological to behavioral. Consistent with contemporary societal determinants of health approaches, the impact of historical trauma calls upon researchers to explicitly examine theoretically and empirically how historical processes and contexts become embodied. Scholarship that theoretically engages how historically traumatic events become embodied and affect the magnitude and distribution of health inequities is clearly needed. However, the scholarship on historical trauma is limited. Some scholars have focused on these events as etiological agents to social and psychological distress; others have focused on events as an outcome (e.g., historical trauma response); others still have focused on these events as mechanisms or pathways by which historical trauma is transmitted; and others have focused on historical trauma-related factors (e.g., collective loss) that interact with proximal stressors. These varied conceptualizations of historical trauma have hindered the ability to cogently theorize it and its impact on Native health. The purpose of this article is to explicate the link between historical trauma and the concept of embodiment. After an interdisciplinary review of the “state of the discipline,” we utilize ecosocial theory and the indigenist stress-coping model to argue that contemporary physical health reflects, in part, the embodiment of historical trauma. Future research directions are discussed.

Background American Indian and Alaska Natives suffer pervasive health disparities, including disproportionately high rates of HIV. Sexual network dynamics, including concurrency and sexual mixing patterns, are key determinants of HIV disparities. Methods We analyzed data from the first national study of gay, lesbian, bisexual, and transgender American Indian and Alaska Natives to examine the prevalence of concurrency, sex and race of partners, and level of risk across different partnership patterns. Egocentric network data were analyzed at the level of the respondents, who were grouped according to the sex of their last 3 partners. Results Overall rates of HIV and concurrency were high in this population. HIV prevalence (34%) and cumulative prevalence of concurrency (55%) were highest among men who had sex with only men, while women who had sex with only women reported lower concurrency and HIV. Women who had sex with women and men also had high HIV prevalence (15%) and reported slightly higher concurrency risk and low condom use, making them effective bridge populations. Conclusions The uniformly high rates of Native partner selection creates the potential for amplification of disease spread within this small community, while the high rates of selecting partners of other races creates the potential for bridging to other groups in the transmission network. These findings provide some of the first insights into sexual networks and concurrency among Native gay, lesbian, bisexual, and transgender populations and suggest that both men and women deserve attention in HIV prevention efforts at individual, dyadic and population levels.

Same-sex intimate relationships were central to the lives of many of social work’s early women leaders. Recognizing these relationships is important to address the erasure of sexuality in the profession’s historical record and to give sexual minority social workers access to their history. This article explores conceptual issues in lesbian historical scholarship, describes the same-sex relationships of four remarkable social workers—Jane Addams, Mary Richmond, Jessie Taft, and Virginia Robinson—and calls for further research in this area.

Objectives. We examined associations between racial discrimination and actualization, defined as the degree of positive integration between self-identity and racial group identity, and self-rated health and physical pain and impairment. Methods. We used logistic regressions to analyze data from 447 gay, lesbian, bisexual, and other sexual-minority American Indians/Alaska Natives. Results. Greater self-reported discrimination was associated with higher odds of physical pain and impairment (odds ratio [OR] = 1.42; 95% confidence interval [CI] = 1.13, 1.78); high levels of actualization were associated with lower odds of physical pain and impairment (OR = 0.59; 95% CI = 0.35, 0.99) and self-rated fair or poor health (OR = 0.54; 95% CI = 0.32, 0.90). Actualization also moderated the influence of discrimination on self-rated health (t = –2.33; P = .020). Discrimination was positively associated with fair or poor health among participants with low levels of actualization, but this association was weak among those with high levels of actualization. Conclusions. Among two-spirit American Indians/Alaska Natives, discrimination may be a risk factor for physical pain and impairment and for fair or poor self-rated health among those with low levels of actualization. Actualization may protect against physical pain and impairment and poor self-rated health and buffer the negative influence of discrimination.

In their recent article, N. Spillane and G. Smith (2007) suggested that reservation-dwelling American Indians have higher rates of problem drinking than do either non-American Indians or those American Indians living in nonreservation settings. These authors further argued that problematic alcohol use patterns in reservation communities are due to the lack of contingencies between drinking and "standard life reinforcers" (SLRs), such as employment, housing, education, and health care. This comment presents evidence that these arguments were based on a partial review of the literature. Weaknesses in the application of SLR constructs to American Indian reservation communities are identified as is the need for culturally contextualized empirical evidence supporting this theory and its application. Cautionary notes are offered about the development of literature reviews, theoretical frameworks, and policy recommendations for American Indian communities.

Many Native men and women embrace the term two-spiritto capture their sexuality and gender expression. By analyzing the narratives of almost 70 two-spirit Native leaders from across the U.S., we explored contemporary experiences of caregiving among two-spirit people, historical two-spirit roles related to caregiving, and the implications of these roles for two-spirit and Native communities. The central role of caregiving among two-spirit people, related Native community expectations, the diversity of caregiving experiences across the lifespan, and the importance of caregiving in maintaining indigenous community ties emerged as key themes.

Many Native women embrace the term two-spirit to capture their sexuality and gender expression. By analyzing the narratives of five two-spirit women who are Native activists, we explored contemporary understandings of the concept and what it means for Native communities. The incorporation of the identity within indigenous worldviews, its manifestation in terms of (be)coming out, and the triple stressors of heterosexism, racism, and sexism emerged as key themes.

National health initiatives emphasize the importance of eliminating health disparities among historically disadvantaged populations. Yet, few studies have examined the range of health outcomes among lesbian, gay, bisexual, and transgender (LGBT) people. To stimulate more inclusive research in the area, we present the Health Equity Promotion Model—a framework oriented toward LGBT people reaching their full mental and physical health potential that considers both positive and adverse health-related circumstances. The model highlights (a) heterogeneity and intersectionality within LGBT communities; (b) the influence of structural and environmental context; and (c) both health-promoting and adverse pathways that encompass behavioral, social, psychological, and biological processes. It also expands upon earlier conceptualizations of sexual minority health by integrating a life course development perspective within the health-promotion model. By explicating the important role of agency and resilience as well as the deleterious effect of social structures on health outcomes, it supports policy and social justice to advance health and well-being in these communities. Important directions for future research as well as implications for health-promotion interventions and policies are offered.

High rates of racial discrimination and non- ceremonial tobacco smoking exist among American Indian/ Alaska Native (AIAN) Two- Spirit/ LGBT (Lesbian, Gay, Bisexual, Transgender) populations. The authors examined whether or not pain mediates between racial discrimination and smoking among Two- Spirits. Two- Spirit adults (n=447) from seven urban U.S. locations were surveyed during the HONOR project. The Indigenist stress coping model was used as framework in which to conduct descriptive, bivariate and regression analyses. A majority of the participants reported smoking (45.2%) and pain (57%). Pain was found to mediate the association between racial discrimination and smoking. Racial discrimination appears to be a significant factor influencing tobacco smoking and health behaviors within Two- Spirit populations. Effective tobacco cessation and/or prevention planning for Two- Spirits and others who experience frequent racial discrimination, stress, and trauma should also consider the influence of pain. Pain may serve as the embodiment of discrimination, and this possibility requires future research.

A community-based mail survey of 155 urban American Indian women revealed 91% engaged in at least one lifetime HIV sexual or drug risk behavior, including 19% who had sex with an injection drug user and 7% who had traded sex. Sixty-eight percent of the respondents were sexually active in the last year, with more than half never using condoms. Six percent had ever injected nonprescription drugs; 62% drank alcohol in the last year, with 28% reporting at least one occasion of consuming six or more drinks containing alcohol. Respondents reported high rates of lifetime physical (37%) and sexual (39%) assault, which was generally associated with lifetime but not more recent indicators of sexual and drug risk behavior. Injection drug use mediated the relationship between nonpartner sexual (but not physical) trauma and high-risk sexual behaviors. Findings underscore the need for the integrated assessment and treatment of abuse and substance use as well as more research on the risk behaviors of this understudied and underserved population.

Summary Employing both quantitative and qualitative methodologies, this study examined: sexual orientation bias experiences among American Indians (AIs) who were gay, lesbian, bisexual, transgend-ered, or two-spirited (GLBTT-S); service provider attitudes toward AI GLBTT-S; and service barriers and needs with respect to AI GLBTT-S at one AI community-based organization. Among the 14 AI GLBTT-S surveyed, the percentages reporting various bias-related experiences were comparable or greater to those reported for non-AI GLBTT-S in other studies (e.g., 36% had been physically assaulted because of their sexual orientation). The 22 service providers surveyed revealed generally low levels of heterosexism, which was inversely related to contact and comfort with AI GLBTT-S as well as understanding of AI GLBTT-S terms. Data from 8 focus groups (7 with service providers and 1 with AI two-spirited men) yielded four main themes related to problems and barriers to service utilization for AI GLBTT-S (i.e., invisibility, ...

Rapidly rising interest - from national and international health organisations, governments, civil society, the private sector and myriad academic disciplines - in what has become known as the ‘social determinants of health’1 2 is welcome to the many, in and outside of public health, who have long held that issues of social justice and the public's health are inextricably linked (box 1).2 3 As inevitably happens, however, when an issue gets ‘mainstreamed’, a multiplicity of disparate voices enter the discussion, informed by not only different disciplinary vantages, but also divergent values, priorities and politics. ### Box 1 Political, historical, intellectual and economic context of a Latin American/North American discussion about societal determinants of between-country and within-country health inequities 1. Political, historical, and intellectual context 1. Explicit efforts to develop theories articulating the causal connections between political economy, social injustice and health inequities can readily be traced back to the mid-19th century.2–8 Examples include the European writings of Rudolf Virchow (1821–1902) and Friedrich Engels (1820–1895) in the 1840s, as linked to societal upheavals spurred by the rise of industrial capitalism, along with their subsequent elaborations in the early 20th century by European, North American and Latin American analysts and politicians, such as Chilean president Salvador Allende (1908–1973), variously concerned with the health impact of political and economic systems, and political and economic injustice, both within and across nations and regions.2–6 More recent antecedents include: A. the rise of critical science frameworks during the 1960s and 1970s, including within the health fields, as spurred by post-World War II national liberation and anti-imperialist movements along with the emergence of worldwide social movements regarding racism, indigenous rights, gender, sexuality, human rights and the environment (ecology), and B. since the mid-1990s, a …

Among 230 HIV+ women in New York City, 105 had been heterosexually active in the last 90 days and 54% of these reported unsafe sex. Contrary to our hypotheses based on relational theory, respondents with steady partners were more likely to have unprotected sex than nonpartnered women. However, among respondents with steady partners, the degree of commitment to the relationship was positively associated with condom use. The only other correlate of unprotected sex was current drug use. Almost all steady partners were aware of the woman's HIV status, and, contrary to our hypothesis, respondents were not more likely to have protected sex with HIV− than HIV+ steady partners. The discussion considers self-in-relation theory, culture, power, and contextualistic behaviorism.

SUMMARY Implicit in much of American Indian acculturation research is the erroneous assumption that acculturation is synonymous with identity and, as a result, can be used as a proxy for identity in survey research. This lack of distinction between the two means may partly explain some discrepant findings in American Indian wellness studies. To clarify the conceptual distinction, the current study examined the relationship between urban American Indian identity attitudes and acculturation styles. The findings indicate that although identity attitudes and acculturative behaviors are related they are separate constructs that should not be used as proxies for one another in survey research or mental health studies. Contrary to the assimilationist models, native peoples have survived by taking the best of both worlds, integrating them, maintaining and transforming native cultures, and, ultimately buffering against negative colonizing processes through the internalization of positive identity attitudes and the...

Research on American Indian identity has been, for the most part, poorly conceptualized and its findings contradictory. Indian identity has been shown to relate to positive mental health and cultural continuity and survival. However, the identity of gay and lesbian American Indians has not yet been addressed. Toward the formulation of a preliminary model of urban lesbian and gay American Indian (GAI) identity development, the author delineates acculturation levels, cultural values, and conflicts in allegiances that GAIs face in negotiating a positive identity. Implications for clinical practice, research, and mental health service delivery are outlined.

American Indian and Alaska Native (AIAN) men who have sex with men (MSM) are considered particularly high risk for HIV transmission and acquisition. In a multi-site cross-sectional survey, 174 AIAN men reported having sex with a man in the past 12 months. We describe harm reduction strategies and sexual behavior by HIV serostatus and seroconcordant partnerships. About half (51.3%) of the respondents reported no anal sex or 100% condom use and 8% were in seroconcordant monogamous partnership. Of the 65 men who reported any sero-adaptive strategy (e.g., 100% seroconcordant partnership, strategic positioning or engaging in any strategy half or most of the time), only 35 (54.7%) disclosed their serostatus to their partners and 27 (41.5%) tested for HIV in the past 3 months. Public health messages directed towards AIAN MSM should continue to encourage risk reduction practices, including condom use and sero-adaptive behaviors. However, messages should emphasize the importance of HIV testing and HIV serostatus disclosure when relying solely on sero-adaptive practices.

This paper reports the findings of a survey of 108 elderly heterosexual and homosexual men and women in urban Central and Southern California. The purpose of the study was to test the assumption that elderly gay men and lesbians are more depressed and socially-isolated than their heterosexual cohort. The findings indicate that there are no significant differences between older heterosexuals and homosexuals in regard to depression and social support. However, the sources of social support from friends, while heterosexual elderly derive more support from family. The findings suggest a need to redefine the concept of family to include "friendship families." Future research which investigates the way in which these friendship families are created and maintained has the potential to benefit all elderly, especially those who have no biological families or whose biological families are unavailable for support.

American Indian and Alaska Native (AIAN) populations are disproportionately at risk for cardiovascular disease (CVD), diabetes, and obesity, compared with the general US population. This article describes the həli?dx(w)/Healthy Hearts Across Generations project, an AIAN-run, tribally based randomized controlled trial (January 2010-June 2012) designed to evaluate a culturally appropriate CVD risk prevention program for AI parents residing in the Pacific Northwest of the United States. At-risk AIAN adults (n = 135) were randomly assigned to either a CVD prevention intervention arm or a comparison arm focusing on increasing family cohesiveness, communication, and connectedness. Both year-long conditions included 1 month of motivational interviewing counseling followed by personal coach contacts and family life-skills classes. Blood chemistry, blood pressure, body mass index, food intake, and physical activity were measured at baseline and at 4- and 12-month follow-up times.

Community-based participatory research (CBPR) has been hailed as an alternative approach to one-sided research endeavors that have traditionally been conducted on communities as opposed to with them. Although CBPR engenders numerous relationship strengths, through its emphasis on co-sharing, mutual benefit, and community capacity building, it is often challenging as well. In this article, we describe some of the challenges of implementing CBPR in a research project designed to prevent cardiovascular disease among an indigenous community in the Pacific Northwest of the United States and how we addressed them. Specifically, we highlight the process of collaboratively constructing a Research Protocol/Data Sharing Agreement and qualitative interview guide that addressed the concerns of both university and tribal community constituents. Establishing these two items was a process of negotiation that required: (i) balancing of individual, occupational, research, and community interests; (ii) definition of terminology (e.g., ownership of data); and (iii) extensive consideration of how to best protect research participants. Finding middle ground in CBPR requires research partners to examine and articulate their own assumptions and expectations, and nurture a relationship based on compromise to effectively meet the needs of each group.

American Indian/Alaska Native (AI/AN) men who have sex with men (MSM) are at high risk of human immunodeficiency virus (HIV) acquisition and transmission. This study aimed to investigate a potential area of focus for HIV prevention interventions by assessing the impact of sexual risk cognitions on sexual risk-taking among AI/AN MSM. AI/AN MSM (N = 173) from a national cross-sectional survey were analyzed. Reporting more frequent sexual risk cognitions overall (high sexual risk cognitions) was associated with multiple HIV risk factors including unprotected anal intercourse and serodiscordant unprotected anal intercourse. Participants with high sexual risk cognitions had a 2.3 (95% Confidence Interval: 1.1, 4.7) times greater odds of engaging in unprotected anal intercourse regardless of childhood sexual abuse, depression, and alcohol dependence. Most individual sexual risk cognitions were associated with unprotected anal intercourse, serodiscordant unprotected anal intercourse, or both. Results suggest that sexual risk cognitions may be a productive area for further work on HIV prevention among AI/AN MSM.

Lesbian, gay, and bisexual individuals who are also racial/ethnic minorities (LGBT-POC) are a multiply marginalized population subject to microaggressions associated with both racism and heterosexism. To date, research on this population has been hampered by the lack of a measurement tool to assess the unique experiences associated with the intersection of these oppressions. To address this gap in the literature, we conducted a three-phase, mixed method empirical study to assess microaggressions among LGBT-POC. The LGBT People of Color Microaggressions Scale is an 18-item self-report scale assessing the unique types of microaggressions experienced by ethnic minority LGBT adults. The measure includes three subscales: (a) Racism in LGBT communities, (b) Heterosexism in Racial/Ethnic Minority Communities, and (c) Racism in Dating and Close Relationships, that are theoretically consistent with prior literature on racial/ethnic minority LGBTs and have strong psychometric properties including internal consistency and construct validity in terms of correlations with measures of psychological distress and LGBT-identity variables. Men scored higher on the LGBT-PCMS than women, lesbians and gay men scored higher than bisexual women and men, and Asian Americans scored higher than African Americans and Latina/os.

The success of highly active antiretroviral therapy (HAART) among persons living with HIV is largely dependent on strict medication adherence. Recent research suggests that alcohol and other drug use (AOD) may be an important barrier to HAART adherence. In this study, we examined the impact of AOD on HAART adherence as well as the moderating effects of general and medication-specific social support. The data were collected as part of a longitudinal randomized control trial with 224 HIV-positive patients at an HIV primary care clinic in the northwestern United States. Findings indicated that AOD use was negatively associated with HAART adherence and that medication-specific (but not general) social support moderated the AOD-adherence association at 3 (but not at 6 or 9) months. Results indicate the importance of medication-specific social support to treat comorbid AOD use and HIV; implications for future research and intervention programs for HIV-positive AOD users are discussed.